Takahisa Murakami

Long-Term Stroke Risk Due to Partial White-Coat or Masked Hypertension Based on Home and Ambulatory Blood Pressure Measurements The Ohasama Study

The prognostic significance of white-coat hypertension (WCHT) is controversial, and different findings on self-measured home measurements and 24-h ambulatory monitoring make identifying WCHT difficult. We examined whether individuals with partially or completely defined WCHT, as well as masked hypertension, as determined by different out-of-office blood pressure measurements, have a distinct long-term stroke risk. We followed 1464 participants (31.8% men; mean age, 60.6±10.8 years) in the general population of Ohasama, Japan, for a median of 17.1 years. A first stroke occurred in 212 subjects. Using sustained normal blood pressure (events/n=61/776) as a reference, adjusted hazard ratios for stroke (95% confidence intervals; events/n) were 1.38 (0.82–2.32; 19/137) for complete WCHT (isolated office hypertension), 2.16 (1.36–3.43; 29/117) for partial WCHT (either home or ambulatory normotension with office hypertension), 2.05 (1.24–3.41; 23/100) for complete masked hypertension (both home and ambulatory hypertension with office normotension), 2.08 (1.37–3.16; 38/180) for partial masked hypertension (either home or ambulatory hypertension with office normotension), and 2.46 (1.61–3.77; 42/154) for sustained hypertension. When partial WCHT and partial masked hypertension groups were further divided into participants only with home hypertension and those only with ambulatory hypertension, all subgroups had a significantly higher stroke risk (adjusted hazard ratio ≥1.84, P⩽0.04). In conclusion, impacts of partial WCHT as well as partial masked hypertension for long-term stroke risk were comparable to those of complete masked hypertension or sustained hypertension. We need both home and 24-h ambulatory blood pressure measurements to evaluate stroke risk accurately.

Association Between Tooth Loss, Receipt of Dental Care, and Functional Disability in an Elderly Japanese Population: The Tsurugaya Project

To examine whether number of remaining teeth and regular dental care affect incident functional disability in elderly Japanese adults.

Impaired Higher-Level Functional Capacity as a Predictor of Stroke in Community-Dwelling Older Adults: The Ohasama Study

Background and Purpose— Functional capacity is a predictor, as well as a consequence, of stroke. However, little research has been done to examine whether higher-level functional capacity above basic activities of daily living is a predictor of stroke. Methods— We followed 1493 Japanese community-dwelling adults aged ≥60 years (mean age, 70.1 years) who were independent in basic activities of daily living and had no history of stroke. Baseline data were collected using a self-administered questionnaire. Higher-level functional capacity was measured using the total score and 3 subscales (instrumental activities of daily living, intellectual activity, and social role) derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Adjusted hazard ratios and 95% confidence intervals were calculated by the Cox proportional hazards model. Results— During a mean follow-up of 10.4 years, 191 participants developed a first stroke. Impaired higher-level functional capacity based on total score of the Tokyo Metropolitan Institute of Gerontology Index of Competence was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.15–2.33). Among the 3 subscales, only intellectual activity was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.21–2.22). Social role was significantly associated with stroke only among those aged ≥75 years (hazard ratio, 1.78; 95% confidence interval, 1.07–2.98). Conclusions— Impaired higher-level functional capacity, especially in the domain of intellectual activity, was a predictor of stroke, even among community-dwelling older adults with independent basic activities of daily living at baseline. Monitoring of higher-level functional capacity might be useful to detect those at higher risk of developing stroke in the future.

Reference values and associated factors for Japanese newborns' blood pressure and pulse rate: the babies' and their parents' longitudinal observation in Suzuki Memorial Hospital on intrauterine period (BOSHI) study.

Objective: Currently, normative means and ranges of blood pressure (BP) and pulse rates in Japanese newborns are not available. The objective of the present study was to estimate BP, pulse rate, and their distribution among Japanese newborns. Methods: Using oscillometric devices, arm or calf BP and pulse rate levels were obtained from 3148 infants born between 2007 and 2014, consecutively at Suzuki Memorial Hospital, Iwanuma, Japan. Of those, data from 2628 full-term, singleton newborns with BP measured on day 3 after birth were analyzed. Results: Arm SBP/DBP and pulse rate in the reference group (n = 2628) were 70.5 ± 7.4/44.3 ± 6.7 mmHg and 117.3 ± 16.6 bpm, respectively. The 5–95th percentiles were 58–83 mmHg for SBP, 35–57 mmHg for DBP, and 91–145 bpm for pulse rate. Similar values were obtained from calf measurements. In multiple regression analysis, birth weight and spontaneous cephalic delivery were positively and light/deep sleep was inversely associated with higher arm SBP/DBP (P ⩽ 0.04), whereas sex, Apgar score, gestational age, and mothers age did not significantly affect BP levels (P ≥ 0.06). Male sex, gestational age, spontaneous cephalic delivery, and light/deep sleep were inversely associated with higher pulse rate (P ⩽ 0.02). Conclusion: The present study is the first to show the distributions of Asian newborns’ BP levels and pulse rate. The assessment of newborns’ BP levels and pulse rate should consider birth weight, gestational age after birth, and actual condition at BP measurement.

