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Ichikawa T, Okada H, Hamaguchi M, Nishioka N, Tateyama Y, Shimamoto T, Kurogi K, Murata H, Ito M, Iwami T, Fukui M. The transition of metabolic phenotypes and cardiovascular events: Panasonic cohort study 16. Obesity (Silver Spring) 2024; 32:999-1008. [PMID: 38444281 DOI: 10.1002/oby.23999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/16/2023] [Accepted: 01/06/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE The study objective was to investigate whether changes in metabolic phenotype affect the risk of cardiovascular events. METHODS All 117,589 participants were included in this retrospective cohort study. The metabolic phenotypes of the participants were assessed at two points (the second evaluation was set 2 years after the first evaluation), and the incidence rate of cardiovascular events was observed for 11 years. The main outcome was 3-point major adverse cardiac events (MACE), which comprises cardiovascular death, nonfatal coronary artery disease, and nonfatal stroke incidence. RESULTS Of the participants, 2748 (2.3%) cases of 3-point MACE were identified during follow-up. The stable metabolically healthy obesity group had a higher risk of 3-point MACE than those with stable metabolically healthy nonobesity (MHNO). Additionally, the change from metabolically healthy obesity to MHNO for 2 years decreased the risk of 3-point MACE (hazard ratio [HR], 1.12: 95% CI: 0.84-1.47) to the same level as stable MHNO. However, the change from metabolically abnormal nonobesity and metabolically abnormal obesity to MHNO for 2 years maintained a higher risk of 3-point MACE (HR, 1.66 [95% CI: 1.36-2.01]; HR, 1.91 [95% CI: 1.22-2.81]) than those with stable MHNO. CONCLUSIONS Change in metabolic phenotype is associated with incident 3-point MACE.
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Affiliation(s)
- Takahiro Ichikawa
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Yukiko Tateyama
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Tomonari Shimamoto
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Kazushiro Kurogi
- Department of Health Care Center, Panasonic Health Insurance Organization, Moriguchi, Japan
| | - Hiroaki Murata
- Department of Orthopaedic Surgery, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Masato Ito
- Department of Health Care Center, Panasonic Health Insurance Organization, Moriguchi, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Hata J, Ninomiya T. Epidemiology of Stroke in a General Japanese Population: The Hisayama Study. J Atheroscler Thromb 2023; 30:710-719. [PMID: 37258234 PMCID: PMC10322733 DOI: 10.5551/jat.rv22004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023] Open
Abstract
The Hisayama Study is an ongoing epidemiological study of stroke, coronary artery disease (CAD), and other noncommunicable diseases in a general Japanese population established in 1961. According to the longitudinal data from the Hisayama Study, average levels of systolic blood pressure among hypertensive individuals have decreased with time since 1961. In contrast, the prevalence of metabolic risk factors such as obesity, hypercholesterolemia, and glucose intolerance has increased with time. The incidence rates of ischemic stroke in this population have declined significantly as a result of improvement in hypertension management, but the proportion of atherothrombotic brain infarction (ATBI) and embolic stroke among the total ischemic stroke cases have increased probably due to the increased prevalence of metabolic risk factors and the increased number of patients with atrial fibrillation (AF) with super-aging population. Therefore, a strategy to reduce the risks of ATBI and embolic stroke by comprehensive management of their risk factors is necessary.In this review, we first show the secular trends in the incidence of stroke and the prevalence of its risk factors using the data from the Hisayama Study. Then, the studies for the association of traditional risk factors with stroke development in the Hisayama Study are introduced. Finally, we developed risk prediction models to estimate the absolute risk of atherosclerotic cardiovascular disease (ASCVD; including ATBI and CAD) and AF, that may be used for the stratification of future risk of ATBI and AF-related stroke in clinical practice or health examination.
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Affiliation(s)
- Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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3
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Zhang S, Qian ZM, Chen L, Zhao X, Cai M, Wang C, Zou H, Wu Y, Zhang Z, Li H, Lin H. Exposure to Air Pollution during Pre-Hypertension and Subsequent Hypertension, Cardiovascular Disease, and Death: A Trajectory Analysis of the UK Biobank Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:17008. [PMID: 36696106 PMCID: PMC9875843 DOI: 10.1289/ehp10967] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 11/27/2022] [Accepted: 12/15/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND The associations between air pollution exposure and morbidity and mortality of cardiovascular diseases (CVDs) have been widely reported; however, evidence on such associations across different dynamic disease trajectories remain unknown. OBJECTIVE We examined whether ambient air pollution during the prehypertension (pre-HTN) stage could aggravate the progression from hypertension (HTN) to CVD, and consequent death. METHODS A total of 168,010 adults with pre-HTN (120 - 139 mmHg systolic blood pressure or 80 - 89 mmHg diastolic blood pressure) from the UK Biobank were included in this analysis. We used a multistate model to explore the associations between five air pollutants (PM 2.5 , PM 2.5 absorbance, PM 10 , NO 2 , and NO x ) and the risk of six disease transitions (from pre-HTN to HTN, from pre-HTN to CVD, from pre-HTN to death, from HTN to CVD, from HTN to death, and from CVD to death). Mediation analyses were further conducted to explore the role of intermediate diseases in the dynamic progression of CVDs. RESULTS During a median follow-up of 12 y, 13,743 (8.18%) of participants with pre-HTN developed HTN, whereas 12,825 (7.63%) and 4,467 (2.66%) directly developed CVD or died, respectively. Air pollution was positively associated with the dynamic disease progression. For example, a per-interquartile range increase of PM 2.5 was significantly associated with the hazard ratios (HRs) of 1.105 [95% confidence intervals (CI): 1.083, 1.127], 1.045 (95% CI: 1.022, 1.068), and 1.086 (95% CI: 1.047, 1.126) in the transition from pre-HTN to HTN, CVD, and death, respectively. Higher levels of air pollution were associated with increased transition probability of disease progression. Mediation analyses indicated that intermediate diseases subsequently significantly mediated air pollutant-associated risk to develop more serious disease. CONCLUSIONS This study provides evidence that air pollution might play a role in the early stages of CVD progression. Controlling air pollution might be an effective measure to prevent CVD progression and reduce the disease burden of CVD. https://doi.org/10.1289/EHP10967.
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Affiliation(s)
- Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Lan Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hongtao Zou
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yinglin Wu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Haitao Li
- Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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4
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Campos JO, Barros MAV, Oliveira TLPSA, Nobre IG, de Morais AS, Santos MAM, Leandro CG, Costa-Silva JH. Cardiac autonomic dysfunction in school age children with overweight and obesity. Nutr Metab Cardiovasc Dis 2022; 32:2410-2417. [PMID: 35872100 DOI: 10.1016/j.numecd.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS We investigated cardiac autonomic function in overweight and obese school-age children. METHODS AND RESULTS Quantitative cross-sectional study conducted with children (n = 110) of both genders. Children were divided by normal weight (NW; n = 54), overweight (OW; n = 24) and obese (OB; n = 32). Systolic (SBP) and diastolic (DBP) blood pressure and electrocardiograms were recorded and analyzed for heart rate and the heart rate variability (HRV) in time (SDRR, RMSSD, PRR50, SD1 and SD2) and frequency domains (HF, LF and LF/HF). The OB group presented higher SBP (p ≤ 0.01) and DBP (p ≤ 0.01). For HRV, the OB group had a lower PRR50 (p ≤ 0.01) and HF (p ≤ 0.01), associated with higher LF (p ≤ 0.01). Moderate negative correlations were found between the HF, BMI (r = -0.37; p ≤ 0.01) and WC (r = -0.38; p ≤ 0.01). Positive moderate correlation were found between LF, LF/HF and BMI (LF: r = 0.32; p ≤ 0.01; LF/HF: r = 0.31; p ≤ 0.01) and WC (LF: r = 0.34; p ≤ 0.01; LF/HF: = 0.34; p ≤ 0.01). Multiple linear regression showed a positive association between body fat and the SDRR (β: 0.48; CI: 0.2-4.2; p = 0.02). No differences were observed in cardiac electrical activity. CONCLUSION Children with obesity but not overweight presented higher blood pressure and cardiac autonomic dysfunction, with sympathetic predominance on the heart rate. This fact was positively correlated with BMI and may be considered an important marker for cardiovascular risk in children.
