Hozawa  Atsushi

Imai  Yutaka

Ohkubo  Takayoshi

Circulation

English

Ohkubo, Takayoshi

Hozawa, Atsushi

Imai, Yutaka

Tohoku University Repository (TOUR) / 東北大学機関リポジトリ

Prognostic Impact of 24-Hour Mean BloodPressure and Pulse Pressure on Stroke著者 Ohkubo  Takayoshi, Hozawa  Atsushi, Imai Yutakajournal orpublication titleCirculationvolume 104page range 160-161year 2001URL http://hdl.handle.net/10097/51535Takayoshi Ohkubo, Atsushi Hozawa and Yutaka ImaiStrokePrognostic Impact of 24-Hour Mean Blood Pressure and Pulse Pressure onISSN: 1524-4539 Copyright © 2001 American Heart Association. All rights reserved. Print ISSN: 0009-7322. OnlineCirculation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX 725142001, 104:e160Circulation http://circ.ahajournals.org/content/104/25/e160located on the World Wide Web at: The online version of this article, along with updated information and services, ishttp://www.lww.com/reprintsReprints: Information about reprints can be found online at   journalpermissions@lww.com410-528-8550. E-mail: Kluwer Health, 351 West Camden Street, Baltimore, MD 21202-2436. Phone: 410-528-4050. Fax: Permissions: Permissions & Rights Desk, Lippincott Williams & Wilkins, a division of Wolters  http://circ.ahajournals.org//subscriptions/Subscriptions: Information about subscribing to Circulation is online at  at TOHOKU UNIVERSITY on September 12, 2011http://circ.ahajournals.org/Downloaded from Prognostic Impact of 24-Hour Mean BloodPressure and Pulse Pressure on StrokeTo the Editor:Using 4.7 years of follow-up data on 2311 Western, hyperten-sive subjects, Verdecchia and colleagues1 reported that 24-hourambulatory mean blood pressure (BP), not pulse pressure (PP),was an independent predictor of stroke risk. Because the associ-ation between BP and stroke risk has been reported to be muchsteeper in Eastern populations than in Western populations,2 theprognostic impact of 24-hour mean BP and PP on stroke could bedifferent between these populations. Therefore, we investigatedthe association between 24-hour mean BP and PP and strokeusing data from a general Japanese population.The design and procedures of this study (the Ohasama study)have been reported previously.3,4 We followed 1464 subjectswithout a history of stroke who underwent 24-hour ambulatoryBP monitoring (mean age, 61 years; 40% were women). Therewere 74 first strokes during a mean of 6.4 years of follow-up.After adjustment for age, sex, and other classic risk factors in aCox regression model, the risk of stroke increased by 80% (95%confidence interval [CI], 43% to 126%) for every 10 mm Hgincrease in 24-hour mean BP, whereas 24-hour PP was notassociated with the risk of stroke after controlling for 24-hourmean BP. This association between 24-hour mean BP and strokewas much steeper in participants with hypertension (24-hour BP134/79 mm Hg4; 105% increase in risk for every 10 mm Hgincrease; 95% CI, 31% to 222%), indicating a one-third greaterincrease in stroke risk than in the Western hypertensive popula-tion studied by Verdecchia and colleagues1 (42%; P for homo-geneity 0.001). These results suggest that ambulatory meanBP, rather than PP, is the major independent predictor of strokein both Western and Eastern populations, although the impact of24-hour mean BP on stroke is stronger in Eastern than in Westernpopulations.Takayoshi Ohkubo, MD, PhDAtsushi Hozawa, MDDepartment of Public HealthTohoku University Graduate School of MedicineSendai, JapanYutaka Imai, MD, PhDDepartment of Clinical Pharmacology and TherapeuticsTohoku University Graduate School of Medicine andPharmaceutical ScienceSendai, Japan1. Verdecchia P, Schillaci G, Reboldi G, et al. Different prognostic impactof 24-hour mean blood pressure and pulse pressure on stroke and coro-nary artery disease in essential hypertension. Circulation. 2001;103:2579–2584.2. Eastern Stroke and Coronary Heart Disease Collaborative ResearchGroup. Blood pressure, cholesterol and stroke in eastern Asia. Lancet.1998;352:1801–1807.3. Ohkubo T, Hozawa A, Nagai K, et al. Prediction of stroke by ambulatoryblood pressure monitoring versus screening blood pressure measurementsin a general population: the Ohasama study. J Hypertens. 2000;18:847–854.4. Ohkubo T, Imai Y, Tsuji I, et al. Reference values for 24-hour ambulatoryblood pressure monitoring based on a prognostic criterion: the OhasamaStudy. Hypertension. 1998;32:255–259.ResponseThe findings by Ohkubo and coworkers indicate that thesteady component of blood pressure (ie, mean blood pressure) issuperior to its pulsatile component (ie, pulse pressure) forpredicting cerebrovascular events in a general Japanese popula-tion at elevated average risk of stroke. The relationship of meanblood pressure to stroke was steeper in their Japanese populationthan in our Italian population.1 Overall, these data stronglyreinforce the concept that the mean levels of blood pressure, notthe fluctuations around the mean, are the main determinants ofmajor cerebrovascular complications, regardless of the ethnicityof the population. However, the progressive fall in diastolicblood pressure with age leads to a progressive underestimation ofperipheral vascular resistance by the mean blood pressure equa-tion.2 Thus, mean blood pressure and pulse pressure tend tobecome equally strong predictors of cerebrovascular events inpopulations with isolated systolic hypertension.3 It would beimportant to test this hypothesis in Japanese populations.Paolo Verdecchia, MDCardiologia e Fisiopatologia CardiovascolareUniversity of PerugiaPerugia, Italyverdec@tin.itGiuseppe Schillaci, MD,Medicina InternaAngiologia e Malattie da ArteriosclerosiUniversity of PerugiaPerugia, ItalyGianpaolo Reboldi, MD, MSc, PhDDipartimento di Medicina InternaUniversity of PerugiaPerugia, ItalyStanley S. Franklin, MDThe Preventive Cardiology ProgramUniversity of CaliforniaIrvine, Calif.Carlo Porcellati, MDOspedale R. SilvestriniDipartimento di Malattie CardiovascolariPerugia, Italy1. Verdecchia P, Schillaci G, Reboldi G, et al. Different prognostic impactof 24-hour mean blood pressure and pulse pressure on stroke and coro-nary artery disease in essential hypertension. Circulation. 2001;103:2579–2584.2. Franklin SS. Ageing and hypertension: the assessment of blood pressureindices in predicting coronary heart disease. J Hypertens. 1999;17(suppl5):S29–S36.3. Blacher J, Staessen JA, Girerd X, et al. Pulse pressure not mean pressuredetermines cardiovascular risk in older hypertensive patients. Arch InternMed. 2000;160:1085–1089.1 at TOHOKU UNIVERSITY on September 12, 2011http://circ.ahajournals.org/Downloaded from 

Prognostic Impact of 24-Hour Mean Blood Pressure and Pulse Pressure on Stroke

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Prognostic Impact of 24-Hour Mean Blood Pressure and Pulse Pressure on Stroke

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