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(Hypertension. 2006;48:877.)
© 2006 American Heart Association, Inc.

Original Articles

Predicting Stroke Using 4 Ambulatory Blood Pressure Monitoring-Derived Blood Pressure Indices

The Ohasama Study

Ryusuke Inoue; Takayoshi Ohkubo; Masahiro Kikuya; Hirohito Metoki; Kei Asayama; Taku Obara; Haruhisa Hoshi; Junichiro Hashimoto; Kazuhito Totsune; Hiroshi Satoh; Yoshiaki Kondo; Yutaka Imai

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

Correspondence to Takayoshi Ohkubo, Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan. E-mail tohkubo{at}mail.tains.tohoku.ac.jp

We investigated the association between stroke and blood pressure (BP) indices (systolic BP [SBP], diastolic BP [DBP], mean BP [MBP], and pulse pressure [PP]) determined by ambulatory BP monitoring. The predictive power for stroke of these indices was compared in the general Japanese population. We obtained ambulatory BP data in 1271 subjects (40% men) aged 40 (mean: 61) years. During a mean follow-up of 11 years, 113 strokes were observed. The multivariate adjusted relative hazard and likelihood ratio for a 1-SD increase for each BP index was determined by Cox proportional hazard regression. Comparison of the likelihood ratio between Cox models including 2 indices and those including 1 index indicated that PP was significantly less informative than other indices (P<0.01 when adding MBP, SBP, or DBP to the PP model; P>0.09 when adding PP to the model including another index). However, after removing age from covariates, PP became more informative than DBP and MBP (P<0.0001 when adding PP to the MBP or DBP model, whereas SBP was more informative than PP even after removing age; P<0.05 when adding SBP to the PP model). In conclusion, PP was the weakest predictor of stroke. Exclusion of age from covariates increased the predictive power of PP, suggesting that the stroke risk associated with PP reflected the risk of aging per se.

Key Words: ambulatory blood pressure monitoring • pulse pressure • systolic blood pressure • diastolic blood pressure • mean blood/arterial pressure • stroke

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