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Affiliation(s)
- Jéssica O Campos
- Laboratory of Nutrition, Physical Activity and Phenotypic Plasticity, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil; Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - Monique A V Barros
- Laboratory of Nutrition, Physical Activity and Phenotypic Plasticity, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil; Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - Tafnes L P S A Oliveira
- Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - Isabele G Nobre
- Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - André S de Morais
- Academic Center of Agreste, Universidade Federal de Pernambuco, UFPE, Caruaru PE, Brazil
| | - Marcos A M Santos
- Superior School of Physical Education, Universidade de Pernambuco, Recife, PE, Brazil
| | - Carol G Leandro
- Laboratory of Nutrition, Physical Activity and Phenotypic Plasticity, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil; Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil
| | - João H Costa-Silva
- Laboratory of Nutrition, Physical Activity and Phenotypic Plasticity, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil; Laboratory of Physical Evaluation and Signal Processing, Academic Center of Vitória, Universidade Federal de Pernambuco, UFPE, Vitória de Santo Antão, PE, Brazil. /
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5
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Song Q, Liu S, Ling QH, Gao QN, Yang RX, Chen SH, Wu S, Chen ML, Cai J. Severity of Nonalcoholic Fatty Liver Disease is Associated With Cardiovascular Outcomes in Patients With Prehypertension or Hypertension: A Community-Based Cohort Study. Front Endocrinol (Lausanne) 2022; 13:942647. [PMID: 36093080 PMCID: PMC9453754 DOI: 10.3389/fendo.2022.942647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It is unclear whether more severe non-alcoholic fatty liver disease (NAFLD) combined with prehypertension or hypertension is associated with a higher risk of cardiovascular events (CVEs). To evaluate the relationship between the severity of NAFLD and CVEs among patients with prehypertension or hypertension. METHODS In this prospective community-based Kailuan cohort, participants without cardiovascular disease and alcohol abuse, or other liver diseases were enrolled. NAFLD was diagnosed by abdominal ultrasonography. Prehypertension was defined as systolic blood pressure (BP) of 120-139 mmHg or diastolic BP of 80-89 mmHg. Participants with NAFLD were divided into mild, moderate, and severe subgroups. Follow-up for CVEs including myocardial infarction, hemorrhagic stroke, and ischemic stroke. The Cox proportional hazards model was used to estimate hazard ratios and 95% CIs of CVEs according to the severity of NAFLD and hypertensive statutes. The C-statistic was used to evaluate the efficiency of models. RESULTS A total of 71926 participants (mean [SD] age, 51.83 [12.72] years, 53794 [74.79%] men, and 18132 [25.21%] women) were enrolled in this study, 6,045 CVEs occurred during a median of 13.02 (0.65) years of follow-up. Compared with participants without NAFLD, the hazard ratios of CVEs for patients with mild, moderate, and severe NAFLD were 1.143 (95% CI 1.071-1.221, P < 0.001), 1.218 (95% CI 1.071-1.221, P < 0.001), and 1.367 (95% CI 1.172-1.595, P < 0.001), respectively. Moreover, participants with prehypertension plus moderate/severe NAFLD and those with hypertension plus moderate/severe NAFLD had 1.558-fold (95% CI 1.293-1.877, P < 0.001) and 2.357-fold (95% CI 2.063-2.691, P < 0.001) higher risks of CVEs, respectively, compared with those with normal BP and no NAFLD. Adding a combination of NAFLD and BP status to the crude Cox model increased the C-statistic by 0.0130 (0.0115-0.0158, P < 0.001). CONCLUSIONS Our findings indicated that the increased cardiovascular risk with elevated BP is largely driven by the coexistence of moderate/severe NAFLD, suggesting that the severity of NAFLD may help further stratify patients with prehypertension and hypertension.
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Affiliation(s)
- Qi–Rui Song
- State Key Laboratory of Cardiovascular Disease of China, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuo–Lin Liu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Qian-Hui Ling
- State Key Laboratory of Cardiovascular Disease of China, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian-Nan Gao
- State Key Laboratory of Cardiovascular Disease of China, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui-Xue Yang
- State Key Laboratory of Cardiovascular Disease of China, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuo-Hua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shou–Ling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
- *Correspondence: Shou–Ling Wu, ; Mu-Lei Chen, ; Jun Cai,
| | - Mu-Lei Chen
- Heart Center and Beijing Key Laboratory of Hypertension, Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Shou–Ling Wu, ; Mu-Lei Chen, ; Jun Cai,
| | - Jun Cai
- State Key Laboratory of Cardiovascular Disease of China, Hypertension Center, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Shou–Ling Wu, ; Mu-Lei Chen, ; Jun Cai,
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Oishi E, Hata J, Honda T, Sakata S, Chen S, Hirakawa Y, Yoshida D, Shibata M, Ohara T, Furuta Y, Kitazono T, Ninomiya T. Development of a risk prediction model for incident hypertension in Japanese individuals: the Hisayama Study. Hypertens Res 2021; 44:1221-1229. [PMID: 34059807 DOI: 10.1038/s41440-021-00673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/09/2022]
Abstract
The identification of individuals at high risk of developing hypertension can be of great value to improve the efficiency of primary prevention strategies for hypertension. The objective of this study was to develop a risk prediction model for incident hypertension based on prospective longitudinal data from a general Japanese population. A total of 982 subjects aged 40-59 years without hypertension at baseline were followed up for 10 years (2002-12) for the incidence of hypertension. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or the use of antihypertensive agents. The risk prediction model was developed using a Cox proportional hazards model. A simple risk scoring system was also established based on the developed model. During the follow-up period (median 10 years, interquartile range 5-10 years), 302 subjects (120 men and 182 women) developed new-onset hypertension. The risk prediction model for hypertension consisted of age, sex, SBP, DBP, use of glucose-lowering agents, body mass index (BMI), parental history of hypertension, moderate-to-high alcohol intake, and the interaction between age and BMI. The developed model demonstrated good discrimination (Harrell's C statistic=0.812 [95% confidence interval, 0.791-0.834]; optimism-corrected C statistic based on 200 bootstrap samples=0.804) and calibration (Greenwood-Nam-D'Agostino χ2 statistic=12.2). This risk prediction model is a useful guide for estimating an individual's absolute risk for hypertension and could facilitate the management of Japanese individuals at high risk of developing hypertension in the future.
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Affiliation(s)
- Emi Oishi
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanori Honda
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoko Sakata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sanmei Chen
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichiro Hirakawa
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daigo Yoshida
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mao Shibata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Ohara
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Furuta
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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7
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Ren Y, Zuo Y, Wang A, Chen S, Tian X, Li H, He Y, Wu S, Ma C. Diabetes modifies the association of prehypertension with cardiovascular disease and all-cause mortality. J Clin Hypertens (Greenwich) 2021; 23:1221-1228. [PMID: 33813784 PMCID: PMC8678834 DOI: 10.1111/jch.14246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/27/2021] [Accepted: 03/16/2021] [Indexed: 12/05/2022]
Abstract
Prehypertension is a risk factor for cardiovascular disease (CVD) and all‐cause mortality. However, it is unclear whether prehypertension combined with diabetes associate with a higher risk for cardiovascular disease and all‐cause mortality. The purpose of this study was to explore the relationship between prehypertension and the risk of CVD and all‐cause mortality was different among individuals with or without diabetes. In the prospective community‐based Kailuan study, 67 344 participants without hypertension or a history of CVD at baseline (2006) were included. Prehypertension was defined as systolic blood pressure of 120–139 mmHg or diastolic blood pressure of 80–89 mmHg. The outcomes were CVD and all‐cause mortality were followed up through December 31, 2017. We performed Cox proportional hazards models to evaluate the relationships between prehypertension and CVD and all‐cause mortality by diabetes status. During a median follow‐up of 11.03 years, 2981 CVD events and 4655 all‐cause mortality occurred. After adjusting age, sex, and other factors, the associations of prehypertension with risk of CVD and all‐cause mortality were significant in participants without diabetes (hazard ratio and 95% confidence interval: 1.54 [1.38–1.71] and 1.27 [1.17–1.38]), but not in participants with diabetes (1.20 [0.93–1.56] and 0.88 [0.73–1.07]). The interactions between prehypertension and diabetes for the risk of CVD and all‐cause mortality were all significant (all p < .05). Prehypertension was only associated with an increased risk for CVD and all‐cause mortality in non‐diabetes participants. Diabetes modifies the relation of prehypertension with the risk of CVD and all‐cause mortality.
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Affiliation(s)
- Yanlong Ren
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Haibin Li
- Department of Epidemiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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8
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Sugiura T, Takase H, Ohte N, Dohi Y. Dietary salt intake increases with age in Japanese adults. Nutr Res 2021; 89:1-9. [PMID: 33866192 DOI: 10.1016/j.nutres.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/20/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
Excess salt intake is linked to cardiovascular disease as well as hypertension, but whether individual salt intake increases with age has not been studied. The present study was designed to test the hypothesis that individual salt intake increases with age in Japanese adults. In this retrospective observational follow-up study, men and women age ≥30 years who participated in a baseline health checkup (2008-2009) at our center and had a health checkup 10 years later (n = 2598) were enrolled and salt intake was estimated by spot urine analysis. Yearly changes in salt intake were also assessed in participants with complete annual data over the course of 10 years from baseline (n = 1543). The follow-up study demonstrated increased salt intake (8.8 ± 2.0 to 9.3 ± 2.1 g/d, P < .001) with increasing age (54.0 ± 9.7 to 64.0 ± 9.8 years). Salt intake increased year over year in participants who had a health checkup annually for the 10-year follow-up period (n = 1543; analysis of variance, P < .001). Cross-sectional analyses using propensity-matched model revealed similar regional levels of salt intake in the baseline period (8.9 ± 2.0 g/d, 55.8 ± 11.4 years, n = 5018) and at 10 years (8.8 ± 2.0 g/d, P = .21; 55.9 ± 13.0 years, P = .65, n = 5105). These results suggest that dietary salt intake increases with age in Japanese adults, which should be considered in devising population-based strategies to lower dietary salt intake.
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Affiliation(s)
- Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan.
