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(Stroke. 2009;40:2674.)
© 2009 American Heart Association, Inc.

Original Contributions

Relationship Between Blood Pressure Category and Incidence of Stroke and Myocardial Infarction in an Urban Japanese Population With and Without Chronic Kidney Disease

The Suita Study

Yoshihiro Kokubo, MD, PhD; Satoko Nakamura, MD, PhD; Tomonori Okamura, MD, PhD; Yasunao Yoshimasa, MD, PhD; Hisashi Makino, MD, PhD; Makoto Watanabe, MD, PhD; Aya Higashiyama, MD; Kei Kamide, MD, PhD; Katsuyuki Kawanishi, MD, PhD; Akira Okayama, MD, PhD Yuhei Kawano, MD, PhD

From the Department of Preventive Cardiology (Y. Kokubo, T.O., M.W., A.H., A.O.), the Division of Hypertension and Nephrology (S.N., K. Kamide, Y. Kawano), and the Department of Atherosclerosis and Diabetes (Y.Y., H.M.), National Cardiovascular Center, Osaka, Japan; the Department of Geriatric Medicine (K. Kamide), Osaka University Graduate School of Medicine, Osaka, Japan; the Suita Medical Association (K. Kawanishi), Osaka, Japan; and the Japan Anti-Tuberculosis Association (A.O.), Tokyo, Japan.

Correspondence to Yoshihiro Kokubo, MD, PhD, FAHA, Department of Preventive Cardiology, National Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565 Japan. E-mail ykokubo{at}hsp.ncvc.go.jp

Background and Purpose— Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for stroke and myocardial infarction (MI). Few studies, however, have examined the relationship between blood pressure (BP) category and these diseases in subjects with and without CKD.

Methods— We studied 5494 Japanese individuals (ages 30 to 79, without stroke or MI at baseline) who completed a baseline survey and received follow-up through December 2005. The glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease study equation modified by the Japanese coefficient. CKD was defined as an estimated GFR <60 mL/min/1.73m². BP categories were defined by the European Society of Hypertension and European Society of Cardiology 2007 criteria.

Results— In 64 395 person-years of follow-up, we documented 346 incidences of cardiovascular diseases (CVD; 213 strokes and 133 MI events). Compared with the GFR (90 mL/min/1.73m²) group, the hazard ratios (95% confidential intervals) for stroke were 1.9 (1.3 to 3.0) in the GFR 50 to 59 mL/min/1.73m² group and 2.2 (1.2 to 4.1) in the GFR <50 mL/min/1.73m² group. Results for cerebral infarction were similar. Compared with the optimal BP subjects without CKD, the normal BP, high-normal BP, and hypertensive subjects without CKD showed increased risks of CVD and stroke; however the impact of each BP category on CVD (P for interaction: 0.04 in men, 0.49 in women) and stroke (0.03 in men, 0.90 in women) was more evident in men with CKD.

Conclusions— CKD may increase the association of BP and CVD in a Japanese urban population.

Key Words: chronic kidney disease • blood pressure category • stroke • myocardial infarction • epidemiology • prospective studies • general population