Satoshi Konno

Prognostic significance of the brachial–ankle pulse wave velocity in patients with essential hypertension: final results of the J-TOPP study

Brachial–ankle pulse wave velocity (baPWV) is a new tool for measuring arterial stiffness. The prognostic significance of this measure, however, is not fully established. We initiated a multicenter cohort study to examine the prognostic significance of baPWV in patients with essential hypertension in 2002. After baseline measurements were obtained, 662 previously untreated patients (mean age 60±12u2009years, mean blood pressure 156±19/94±12u2009mmu2009Hg, 45% men) underwent long-term follow-up according to the current hypertension treatment guidelines. During the follow-up period (mean: 3 years, range: 3 months–8 years), 24 cardiovascular events were observed. The subjects were divided into high and low baPWV groups according to the median value (1750, cmu2009s−1). Patients in the high baPWV group were older and had a lower body mass index, higher blood pressure, faster heart rate and higher fasting glucose and plasma creatinine concentrations compared with those in the low baPWV group. Cardiovascular morbidities per 1000 person-years for the high and low baPWV groups were 17.48 and 6.38, respectively (P<0.05), and the 8-year cardiovascular event-free survival rates were 78.2% and 93.5%, respectively (log-rank test, P=0.01). A multivariate Cox proportional hazard analysis showed that high baPWV compared with low baPWV was associated with a significantly poorer outcome (hazard ratio (HR) 2.97; 95% CI: 1.006–9.380). In conclusion, baPWV is an independent risk factor for future cardiovascular events in patients with essential hypertension.

High-normal blood pressure is associated with microalbuminuria in the general population: the Watari study

Microalbuminuria, for which hypertension and diabetes are well-known risk factors, has recently been used to detect individuals at risk for cardiovascular and chronic kidney diseases in the general population. We aimed to determine the thresholds of blood pressure or blood glucose concentration at which the odds ratio of having microalbuminuria begins to increase. An annual public health checkup was conducted on 3166 participants aged 29–84 years (mean, 61±11 years; 40% men) living in Watari town, Japan. We studied their demographic data, medical history of hypertension, diabetes, dyslipidemia, sitting blood pressure and fasting blood samples. Urinary albumin excretion was examined in terms of the albumin/creatinine ratio in spot urine samples. Microalbuminuria was defined as 30–299u2009mg albumin per gram creatinine. Final analyses included 2133 participants under no anti-hypertensive or anti-diabetic medication. Microalbuminuria was detected in 118 subjects (5.5%). We used the adjusted odds ratios for microalbuminuria in different blood pressure and blood glucose groupings as the reference. The adjusted odds ratio increased linearly with increase in systolic blood pressure. A similar trend, although not as linear, was observed with diastolic blood pressure. The odds ratio increased significantly with high-normal levels of both systolic and diastolic blood pressure. For blood glucose, the adjusted odds ratio increased significantly from the impaired fasting glucose level. Therefore, the odds ratio for microalbuminuria begins to increase from high-normal blood pressure and impaired fasting glucose levels in comparison with the reference. Early intervention in such cases may be useful for reducing cardiovascular and renal risks.

Blood Pressure Among Public Employees After the Great East Japan Earthquake: The Watari Study

BACKGROUNDnIncreases in blood pressure were reported in overworked public workers following the Mid-Niigata earthquake. This study aimed to compare blood pressure changes between public employees and the general population after the Great East Japan Earthquake of March 2011.nnnMETHODSnWe analyzed 1,776 individuals from the general population and 240 public employees of the town of Watari who received medical check-ups in 2010 and from July 2011 through November 2011. Anthropometric parameters and sitting blood pressure were compared, and fasting blood samples were taken from all participants. In post-disaster measurements, the degrees of insomnia, depression, fatigue, and life disruption due to the disaster were assessed using a questionnaire. Information on the working hours of public employees was obtained from authorized sources.nnnRESULTSnAfter age-sex adjustments, the public employees showed greater increases in systolic (11.3 vs. -1.9mm Hg, P < 0.001) and diastolic (7.8 vs. 1.1mm Hg, P < 0.001) blood pressure than the general population when compared with measurements taken during the previous year. In contrast, the degrees of fatigue, depression, and life disruption were equivalent in the 2 groups. The average monthly overtime hours worked by public employees in March 2011 was 10-fold higher compared with the previous March.nnnCONCLUSIONnPublic employees showed greater and more prolonged increases in blood pressure than the general population after the Great East Japan earthquake. Thus blood pressure should be monitored after a great earthquake among public employees, and treatment should be considered if necessary.

High-normal diastolic blood pressure is a risk for development of microalbuminuria in the general population: the Watari study.