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuaki Dohi
- Department of Internal Medicine, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Nagoya, Japan
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Li F, Lin Q, Li M, Chen L, Li Y. The Association between Blood Pressure Trajectories and Risk of Cardiovascular Diseases among Non-Hypertensive Chinese Population: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2909. [PMID: 33809125 PMCID: PMC7999224 DOI: 10.3390/ijerph18062909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
Although previous studies have discussed the association between trajectories of blood pressure (BP) and risk of cardiovascular diseases (CVDs), the association among the non-hypertensive general population of youth and middle age has not been elucidated. We used the growth mixture model to explore the trajectories of BP among the non-hypertensive Chinese population and applied Cox regression to evaluate the association between trajectories of BP and the risk of stroke or myocardial infarction (MI). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were categorized into three classes, respectively. Statistically significant associations were observed between SBP trajectories and stroke (range of adjusted hazard ratios (aHR): 1.369-3.837) or MI (rang of aHR = 6.047-13.017). Association between DBP trajectories and stroke (aHR: 3.685) or MI (range of aHR = 1.312-2.821) were also observed, although they did not reach statistical significance. Trajectories of SBP were more important risk factors than that of DBP in stroke and MI in our study population. BP management is important among pre-hypertensive adults to prevent stroke and MI when they age. Well-designed research with a larger sample size is required to confirm our findings and develop efficient methods to prevent CVDs.
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Affiliation(s)
- Fang Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China;
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha 410078, China
| | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha 410078, China; (Q.L.); (M.L.)
| | - Mingshu Li
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha 410078, China; (Q.L.); (M.L.)
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China;
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha 410078, China
| | - Yingjun Li
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou 310053, China
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10
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Associations of blood pressure levels with clinical events in older patients receiving home medical care. Hypertens Res 2020; 44:197-205. [DOI: 10.1038/s41440-020-00538-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022]
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11
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 1059] [Impact Index Per Article: 264.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Prehypertension and risk of cardiovascular diseases: a meta-analysis of 47 cohort studies. J Hypertens 2020; 37:2325-2332. [PMID: 31335511 DOI: 10.1097/hjh.0000000000002191] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the association of prehypertension (SBP 120-139 mmHg and/or DBP 80-89 mmHg) and total cardiovascular diseases (CVDs), coronary heart disease (CHD), myocardial infarction (MI), and stroke. METHODS PubMed, Embase, and Web of Science were searched for articles published up to 7 November 2018. Normal range BP was considered SBP less than 120 mmHg and DBP less than 80 mmHg. RRs and 95% CIs were pooled using fixed-effects models. Meta-regression was conducted to estimate the heterogeneity among subgroups. RESULTS We included 27 articles (47 studies including 491 666 study participants) in the analysis. Prehypertension was associated with total CVDs (RR 1.40, 95% CI 1.34-1.46), CHD (1.40, 1.28-1.52), MI (1.86, 1.50-2.32), and stroke (1.66, 1.56-1.76). Risk of total CVDs, MI, and stroke was increased with low-range prehypertension (low-range: SBP 120-129 mmHg and/or DBP 80-84 mmHg) versus normal BP - RR 1.42 (95% CI 1.29-1.55), 1.43 (1.10-1.86), and 1.52 (1.27-1.81), respectively - and risk of total CVDs, CHD, MI, and stroke was increased with high-range prehypertension (high-range: SBP 130-139 mmHg and/or DBP 85-89 mmHg) - RR 1.81 (95% CI 1.56-2.10), 1.65 (1.13-2.39), 1.99 (1.59-2.50), and 1.99 (1.68-2.36), respectively. The population-attributable risk for the association of total CVDs, CHD, MI, and stroke with prehypertension was 12.09, 13.26, 24.60, and 19.15%, respectively. CONCLUSION Prehypertension, particularly high-range, is associated with increased risk of total CVDs, CHD, MI, and stroke. Effective control of prehypertension could prevent more than 10% of CVD cases.
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13
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Zeng ZY, Liu SX, Xu H, Xu X, Liu XZ, Zhao XX. Association of triglyceride glucose index and its combination of obesity indices with prehypertension in lean individuals: A cross-sectional study of Chinese adults. J Clin Hypertens (Greenwich) 2020; 22:1025-1032. [PMID: 32442359 DOI: 10.1111/jch.13878] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/14/2022]
Abstract
For normal-weight population, the management of prehypertension may be more beneficial by identifying insulin resistance (IR) status than relying solely on traditional indicators of obesity. We investigated the association of triglyceride glucose (TyG) index, a simple surrogate marker of IR, and its combination of obesity indices with prehypertension in lean individuals. A total of 105 070 lean adults without hypertension were included in this analysis. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), and TyG were calculated according to the corresponding formula; TyG-BMI, TyG-WC, and TyG-WHtR were calculated by multiplying the corresponding two parameters. Gardner-Altman plots, partial correlation, and logistic regression analyses were applied to explore the associations in continuous variables and quartiles. The prehypertensive ones had higher mean values of TyG, TyG-BMI, TyG-WC, and TyG-WHtR than normotensive individuals. All the four indicators showed positive correlations with systolic blood pressure and diastolic blood pressure. After full adjustment, only TyG-BMI and TyG-WC were significantly associated with prehypertension in both genders. Furthermore, TyG-BMI had the highest OR for prehypertension. Our study showed that TyG-BMI might be an accessible and complementary monitor in the hierarchical management of non-obese prehypertensive patients.
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Affiliation(s)
- Zhen Yu Zeng
- Department of Cardiology, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
| | - Su Xuan Liu
- Department of Cardiology, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
| | - Hao Xu
- Department of Infectious Diseases, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
| | - Xia Xu
- Department of Rheumatology, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
| | - Xing Zhen Liu
- Hangzhou Aeronautical Sanatorium of Chinese Air Force, Hangzhou, China
| | - Xian Xian Zhao
- Department of Cardiology, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
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14
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Duan W, Wu J, Liu S, Jiao Y, Zheng L, Sun Y, Sun Z. Impact of Prehypertension on the Risk of Major Adverse Cardiovascular Events in a Chinese Rural Cohort. Am J Hypertens 2020; 33:465-470. [PMID: 32030405 DOI: 10.1093/ajh/hpaa019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/09/2019] [Accepted: 02/04/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The study was performed to investigate the impact of prehypertension defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) on the risk of major adverse cardiovascular events (MACE) in a Chinese rural cohort. METHODS The epidemiological prospective cohort study included 38,765 participants aged ≥35 years followed for a median of 12.5 years-divided into normal BP (n = 7,366), prehypertension (n = 18,095), and hypertension groups (n = 13,304)-were enrolled for the final analysis. Follow-up for MACE including cardiovascular disease (CVD) death, stroke and myocardial infarction (MI) was conducted. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS The age and sex-adjusted incidence of MACE and its subtypes rose progressively with elevation of BP levels (P < 0.001). After adjusting multivariable Cox proportional hazards, significant increases were observed from the prehypertensive group for incident MACE (HR = 1.337, 95% CI: 1.186-1.508, P < 0.001), CVD mortality (HR = 1.331, 95% CI: 1.109-1.597, P = 0.002), and stroke (HR = 1.424, 95% CI:1.237-1.639, P < 0.001) but not MI (P > 0.05) compared with normal BP. CONCLUSION Prehypertensive individuals had a greater risk of incident MACE, CVD mortality, and stroke, implying that improvements in BP monitoring and early intervention in individuals with prehypertension in rural China are urgently needed.
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Affiliation(s)
- Weili Duan
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Jiake Wu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Sitong Liu
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Yundi Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, P. R. China
| | - Yingxian Sun
- Department of Cardiology, the First Affiliated Hospital of China Medical University, Shenyang, P. R. China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, P. R. China
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15
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Nam KW, Kwon HM, Jeong HY, Park JH, Kwon H, Jeong SM. Cerebral Small Vessel Disease and Stage 1 Hypertension Defined by the 2017 American College of Cardiology/American Heart Association Guidelines. Hypertension 2019; 73:1210-1216. [PMID: 31067203 DOI: 10.1161/hypertensionaha.119.12830] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although the American College of Cardiology/American Heart Association guidelines have introduced a novel definition of hypertension in their 2017 hypertension guidelines, the influence of novel stage 1 hypertension on cerebrovascular diseases remains unclear. In this study, we evaluated the relationship between stage 1 hypertension, as defined by the 2017 American College of Cardiology/American Heart Association guidelines and cerebral small vessel disease in a healthy population. We assessed consecutive health checkup participants without the use of antihypertensive medication between 2006 and 2013. White matter hyperintensity volumes were rated using semiautomated quantitative methods. The presence of lacunes, cerebral microbleeds, and enlarged perivascular spaces was also measured as cerebral small vessel disease lesions. We classified the blood pressure of all participants according to the 2017 American College of Cardiology/American Heart Association guidelines. A total of 2460 participants were evaluated. In adjusted linear and logistic regression analyses, stage 1 hypertension was independently associated with white matter hyperintensity volume (β=0.158; 95% CI, 0.046-0.269; P=0.006), presence of lacune (adjusted odds ratio, 1.66; 95% CI, 1.00-2.73; P=0.048), and deep cerebral microbleeds (adjusted odds ratio, 2.50, 95% CI, 1.08-5.79; P=0.033). Stage 2 hypertension showed higher coefficients or adjusted odds ratio values and lower P values in all analyses of white matter hyperintensity volumes, lacunes, and deep cerebral microbleeds, indicating dose-response effects across blood pressure categories. Stage 1 hypertension according to the 2017 American College of Cardiology/American Heart Association guidelines is associated with cerebral small vessel disease lesions, especially in white matter hyperintensity lesions, lacunes, and deep cerebral microbleeds.
