Comparison of the Effect of Blood Pressure on the Development of Stroke, Acute Myocardial Infarction, and End-Stage Renal Disease.

Iseki, Kunitoshi; Kimura, Yorio; Wakugami, Kiyoshi; Okumura, Koichiro; Muratani, Hiromi; Ikemiya, Yoshiharu; Fukiyama, Koshiro

doi:10.1291/hypres.23.143

Cited by 35 publications

(22 citation statements)

References 35 publications

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“…There are substantial regional differences in the incidence and prevalence of ESRD between Japan and the United States; therefore, our results may not be applicable in other regions and countries. Mortality rates from stroke and AMI have decreased tremendously over the past 30 yr (24). Life expectancy at birth in Japan is longer than that in any other country.…”

Section: Discussionmentioning

confidence: 99%

The Okinawa Screening Program

Iseki¹

2003

Journal of the American Society of Nephrology

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Abstract. Predictors of ESRD were identified using independent registries of both ESRD patients and the general population in Okinawa, Japan. Besides male gender, we found that the significant predictors of ESRD to be proteinuria, hematuria, and hypertension, especially diastolic BP. Among the laboratory findings, a high serum creatinine level was shown to be a strong predictor of ESRD. The effects of age, obesity, and hypercholesterolemia were insignificant, but this needs to be confirmed in a larger cohort and other registries.The number of ESRD patients requiring chronic dialysis is increasing worldwide. In Japan, a high incidence and prevalence of ESRD has been reported in Okinawa, the island prefecture in the southernmost part of the country (1,2). Since 1971, all chronic dialysis patients treated in Okinawa from the start of therapy have been entered into a registry, and the ESRD trends over the past 30 yr have recently been published (1). For geographic and cultural reasons, ESRD patients in Okinawa tend not to move away (3,4). Therefore, Okinawa provides a good population in which to study the outcomes of ESRD and cardiovascular disease (3,4). Understanding the process of disease progression is necessary in determining strategies for the prevention of ESRD.We are fortunate to have access to independent registries for ESRD patients (5), the general population (6,7), and all hospital-based records of stroke and acute myocardial infarction (AMI) (3) in Okinawa. In this paper, we have identified predictors for ESRD using these registries. Materials and Methods Study DesignData from three independent registries covering the entire area of Okinawa were accessed: the ESRD program (5), the screening program of the Okinawa General Health Maintenance Association (OGHMA) (6 -11), and the hospital-based registry of stroke and AMI (3). The start date of chronic dialysis was used as the date of onset of ESRD in individual patients. The 1983 screening participants and the individuals who had become dialysis patients from April 1983 to March 1994 were identified by using the dialysis registry, which covers the entire geographic area. The identities of these dialysis patients were verified by reviewing their medical charts in the dialysis units. ESRD Patient RegistryAll chronic dialysis patients who survive at least 1 mo on scheduled dialysis are included in the Okinawa Dialysis Study (OKIDS) registry.Patients dying within 1 mo from the start of dialysis are not included in the registry because it cannot be determined whether renal function in these patients has been improving or deteriorating or whether other medical conditions accounted for their rapid demise. Pertinent clinical data were obtained for all new dialysis patients, and important medical events recorded in the files of chronic dialysis patients were noted. Data were obtained under collaboration with physicians in all dialysis units. In 1990, there were 27 dialysis units in Okinawa; by the end of 2000, there were 46: nine in the public sector, 17 in private ...

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Section: Discussionmentioning

confidence: 99%

The Okinawa Screening Program

Iseki¹

2003

Journal of the American Society of Nephrology

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“…We postulated that the lack or weakness of association between smoking and risks of stroke in most previous Japanese studies, in contrast to Caucasian studies, is due in part to the different proportions of ischemic stroke subtypes (lacunar infarction and large-artery occlusive infarction) between Japanese and Caucasians, a low statistical power to detect significant associations, and a lower concern for hypertension, a strong cardiovascular risk factor (13). We hypothesized that smoking raises the risk of total stroke, ischemic stroke, and coronary heart disease among middle-aged Japanese men, and that these trends are more evident among hypertensive men.…”

Section: Introductionmentioning

confidence: 98%

Smoking Raises the Risk of Total and Ischemic Strokes in Hypertensive Men.

et al. 2003

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To examine the relation between cigarette smoking and risk of stroke and coronary heart disease among Japanese, we conducted a 14-year prospective study of 3,626 men aged 40-69, initially free from history of stroke and coronary heart disease. We identified 257 strokes (75 hemorrhagic and 173 ischemic strokes) and 100 coronary heart disease events. When we adjusted for age and other cardiovascular risk factors, a significant excess risk among current smokers of 20 cigarettes/day vs. never-smokers was found for total stroke (relative risk (RR) 1.6 (95% confidence interval (CI), 1.1-2.4)). The excess risk of total stroke was particularly evident among hypertensives (RR 2.3 (1.2-4.4)). The multivariate RR of ischemic stroke was 1.6 (1.0-2.5) for total subjects, and 2.2 (1.0-5.0) among hypertensives. Significant excess risks among current smokers of 20 cigarettes/day vs. never-smokers were also found for coronary heart disease (RR 4.6 (1.6-12.9)) and total cardiovascular disease ( 1.9 (1.3-2.7)). The estimated proportion of the events attributable to current smoking was 30 (95% CI, 11-44)% for total stroke and 34 (5-54)% for coronary heart disease.In conclusion, current smoking of 20 cigarettes per day increased the risk of both total stroke and ischemic stroke among Japanese middle-aged men, and particularly among middle-aged hypertensive men.

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“…Levy et al [18] observed that risk for HF in hypertensive when compared to normotensive, was twice as high in men and three times higher in women [10,12]. Framingham Heart Study also reported that diabetic women, even at ages 35 to 64, were twice as likely to develop HF as diabetic men of the same age.…”

Section: Risk Factors and Aetiologymentioning

confidence: 99%

Heart Failure in Women

Kadiyala

2017

Ind J Car Dis Wom

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Comparison of the Effect of Blood Pressure on the Development of Stroke, Acute Myocardial Infarction, and End-Stage Renal Disease.

Cited by 35 publications

References 35 publications

The Okinawa Screening Program

The Okinawa Screening Program

Smoking Raises the Risk of Total and Ischemic Strokes in Hypertensive Men.

Heart Failure in Women

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