Objective: Although hypertension is a well known risk factor for microalbuminuria, it is unclear whether blood pressure less than 140/90u200ammHg could be a risk for microalbuminuria. We assessed the relationship between baseline blood pressure and the future onset of microalbuminuria in the general population. Methods: We studied 2603 town inhabitants of Watari, located in the southeastern part of Miyagi prefecture, Japan. Demographic data, medical history, sitting blood pressure, fasting blood chemistry, and urinary albumin-creatinine ratio were measured at baseline and were followed annually during the next 3 years. Results: Among 2338 individuals who were normoalbuminuric at baseline (albumin-creatinine ratio <30u200amg/g Cr), 161 developed microalbuminuria (albumin-creatinine ratio 30–299u200amg/g Cr) during a mean follow-up period of 2.4 years. Incident microalbuminuria patients were older (63.7u200a±u200a8.6 vs. 61.4u200a±u200a10.5 years; Pu200a<u200a0.01), included fewer men (31.1 vs. 40.1%; Pu200a<u200a0.05), had a greater BMI (23.8u200a±u200a3.6 vs. 23.1u200a±u200a3.1u200akg/m2; Pu200a<u200a0.01), higher blood pressures (133.5u200a±u200a18.1/75.8u200a±u200a11.9 vs. 127.6u200a±u200a18.1/73.4u200a±u200a11.0u200ammHg; Pu200a<u200a0.01 for both systolic and diastolic), higher triglycerides (median 1.18 vs. 1.02u200ammol/l; Pu200a<u200a0.01), higher fasting blood glucose (median 5.05 vs. 4.94u200ammol/l; Pu200a<u200a0.01), higher urinary albumin excretion (median 13.0 vs. 5.9u200amg/g Cr; Pu200a<u200a0.001), and lower serum creatinine concentrations (59.2u200a±u200a12.8 vs. 61.4u200a±u200a13.2u200a&mgr;mol/l; Pu200a<u200a0.05) compared to persistent normoalbuminuric individuals. Multivariate Cox proportional hazards analysis including all covariates revealed that only baseline urinary albumin excretion was an independent predictor for future microalbuminuria, whereas high-normal DBP, triglyceride, and fasting blood glucose concentrations were all significant predictors in the model excluding urinary albumin excretion. Conclusions: High-normal DBP associated with metabolic disorders could initiate glomerular damage, leading to future microalbuminuria.

Skill Underutilization is Associated with Higher Prevalence of Hypertension: The Watari Study

Skill Underutilization is Associated with Higher Prevalence of Hypertension: the Watari Study: Satoshi KONNO, et al. Preventive Medical Center and Division of Hypertension, Tohoku Rosai Hospital—

Increased double product on Monday morning during work

It has been reported that cardiovascular events often occur on Monday morning, especially in the young working population. Because hypertension is a major cardiovascular risk, we examined whether blood pressure was elevated on Monday, especially in the morning during work. However, there were no weekly rhythms in blood pressure itself. Instead, we found significant interactions between the double product (systolic blood pressure × heart rate) and weekly (high on Monday) and circadian (high in the morning) rhythms. Further studies are required to determine whether Monday morning preference in cardiovascular events is caused by increased double product.

5C.08: AGE AND GENDER SPECIFIC CARDIO-METABOLIC RISKS AND THEIR RELATIONS TO LIFE STYLE DISORDER IN THE GENERAL POPULATION: THE WATARI STUDY.

Objective: In developed countries, systolic blood pressure is known to increase with age. Metabolic risks may generally worse with increasing age. But this trend may be modified by environmental factors which are different between gender and generation. The aim of this study was to examine the relationship between age and gender-related difference in cardio-metabolic risks and life style factors in the Japanese general population. Design and method: We studied 3628 inhabitants of Watari (mean age 63.9 yrs, 42.5% men), Miyagi prefecture, who participated in a health check-up in 2009. Anthropometry, sitting blood pressures, fasting blood samples were examined. Unhealthy dietary behaviors (night meal, late dinner, fast eating, skipping breakfast, smoking, heavy drinking, lack of regular exercise) were evaluated by standard questionnaire. Presence or absence of each behavior was scored 0 or 1 and total score was calculated as healthy life style score (range 0 to 7, higher the better). Gender difference in age-related changes in blood pressures, BMI, lipid and glucose metabolism were examined by two way ANOVA. Results: Systolic blood pressure was continuously increased from age 30u200as to 70u200as in both genders. Systolic blood pressure was significantly higher in men than in women in age 30u200as (122.0u200a±u200a13.9 vs. 113.3u200a±u200a12.8 mmHg, pu200a<u200a0.001) but the difference decreased with an increase in age. Similar gender interaction was observed for diastolic blood pressure, BMI, triglyceride and high density lipoprotein (all pu200a<u200a0.001) but was not for HbA1c. The healthy life style score was lowest in men age 30u200as (5.1u200a±u200a1.5) and it increased with an increase in age. Women demonstrated significantly higher healthy life style score than men in all generations. The gender difference in the score was largest in age 30u200as and decreased with an increase in age. Conclusions: Cardio-metabolic risks are worse in men than in women in young generation but this gender difference diminishes with age. The gender difference in the young may be largely attributable to life style factors. Glucose metabolism may be less affected by life style than blood pressure or lipid.

