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(Stroke. 2009;40:2859.)
© 2009 American Heart Association, Inc.

Research Letters

Stroke Risk of Blood Pressure Indices Determined by Home Blood Pressure Measurement

The Ohasama Study

Ryusuke Inoue, MD, PhD; Takayoshi Ohkubo, MD, PhD; Masahiro Kikuya, MD, PhD; Hirohito Metoki, MD, PhD; Kei Asayama, MD, PhD; Atsuhiro Kanno, MD; Taku Obara, PhD; Takuo Hirose, PhD; Azusa Hara, PhD; Haruhisa Hoshi, MD, PhD; Kazuhito Totsune, MD, PhD; Hiroshi Satoh, MD, PhD; Yoshiaki Kondo, MD, PhD Yutaka Imai, MD, PhD

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

Correspondence to Takayoshi Ohkubo, MD, PhD, Department of Planning of Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan. E-mail tohkubo{at}mail.tains.tohoku.ac.jp

Background and Purpose— The purpose of this prospective cohort study was to investigate associations between stroke and blood pressure (BP) indices (systolic BP [SBP], diastolic BP [DBP], mean BP, and pulse pressure [PP]) determined by home BP measurement.

Methods— Associations between stroke and BP indices were examined in a rural Japanese population. Home BP data of 2369 subjects (40% men) 35 years of age (mean, 59 years) without a history of stroke were obtained. Associations between stroke and each index were determined using Cox proportional hazards regression and the likelihood ratio (LR) test.

Results— During follow-up (mean, 11.7 years), 238 strokes occurred. The LR test showed that SBP and mean BP were significantly more strongly associated with total and ischemic stroke than DBP and PP (LR ² 9.3, P<0.01 for SBP/mean BP, LR ² 3.8, P0.05 for DBP/PP). SBP tended to be more strongly associated with total/ischemic stroke than mean BP (LR ²=3.8, P=0.05 for SBP, LR ² 0.2, P>0.6 for mean BP). PP tended to be slightly more strongly associated with ischemic stroke than DBP (LR ²=7.5, P<0.01 for DBP, LR ²=9.3, P<0.01 for PP), whereas DBP was significantly more strongly associated with hemorrhagic stroke than PP (LR ²=9.2, P<0.01 for DBP, LR ²=2.5, P=0.01 for PP).

Conclusion— PP obtained from home BP measurements was weakly associated with stroke, whereas SBP showed the strongest association. Additionally, DBP and PP may be associated with different stroke types.

Key Words: diastolic blood pressure • home blood pressure measurement • mean blood pressure • pulse pressure • stroke • systolic blood pressure