Details of a Researcher - Okamura, Tomonori

Papers - Okamura, Tomonori

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Hypertension and medical expenditure in the Japanese population: Review of prospective studies.

Nakamura K, Okamura T, Miura K, Okayama A

World journal of cardiology 6 ( 7 ) 531 - 8 2014.07

Research paper (scientific journal)

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Hypertension and medical expenditure in the Japanese population: Review of prospective studies.

Nakamura K, Okamura T, Miura K, Okayama A

World journal of cardiology 6 ( 7 ) 531 - 8 2014.07

Research paper (scientific journal)

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Lipoprotein particle profiles compared with standard lipids in association with coronary artery calcification in the general Japanese population

Hisamatsu Takashi, Fujiyoshi Akira, Miura Katsuyuki, Ohkubo Takayoshi, Kadota Aya, Kadowaki Sayaka, Kadowaki Takashi, Yamamoto Takashi, Miyagawa Naoko, Zaid Maryam, Torii Sayuki, Takashima Naoyuki, Murakami Yoshitaka, Okamura Tomonori, Horie Minoru, Ueshima Hirotsugu

Atherosclerosis 236 ( 2 ) 237 - 243 2014.07

Research paper (scientific journal), Joint Work, Accepted, ISSN 0021-9150

Objective: The utility of lipoprotein particle profiles measured by nuclear magnetic resonance (NMR) spectroscopy beyond standard serum lipids remains inconclusive. Furthermore, few studies have compared NMR measurements with standard lipids in association with coronary artery calcification (CAC) in Japanese, where the coronary atherosclerotic burden is low. We examined whether NMR-based lipoprotein particle profiles are associated with CAC, and compared them with standard lipid and lipid ratios in the Japanese general population. Methods and Results: We conducted a cross-sectional study in 851 men aged 40-79 years without cardiovascular diseases and lipid-lowering therapies. Adjusted odds ratios (ORs) (95% confidence intervals) for the top versus the bottom quartile of NMR-measured particle concentrations were 2.01 (1.24-3.23) for low-density lipoprotein (LDL-P), 1.04 (0.62-1.75) for high-density lipoprotein (HDL-P), 1.82 (1.13-2.95) for very-low-density lipoprotein (VLDL-P), and 1.92 (1.18-3.17) for LDL-P/HDL-P ratio. Similarly adjusted ORs of NMR-measured particle sizes were 0.59 (0.36-0.97) for LDL-P, 0.66 (0.40-1.10) for HDL-P, and 0.67 (0.40-1.12) for VLDL-P. The corresponding ORs were 1.82 (1.14-2.90) for total cholesterol (TC), 2.06 (1.28-3.30) for low-density lipoprotein cholesterol (LDL-C), 0.56 (0.34-0.91) for high-density lipoprotein cholesterol (HDL-C), 2.02 (1.24-3.29) for triglycerides, 2.08 (1.29-3.36) for non-high-density lipoprotein cholesterol (non-HDL-C), 2.27 (1.37-3.78) for TC/HDL-C ratio, and 1.73 (1.06-2.85) for LDL-C/HDL-C ratio. After mutual adjustment for total LDL-P concentration and TC/HDL-C ratio or non-HDL-C, LDL-P was no longer associated, whereas TC/HDL-C ratio remained significantly associated with CAC. Conclusions: In community-based Japanese men, the overall association of CAC with NMR-measured lipoprotein indices is comparable, but not superior, to that with standard lipids.

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Validation of homogeneous assays for HDL-cholesterol using fresh samples from healthy and diseased subjects

Miida Takashi, Nishimura Kunihiro, Okamura Tomonori, Hirayama Satoshi, Ohmura Hirotoshi, Yoshida Hiroshi, Miyashita Yoh, Ai Masumi, Tanaka Akira, Sumino Hiroyuki, Murakami Masami, Inoue Ikuo, Kayamori Yuzo, Nakamura Masakazu, Nobori Tsutomu, Miyazawa Yukihisa, Teramoto Tamio, Yokoyama Shinji

Atherosclerosis 233 ( 1 ) 253 - 259 2014.03

Research paper (scientific journal), Joint Work, Accepted, ISSN 0021-9150

Background: High-density lipoprotein-cholesterol (HDL-C) is a negative risk factor for cardiovascular events. Although several homogeneous HDL-C assays are available, their accuracy has not been validated, particularly in subjects with disease. We aimed to clarify whether HDL-C concentrations measured by homogeneous assays [HDL-C (H)] agree with those determined by the reference measurement procedures [HDL-C (RMP)] using ultracentrifugation and precipitation with heparin-manganese reagent in fresh clinical samples. Methods: HDL-C concentrations in samples from 48 healthy subjects and 119 subjects with disease were determined using 12 homogeneous assays and RMPs. Results: All reagents showed excellent intra- and inter-assay CVs (<2.23%) for two pooled sera. Furthermore, the mean bias was within ±1.0% in nine reagents using samples from healthy subjects and in eight reagents using samples from subjects with disease. In a single HDL-C (H) determination, the total error requirement of the National Cholesterol Education Program (95% of results<13%) was fulfilled in nine reagents using samples from healthy subjects and six reagents in those from subjects with disease. Error component analysis revealed that only one reagent exceeded ±10% total error in samples from healthy subjects, whereas four reagents exceeded this error in samples from subjects with disease. Correlations between HDL-C (H) and HDL-C (RMP) revealed that the slopes were within 1.00±0.06 in six reagents in healthy subjects, and eight reagents in subjects with disease. Conclusions: Except for three reagents, HDL-C (H) agrees well with HDL-C (RMP) in subjects with common disease, but not in those with extremely low HDL-C or abnormal HDL composition. © 2014 The Authors.