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Affiliation(s)
- Ki-Woong Nam
- From the Department of Neurology (K.-W.N., H.-Y.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Korea (H.-M.K.)
| | - Han-Yeong Jeong
- From the Department of Neurology (K.-W.N., H.-Y.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Jin-Ho Park
- Department of Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Hyuktae Kwon
- Department of Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Su-Min Jeong
- Department of Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
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16
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Associations of blood pressure categories according to the 2017 American College of Cardiology/American Heart Association hypertension guideline and long-term blood pressure change with incident cardiovascular disease in middle-aged and elderly Chinese. J Hypertens 2019; 37:2007-2014. [DOI: 10.1097/hjh.0000000000002137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Kadomatsu Y, Tsukamoto M, Sasakabe T, Kawai S, Naito M, Kubo Y, Okada R, Tamura T, Hishida A, Mori A, Hamajima N, Yokoi K, Wakai K. A risk score predicting new incidence of hypertension in Japan. J Hum Hypertens 2019; 33:748-755. [PMID: 31431683 DOI: 10.1038/s41371-019-0226-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/16/2019] [Accepted: 08/06/2019] [Indexed: 11/09/2022]
Abstract
The prevention of hypertension starts with the awareness of risk. Our aim was to construct a simple and well-validated risk model for nonhypertensive people in Japan consisting of basic clinical variables, using a dataset for two areas derived from the Japan Multi-Institutional Collaborative Cohort Study. We constructed a continuous-value model using data on 5105 subjects participating in both the baseline survey and a second survey conducted after 5 years. The area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow χ2 statistic for the entire cohort were 0.826 and 7.06, respectively. For validation, the entire cohort was randomly divided 100 times into derivation and validation sets at a ratio of 6:4. The summarized median AUC and the Hosmer-Lemeshow χ2 statistic were 0.83 and 12.2, respectively. The AUC of a point-based model consisting of integer scores assigned to each variable was 0.826 and showed no difference, compared with the continuous-value model. This simple risk model may help the general population to assess their risks of new-onset hypertension.
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Affiliation(s)
- Yuka Kadomatsu
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. .,Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Mineko Tsukamoto
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tae Sasakabe
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Public Health, Aichi Medical University, Nagakute, Japan
| | - Sayo Kawai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Public Health, Aichi Medical University, Nagakute, Japan
| | - Mariko Naito
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Oral Epidemiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rieko Okada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Abstract
The Hisayama Study is a population-based prospective cohort study designed to evaluate the risk factors for lifestyle-related diseases, such as stroke, coronary heart disease, hypertension, diabetes, and dementia, in a general Japanese population. The prospective follow-up surveys have been conducted in subjects aged 40 or older since 1961. Notable characteristics of this study include its high participation rate (70-80% of all residents aged 40 or older), high follow-up rate (99% or over), and high autopsy rate (approximately 75% of deceased cases). The Hisayama Study has provided valuable evidence of secular change in the prevalence and incidence of several lifestyle-related disease and their risk factors. The study has thereby contributed to elucidation of the preventive strategies for lifestyle-related disease. Research efforts in this cohort are ongoing and will provide additional data for the improvement of human health and longevity.
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Affiliation(s)
- Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
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19
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Yuen JWM, Yan YKY, Wong VCW, Tam WWS, So KW, Chien WT. A Physical Health Profile of Youths Living with a "Hikikomori" Lifestyle. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E315. [PMID: 29439488 PMCID: PMC5858384 DOI: 10.3390/ijerph15020315] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 12/25/2022]
Abstract
A cross-sectional study was designed to understand the impacts of "hikikomori" lifestyle on physical health. A total of 104 eligible hikikomori cases were recruited from the social services network of Hong Kong with a mean age of 19.02 ± 3.62 (ranged 13-31) year-old, and had completed the set of questionnaires and a series of anthropometric and physical health measurements. Despite SF36 score of 84.0 indicated good physical functioning in general, participants were lived sedentarily with high incidence of hypertension at 15.4% and prehypertension at 31.7%. Occurrence of hypertension and prehypertension in cases living as hikikomori >6 months were 3 times and 1.5 times higher than those newly onset cases, respectively. The blood pressure levels were correlated with age and all obesity index parameters measured including waist circumference and body mass index. Results also observed a shift of body weight from underweight to overweight and obesity along the hikikomori duration. Half of the hypertensive cases involved the elevation of systolic blood pressure, which suggested higher odds of cardiovascular complications. In conclusion, the hikikomori lifestyle could be a risk behavior that may harm the younger generation physically by promoting obesity and hypertension and probably other chronic illnesses.
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Affiliation(s)
- John W M Yuen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
| | - Yoyo K Y Yan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
| | - Victor C W Wong
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong, China.
| | - Wilson W S Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Lower Kent Ridge Road, Singapore 119077, Singapore.
| | - Ka-Wing So
- Withdrawal Youth Service, Hong Kong Christian Service, Tsim Sha Tsui, Kowloon, Hong Kong, China.
| | - Wai-Tong Chien
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
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20
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Oishi E, Ohara T, Sakata S, Fukuhara M, Hata J, Yoshida D, Shibata M, Ohtsubo T, Kitazono T, Kiyohara Y, Ninomiya T. Day-to-Day Blood Pressure Variability and Risk of Dementia in a General Japanese Elderly Population: The Hisayama Study. Circulation 2017; 136:516-525. [PMID: 28784822 PMCID: PMC5548511 DOI: 10.1161/circulationaha.116.025667] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 06/22/2017] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Several observational studies have reported that higher visit-to-visit blood pressure variability is a risk factor for cognitive impairment and dementia. However, no studies have investigated the association of day-to-day blood pressure variability assessed by home blood pressure measurement with the development of dementia.
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Affiliation(s)
- Emi Oishi
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Tomoyuki Ohara
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.).
| | - Satoko Sakata
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Masayo Fukuhara
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Jun Hata
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Daigo Yoshida
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Mao Shibata
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Toshio Ohtsubo
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Takanari Kitazono
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Yutaka Kiyohara
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Toshiharu Ninomiya
- From Department of Epidemiology and Public Health (E.O., T. Ohara, S.S., J.H., D.Y., M.S., T.N.), Department of Medicine and Clinical Science (E.O., S.S., J.H., T. Ohtsubo, T.K.), Department of Neuropsychiatry (T. Ohara), and Department of Center for Cohort Studies (J.H., D.Y., T.K., T.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan (M.F.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
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Li G, Guo G, Wang W, Wang K, Wang H, Dong F, Qian Y, Gong H, Xu G, Li Y, Pan L, Zhang B, Shan G. Association of prehypertension and cardiovascular risk factor clustering in Inner Mongolia: a cross-sectional study. BMJ Open 2017; 7:e015340. [PMID: 28667215 PMCID: PMC5734362 DOI: 10.1136/bmjopen-2016-015340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To assess the clustering of cardiovascular disease (CVD) risk factors in Han and Mongolian adults with prehypertension or hypertension in Northern China. METHODS We selected 3227 Han and Mongolian participants (20-80 years old) using a multistage cluster sampling method in 2014. The participants were interviewed by standard questionnaires and underwent anthropometric measurement and biochemical testing. Han and Mongolian participants were divided into optimal, prehypertension, and hypertension groups based on blood pressure. A multinomial logit analysis was performed to explore relationships between CVD risk factor clustering and prehypertension or hypertension, and the heterogeneity between Han and Mongolian was evaluated by the Cochran Q test. The differences between the ethnic groups in the proportions of risk factors was tested with the χ2 test. RESULTS The clustering of two or three CVD risk factors in the prehypertension or hypertension groups was consistently higher than in the optimal group (Bonferroni, p<0.0167). The odds ratios (ORs) of prehypertension and hypertension increased with the number of CVD risk factors (ptrend <0.0001). In multivariate modelling, the adjusted ORs of one, two, and ≥3 CVD risk factors versus no risk factors was, respectively, 1.95, 2.25, and 2.28 in Han prehypertensive participants, and 1.73, 2.83, and 3.69 in Mongolian prehypertensive participants. In addition, the adjusted ORs were 3.15, 4.75, and 6.49 in Han hypertensive participants, and 1.90, 5.29, and 8.13 in Mongolian hypertensive participants (all p<0.05). There was no significant heterogeneity between Han and Mongolian participants in the prehypertension or hypertension groups. The age-standardised prevalence of ≥3 risk factors was 38.30% in Han men and 39.79% in Mongolian men. The rate was significantly lower in Han women than Mongolian women (9.18% vs 14.55%, p=0.002). CONCLUSIONS These findings showed clustering of CVD risk factors in prehypertensive Han and Mongolian adults, and showed prehypertension may be a useful target for intervention.
