This Article Full Text Full Text (PDF) All Versions of this Article: 45/2/240    most recent 01.HYP.0000152079.04553.2cv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kikuya, M. Articles by Imai, Y. Search for Related Content PubMed PubMed Citation Articles by Kikuya, M. Articles by Imai, Y. Related Collections Cerebrovascular disease/stroke Epidemiology

(Hypertension. 2005;45:240.)
© 2005 American Heart Association, Inc.

Scientific Contributions

Ambulatory Blood Pressure and 10-Year Risk of Cardiovascular and Noncardiovascular Mortality

The Ohasama Study

Masahiro Kikuya; Takayoshi Ohkubo; Kei Asayama; Hirohito Metoki; Taku Obara; Shin Saito; Junichiro Hashimoto; Kazuhito Totsune; Haruhisa Hoshi; Hiroshi Satoh; Yutaka Imai

From the Department of Planning for Drug Development and Clinical Evaluation (K.M., T.O., J.H.), Tohoku University 21st Century COE Program Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation (T.O., J.H., K.T., H.S., Y.I.), Clinical Pharmacology and Therapeutics (K.A., H.M., T.O., S.S., K.T., Y.I.), Environmental Health Science (H.S.), Tohoku University Graduate School of Medicine and Pharmaceutical Science, Sendai, Japan; and Ohasama Hospital (H.H.), Iwate, Japan.

Correspondence to Yutaka Imai, MD, PhD, Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Medicine and Pharmaceutical Science, 1-1 Seiryomachi, Sendai, 980-8574, Japan. E-mail Imai{at}tinet-i.ne.jp

The objective of this study was to elucidate the long-term prognostic significance of ambulatory blood pressure. Ambulatory and casual blood pressure values were obtained from 1332 subjects (872 women and 460 men) aged 40 years from the general population of a rural Japanese community. Survival was then followed for 14 370 patient years and analyzed by a Cox hazard model adjusted for possible confounding factors. There were 72 cardiovascular deaths during the 10.8-year follow-up. The relationship between 24-hour systolic blood pressure and the cardiovascular mortality risk was U-shaped in the first 5 years, then changed to J-shaped over the rest of the 10.8-year follow-up. After censoring the first 2 years of data, the risk flattened until it again increased for the fifth quintile of 24-hour systolic blood pressure for the 10.8-year follow-up period. For 24-hour diastolic blood pressure, the J-shaped relationship remained unchanged, regardless of follow-up duration and censoring. Ambulatory systolic blood pressure values consistently showed stronger predictive power for cardiovascular mortality risk than did casual systolic blood pressure in the 10.8-year follow-up data, whereas such relationships became more marked after censoring the first 2 years. When nighttime and daytime systolic blood pressure values were simultaneously included in the same Cox model, only nighttime blood pressure significantly predicted the cardiovascular mortality risk for the 10.8-year follow-up data. We conclude that the relationship between ambulatory systolic blood pressure and cardiovascular mortality is not U-shaped or J-shaped, and that nighttime blood pressure has better prognostic value than daytime blood pressure.

Key Words: blood pressure monitoring, ambulatory • cardiovascular diseases • prospective studies

This article has been cited by other articles:

				R. C. Hermida and D. E. Ayala Chronotherapy With the Angiotensin-Converting Enzyme Inhibitor Ramipril in Essential Hypertension: Improved Blood Pressure Control With Bedtime Dosing Hypertension, July 1, 2009; 54(1): 40 - 46. [Abstract] [Full Text] [PDF]

				T. O. Morgan Does It Matter When Drugs Are Taken? Hypertension, July 1, 2009; 54(1): 23 - 24. [Full Text] [PDF]

				R. Agarwal Blood Pressure Components and the Risk for End-Stage Renal Disease and Death in Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., April 1, 2009; 4(4): 830 - 837. [Abstract] [Full Text] [PDF]

				A. de la Sierra, J. Redon, J. R. Banegas, J. Segura, G. Parati, M. Gorostidi, J. J. de la Cruz, J. Sobrino, J. L. Llisterri, J. Alonso, et al. Prevalence and Factors Associated With Circadian Blood Pressure Patterns in Hypertensive Patients Hypertension, March 1, 2009; 53(3): 466 - 472. [Abstract] [Full Text] [PDF]

				J.R Fernandez, R.C Hermida, and A Mojon Chronobiological analysis techniques. Application to blood pressure Phil Trans R Soc A, January 28, 2009; 367(1887): 431 - 445. [Abstract] [Full Text] [PDF]

				D. A. Calhoun, D. Jones, S. Textor, D. C. Goff, T. P. Murphy, R. D. Toto, A. White, W. C. Cushman, W. White, D. Sica, et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research Circulation, June 24, 2008; 117(25): e510 - e526. [Abstract] [Full Text] [PDF]

