Serial Blood Pressure Measurements and Cardiovascular Disease in a Japanese Cohort

A cohort of 16,711 residents of Hiroshima and Nagasaki have participated in a program of biennial clinical examination and history taking that began in 1958. During 1958-1974, a total of 621 confirmed cases of cerebrovascular disease and 218 confirmed cases of coronary heart disease were incident. This study makes a detailed examination of the relationship between a series of biennial examination blood pressure (BP) measurements and cardiovascular disease risk. Two aspects are emphasized: the quantitative relationship between risk and both systolic blood pressure (SBP) and diastolic blood pressure (DBP), and the predictive value of BP levels some years in the past, given more recent BP determinations. Cerebral hemorrhage incidence is shown to depend markedly on recent DBP level, while earlier DBP levels make an additional important contribution to risk prediction. Corresponding SBP levels have little additional predictive value. With cerebral infarction, SBP is the more important predictor, though elevated DBP conveys some additional risk at high SBP levels. Recent BP levels are more strongly predictive for cerebral infarction than are BP levels some years earlier. Elevated SBP is also an important predictor of coronary heart disease risk in this population, while elevated DBP does not appear to be predictive at specified SBP. SBP levels several years in the past are more closely associated with coronary heart disease risk than are recent SBP readings. The dependence of BP relative risk functions on sex and age is examined and some departures from the results just listed are noted at younger ages. Implications for disease mechanism and hypertensive therapy are discussed.