Cardiovascular Risk With and Without Antihypertensive Drug Treatment in the Japanese General Population

Asayama, Kei; Satoh, Michihiro; Murakami, Yoshitaka; Ohkubo, Takayoshi; Nagasawa, Shin‐ya; Tsuji, Ichiro; Nakayama, Takeo; Okayama, Akira; Miura, Katsuyuki; Imai, Yutaka; Ueshima, Hirotsugu; Okamura, Tomonori; Irie, Fujiko; Iso, Hiroyasu; Kiyohara, Yutaka; Nakagawa, Hideaki; Sairenchi, Toshimi; Saitoh, Shigeyuki; Sakata, Kiyomi; Tamakoshi, Akiko; Yamada, Michiko; Kitamura, Akihiko; Miyamoto, Yoshihiro

doi:10.1161/hypertensionaha.113.03206

Cited by 59 publications

(34 citation statements)

References 47 publications

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“…Furthermore, we estimated the absolute disease risks for incident CVD associated with different levels of BP in the community and demonstrated that treated hypertensives had a greater risk of incident CVD compared with untreated participants with similar BP. These observations are in line with the results from population‐based analyses from Japan and Sweden reporting greater risks of cardiovascular mortality and stroke in treated versus untreated persons 9, 10, 11. Finally, we report that the increased hazard for CVD is attenuated by ≈3% to 20% on adjustment for the greater subclinical disease burden in treated hypertensives, consistent with the concept that part of the increased CVD risk is related to the greater subclinical disease burden.…”

Section: Discussionsupporting

confidence: 90%

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Lieb

Enserro

Sullivan

et al. 2015

JAHA

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BackgroundHypertensive individuals on blood pressure (BP)–lowering treatment with BP in the normal or high‐normal range have higher cardiovascular risk than untreated persons with usual BP in the same range. This residual risk (relative and absolute) is not well quantified and may be attributable in part to the higher burden of subclinical disease in treated individuals.Methods and ResultsWe assigned 3024 Framingham Offspring Cohort participants to 5 categories based on systolic BP (SBP) and diastolic BP (DBP) and use of BP‐lowering treatment: (1) untreated SBP/DBP <120/80 mm Hg; (2) untreated SBP/DB ≥120/80 to <140/90 mm Hg; (3) treated SBP/DBP <140/90 mm Hg; (4) untreated SBP/DBP ≥140/90 mm Hg; and (5) treated SBP/DBP ≥140/90 mm Hg. A composite subclinical disease score was constructed, including information on left ventricular hypertrophy, systolic dysfunction, carotid ultrasound abnormality, peripheral artery disease, and microalbuminuria. The prevalence of subclinical disease rose across BP groups, as did the event rates for incident cardiovascular disease (449 events, median follow‐up of 11 years; group 1, 0.65 event per 100 person‐years; group 5, 3.20 events per 100 person‐years; P<0.0001 for trend). On multivariable adjustment, treated hypertensives in groups 3 and 5 had 50% (95% CI 13% to 99%) and 28% (95% CI −6% to 73%) higher hazards, respectively, of developing cardiovascular disease compared with their untreated counterparts with similar levels of BP (groups 1 and 2 and group 4, respectively). The increased risk of cardiovascular disease in treated hypertensives was attributable in part to greater subclinical disease burden.ConclusionsTreated hypertensives have higher subclinical cardiovascular disease burden, which partly explains their higher cardiovascular disease risk compared with untreated persons with similar BP levels.

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Section: Discussionsupporting

confidence: 90%

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Lieb

Enserro

Sullivan

et al. 2015

JAHA

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“…Other studies have used similar designs in a variety of populations, including normotensive subjects, to assess cardiovascular risk related to BP over a wide BP range. [22][23][24] Each study has unique features pertaining to special aspects of their population and BP data.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