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Affiliation(s)
- Guoju Li
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Guanghong Guo
- Department of Clinical Biochemistry, Chinese PLA General Hospital, Beijing, China
| | - Wenrui Wang
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Ke Wang
- Department of Obstetrics, Key Laboratory of 9 Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China 10 Second University Hospital, Sichuan University, Chengdu, China
| | - Hailing Wang
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Fen Dong
- China-Japan Friendship Hospital, Beijing, China
| | - Yonggang Qian
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Haiying Gong
- Fangshan District Center for Disease Control and Prevention, Beijing, China
| | - Guodong Xu
- China-Japan Friendship Hospital, Beijing, China
| | - Yanlong Li
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Biao Zhang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
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22
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Malachias M, Plavnik FL, Machado CA, Malta D, Scala LCN, Fuchs S. 7th Brazilian Guideline of Arterial Hypertension: Chapter 1 - Concept, Epidemiology and Primary Prevention. Arq Bras Cardiol 2017; 107:1-6. [PMID: 27819380 PMCID: PMC5319472 DOI: 10.5935/abc.20160151] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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23
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Sakata S, Hata J, Fukuhara M, Yonemoto K, Mukai N, Yoshida D, Kishimoto H, Ohtsubo T, Kitazono T, Kiyohara Y, Ninomiya T. Morning and Evening Blood Pressures Are Associated With Intima-Media Thickness in a General Population - The Hisayama Study. Circ J 2017. [PMID: 28626161 DOI: 10.1253/circj.cj-16-1306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The association of morning and evening home blood pressures (HBPs) with carotid atherosclerosis has been uncertain in general populations, so we aimed to investigate it in a general Japanese population.Methods and Results:We performed a cross-sectional survey of 2,856 community-dwelling individuals aged ≥40 years to examine the association of morning and evening HBPs with carotid mean intima-media thickness (IMT). The age- and sex-adjusted geometric averages of carotid mean IMT increased significantly with increasing morning HBP (optimal: 0.67 mm; normal: 0.69 mm; high normal: 0.72 mm; grade 1 hypertension: 0.74 mm; and grade 2+3 hypertension: 0.76 mm) and with increasing evening HBP (0.68 mm, 0.71 mm, 0.73 mm, 0.76 mm, and 0.78 mm, respectively) (both P for trend <0.001). These associations remained significant even after adjusting for potential confounding factors. Likewise, both isolated morning hypertension (morning HBP ≥135/85 mmHg and evening HBP <135/85 mmHg) and isolated evening hypertension (evening HBP ≥135/85 mmHg and morning HBP <135/85 mmHg) as well as sustained hypertension (both morning and evening HBP ≥135/85 mmHg) were significantly associated with thicker mean IMT. CONCLUSIONS Our findings suggested that both morning and evening HBPs were significantly associated with carotid atherosclerosis in this general Japanese population.
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Affiliation(s)
- Satoko Sakata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Masayo Fukuhara
- Division of General Internal Medicine, Kyushu Dental University
| | - Koji Yonemoto
- Advanced Medical Research Center, Faculty of Medicine, University of the Ryukyus
| | - Naoko Mukai
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Daigo Yoshida
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University
| | - Hiro Kishimoto
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University
| | - Toshio Ohtsubo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Takanari Kitazono
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | | | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University
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Hedén Ståhl C, Lind M, Svensson A, Kosiborod M, Gudbjörnsdottir S, Pivodic A, Clements M, Rosengren A. Long-term excess risk of stroke in people with Type 2 diabetes in Sweden according to blood pressure level: a population-based case-control study. Diabet Med 2017; 34:522-530. [PMID: 27885698 PMCID: PMC5363349 DOI: 10.1111/dme.13292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 01/14/2023]
Abstract
AIMS To estimate the risk of stroke in people with Type 2 diabetes with different blood pressure levels compared with the risk in the general population in Sweden. METHODS This prospective case-control study included 408 076 people with Type 2 diabetes, aged ≥ 18 years, and free of prior stroke, registered in the Swedish National Diabetes Register 1998-2011. Age- and sex-matched control subjects (n = 1 913 507) without stroke from the general population were included. Stroke diagnoses were retrieved using International Classification of Disease codes from the Swedish patient and death registers. Cox hazard ratios and 95% confidence intervals (CIs) were estimated at six different blood pressure levels. RESULTS During a median follow-up of 4 years, 19 548 (4.8%) people with Type 2 diabetes and 61 690 (3.2%) without diabetes were diagnosed with stroke, corresponding to an adjusted hazard ratio of 1.43 (95% CI 1.41-1.46) for people with Type 2 diabetes as a group. Compared with people without diabetes, the risk of stroke for people with Type 2 diabetes with different blood pressure levels was significantly higher, starting at blood pressure levels > 130/80 mmHg. Hazard ratios for stroke were 1.20 (95% CI 1.16-1.24), 1.47 (95% CI 1.43-1.50), and 1.97 (95% CI 1.90-2.03) for blood pressure categories of 130-139/80-89 mmHg, 140-159/90-99 mmHg and ≥ 160/≥ 100 mmHg, respectively, after adjustment for age, sex, diabetes duration, being born in Sweden, maximum education level and baseline comorbidities. CONCLUSIONS People with Type 2 diabetes and blood pressure < 130/80 mmHg had a risk of stroke similar to that of the general population.
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Affiliation(s)
- C. Hedén Ståhl
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
| | - M. Lind
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
- Department of MedicineNU‐Hospital OrganizationUddevallaSweden
| | - A.‐M. Svensson
- Centre of Registers in the Västra Götaland RegionGothenburgSweden
| | - M. Kosiborod
- Saint Luke's Mid America Heart InstituteUniversity of Missouri–Kansas City School of MedicineMOUSA
| | | | - A. Pivodic
- Statistiska KonsultgruppenGothenburgSweden
| | - M. Clements
- University of Missouri–Kansas City School of Medicine and Children's Mercy HospitalKansas CityMOUSA
- University of Kansas School of MedicineKansas CityMOUSA
| | - A. Rosengren
- Department of Molecular and Clinical MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
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25
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Kitamura A, Yamagishi K, Imano H, Kiyama M, Cui R, Ohira T, Umesawa M, Muraki I, Sankai T, Saito I, Iso H. Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels - The Circulatory Risk in Communities Study (CIRCS). Circ J 2017; 81:1022-1028. [PMID: 28367846 DOI: 10.1253/circj.cj-16-1129] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In Japan, a community-based screening program for cardiovascular disease (CVD) has been effective in preventing stroke and coronary artery disease (CAD). The present study aimed to clarify which risk factors assessed at the screening examinations affect the incidence of CVD and the magnitude of the association after the late 1990 s.Methods and Results:We conducted a 12.5-year prospective study of 10,612 Japanese residents aged 40-74 years between 1995 and 2000, initially free of CVD and who underwent the screening examinations. During the follow-up, 364 cases of stroke and 137 cases of CAD were identified. The population attributable fraction of stroke was the largest for hypertension (HT; 46%), while the relative risk of stroke was the highest for atrial fibrillation (multivariable hazard ratio, 4.9; 95% confidence interval, 2.9-8.3). The population attributable fraction of CAD was relatively large for HT, current smoking, and high non-high-density lipoprotein cholesterol (20-29%). A dose-response relationship was found between the incidence of these cardiovascular events and the number of comorbid hypertensive subclinical organ damage markers: funduscopic changes, ST-T changes on ECG at rest, proteinuria and low estimated glomerular filtration rate. CONCLUSIONS HT and hypertensive subclinical organ damage are significantly associated with incident stroke and CAD at the population level, suggesting that management of HT and assessment of subclinical organ damage in hypertensive subjects at a screening program are still beneficial for community-based CVD prevention.
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Affiliation(s)
- Akihiko Kitamura
- Osaka Center for Cancer and Cardiovascular Disease Prevention.,Tokyo Metropolitan Institute of Gerontology
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba
| | - Hironori Imano
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention
| | - Renzhe Cui
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine
| | - Mitsumasa Umesawa
- Department of Public Health, Dokkyo Medical University School of Medicine
| | - Isao Muraki
- Osaka Center for Cancer and Cardiovascular Disease Prevention
| | - Tomoko Sankai
- Department of Community Health, Faculty of Medicine, University of Tsukuba
| | - Isao Saito
- Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
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26
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Jung MH, Ihm SH, Lee DH, Chung WB, Jung HO, Youn HJ. Prehypertension is associated with early complications of atherosclerosis but not with exercise capacity. Int J Cardiol 2017; 227:387-392. [DOI: 10.1016/j.ijcard.2016.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/21/2016] [Accepted: 11/05/2016] [Indexed: 11/30/2022]
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27
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Myojin T, Ojima T, Kikuchi K, Okada E, Shibata Y, Nakamura M, Hashimoto S. Orthopedic, ophthalmic, and psychiatric diseases primarily affect activity limitation for Japanese males and females: Based on the Comprehensive Survey of Living Conditions. J Epidemiol 2016; 27:75-79. [PMID: 28142015 PMCID: PMC5328730 DOI: 10.1016/j.je.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background Healthy life expectancy (HLE) is used as one of the primary objectives of fundamental health promotion plans and social development plans. Activity limitation is used to calculate HLE, but little study has been done to identify determinants of activity limitation in order to extend HLE. The purpose of this study is to identify diseases and injuries that commonly lead to activity limitation to prioritize countermeasures against activity limitation. Methods We used anonymous data from the 2007 “Comprehensive Survey of Living Conditions,” collected by the Ministry of Health, Labour and Welfare of Japan according to the Statistics Act, Article 36. We used logistic regression analyses and calculated odds ratios (ORs) after adjusting for age and sex. Limitation in daily activities was applied as the dependent variable, and each disease/injury was applied as an independent variable in this analysis. Furthermore, population attributable fractions (PAFs) were calculated. Results The provided data included 98,789 subjects. We used data for 75,986 valid subjects aged 12 years or older. The following diseases showed high PAF: backache (PAF 13.27%, OR 3.88), arthropathia (PAF 7.61%, OR 4.82), eye and optical diseases (PAF 6.39%, OR 2.01), and depression and other mental diseases (PAF 5.70%, OR 11.55). PAFs of cerebrovascular diseases, hypertension, and diabetes were higher for males than for females; on the other hand, PAFs of orthopedic diseases were higher among females. Conclusions Our results indicate that orthopedic diseases, ophthalmic diseases, and psychiatric diseases particularly affect activity limitation.