				D. A. Calhoun, D. Jones, S. Textor, D. C. Goff, T. P. Murphy, R. D. Toto, A. White, W. C. Cushman, W. White, D. Sica, et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research Hypertension, June 1, 2008; 51(6): 1403 - 1419. [Abstract] [Full Text] [PDF]

				M. L. Jehn, D. J. Brotman, and L. J. Appel Racial Differences in Diurnal Blood Pressure and Heart Rate Patterns: Results From the Dietary Approaches to Stop Hypertension (DASH) Trial Arch Intern Med, May 12, 2008; 168(9): 996 - 1002. [Abstract] [Full Text] [PDF]

				M. L. Burr, E. Dolan, E. W. O'Brien, E. T. O'Brien, and P. McCormack The value of ambulatory blood pressure in older adults: the Dublin outcome study Age Ageing, March 1, 2008; 37(2): 201 - 206. [Abstract] [Full Text] [PDF]

				R. C. Hermida, D. E. Ayala, J. R. Fernandez, and C. Calvo Chronotherapy Improves Blood Pressure Control and Reverts the Nondipper Pattern in Patients With Resistant Hypertension Hypertension, January 1, 2008; 51(1): 69 - 76. [Abstract] [Full Text] [PDF]

				R. H. Fagard, H. Celis, L. Thijs, J. A. Staessen, D. L. Clement, M. L. De Buyzere, and D. A. De Bacquer Daytime and Nighttime Blood Pressure as Predictors of Death and Cause-Specific Cardiovascular Events in Hypertension Hypertension, January 1, 2008; 51(1): 55 - 61. [Abstract] [Full Text] [PDF]

				J. Redon and E. Lurbe Nocturnal Blood Pressure Versus Nondipping Pattern: What Do They Mean? Hypertension, January 1, 2008; 51(1): 41 - 42. [Full Text] [PDF]

				R. C. Hermida, D. E. Ayala, J. R. Fernandez, and C. Calvo Comparison of the Efficacy of Morning Versus Evening Administration of Telmisartan in Essential Hypertension Hypertension, October 1, 2007; 50(4): 715 - 722. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]

				M. Kikuya, J. A. Staessen, T. Ohkubo, L. Thijs, H. Metoki, K. Asayama, T. Obara, R. Inoue, Y. Li, E. Dolan, et al. Ambulatory Arterial Stiffness Index and 24-Hour Ambulatory Pulse Pressure as Predictors of Mortality in Ohasama, Japan Stroke, April 1, 2007; 38(4): 1161 - 1166. [Abstract] [Full Text] [PDF]

				P. Verdecchia, F. Angeli, C. Borgioni, R. Gattobigio, and G. Reboldi Ambulatory Blood Pressure and Cardiovascular Outcome in Relation to Perceived Sleep Deprivation Hypertension, April 1, 2007; 49(4): 777 - 783. [Abstract] [Full Text] [PDF]

				D. W. Jones and J. E. Hall Racial and Ethnic Differences in Blood Pressure: Biology and Sociology Circulation, December 19, 2006; 114(25): 2757 - 2759. [Full Text] [PDF]

				X. Wang, J. C. Poole, F. A. Treiber, G. A. Harshfield, C. D. Hanevold, and H. Snieder Ethnic and Gender Differences in Ambulatory Blood Pressure Trajectories: Results From a 15-Year Longitudinal Study in Youth and Young Adults Circulation, December 19, 2006; 114(25): 2780 - 2787. [Abstract] [Full Text] [PDF]

				R. Agarwal, A. J. Peixoto, S. F.F. Santos, and C. Zoccali Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure Clin. J. Am. Soc. Nephrol., May 1, 2006; 1(3): 389 - 398. [Abstract] [Full Text] [PDF]

				M. E. Ernst, B. L. Carter, C. J. Goerdt, J. J.G. Steffensmeier, B. B. Phillips, M. B. Zimmerman, and G. R. Bergus Comparative Antihypertensive Effects of Hydrochlorothiazide and Chlorthalidone on Ambulatory and Office Blood Pressure Hypertension, March 1, 2006; 47(3): 352 - 358. [Abstract] [Full Text] [PDF]

				R. C. Hermida, C. Calvo, D. E. Ayala, and J. E. Lopez Decrease in Urinary Albumin Excretion Associated With the Normalization of Nocturnal Blood Pressure in Hypertensive Subjects Hypertension, October 1, 2005; 46(4): 960 - 968. [Abstract] [Full Text] [PDF]

				R. C. Hermida, D. E. Ayala, C. Calvo, J. E. Lopez, A. Mojon, M. J. Fontao, R. Soler, and J. R. Fernandez Effects of Time of Day of Treatment on Ambulatory Blood Pressure Pattern of Patients With Resistant Hypertension Hypertension, October 1, 2005; 46(4): 1053 - 1059. [Abstract] [Full Text] [PDF]