Risk Factors for Stroke among Young-Old and Old-Old Community-Dwelling Adults in Japan: The Ohasama Study

Aim: Few studies have addressed stroke risk factors in older populations, particularly among the old-old. We examined differences in traditional risk factors for stroke among the old-old compared with the young-old in community-dwelling Japanese adults. Methods: We followed 2,065 residents aged ≥ 60 years who had no history of stroke. Traditional risk factors for stroke were obtained from a self-administered questionnaire at baseline. We classified participants into two age categories, 60–74 years (n = 1,502) and ≥ 75 years (n = 563), and assessed whether traditional risk factors were differentially associated with stroke incidence according to age category. Hazard ratios were calculated by the Cox proportional hazards model, adjusting for confounding factors and competing risk of death. Results: During a median follow-up of 12.8 and 7.9 years, 163 and 111 participants aged 60–74 and ≥ 75 years, respectively, developed a first stroke. Hypertension was consistently associated with increased risk of stroke, regardless of age category. Diabetes mellitus was associated with increased risk of stroke in those aged 60–74 years (hazard ratio, 1.50; 95% confidence interval, 1.00–2.25), but not in those aged ≥ 75 years (hazard ratio, 0.65; 95% confidence interval, 0.33–1.29), with significant interaction by age (P = 0.035). No traditional risk factor other than hypertension was associated with stroke among those aged ≥ 75 years. Conclusion: Those with hypertension had significantly higher stroke risk among old people, while diabetes mellitus was differentially associated with stroke according to age category. Our findings indicate the importance of different prevention strategies for stroke incidence according to age category.

The velocity of antihypertensive effects of seven angiotensin II receptor blockers determined by home blood pressure measurements.

Background: We aimed to examine the blood pressure (BP)-lowering effect and the time to attain the maximal antihypertensive effect (stabilization time) of several angiotensin II receptor blockers (ARBs) based on home BP measurements. Methods: We surveyed consecutive newly diagnosed, untreated patients with hypertension who started the treatment with a mid-level dose of one of seven ARBs (losartan 50 mg, telmisartan 40 mg, candesartan 8 mg, olmesartan 20 mg, valsartan 80 mg, irbesartan 100 mg, or azilsartan 20 mg). All study participants measured home BP in the morning for at least 1 week during an untreated period and 4 weeks during the treatment period. Results: Age, the proportion of men, and baseline home BP levels did not differ significantly between groups (total n = 232; age, 62.2 years; 50.9% men; home SBP/DBP, 151.6/90.0 mmHg). Significant differences in the BP-lowering effect and the stabilization time between ARBs were observed (P ⩽ 0.02). The extent of BP-lowering effects of azilsartan 20 mg was significantly greater than that of valsartan 80 mg or irbesartan 100 mg (15.3 vs. 7.9 or 8.2 mmHg, respectively P ⩽ 0.03). The stabilization time of losartan for home SBP was significantly longer than that of valsartan, irbesartan, or azilsartan (22.8 vs. 7.1, 4.7, or 7.1 days, respectively, P ⩽ 0.01). Conclusion: The maximum effect and the stabilization time differed among ARBs used at the mid-level dose in Japan. An ARB should be chosen based on its desired characteristics.

Monitoring and evaluation of out-of-office blood pressure during pregnancy

Blood pressure (BP) is important to measure during pregnancy because it provides the basis for classifying hypertension, which has several etiologies. Similarly, monitoring home and ambulatory BP can provide useful information outside a medical setting for adults who are not pregnant. Office BP is higher during early pregnancy in primiparous women than in multiparous women, whereas out-of-office BP does not differ between them. White-coat hypertension might be benign compared with hypertension determined from ambulatory BP values that might be associated with a high risk for preeclampsia. Although reference values have been proposed on the basis of the distribution of BP among normotensive pregnant women, prognosis-based reference values are also required.