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Affiliation(s)
- Tomoya Myojin
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Keiko Kikuchi
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Eisaku Okada
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yosuke Shibata
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shuji Hashimoto
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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28
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Li Y, Xia P, Xu L, Wang Y, Chen L. A Meta-Analysis on Prehypertension and Chronic Kidney Disease. PLoS One 2016; 11:e0156575. [PMID: 27248143 PMCID: PMC4889081 DOI: 10.1371/journal.pone.0156575] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 05/17/2016] [Indexed: 11/19/2022] Open
Abstract
Background Recent studies have demonstrated that there is an association between prehypertension and an increased risk of end-stage renal disease. However, there is conflicting evidence regarding the relationship between prehypertension and chronic kidney disease (CKD). This meta-analysis aimed to demonstrate the association between prehypertension and the incidence of CKD and identify the impacts of gender and ethnic differences. Methods MEDLINE, EMBASE, Cochrane Library (from inception through March 2016) and article reference lists were searched for relevant studies regarding blood pressure and CKD. Blood pressure (BP) measurements were classified as follows: optimal BP (less than 120/80 mmHg), prehypertension (120-139/80-89 mmHg) and hypertension (over 140/90 mmHg). CKD was defined by estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m2 or proteinuria. Two investigators independently extracted the data and assessed the quality of studies enrolled in this meta-analysis using the Newcastle-Ottawa Scale (NOS). We performed the meta-analysis using Stata/SE 12.0 (StataCorp LP). The random-effect models were used in the heterogeneous analyses. Results After retrieving data from 4,537 potentially relevant articles, we identified 7 cohort studies including 261,264 subjects, according to the predefined selection criteria. Five studies were conducted in Mongolians from East Asia, and the other two studies were performed in Indo-Europeans from Austria and Iran. The participants ranged in age from 20 to 89 years, and the proportion of females ranged from 27.2% to 63.8%. The follow-up period ranged from 2 to 11 years. Compared with the optimal BP values, prehypertension showed an increased risk of CKD (pooled RR = 1.28; 95% CI = 1.13–1.44; P = 0.000; I2 = 77.9%). In the sex-stratified analysis, we found a similar trend in women (pooled RR = 1.29; 95% CI = 1.01–1.63; P = 0.039; I2 = 76.1%) but not in men. This effect was observed only in Mongolians from East Asia (pooled RR = 1.37; 95% CI = 1.18–1.59; P = 0.000; I2 = 81.3%) and not in Indo-Europeans. Conclusions Prehypertension is considered a potential cause of CKD. Gender and ethnic differences are exhibited in this association.
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Affiliation(s)
- Yang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peng Xia
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lubin Xu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Biological Information and Statistics Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail:
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29
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Bouchi R, Ohara N, Asakawa M, Nakano Y, Takeuchi T, Murakami M, Sasahara Y, Numasawa M, Minami I, Izumiyama H, Hashimoto K, Yoshimoto T, Ogawa Y. Is visceral adiposity a modifier for the impact of blood pressure on arterial stiffness and albuminuria in patients with type 2 diabetes? Cardiovasc Diabetol 2016; 15:10. [PMID: 26790628 PMCID: PMC4721003 DOI: 10.1186/s12933-016-0335-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/13/2016] [Indexed: 01/24/2023] Open
Abstract
Background We aimed to investigate whether visceral adiposity could modify the impact of blood pressure on arterial stiffness and albuminuria in patients with type 2 diabetes. Methods This cross-sectional study examines the interaction of visceral adiposity with increased blood pressure on arterial stiffness and albuminuria. 638 patients with type 2 diabetes (mean age 64 ± 12 years; 40 % female) were enrolled. Visceral fat area (VFA, cm2) was assessed by a dual-impedance analyzer, whereby patients were divided into those with VFA < 100 (N = 341) and those with VFA ≥ 100 (N = 297). Albuminuria was measured in a single 24-h urine collection (UAE, mg/day) and brachial-ankle pulse wave velocity (ba-PWV, cm/s) was used for the assessment of arterial stiffening. Linear regression analyses were used to investigate the association of systolic blood pressure (SBP) and VFA with UAE and baPWV. Results Patients with VFA ≥ 100 were significantly younger, had higher SBP, HbA1c, triglycerides, UAE, alanine aminotransferase, C-reactive protein and lower high-density lipoprotein and shorter duration of diabetes than those with VFA < 100. SBP was significantly and almost equivalently associated with ba-PWV both in VFA < 100 (standardized β 0.224, p = 0.001) and VFA ≥ 100 (standardized β 0.196, p = 0.004) patients in the multivariate regression analysis adjusting for covariates including age, gender, HbA1c, diabetic complications and the use of insulin and anti-hypertensive agents. By contrast, the association of SBP with UAE was stronger in patients with VFA ≥ 100 (standardized β 0.263, p = 0.001) than that in patients with VFA < 100 (standardized β 0.140, p = 0.080) in the multivariate regression model. In the whole cohort, the significant interaction between SBP and VFA on UAE (standardized β 0.172, p = 0.040) but not on ba-PWV (standardized β −0.008, p = 0.916) was observed. Conclusions The effect of increased blood pressure on arterial stiffness is almost similar in type 2 diabetic patients with both low and high visceral adiposity, while its association with albuminuria is stronger in the latter.
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Affiliation(s)
- Ryotaro Bouchi
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Norihiko Ohara
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Masahiro Asakawa
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yujiro Nakano
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Takato Takeuchi
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Masanori Murakami
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yuriko Sasahara
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Mitsuyuki Numasawa
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Isao Minami
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Hajime Izumiyama
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. .,Center for Medical Welfare and Liaison Services, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Koshi Hashimoto
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. .,Department of Preemptive Medicine and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Takanobu Yoshimoto
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yoshihiro Ogawa
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. .,CREST, Japan Agency for Medical Research and Development, Tokyo, Japan.
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30
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Fuchs FD, de Mello RB, Fuchs SC. Preventing the progression of prehypertension to hypertension: role of antihypertensives. Curr Hypertens Rep 2015; 17:505. [PMID: 25432897 PMCID: PMC4247475 DOI: 10.1007/s11906-014-0505-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent guidelines for the diagnosis and management of hypertension reversed the historical trend to recommend lower blood pressure (BP) thresholds to diagnose hypertension in high-risk individuals, such as patients with diabetes and elderly patients. The decision to raise the BP thresholds for diagnosis of hypertension in patients with diabetes was mostly based on the findings of the ACCORD trial. Nonetheless, the results of the ACCORD trial are within the predicted benefit to prevent coronary artery disease and stroke by meta-analysis of randomized controlled trials (RCT), particularly in regard to the prevention of stroke. The Eighth Joint National Committee (JNC 8) did not address prehypertension. There are many RCT done in individuals with prehypertension and concomitant cardiovascular disease showing the benefit of treatment of these patients. Trials exploring the efficacy of interventions to prevent cardiovascular disease in individuals with prehypertension free of cardiovascular disease would be hardly feasible in face of the low absolute risk of these individuals. Considering the risks of prehypertension for cardiovascular disease and the fast progression to hypertension of a large proportion of individuals with prehypertension, it is worth to consider drug treatment for individuals with prehypertension. RCT showed that the progression to hypertension can be partially halted by BP-lowering agents. These and ongoing clinical trials are herein revised. Prehypertension may be a window of opportunity to prevent hypertension and its cardiovascular consequences.
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Affiliation(s)
- Flávio Danni Fuchs
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, UFRGS, Ramiro Barcelos 2350, Sala 2060, 90035-903, Porto Alegre, Brazil,
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O'Connor CM, O'Gara PT, Ogedegbe O, Oparil S, White WB. Treatment of hypertension in patients with coronary artery disease. ACTA ACUST UNITED AC 2015; 9:453-98. [PMID: 25840695 DOI: 10.1016/j.jash.2015.03.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O’Connor CM, O’Gara PT, Ogedegbe G, Oparil S, White WB. Treatment of Hypertension in Patients With Coronary Artery Disease. Hypertension 2015; 65:1372-407. [PMID: 25828847 DOI: 10.1161/hyp.0000000000000018] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O'Connor CM, O'Gara PT, Ogedegbe G, Oparil S, White WB. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation 2015; 131:e435-70. [PMID: 25829340 PMCID: PMC8365343 DOI: 10.1161/cir.0000000000000207] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O’Connor CM, O’Gara PT, Ogedegbe O, Oparil S, White WB. Treatment of Hypertension in Patients With Coronary Artery Disease. J Am Coll Cardiol 2015; 65:1998-2038. [PMID: 25840655 DOI: 10.1016/j.jacc.2015.02.038] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Huang Y, Cai X, Liu C, Zhu D, Hua J, Hu Y, Peng J, Xu D. Prehypertension and the risk of coronary heart disease in Asian and Western populations: a meta-analysis. J Am Heart Assoc 2015; 4:jah3838. [PMID: 25699996 PMCID: PMC4345875 DOI: 10.1161/jaha.114.001519] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The results of studies on the association between prehypertension (blood pressure 120 to 139/80 to 89 mm Hg) and coronary heart disease (CHD) remain controversial. Furthermore, it is unclear whether prehypertension affects the risk of CHD in Asian and Western populations differently. This meta-analysis evaluated the risk of CHD associated with prehypertension and its different subgroups. METHODS AND RESULTS The PubMed and Embase databases were searched for prospective cohort studies with data on prehypertension and the risk of CHD. Studies were included if they reported multivariate-adjusted relative risks (RRs) with 95% CIs of CHD from prehypertension. A total of 591 664 participants from 17 prospective cohort studies were included. Prehypertension increased the risk of CHD (RR 1.43, 95% CI 1.26 to 1.63, P<0.001) compared with optimal blood pressure (<120/80 mm Hg). The risk of CHD was higher in Western than in Asian participants (Western: RR 1.70, 95% CI 1.49 to 1.94; Asian: RR 1.25, 95% CI 1.12 to 1.38; ratio of RRs 1.36, 95% CI 1.15 to 1.61). The population-attributable risk indicated that 8.4% of CHD in Asian participants was attributed to prehypertension, whereas this proportion was 24.1% in Western participants. CONCLUSIONS Prehypertension, even at the low range, is associated with an increased risk of CHD. This risk is more pronounced in Western than in Asian populations. These results supported the heterogeneity of target-organ damage caused by prehypertension and hypertension among different ethnicities and underscore the importance of prevention of CHD in Western patients with prehypertension.
