Impact of blood pressure levels on different types of stroke: the Hisayama study
Abstract
OBJECTIVE: Clinical uncertainty remains whether the blood pressure classification and risk stratifications recommended by the Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009) are useful in predicting the risks of stroke and its subtypes in the general Japanese population. METHODS: A total of 1621 stroke-free residents of a Japanese community aged at least 40 years were followed up for 32 years. Outcomes were total and cause-specific stroke (lacunar infarction, atherothrombotic infarction, cardioembolic infarction, cerebral haemorrhage and subarachnoid haemorrhage). Incidence was calculated by the pooling of repeated observations method. RESULTS: The age-adjusted incidence of total stroke rose progressively with higher blood pressure levels in both sexes (both P for trend <0.0001). A similar pattern was observed for lacunar infarction in both sexes and for cerebral haemorrhage in men: the differences were significant between optimal blood pressure and grades 1-3 hypertension (all P < 0.05). The age-adjusted incidence of atherothrombotic infarction in either sex and that of cardioembolic infarction and subarachnoid haemorrhage in women significantly increased in grade 3 hypertension (all P < 0.05). These associations remained substantially unchanged even after adjustment for other risk factors. In regard to risk stratification, the age-adjusted incidence of stroke significantly increased with the level of risk in both sexes. CONCLUSION: Our findings suggest that the blood pressure classification and risk stratifications recommended by the JSH 2009 guidelines are useful in predicting the risk of stroke in a general Japanese population, but the magnitude and patterns of the impact of blood pressure categories are different among stroke subtypes.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The consolidated results of nine cohort studies indicated that cerebral infarction incidence is significantly decreased by 15% in patients with a decrease of 1 mmol/L (38.6 mg/dL) in the LDL-C level.
“Furthermore, the consolidated results of nine cohort studies indicated that cerebral infarction incidence is significantly decreased by 15% in patients with a decrease of 1 mmol/L (38.6 mg/dL) in the LDL-C level854).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [854]
According to a meta-analysis of cohort studies, a decrease of 1 mmol/L (38.6 mg/dL) in the cholesterol level increases the cerebral hemorrhage incidence by 19%.
“According to a meta-analysis of cohort studies, a decrease of 1 mmol/L (38.6 mg/dL) in the cholesterol level increases the cerebral hemorrhage incidence by 19%854).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [854]
Cites
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., et al. (2003) · Hypertension · doi:10.1161/01.hyp.0000107251.49515.c2 · Cited by 13,271 · see citing works
Adams, H. P., Bendixen, B. H., Kappelle, L. J., Biller, J., Love, B. B., Gordon, D., & Marsh, E. E. (1993) · Stroke · doi:10.1161/01.str.24.1.35 · Cited by 12,350 · see citing works
2007 Guidelines for the Management of Arterial Hypertension
Mancia, G., Backer, G. D., Dominiczak, A. F., Cífková, R., Fagard, R. H., Germanò, G., Grassi, G. M., Heagerty, A. M., Kjeldsen, S. E., Laurent, S., et al. (2007) · Journal of Hypertension · doi:10.1097/hjh.0b013e3281fc975a · Cited by 5,818 · see citing works
World Health Organization, I. S. O. H. W. G. (2003) · Journal of Hypertension · doi:10.1097/00004872-200311000-00002 · Cited by 2,654 · see citing works
One-year cardiovascular event rates in outpatients with atherothrombosis
Steg, P. G., Bhatt, D. L., Wilson, P. W. F., D’Agostino, R., Ohman, E. M., Röther, J., Liau, C.-S., Hirsch, A. T., Mas, J.-L., Ikeda, Y., et al. (2007) · JAMA · doi:10.1001/jama.297.11.1197 · Cited by 1,382 · see citing works
The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009)
Ogihara, T., Kikuchi, K., Matsuoka, H., Fujita, T., Higaki, J., Horiuchi, M., Imai, Y., Imaizumi, T., Ito, S., Iwao, H., et al. (2009) · Hypertension Research · doi:10.1038/hr.2014.68 · Cited by 1,094 · see citing works
Kinoshita, M., Yokote, K., Arai, H., Iida, M., Ishigaki, Y., Ishibashi, S., Umemoto, S., Egusa, G., Ohmura, H., Okamura, T., et al. (2018) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.gl2017 · Cited by 813 · see citing works
Self-citationBlood pressure and cardiovascular disease in the Asia Pacific region
Asia Pacific Cohort Studies Collaboration (2003) · Journal of Hypertension · doi:10.1097/00004872-200304000-00013 · Cited by 643 · see citing works
Race, sex and occlusive cerebrovascular disease: a review.
