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(Hypertension. 2008;52:652.)
© 2008 American Heart Association, Inc.

Original Articles

Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease in a Japanese Urban Cohort

The Suita Study

Yoshihiro Kokubo; Kei Kamide; Tomonori Okamura; Makoto Watanabe; Aya Higashiyama; Katsuyuki Kawanishi; Akira Okayama; Yuhei Kawano

From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.) and the Division of Hypertension and Nephrology (K. Kamide, Y. Kawano), National Cardiovascular Center, Osaka, Japan; The Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan.

Correspondence to Yoshihiro Kokubo, MD, PhD, Department of Preventive Cardiology, National Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565 Japan. E-mail ykokubo{at}hsp.ncvc.go.jp

Few prospective studies have examined the association between high-normal blood pressure and cardiovascular disease (CVD) in Asia. We examined the impact of high-normal blood pressure on the incidence of CVD in a general urban population cohort in Japan. We studied 5494 Japanese individuals (ages 30 to 79 years without CVD at baseline) after completing a baseline survey who received follow-up through December 2005. Blood pressure categories were defined on the basis of the ESH-ESC 2007 criteria. In 64 391 person-years of follow-up, we documented the incidence of 346 CVD events. The frequencies of high-normal blood pressure and hypertension Stage 1 and Stage 2 were 18.0%, 20.1%, and 10.1% for men and 15.9%, 15.6%, and 8.8% for women, respectively. Antihypertensive drug users were also classified into the baseline blood pressure categories. Compared with the optimal blood pressure group, the multivariable hazard ratios (95% confidence intervals) of CVD for normal and high-normal blood pressure and hypertension Stage 1 and Stage 2 were 2.04 (1.19 to 3.48), 2.46 (1.46 to 4.14), 2.62 (1.59 to 4.32), and 3.95 (2.37 to 6.58) in men and 1.12 (0.59 to 2.13), 1.54 (0.85 to 2.78), 1.35 (0.75 to 2.43), and 2.86 (1.60 to 5.12) in women, respectively. The risks of myocardial infarction and stroke for each blood pressure category were similar to those of CVD. Population-attributable fractions of high-normal blood pressure and hypertension for CVD were 12.2% and 35.3% in men and 7.1% and 23.4% in women, respectively. In conclusion, high-normal blood pressure is a risk factor for the incidence of stroke and myocardial infarction in a general urban population of Japanese men.

Key Words: cardiovascular diseases • epidemiology • general population • high-normal blood pressure • myocardial infarction • prospective studies • stroke

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