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Affiliation(s)
- Yuli Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.H., C.L., D.Z., J.H., J.P., D.X.)
| | - Xiaoyan Cai
- Department of Cardiology, the First People's Hospital of Shunde, Foshan, China (X.C., Y.H.)
| | - Changhua Liu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.H., C.L., D.Z., J.H., J.P., D.X.)
| | - Dingji Zhu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.H., C.L., D.Z., J.H., J.P., D.X.)
| | - Jinghai Hua
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.H., C.L., D.Z., J.H., J.P., D.X.)
| | - Yunzhao Hu
- Department of Cardiology, the First People's Hospital of Shunde, Foshan, China (X.C., Y.H.)
| | - Jian Peng
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.H., C.L., D.Z., J.H., J.P., D.X.)
| | - Dingli Xu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.H., C.L., D.Z., J.H., J.P., D.X.)
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Abstract
Prehypertension (blood pressure 120-139/80-89 mmHg) affects ~25-50% of adults worldwide, and increases the risk of incident hypertension. The relative risk of incident hypertension declines by ~20% with intensive lifestyle intervention, and by 34-66% with single antihypertensive medications. To prevent one case of incident hypertension in adults with prehypertension and a 50% 5-year risk of hypertension, 10 individuals would need to receive intensive lifestyle intervention, and four to six patients would need to be treated with antihypertensive medication. The relative risk of incident cardiovascular disease (CVD) is greater with 'stage 2' (130-139/85-89 mmHg) than 'stage 1' (120-129/80-84 mmHg) prehypertension; only stage 2 prehypertension increases cardiovascular mortality. Among individuals with prehypertension, the 10-year absolute CVD risk for middle-aged adults without diabetes mellitus or CVD is ~10%, and ~40% for middle-aged and older individuals with either or both comorbidities. Antihypertensive medications reduce the relative risk of CVD and death by ~15% in secondary-prevention studies of prehypertension. Data on primary prevention of CVD with pharmacotherapy in prehypertension are lacking. Risk-stratified, patient-centred, comparative-effectiveness research is needed in prehypertension to inform an acceptable, safe, and effective balance of lifestyle and medication interventions to prevent incident hypertension and CVD.
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Tsuruya K, Fukuma S, Wakita T, Ninomiya T, Nagata M, Yoshida H, Fujimi S, Kiyohara Y, Kitazono T, Uchida K, Shirota T, Akizawa T, Akiba T, Saito A, Fukuhara S. Dietary patterns and clinical outcomes in hemodialysis patients in Japan: a cohort study. PLoS One 2015; 10:e0116677. [PMID: 25607947 PMCID: PMC4301814 DOI: 10.1371/journal.pone.0116677] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 12/11/2014] [Indexed: 12/25/2022] Open
Abstract
Background & Objectives Little is known about actual dietary patterns and their associations with clinical outcomes in hemodialysis patients. We identified dietary patterns in hemodialysis patients in Japan and examined associations between dietary patterns and clinical outcomes. Design, setting, participants, measurements We used data from 3,080 general-population participants in the Hisayama study (year 2007), and data from 1,355 hemodialysis patients in the Japan Dialysis Outcomes and Practice Patterns Study (JDOPPS: years 2005–2007). Food intake was measured using a brief self-administered diet-history questionnaire (BDHQ). To identify food groups with the Hisayama population data, we used principal components analysis with Promax rotation. We adjusted the resulting food groups for total daily energy intake, and then we used those adjusted food-group scores to identify dietary patterns in the JDOPPS patients by cluster analysis (Ward’s method). We then used Cox regression to examine the association between dietary patterns and a composite of adverse clinical outcomes: hospitalization due to cardiovascular disease or death due to any cause. Results We identified three food groups: meat, fish, and vegetables. Using those groups we then identified three dietary patterns: well-balanced, unbalanced, and other. After adjusting for potential confounders, we found an association between an unbalanced diet and important clinical events (hazard ratio 1.90, 95% C.I. 1.19–3.04). Conclusions Hemodialysis patients whose diet was unbalanced were more likely to have adverse clinical outcomes. Thus hemodialysis patients might benefit not only from portion control, but also from a diet that is well-balanced diet with regard to the food groups identified here as meat, fish, and vegetables.
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Affiliation(s)
- Kazuhiko Tsuruya
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Tokyo, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | | | - Toshiharu Ninomiya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaharu Nagata
- Community Medicine Education Unit, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisako Yoshida
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Yutaka Kiyohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiro Uchida
- Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan
| | - Tomoko Shirota
- Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takashi Akiba
- Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan
| | - Akira Saito
- Division of Nephrology and Dialysis Center, Shonantobu General Hospital, Kanagawa, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
- * E-mail:
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Wang D, Zhou Y, Guo Y, Wang C, Wang A, Jin Z, Gao X, Wu S, Zhao X, Jonas JB. Arterial pre-hypertension and hypertension in intracranial versus extracranial cerebrovascular stenosis. Eur J Neurol 2014; 22:533-9. [PMID: 25516072 DOI: 10.1111/ene.12611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - Y. Zhou
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - Y. Guo
- Department of Epidemiology and Biostatistics; School of Population Health; University of Queensland; Brisbane QLD Australia
| | - C. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - A. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - Z. Jin
- Department of Emergency Medicine; Anzhen Hospital; Capital Medical University; Beijing Institute of Heart Lung and Blood Vessels; Beijing China
| | - X. Gao
- Channing Laboratory; Department of Medicine, Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Nutrition; Harvard University School of Public Health; Boston MA USA
| | - S. Wu
- Department of Cardiology; Kailuan Hospital; Tangshan China
| | - X. Zhao
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing China
- China National Clinical Research Center for Neurological Diseases; Beijing China
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing China
| | - J. B. Jonas
- Beijing Institute of Ophthalmology; Beijing Tongren Eye Center; Beijing China
- Key Laboratory of Ophthalmology and Visual Science; Beijing Tongren Hospital; Capital Medical University; Beijing China
- Department of Ophthalmology; Medical Faculty Mannheim of the Ruprecht- Karls-University; Heidelberg Germany
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Guo X, Zhang X, Guo L, Li Z, Zheng L, Yu S, Yang H, Zhou X, Zhang X, Sun Z, Li J, Sun Y. Association between pre-hypertension and cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Curr Hypertens Rep 2014; 15:703-16. [PMID: 24234576 DOI: 10.1007/s11906-013-0403-y] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The quantitative associations between prehypertension or its separate blood pressure (BP) ranges and the risk of main cardiovascular diseases (CVDs) have not been reliably documented. METHODS We performed a comprehensive search of PubMed (1966 to June 2012) and the Cochrane Library (1988 to June 2012) without language restrictions. Prospective studies were included if they reported multivariate-adjusted risk ratios (RRs) and corresponding 95 % confidence intervals (CIs) of desirable outcomes, including fatal or non-fatal incident stroke, coronary heart disease, myocardial infarction (MI) or total CVD events, with respect to prehypertension or its separate BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline with normal BP (<120/80 mmHg) as reference. Pooled RRs were estimated using a random-effects model or a fixed-effects model. RESULTS Twenty-nine articles met our inclusion criteria, with 1,010,858 participants. Both low-range and high-range prehypertension were associated with a greater risk of developing or dying of total CVD (low-range: RR: 1.24; 95 % CI: 1.10 to 1.39; high range: RR: 1.56; 95 % CI: 1.36 to 1.78), stroke (low-range: RR: 1.35; 95 % CI: 1.10 to 1.66; high-range: RR: 1.95; 95 % CI: 1.69 to 2.24) and myocardial infarction (MI) (low range: RR: 1.43; 95 % CI: 1.10 to 1.86; high range: RR: 1.99; 95 % CI: 1.59 to 2.50). The whole range prehypertension had a 1.44-fold (95 % CI: 1.35 to 1.53), 1.73-fold (95 % CI: 1.61 to 1.85), and 1.79-fold (95 % CI: 1.45 to 2.22) risk of total CVD, stroke, and MI, respectively. There was no evidence of publication bias. CONCLUSIONS Prehypertensive patients have a greater risk of incident stroke, MI and total CVD events. The impact was markedly different between the low and high prehypertension ranges
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An epidemiological study determining blood pressure in a Portuguese cohort: the Guimarães/Vizela study. J Hum Hypertens 2014; 29:190-7. [DOI: 10.1038/jhh.2014.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 11/08/2022]
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Chapter 1. Epidemiology of hypertension. Hypertens Res 2014. [DOI: 10.1038/hr.2014.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Huang Y, Su L, Cai X, Mai W, Wang S, Hu Y, Wu Y, Tang H, Xu D. Association of all-cause and cardiovascular mortality with prehypertension: a meta-analysis. Am Heart J 2014; 167:160-168.e1. [PMID: 24439976 DOI: 10.1016/j.ahj.2013.10.023] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies of prehypertension and mortality are controversial after adjusting for other cardiovascular risk factors. This meta-analysis sought to evaluate the association of prehypertension with all-cause and cardiovascular disease (CVD) mortality. METHODS The PubMed, EMBASE, Cochrane Library databases, and conference proceedings were searched for studies with data on prehypertension and mortality. The relative risks (RRs) of all-cause, CVD, coronary heart disease (CHD), and stroke mortality were calculated and presented with 95% CIs. Subgroup analyses were conducted according to blood pressure, age, gender, ethnicity, follow-up duration, participant number, and study characteristics. RESULTS Data from 1,129,098 participants were derived from 20 prospective cohort studies. Prehypertension significantly increased the risk of CVD, CHD, and stroke mortality (RR 1.28, 95% CI 1.16-1.40; RR 1.12, 95% CI 1.02-1.23; and RR 1.41, 95% CI 1.28-1.56, respectively), but did not increase the risk of all-cause mortality after multivariate adjustment (RR 1.03, 95% CI 0.97-1.10). The difference between CHD mortality and stroke mortality was significant (P < .001). Subgroup analyses showed that CVD mortality was significantly increased in high-range prehypertension (RR 1.28, 95% CI 1.16-1.41) but not in low-range prehypertension (RR 1.08, 95% CI 0.98-1.18). CONCLUSION Prehypertension is associated with CVD mortality, especially with stroke mortality, but not with all-cause mortality. The risk for CVD mortality is largely driven by high-range prehypertension.