163 INFLUENCE OF WORK STRESS ON SEASONAL VARIATION OF BLOOD PRESSURE IN MEN-DIFFERENCE BETWEEN NORMOTENSION AND MILD HYPERTENSION

Objective: The aim of the study was to examine if 1) seasonal blood pressure variation differ between normotension (NT) and mild hypertension (MH), and if 2) work stress influences such variation. Methods: We studied 114 male hospital employees (38.1 ± 4.4 yrs). Anthropometric parameters, supine blood pressure, heart rate and fasting blood were studied in summer and winter. The difference between winter and summer was defined as seasonal variation. Subjects were classified as NT and MH groups by the cut-off values of 130/85 mmHg. Score of skill underutilization by NIOSH stress questionnaire was used as a measure for work stress. Each group was dichotomized by the median value of work stress. Results: From summer to winter, SBP increased in NT (116.1 ± 6.9 vs. 119.1 ± 10.8 mmHg, p < 0.01) but decreased in MH (138.6 ± 9.2 vs. 133.8 ± 11.6 mmHg, p < 0.05). In MH group, the decrease in SBP was related to an increase in uric acid (p < 0.05) but was not related to any hormonal or anthropometric parameters. The ANCOVA showed that high work stress group showed a smaller reduction in SBP than low work stress group (0.3 ± 3.0 vs. -7.6 ± 0.3 mmHg, p < 0.05). In NT group, the increase in SBP during winter was related only to an increase in body weight and was not influenced by work stress. Conclusions: Systolic blood pressure elevation during winter seen in NT group is counteracted in MH group possibly through volume control mechanism, which may be impaired by work stress.

923 JOB-RELATED STRESS AS A RISK FACTOR FOR HYPERTENSION: THE WATARI STUDY

Background: We have shown that job-related stress such as long working hours or under-utilization of skill are risk factors for hypertension or cardiovascular events in hospital employees. The aim of this study was to examine if those results can be generally applied to other occupations. Methods: Study population was 3429 inhabitants of the town of Watari who received a medical check-up in 2010. We examined anthropometry, sitting blood pressure, fasting blood samples and collected information on past medical history, history of present illness, job status, working hours per week and life-style by questionnaire. Degree of job demand and skill under-utilization was quantified by NIOSH job stress questionnaire. Hypertension was defined as sitting blood pressures of ≥140/90 mm Hg or receiving antihypertensive treatment. Results: A total of 1293 subjects who answered having permanent or part-time job were included in the final analysis and were divided into 3 groups according to the level of job stress. The group with the lowest skill use was associated with significantly higher odds ratio for hypertension (1.61, 95% CI:1.06-2.48) compared with the highest skill use group even after adjustment for covariates. Furthermore the group with the longest weekly working hours (50 hrs or more) showed a significantly higher odds ratio (1.49, 95%CI, 1.04-2.14) for obesity (BMI of 25 kg/m2 or more) than the group with the shortest weekly working hours of less than 40 hrs. Conclusion: Skill under-utilization and long working hours may be risk factors for hypertension and obesity, respectively, even in the general population.

116 PROLONGED PRESSOR EFFECTS OF THE GREAT EAST JAPAN EARTHQUAKE IN PUBLIC EMPLOYEES: THE WATARI STUDY

Background: We examined if blood pressure (BP) response after disaster differs between general population and public employees who have to support reconstruction of the community. Methods: The Watari town was hit by the Great East Japan Earthquake and was seriously damaged. We studied 1776 general inhabitants (62.7 ± 10.0 yrs, 43% men) and 240 public employees (39.6 ± 11.3 yrs, 37 % men). Annual health check-up was conducted at 2010 and at more than 3 months after the quake. We studied anthropometry, sitting BPs, and fasting blood samples at both occasions and further examined the degree of depression, fatigue and individual damages by questionnaire. Pressor response was defined as the BP change after the quake in comparison with the previous year. Results: At baseline, the public employees were thinner (BMI: 22.4 ± 3.3 vs. 23.3 ± 3.2 kg/m2, p<0.0001) and demonstrated lower BPs (115.8 ± 14.0/67.4 ± 11.5 vs. 125.0 ± 16.4/73.2 ± 11.0 mm Hg, p<0.0001 for both) than the general population. Pressor response was significantly greater in the public employees than in the general population for systolic (8.9 ± 10.8 vs. -1.6 ± 13.2 mm Hg, p<0.0001) and diastolic BP (6.2 ± 7.9 vs. 1.3 ± 8.5 mm Hg, p<0.0001) even after adjustment for covariates. Scores of depression and fatigue were significantly higher in the public employees than in the general population although the score of individual damage did not differ. Conclusion: The public employees showed prolonged pressor response over 3 months after the quake possibly due to work stress.