Lower and higher BP after brain infarction and higher BP after brain hemorrhage were predictors for poor early prognosis. In subjects with brain infarction, patients with previous hypertension had better outcomes at higher admission BP level than did normotensive patients.

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Coronary heart disease (CHD) is rare in Japanese subjects and serum cholesterol levels are low. However, no data have been published relating the effect of serum cholesterol levels to the incidence of acute myocardial infarction (AMI) in Japan. Data from a large community-based mass screening registry are available for the geographically isolated island of Okinawa, Japan (1980 census, 1.11 million). A total of 38,053 participants (17,859 men and 20,194 women) whose serum cholesterol levels were determined in the 1983 mass screening were examined to determine whether they had experienced AMI. Every case of AMI that occurred during a 3-year period (1 April 1988 to March 1991) throughout Okinawa was recorded in a separate registry. The total number of cases of AMI was 1,021 (674 men and 347 women). Of these, 65 patients (41 men and 24 women) were identified by name, sex, birth date, and zip code in the mass screening registry. The cumulative incidence of AMI increased with the serum level of cholesterol: 42.1 (serum cholesterol < or = 167 mg/dl), 133.5 (serum cholesterol 168-191 mg/dl), 188.9 (serum cholesterol 192-217 mg/dl), and 323.0 (serum cholesterol > or = 218 mg/dl) per 100,000 screened subjects. Multiple logistic analysis was conducted to examine the effect of serum cholesterol on the risk of AMI with adjustment for other variables such as sex, age, systolic and diastolic blood pressure, and proteinuria. The adjusted odds ratio (95% confidence interval) of the observed serum levels of cholesterol was 1.66 (1.29-2.15) with a reference serum cholesterol level of < or = 167 mg/dl. The risk of AMI increased in proportion to the serum level of cholesterol. Serum cholesterol is an independent predictor of AMI in Okinawa, Japan.

Hypertension is a known risk factor for cardiovascular disease, but few epidemiological studies have examined simultaneously the effect of baseline blood pressure on the development of stroke, acute myocardial infarction (AMI), and end-stage renal disease (ESRD). In 1983, a large, community-based mass screening covered about 14% of the adult population in Okinawa, Japan. The total number of people screened was 107,192 (51,122 men, 56,070 women). We had access to two independent registries of end-organ damage: the Co-operative Study Group of Morbidity and Mortality of Cardiovascular Diseases in Okinawa (COSMO) registry for stroke and AMI, and the Okinawa Dialysis Study (OKIDS) registry for ESRD. The total number of people registered was 4,756 with stroke, 1,059 with AMI, and 641 with ESRD during the study period from April 1, 1988, to March 31, 1991. By using the name, sex, birth date, and ZIP code of registrants, we identified those registrants who were screened in 1983 and had developed stroke, AMI, or ESRD. Hypertension was defined as systolic blood pressure (SBP) of 140 mmHg or higher or diastolic blood pressure (DBP) of 90 mmHg or higher. Other readings were regarded as normotensive. The prevalence of hypertension was 35.8% (N= 37,299). The cumulative incidence of stroke, AMI, and ESRD was 154, 21, and 19 subjects among those with SBP 119 mmHg, and 1933, 315, and 71 subjects among those with SBP >_ 160 mmHg. Similarly, the incidence of stroke, AMI, and ESRD was 234, 44, and 25 subjects among those with DBP 69 mmHg and 1980, 381, and 364 subjects among those with DBP? 110 mmHg.Hypertension was prevalent in the adult population in Okinawa, Japan, and was a significant predictor of stroke, AMI, and ESRD. However, the effect of blood pressure on target organs differed and was more evident in those with stroke than in those with AMI and ESRD. (Hypertens Res 2000; 23:143-149) Key Words: hypertension, mass screening, stroke, acute myocardial infarction, end-stage renal disease IntroductionThe Japanese are living longer than ever before (1), especially people in Okinawa, and the death rate from stroke has dropped dramatically in the past 30 years (2). This decline is partly explained by the national policy of decreasing salt intake and increasing public health education. The average salt intake remains around 12 g per d.Because of the rapidly increasing number of aging people, concerns about high blood pressure are increasing. The incidence of cardiovascular diseases differs among ethnic groups (3), however, so clinical guidelines should be based on epidemiological evidence from a given community (4). Only a few studies have examined the determinants of hypertension in a large, community-based popu- Vol. 23, No. 2 (2000) lation. Moreover, few epidemiological studies have examined simultaneously the effect of baseline blood pressure on the development of stroke, myocardial infarction (AMI), and end-stage renal disease (ESRD). Our study documented the prevalence of hypertension and analyzed the risk factors for...

We performed a cross-sectional survey of the incidence of stroke and acute myocardial infarction (AMI) in Okinawa, Japan, with a census population of about 1.2 million. A total of 3,644 cases of first-ever stroke and 898 cases of initial AMI were detected. The age-adjusted annual incidence rate of stroke was 105 per 100,000 of the standard population of Japan based on census population taken in 1985, and that of AMI was 26 per 100,000. The case-fatality rate of stroke within 28 days of onset was 12.8%, and that of AMI was 22.2%. Of the stroke cases, 51.4% were diagnosed as brain infarctions, 38.7% as brain hemorrhages, and 9.3% as subarachnoid hemorrhages.The diagnoses of stroke subtypes were confirmed by computed tomography or magnetic resonance imaging in 98.4% of all stroke cases. The long-term prognosis of patients with stroke and AMI was studied by examining their 10-yr survival rates (follow-up rate 89.8%). The cumulative survival rate was 38.2% in brain infarction cases, 40.4% in brain hemorrhage cases, and 38.2% in AMI cases. The 50% reduction of survival had occurred at 2,880 days after onset in brain infarction cases, at 2,764 days in brain hemorrhage cases, and at 2,658 days in AMI cases. In Okinawa, the incidence rate of AMI was still considerably lower than that in the Western population, and the rate of stroke was similar to that in the Western population. The ten-year survival rates were quite similar in AMI and stroke, and both were unexpectedly high. (Hypertens Res 2000; 23:127-135)