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Wang S, Wu H, Zhang Q, Xu J, Fan Y. Impact of baseline prehypertension on cardiovascular events and all-cause mortality in the general population: a meta-analysis of prospective cohort studies. Int J Cardiol 2013; 168:4857-60. [PMID: 23932039 DOI: 10.1016/j.ijcard.2013.07.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Shijun Wang
- Institute of Molecular Biology & Translational Medicine, Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, China
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Huang Y, Wang S, Cai X, Mai W, Hu Y, Tang H, Xu D. Prehypertension and incidence of cardiovascular disease: a meta-analysis. BMC Med 2013; 11:177. [PMID: 23915102 PMCID: PMC3750349 DOI: 10.1186/1741-7015-11-177] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/27/2013] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Prospective cohort studies of prehypertension and the incidence of cardiovascular disease (CVD) are controversial after adjusting for other cardiovascular risk factors. This meta-analysis evaluated the association between prehypertension and CVD morbidity. METHODS Databases (PubMed, EMBASE and the Cochrane Library) and conference proceedings were searched for prospective cohort studies with data on prehypertension and cardiovascular morbidity. Two independent reviewers assessed the reports and extracted data. The relative risks (RRs) of CVD, coronary heart disease (CHD) and stroke morbidity were calculated and reported with 95% confidence intervals (95% CIs). Subgroup analyses were conducted on blood pressure, age, gender, ethnicity, follow-up duration, number of participants and study quality. RESULTS Pooled data included the results from 468,561 participants from 18 prospective cohort studies. Prehypertension elevated the risks of CVD (RR = 1.55; 95% CI = 1.41 to 1.71); CHD (RR = 1.50; 95% CI = 1.30 to 1.74); and stroke (RR = 1.71; 95% CI = 1.55 to 1.89). In the subgroup analyses, even for low-range prehypertension, the risk of CVD was significantly higher than for optimal BP (RR = 1.46, 95% CI = 1.32 to 1.62), and further increased with high-range prehypertension (RR = 1.80, 95% CI = 1.41 to 2.31). The relative risk was significantly higher in the high-range prehypertensive populations than in the low-range populations (χ2= 5.69, P = 0.02). There were no significant differences among the other subgroup analyses (P>0.05). CONCLUSIONS Prehypertension, even in the low range, elevates the risk of CVD after adjusting for multiple cardiovascular risk factors.
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Affiliation(s)
- Yuli Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China
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Hata J, Ninomiya T, Hirakawa Y, Nagata M, Mukai N, Gotoh S, Fukuhara M, Ikeda F, Shikata K, Yoshida D, Yonemoto K, Kamouchi M, Kitazono T, Kiyohara Y. Secular trends in cardiovascular disease and its risk factors in Japanese: half-century data from the Hisayama Study (1961-2009). Circulation 2013; 128:1198-205. [PMID: 23902756 DOI: 10.1161/circulationaha.113.002424] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Changes in lifestyle and advances in medical technology during the past half century are likely to have affected the incidence and mortality of cardiovascular disease and the prevalence of its risk factors in Japan. METHODS AND RESULTS We established 5 cohorts consisting of residents aged ≥40 years in a Japanese community, in 1961 (n=1618), 1974 (n=2038), 1983 (n=2459), 1993 (n=1983), and 2002 (n=3108), and followed up each cohort for 7 years. The age-adjusted incidence of stroke decreased greatly, by 51% in men and by 43% in women, from the 1960s to the 1970s, but this decreasing trend slowed from the 1970s to the 2000s. Among the stroke subtypes, ischemic stroke in both sexes and intracerebral hemorrhage in men showed a similar pattern. Stroke mortality decreased as a result of the decline in incidence and a significant improvement in survival rate. Although the incidence of acute myocardial infarction did not change in either sex, disease mortality declined slightly in women. From the 1960s to the 2000s, blood pressure control among hypertensive individuals improved significantly and the smoking rate decreased, but the prevalence of glucose intolerance, hypercholesterolemia, and obesity increased steeply. CONCLUSIONS Our findings suggest that in Japanese, the decreasing trends in the incidence of ischemic stroke have recently slowed down, and there has been no clear change in the incidence of acute myocardial infarction, probably because the benefits of hypertension control and smoking cessation have been negated by increasing metabolic risk factors.
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Affiliation(s)
- Jun Hata
- Department of Environmental Medicine (J.H., T.N., Y.H., M.N., N.M., S.G., M.F., F.I., K.S., D.Y., Y.K.) and Department of Medicine and Clinical Science (J.H., T.N., Y.H., M.N., N.M., S.G., M.F., F.I., K.S., M.K., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Biostatistics Center, Kurume University, Kurume, Japan (K.Y.)
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Aortic, but not brachial blood pressure category enhances the ability to identify target organ changes in normotensives. J Hypertens 2013; 31:1124-30. [DOI: 10.1097/hjh.0b013e328360802a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fukuhara M, Arima H, Ninomiya T, Hata J, Hirakawa Y, Doi Y, Yonemoto K, Mukai N, Nagata M, Ikeda F, Matsumura K, Kitazono T, Kiyohara Y. White-coat and masked hypertension are associated with carotid atherosclerosis in a general population: the Hisayama study. Stroke 2013; 44:1512-7. [PMID: 23640825 DOI: 10.1161/strokeaha.111.000704] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE On the basis of combined measurements of clinic blood pressure (CBP) and home blood pressure (HBP), blood pressure status can be divided into normotension, white-coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT). Despite the clear impact of MHT and SHT on clinical and subclinical arterial disease, uncertainty about the influence of WCHT remains. The objective of this study was to investigate the associations of WCHT, MHT, and SHT with carotid atherosclerosis in a general population. METHODS This is a cross-sectional survey of 2915 community-dwelling Japanese aged ≥ 40 years. Normotension was defined as CBP<140/90 and HBP<135/85 mm Hg; WCHT, CBP ≥ 140/90 and HBP<135/85 mm Hg; MHT, CBP<140/90 and HBP ≥ 135/85 mm Hg; and SHT, CBP ≥ 140/90 and HBP ≥ 135/85 mm Hg. Mean intima-media thickness of carotid arteries was measured using a computer-automated system, and carotid stenosis was defined as diameter stenosis ≥ 30%. RESULTS There were 1374 subjects (47.1%) with normotension, 200 (6.9%) with WCHT, 639 (21.9%) with MHT, and 702 (24.1%) with SHT. The geometric average of mean intima-media thickness was significantly higher among subjects with WCHT (0.73 mm), MHT (0.77 mm), and SHT (0.77 mm) than those with normotension (0.67 mm; all P<0.001 versus normotension). Compared with normotension, all types of hypertension were also associated with increased likelihood of carotid stenosis (age- and sex-adjusted odds ratio, 2.36 [95% confidence interval, 1.27-4.37] for WCHT, 1.95 [1.25-3.03] for MHT, and 3.02 [2.01-4.54] for SHT). These associations remained significant even after adjustment for other cardiovascular risk factors. CONCLUSIONS WCHT, as well as MHT, and SHT were associated with carotid atherosclerosis in a general Japanese population.
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Affiliation(s)
- Masayo Fukuhara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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48
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Kuroda J, Kitazono T. [Atherosclerosis: progress in diagnosis and treatments. Topics: II. Atherosclerosis -promoting factors; pathogenesis and pathophysiology; 1. Risk factors for cerebrovascular disease and carotid atherosclerosis]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2013; 102:289-296. [PMID: 23767308 DOI: 10.2169/naika.102.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Junya Kuroda
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
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49
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Affiliation(s)
- Yutaka Kiyohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University
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50
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Kitazono T. [Progress in diagnosis and treatment. Topics: I. Hypertension, heart diseases and neurologic disorders]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2012; 101:2163-2170. [PMID: 22973686 DOI: 10.2169/naika.101.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University, Japan
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