Menstrual Factors and Stroke Incidence in Japanese Postmenopausal Women: The Ohasama Study

Background: The association between stroke and menstrual factors, for example, age at the time of menarche and age at the time of menopause, has not been well studied so far and the findings are inconsistent. We sought to examine this association in Japanese postmenopausal women. Methods: We followed 1,412 postmenopausal women aged ≥35 without a history of stroke in Ohasama, Japan. Baseline data were collected using a self-administered questionnaire. Adjusted hazard ratios (HRs) and 95% CIs of each menstrual factor for stroke incidence were calculated using the Cox proportional hazard model. Results: During a median follow-up of 12.8 years, 143 participants developed a stroke for the first time. Women aged ≤13 at the time of menarche had a significantly higher probability of encountering a stroke incidence in their lives compared with women aged 15 at the time of menarche (HR 1.83; 95% CI 1.04-3.22). The same was also true for cerebral infarction (HR 2.34; 95% CI 1.18-4.66). While early menopause was not significantly associated with stroke incidence, women aged ≤45 at the time of menopause faced a higher risk for cerebral infarction compared with women aged 50 years at the time of menopause (HR 3.25; 95% CI 1.54-6.86). Conclusions: Early menarche and its associated features might be a useful tool for future intervention strategies targeting modifiable factors that trigger menstrual onset.

Nocturnal blood pressure decline based on different time intervals and long-term cardiovascular risk: the Ohasama Study

ABSTRACT A diminished nocturnal decline in blood pressure (BP) represents a risk factor for cardiovascular disease. To define daytime and nighttime ambulatory BP, clock time-dependent methods are used when information on diary-based sleeping time is unavailable. We aimed to compare fixed-clock intervals with diary records to identify nocturnal BP declines as a predictor of long-term cardiovascular risk among the general population. Data were obtained from 1714 participants with no history of cardiovascular disease in Ohasama, Japan (mean age, 60.6 years; 64.9% women). We defined extreme dippers, dippers, non-dippers, and risers as nocturnal systolic BP decline ≥20%, 10–19%. 0–9%, and <0%, respectively. Over a mean follow-up period of 17.0 years, 206 cardiovascular deaths occurred. Based on diary records, multivariable-adjusted hazard ratios (HRs) for cardiovascular death compared with dippers were 1.24 (95% confidence interval [CI], 0.82–1.87) in extreme dippers, 1.21 (0.87–1.69) in non-dippers, and the highest HR of 2.31 (1.47–3.62) was observed in risers. Using a standard fixed-clock interval (daytime 09:00–21:00; nighttime 01:00–06:00), a nighttime 2 h-early shifted fixed-clock (daytime 09:00–21:00; nighttime 23:00–04:00), or a nighttime 2 h-late shifted fixed-clock (daytime 09:00–21:00; nighttime 03:00–08:00), the HR (95%CI) in risers compared with dippers was 1.57 (1.08–2.27), 2.02 (1.33–3.05), or 1.29 (0.86–1.92), respectively. Although use of diary records remains preferable, the standard and nighttime 2 h-early shifted fixed-clock intervals appear feasible for population-based studies.

Long-Term Stroke Risk Due to Partial White-Coat or Masked Hypertension Based on Home and Ambulatory Blood Pressure Measurements

The prognostic significance of white-coat hypertension (WCHT) is controversial, and different findings on self-measured home measurements and 24-h ambulatory monitoring make identifying WCHT difficult. We examined whether individuals with partially or completely defined WCHT, as well as masked hypertension, as determined by different out-of-office blood pressure measurements, have a distinct long-term stroke risk. We followed 1464 participants (31.8% men; mean age, 60.6±10.8 years) in the general population of Ohasama, Japan, for a median of 17.1 years. A first stroke occurred in 212 subjects. Using sustained normal blood pressure (events/n=61/776) as a reference, adjusted hazard ratios for stroke (95% confidence intervals; events/n) were 1.38 (0.82–2.32; 19/137) for complete WCHT (isolated office hypertension), 2.16 (1.36–3.43; 29/117) for partial WCHT (either home or ambulatory normotension with office hypertension), 2.05 (1.24–3.41; 23/100) for complete masked hypertension (both home and ambulatory hypertension with office normotension), 2.08 (1.37–3.16; 38/180) for partial masked hypertension (either home or ambulatory hypertension with office normotension), and 2.46 (1.61–3.77; 42/154) for sustained hypertension. When partial WCHT and partial masked hypertension groups were further divided into participants only with home hypertension and those only with ambulatory hypertension, all subgroups had a significantly higher stroke risk (adjusted hazard ratio ≥1.84, P⩽0.04). In conclusion, impacts of partial WCHT as well as partial masked hypertension for long-term stroke risk were comparable to those of complete masked hypertension or sustained hypertension. We need both home and 24-h ambulatory blood pressure measurements to evaluate stroke risk accurately.