See article vol. 29 : 174-187 Subclinical cerebrovascular diseases (SCVDs) refer to all pathologic processes that affect the small and large vessels of the brain. Magnetic resonance imaging (MRI) and ...magnetic resonance angiography (MRA) enable us to easily detect SCVDs, including small vessel diseases in the brain. SCVDs have been associated with all-cause mortality, future cardiovascular diseases, cognitive impairment, dementia, or decline in high-level functional capacity. To extend not only patients' but also healthy individuals' healthy life expectancy, small vessel disease in the brain should be a target for preventive and treatment strategies. The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA), which is a cohort study of Japanese men, assessed the associations of blood pressure (BP) levels from two separate examinations with lacunar infarcts, periventricular hyperintensity (PVH), microbleeds, deep and subcortical white matter hyperintensity (DSWMH), and intracranial artery stenosis (ICAS).
See article vol.27 : 60-70 Lifetime risk is long-term absolute risk that indicates the absolute risk of a disease during the remainder of an individual's lifetime. The 10-year risk is commonly used ...for cardiovascular risk estimation, but it highly depends on subjects' age. For instance, the 10-year risk of coronary heart disease (CHD) could be <_ 1% even in hypertensive individuals aged 45 years. Based on short-term absolute risks such as 10-year risk, we rarely encourage young individuals with high cardiovascular risk to initiate lifestyle changes or drug treatment. Although the relative risk values could also be available for informing young adults about cardiovascular risk, absolute risk can be more comprehensible information for patients than relative risk. Longterm risk has an important role in public health, particularly in young adults. The U.S. Guideline on the Management of Blood Cholesterol recommends lifetime risk estimation for adolescents and young adults. Lifetime risks of cardiovascular events have been reported in U.S. cohort studies.
The Ohasama Study is a long-term prospective cohort study of the general population in the town of Ohasama (currently, Hanamaki city) in Iwate Prefecture, Japan, that was started in 1986. Ohasama is ...a typical farming village in the Tohoku region that consists of part-time farming households that cultivate mainly fruit trees. At the start of the study, the prevention of hypertension, a main cause of strokes, was taken to be an important issue in public health activities because of the many people who died or needed care as a result of strokes in Ohasama. A home blood pressure measurement program was then begun with the aim of preventing hypertension while increasing a sense of solidarity among community residents and the awareness that “one must protect one’s own health.” As a result, this project became the world’s first community-based epidemiological study using home blood pressure, as well as 24-hour ambulatory blood pressure, for which measurements were also initiated. In the 1990s, the Ohasama Study reported a linear “the lower, the better” relationship between out-of-office blood pressure and cardiovascular risk. To date, we have accumulated advanced evidence regarding the clinical significance of out-of-office blood pressure. Those have contributed to hypertension management guidelines around the world. This article summarizes the results of representative long-term follow-up studies of the Ohasama Study.
We assessed blood pressure (BP) changes during fiscal years (April to March of the following year) 2015–2020 to clarify the effect of the state of emergency due to the coronavirus disease 2019 ...(COVID-19) pandemic in 2020. We then considered BP in 2019 separately, as the Japanese hypertension guidelines were updated in 2019. The present retrospective cohort study extracted data from 157,510 Japanese individuals aged <75 years (mean age: 50.3 years, men: 67.5%) from the annual health check-up data of the DeSC database. The trends in BP were assessed using a repeated measures linear mixed model. After adjusting for the month of health check-ups to exclude seasonal BP variation, systolic BP linearly increased during fiscal years 2015–2018. From the value estimated by the trend in 2015–2018, systolic BP was lower by ≤1 mmHg in fiscal year 2019 among the treated participants. Meanwhile, systolic/diastolic BP (95% confidence interval) increased by 2.11 (1.97–2.24)/1.05 (0.96–1.14) mmHg for untreated women (n = 43,292), 1.60 (1.51–1.70)/1.17 (1.11–1.24) mmHg for untreated men (n = 88,479), 1.92 (1.60–2.23)/0.46 (0.25–0.67) mmHg for treated women (n = 7855), and 1.00 (0.79–1.21)/0.39 (0.25–0.53) mmHg for treated men (n = 17,884) in fiscal year 2020. These increases remained time-dependent covariates after adjustments for age, body mass index, alcohol consumption, smoking, physical activity, and blood sampling indices. Social change due to the pandemic might have increased BP by approximately 1–2/0.5–1 mmHg. Meanwhile, only a slight decrease in BP was observed immediately after the guideline update in Japan.