et al. 2016

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T wo aspects of hypertension that have received considerable attention in recent years are the threshold blood pressure (BP) for diagnosing hypertension and the optimum BP target after drug therapy has been initiated. In each instance, greater emphasis is now given to systolic BP, primarily because it has been shown in numerous studies to be the best predictor of cardiovascular risk. Thresholds for the initiation of therapy based on increases in future cardiovascular events in relation to BP have been determined 1-3 for 24-hour ambulatory BP monitoring, home BP, and electronic, automated office BP (AOBP). As for conventional manual office BP, treatment thresholds were mainly derived from placebo-controlled clinical trials. For example, in the SHEP trial (Systolic Hypertension in the Elderly Program), 4 hypertension was defined as a systolic BP of 160 mm Hg or higher, and the target BP was a decrease of at least 20 mm Hg to <150 mm Hg. This study provided evidence to support treating isolated systolic hypertension of 160 mm Hg or higher in the elderly. Clinical outcome data that would justify treating uncomplicated, mild diastolic hypertension (90-99 mm Hg) based on placebo-controlled clinical trials are lacking. Other epidemiological studies 5 have shown an increase in cardiovascular events in mixed treated and untreated populations starting at a BP ≥115/75 mm Hg. However, these findings only relate BP to the future risk of a cardiovascular event and do not address the optimum BP after drug therapy has been started. Overall, convincing evidence for initiating drug therapy for uncomplicated, mild hypertension (BP 140-159/90-99 mm Hg) based on office BP is limited.There has also not been a specific target BP for treating systolic hypertension, with some guidelines recommending a <150 mm Hg target in the elderly based on the results of the SHEP trial, whereas others have maintained the Abstract-The SPRINT (Systolic Blood Pressure Intervention Trial) reported that some older, higher risk patients might benefit from a target systolic blood pressure (BP) of <120 versus <140 mm Hg. However, it is not yet known how the BP target and measurement methods used in SPRINT relate to cardiovascular outcomes in real-world practice. SPRINT used the automated office BP technique, which requires the patient to be resting quietly and alone, with multiple readings being recorded automatically using an electronic oscillometric sphygmomanometer. We studied the relationship between achieved automated office BP at baseline and cardiovascular events in 6183 community-dwelling residents of Ontario aged ≥66 years who were receiving antihypertensive therapy and followed for a mean of 4.6 years. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in achieved automated office BP at baseline using Cox proportional hazards regression and the BP category with the lowest event rate as the reference category.

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“…The rationale, study design, and methods of the EPOCH-JAPAN study have been described elsewhere 9, 10, 11, 12, 13, 14, 15. In brief, cohort studies were eligible for inclusion in this analysis if they met the following criteria: (1) collection of health examination measures, (2) at least 10 years of follow-up, and (3) greater than 1000 participants.…”

Section: Methodsmentioning

confidence: 99%

Age-specific impact of diabetes mellitus on the risk of cardiovascular mortality: An overview from the evidence for Cardiovascular Prevention from Observational Cohorts in the Japan Research Group (EPOCH-JAPAN)

Hirakawa

Ninomiya

Kiyohara

et al. 2017

Journal of Epidemiology

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BackgroundDiabetes mellitus is a strong risk factor for cardiovascular disease. However, the age-specific association of diabetes with cardiovascular risk, especially in the elderly, remains unclear in non-Western populations.MethodsA pooled analysis was conducted using 8 cohort studies (mean follow-up period, 10.3 years) in Japan, combining the data from 38,854 individual participants without history of cardiovascular disease. In all, 1867 of the participants had diabetes, defined based on the 1998 World Health Organization criteria. The association between diabetes and the risk of death from cardiovascular disease, coronary heart disease (CHD), and stroke was estimated using a stratified Cox model, accounting for variability of baseline hazard functions among cohorts.ResultsDuring the follow-up, 1376 subjects died of cardiovascular disease (including 268 of coronary heart disease and 621 of stroke). Diabetes was associated with an increased risk of cardiovascular death after multivariable adjustment (hazard ratio [HR] 1.62; 95% confidence interval [CI], 1.35–1.94). Similarly, diabetes was a risk factor for CHD (HR 2.13; 95% CI, 1.47–3.09) and stroke (HR 1.40; 95% CI, 1.05–1.85). In the age-stratified analysis of the risk of cardiovascular death, the relative effects of diabetes were consistent across age groups (p for heterogeneity = 0.18), whereas the excess absolute risks of diabetes were greater in participants in their 70s and 80s than in younger subjects.ConclusionsThe management of diabetes is important to reduce the risk of death from cardiovascular disease, not only in midlife but also in late life, in the Japanese population.

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Cardiovascular Risk With and Without Antihypertensive Drug Treatment in the Japanese General Population

Cited by 59 publications

References 47 publications

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement

Age-specific impact of diabetes mellitus on the risk of cardiovascular mortality: An overview from the evidence for Cardiovascular Prevention from Observational Cohorts in the Japan Research Group (EPOCH-JAPAN)

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