Caplan, L. R., Gorelick, P. B., & Hier, D. B. (1986) · Stroke · doi:10.1161/01.str.17.4.648 · Cited by 546 · see citing works
Cerebral Embolism Task Force (1986) · Archives of Neurology · doi:10.1001/archneur.1986.00520010065026 · Cited by 540 · see citing works
Ogihara, T., Kikuchi, K., Matsuoka, H., Fujita, T., Higaki, J., Horiuchi, M., Imai, Y., Imaizumi, T., Ito, S., Iwao, H., et al. (2009) · Hypertension Research · doi:10.1038/hr.2009.34 · Cited by 486 · see citing works
Use of ramipril in preventing stroke: double blind randomised trial
Bosch, J., Yusuf, S., Pogue, J., Sleight, P., Lonn, E., Rangoonwala, B., Davies, R., Ostergren, J., & Probstfield, J. (2002) · BMJ · doi:10.1136/bmj.324.7339.699 · Cited by 421 · see citing works
Tanizaki, Y., Kiyohara, Y., Kato, I., Iwamoto, H., Nakayama, K., Shinohara, N., Arima, H., Tanaka, K., Ibayashi, S., & Fujishima, M. (2000) · Stroke · doi:10.1161/01.str.31.11.2616 · Cited by 346 · see citing works
Self-citationArima, H., Chalmers, J. P., Woodward, M., Anderson, C. S., Rodgers, A., Davis, S. M., MacMahon, S. W., & Neal, B. C. (2006) · Journal of Hypertension · doi:10.1097/01.hjh.0000226212.34055.86 · Cited by 323 · see citing works
Self-citationWilson, P. W. F., Hoeg, J. M., D’Agostino, R. B., Silbershatz, H., Belanger, A. J., Poehlmann, H. W., O’Leary, D. H., & Wolf, P. A. (1997) · New England Journal of Medicine · doi:10.1056/nejm199708213370802 · Cited by 319 · see citing works
Prehypertension and Cardiovascular Disease Risk in the Women’s Health Initiative
Hsia, J. A., Margolis, K. L., Eaton, C. B., WENGER, N. K., Allison, M., Wu, L., LaCroix, A. Z., & Black, H. R. (2007) · Circulation · doi:10.1161/circulationaha.106.656850 · Cited by 288 · see citing works
Chapman, N., Huxley, R., Anderson, C. S., Bousser, M., Chalmers, J. P., Colman, S., Davis, S. M., Donnan, G. A., MacMahon, S. W., Neal, B. C., et al. (2003) · Stroke · doi:10.1161/01.str.0000106480.76217.6f · Cited by 255 · see citing works
Comparison of baseline and repeated measure covariate techniques in the Framingham heart study
Cupples, L. A., D’Agostino, R. B., Anderson, K. M., & Kannel, W. B. (1988) · Statistics in Medicine · doi:10.1002/sim.4780070122 · Cited by 254 · see citing works
Kshirsagar, A. V., Carpenter, M. A., Bang, H., Wyatt, S. B., & Colindres, R. E. (2006) · The American Journal of Medicine · doi:10.1016/j.amjmed.2005.08.023 · Cited by 223 · see citing works
Ohmura, T., Ueda, K., Kiyohara, Y., Kato, I., Iwamoto, H., Nakayama, K., Nomiyama, K., Ohmori, S., Yoshitake, T., Shinkawu, A., et al. (1993) · Diabetologia · doi:10.1007/bf00401066 · Cited by 184 · see citing works
Self-citationon behalf of the COLM study investigators, Ogihara, T., Saruta, T., Rakugi, H., Shimamoto, K., Ito, S., Matsuoka, H., Horiuchi, M., Imaizumi, T., Takishita, S., et al. (2009) · Hypertension Research · doi:10.1038/hr.2008.31 · Cited by 169 · see citing works
Kokubo, Y., Kamide, K., Okamura, T., Watanabe, M., Higashiyama, A., Kawanishi, K., Okayama, A., & Kawano, Y. (2008) · Hypertension · doi:10.1161/hypertensionaha.108.118273 · Cited by 166 · see citing works
Nippon Data 80 Research Group (2003) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001602 · Cited by 159 · see citing works
Mohr, J. P. (1982) · Stroke · doi:10.1161/01.str.13.1.3 · Cited by 155 · see citing works
Relation of Blood Pressure and All-Cause Mortality in 180 000 Japanese Participants
Murakami, Y., Hozawa, A., Okamura, T., & Ueshima, H. (2008) · Hypertension · doi:10.1161/hypertensionaha.107.102459 · Cited by 141 · see citing works
Asayama, K., Ohkubo, T., Kikuya, M., Metoki, H., Hoshi, H., Hashimoto, J., Totsune, K., Satoh, H., & Imai, Y. (2004) · Stroke · doi:10.1161/01.str.0000141679.42349.9f · Cited by 123 · see citing works
Ikeda, A., Iso, H., Yamagishi, K., Inoue, M., & Tsugane, S. (2009) · American Journal of Hypertension · doi:10.1038/ajh.2008.356 · Cited by 121 · see citing works
Arima, H., Tanizaki, Y., Kiyohara, Y., Tsuchihashi, T., Kato, I., Kubo, M., Tanaka, K., Ohkubo, K., Nakamura, H., Abe, I., et al. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.3.361 · Cited by 110 · see citing works