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Self-measured blood pressure (BP) at home, that is, home BP, is a stronger prognosticator than office BP. However, some physicians seem to think that office BP measurement is sufficient to manage ...hypertension. We aimed to assess whether interventions based on using home BP affect clinical outcomes including BP levels when compared with usual care based on office BP. Using the PubMed and the Cochrane Library databases (until July 2017), we searched randomized controlled trials comparing home BP-based treatment to usual care in adults with essential hypertension aged ≥18 years in an area with an established medical system. Outcomes were (1) cardiovascular events and related deaths and (2) changes in ambulatory BP levels. For outcomes of cardiovascular events and related deaths, there were no appropriate studies for the present meta-analysis. For outcomes of BP change, the analysis based on all 12 studies found by our search showed that home BP-based treatment was significantly associated with a 1.18 mmHg larger reduction in the average ambulatory systolic BP than the control group (P = 0.04). However, a high heterogeneity was observed (I
= 75%, P < 0.0001). Based on nine studies employing a lower target BP for home BP than for office BP, the differences in the averages of the ambulatory systolic/diastolic BP changes between the two groups were 3.62/2.16 mmHg, respectively (P < 0.0001). No significant heterogeneity was observed (I
= 0%, P ≤ 0.59). Home BP-based treatment is strongly recommended to control BP, especially in the setting of a lower home BP target than an office BP target level.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Hyperuricemia has been reported to be a risk factor for hypertension, but this association may be affected by alcohol consumption. This study aimed to investigate whether hyperuricemia remains a risk ...factor for hypertension after eliminating the effect of alcohol consumption. This study comprised 7848 participants (4247 men and 3601 women) aged 30-74 years without hypertension who had undergone a medical checkup between April 2008 and March 2009 at Saku Central Hospital, Nagano Prefecture, Japan. Hyperuricemia was defined as uric acid >7.0 mg/dl in men, ≥6.0 mg/dl in women, and/or receiving treatment for hyperuricemia or gout. The incidence of hypertension was defined as the first diagnoses of blood pressure ≥140/≥ 90 mmHg and/or initiations of antihypertensive drug treatment. Multivariable-adjusted hazard ratios (HRs) of hyperuricemia for the incidence of hypertension after adjustment for and classification by alcohol consumption were estimated using the Cox proportional hazard model. During a mean of 4.0 years of follow-up, 1679 individuals developed hypertension. After adjustment for alcohol consumption, the HRs (95% confidence interval) associated with hyperuricemia were 1.37 (1.19-1.58) in men and 1.54 (1.14-2.06) in women. Among nondrinkers, the HR was 1.29 (0.94-1.78) in men with hyperuricemia compared with men without, and the corresponding HR was 1.57 (1.11-2.22) in women. The corresponding HR was 1.88 (1.27-2.86) in all participants with baseline blood pressure <120/80 mmHg. The interactions between hyperuricemia and sex (P = 0.534) and between drinking and sex (P = 0.713) were not significant. In conclusion, hyperuricemia predicts the risk for developing hypertension independent of alcohol drinking status.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The sodium-to-potassium (Na/K) ratio is known to be associated with blood pressure (BP). However, no reference value has been established since the urinary Na/K (uNa/K) ratio is known to have diurnal ...and day-to-day variations. Therefore, we investigated the number of days required to yield a better association between the morning uNa/K ratio and home BP (HBP) and determined a morning uNa/K ratio value that can be used as a reference value in participants who are not taking antihypertensive medication. This was a cross-sectional study using data from the Tohoku Medical Megabank Project Cohort Study. A total of 3122 participants borrowed HBP and uNa/K ratio monitors for 10 consecutive days. We assessed the relationship between the morning uNa/K ratio from 1 day to 10 days and home hypertension (HBP ≥ 135/85 mmHg) using multiple logistic regression models. Although a 1-day measurement of the morning uNa/K ratio was positively associated with home hypertension, multiple measurements of the morning uNa/K ratio were strongly related to home hypertension. The average morning uNa/K ratio was relatively stable after 3 days (adjusted odds ratio of home hypertension per unit increase in the uNa/K ratio for more than 3 days: 1.19-1.23). In conclusion, there was no threshold for the uNa/K ratio, and the morning uNa/K ratio was linearly associated with home hypertension. The Na/K ratio 2.0 calculated from the Dietary Reference Intakes for Japanese might be a good indication. Regarding the stability of the association between the morning uNa/K ratio and BP, more than 3 days of measurements is desirable.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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