Published Online
on September 27, 2004

A more recent version of this article appeared on November 1, 2004

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Submitted on July 6, 2004
Revised on July 19, 2004

Comparison of Four Blood Pressure Indexes for the Prediction of 10-Year Stroke Risk in Middle-Aged and Older Asians

Katsuyuki Miura^*; Yoshiyuki Soyama; Yuko Morikawa; Muneko Nishijo; Yumiko Nakanishi; Yuchi Naruse; Katsushi Yoshita; Sadanobu Kagamimori; and Hideaki Nakagawa

From the Department of Epidemiology and Public Health (K.M., Y.S., Y.M., M.N., Y. Nakanishi, H.N.), Kanazawa Medical University, Ishikawa, Japan; Departments of Community and Geriatric Nursing (Y. Naruse), and Welfare Promotion and Epidemiology (S.K.), Toyama Medical and Pharmaceutical University, Japan; and Division of Health and Nutrition Monitoring (K.Y.), National Institute of Health and Nutrition, Tokyo, Japan.

^* To whom correspondence should be addressed. E-mail: miura{at}kanazawa-med.ac.jp.

Abstract--Information has been sparse on the comparison of 4 blood pressure (BP) indexes (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean BP [MBP]) in relation to long-term stroke incidence, especially in middle-aged and older Asian people. A prospective cohort study was performed in 4989 Japanese (1523 men and 3466 women) aged 35 to 79 at baseline with 10 years of follow-up. End points included stroke incidence (total, ischemic, and hemorrhagic). Multivariate-adjusted hazard ratios with a 1-SD higher value for each BP index were determined by Cox proportional hazard analyses; Wald 2 tests were used to compare the strength of relationships. Analyses were also done for each of 4 age-gender groups consisting of men and women aged 35 to 64 and 65 to 79 years. During follow-up, 132 participants developed stroke. Adjusted hazard ratios for all strokes were 1.68 for SBP, 1.72 for DBP, and 1.80 for MBP, which were higher than that for PP (1.34). SBP and DBP were related positively to stroke risk after adjustment of each other. PP was not the strongest predictor in any age-gender groups among 4 BP indexes. In men aged 65 to 79 years, SBP showed the strongest relationship to all stoke risk (hazard ratio 1.62) among 4 BP indexes. In women aged 65 to 79 years, hazard ratios for all strokes were 2.48 for MBP, 2.46 for DBP, 2.25 for SBP, and 1.57 for PP. The long-term incident stroke risk of high BP in Asians should be assessed by SBP and DBP together, or by MBP, not by PP.

Key words: stroke • blood pressure • epidemiology

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