Self-citationKizer, J. R., Dahlöf, B., Kjeldsen, S. E., Julius, S., Beevers, G., Fairé, U. D., Fyhrquist, F., Ibsen, H., Kristianson, K. J., Lederballe‐Pedersen, O., et al. (2004) · Hypertension · doi:10.1161/01.hyp.0000151324.05355.1c · Cited by 99 · see citing works
Risk Factors for Stroke and Type of Stroke in Persons With Isolated Systolic Hypertension
Davis, B. R., VOGT, T. M., Frost, P. H., Burlando, A. J., Cohen, J. D., Wilson, A. C., Brass, L. M., Frishman, W. H., Price, T. R., & Stamler, J. (1998) · Stroke · doi:10.1161/01.str.29.7.1333 · Cited by 93 · see citing works
Epidemiological and Clinicopathological Study on Cerebrovascular Disease in Japan
KATSUKI, S. (1966) · Progress in brain research · doi:10.1016/s0079-6123(08)64226-0 · Cited by 73 · see citing works
Twenty-Five-Year Prediction of Stroke Deaths in the Seven Countries Study
Menotti, A., Jacobs, D. R., BLACKBURN, H. W., Kromhout, D., Nissinen, A. M., Nedeljković, S., Buzina, R., Mohaček, I., Seccareccia, F., Giampaoli, S., et al. (1996) · Stroke · doi:10.1161/01.str.27.3.381 · Cited by 72 · see citing works
Asayama, K., Ohkubo, T., Yoshida, S., et al. (2009) · Journal of Hypertension · doi:10.1097/hjh.0b013e32831967ca · Cited by 66 · see citing works
Ohmura, T., Ueda, K., Kiyohara, Y., Kato, I., Iwamoto, H., Nakayama, K., Nomiyama, K., Ohmori, S., Yoshitake, T., Shinkawa, A., et al. (1994) · Diabetologia · doi:10.1007/bf00400945 · Cited by 37 · see citing works
Self-citationLinear Relationship Between Blood Pressure and Stroke: The Jichi Medical School Cohort Study
Ishikawa, S., Kario, K., Kayaba, K., Gotoh, T., Nago, N., Nakamura, Y., Tsutsumi, A., & Kajii, E. (2007) · Journal of Clinical Hypertension · doi:10.1111/j.1524-6175.2007.07102.x · Cited by 18 · see citing works
Obara, F., Saitoh, S., Takagi, S., et al. (2007) · Hypertension Research · doi:10.1291/hypres.30.677 · Cited by 18 · see citing works
Asayama, K., Ohkubo, T., Satō, A., Hara, A., Obara, T., Yasui, D., Metoki, H., Inoue, R., Kikuya, M., Hashimoto, J., et al. (2008) · Hypertension Research · doi:10.1291/hypres.31.1315 · Cited by 18 · see citing works
Changes in various blood chemical constituents in relation to menopause. The Hisayama study.
Fujii, I., Ueda, K., Yanai, T., et al. (1986) · Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics · doi:10.3143/geriatrics.23.50 · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Kinoshita, M., Yokote, K., Arai, H., Iida, M., Ishigaki, Y., Ishibashi, S., Umemoto, S., Egusa, G., Ohmura, H., Okamura, T., et al. (2018) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.gl2017 · Cited by 813 · see citing works
Self-citation
- Authors
- Arima, H., Tanizaki, Y., Yonemoto, K., Doi, Y., Ninomiya, T., Hata, J., Fukuhara, M., Matsumura, K., Iida, M., & Kiyohara, Y.
- Affiliations
- Kyushu University (JP)
- Corresponding author
- Arima, Hisatomi
- Venue
- Journal of Hypertension
- Published
- 2009-12
- Volume
- 27
- Issue
- 12
- Pages
- 2437-2443
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W2038966682
- Cited by
- 44
- References
- 41
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 5 · 2020: 1 · 2019: 5 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 2 · 2014: 4 · 2013: 4 · 2012: 3
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Society for the Promotion of Science (21590698)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- blood pressure, stroke, stroke subtypes, hypertension classification, risk stratification, lacunar infarction, atherothrombotic infarction, cardioembolic stroke, cerebral hemorrhage, subarachnoid hemorrhage, stroke incidence, Hisayama Study, Japanese population
- MeSH terms
- Blood Pressure, Cerebral Hemorrhage, Cerebral Infarction, Female, Humans, Hypertension, Japan, Male, Prospective Studies, Subarachnoid Hemorrhage, Cohort Studies, Comorbidity, Incidence, Embolism, Cholesterol, Risk Assessment, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