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Steeper increases in body mass index during childhood correlate with blood pressure elevation in adolescence

Kuwahara Erika, Asakura Keiko, Nishiwaki Yuji, Komatsu Hirokazu, Nakazawa Akemi, Ushiku Hideo, Maejima Fumio, Nishigaki Yoshio, Hasegawa Tomonobu, Okamura Tomonori, Takebayashi Toru

Hypertension Research 37 ( 2 ) 179 - 184 2014.02

Research paper (scientific journal), Joint Work, Accepted, ISSN 0916-9636

The aim of this study was to clarify the relationship between long-term changes in body mass index (BMI) during childhood and adolescent blood-pressure levels in a general Japanese population. We used health report data from 900 Japanese children between 1983 and 2007. After adjusting for baseline BMI and other confounding factors multivariate linear regression analyses were performed to examine the relationship between changes in BMI (ΔBMI) over a 6-year period (6-12 years) and blood pressure once children reached ages 14 or 15. Sub-group analyses were also performed to ascertain the relationship between ΔBMI and blood pressure at 9th grade for children who had been in the bottom BMI tertile at 1st grade. Endpoint blood-pressure levels in boys (systolic and diastolic) and girls (systolic) from the group whose BMIs increased the most were significantly higher than those from the group whose BMIs increased the least (P<0.05, analysis of variance). After adjustment for baseline BMI and school-entrance year, the former group showed higher blood pressure at the endpoint than the latter (P<0.05, multiple regression analysis). Further adjustment for baseline blood pressure also showed similar results in a combined-sex analysis (n=592). Higher ΔBMI was associated with higher SBP 9 even in children whose BMI was in the lowest tertile at baseline after adjustment for sex and school-entrance year (P=0.02, multiple regression analysis). Steeper BMI increases during primary school lead to adolescent increases in blood pressure even if baseline BMI is low. Growth during childhood should be carefully managed. © 2014 The Japanese Society of Hypertension All rights reserved.

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Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese

Miyagawa Naoko, Miura Katsuyuki, Okuda Nagako, Kadowaki Takashi, Takashima Naoyuki, Nagasawa Shin ya, Nakamura Yasuyuki, Matsumura Yasuhiro, Hozawa Atsushi, Fujiyoshi Akira, Hisamatsu Takashi, Yoshita Katsushi, Sekikawa Akira, Ohkubo Takayoshi, Abbott Robert D., Okamura Tomonori, Okayama Akira, Ueshima Hirotsugu

Atherosclerosis 232 ( 2 ) 384 - 389 2014.02

Research paper (scientific journal), Joint Work, Accepted, ISSN 0021-9150

Background: Dietary intake of long-chain n-3 PUFA (LCn3FA) among Japanese is generally higher than that in Western populations. However, little is known whether an inverse association of LCn3FA with cardiovascular disease (CVD) risk exists in a population with higher LCn3FA intake. Objective: To investigate the association between LCn3FA intake and the long-term risk of CVDs in a Japanese general population. Methods: We followed-up a total of 9190 individuals (56.2% women, mean age 50.0 years) randomly selected from 300 areas across Japan and free from CVDs at baseline. Dietary LCn3FA intake was estimated using household weighed food records. Cox models were used to calculate multivariate-adjusted hazard ratios (HR) and confidence intervals (CI) according to sex specific quartiles of LCn3FA intake. Results: During 24-year follow-up (192,897 person-years), 879 cardiovascular deaths were observed. The median daily intake of LCn3FA was 0.37%kcal (0.86g/day). Adjusted HR for CVD mortality was lower in the highest quartile of LCn3FA intake (HR 0.80; 95% CI 0.66-0.96) compared with the lowest quartile, and the trend was statistically significant (P=0.038). The similar but statistically non-significant trends were observed for coronary heart disease death and stroke death. In analyses by age groups, the inverse associations of LCn3FA intake with the risk of total CVD death and stroke death were significant in younger individuals (30-59 years at baseline). Conclusion: LCn3FA intake was inversely and independently associated the long-term risk of total CVD mortality in a representative sample of Japanese with high LCn3FA intake. © 2013 Elsevier Ireland Ltd.

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Effect size and cost-effectiveness estimates of breast and cervical cancer screening reminders by population size through complete enumeration of Japanese local municipalities

Komoto Shigekazu, Nishiwaki Yuji, Okamura Tomonori, Tanaka Hideo, Takebayashi Toru

BMC Public Health 14 ( 1 ) 43 2014.01

Research paper (scientific journal), Joint Work, Accepted

Background: Client reminders are known to increase cancer screening attendance rates. However, there are significant costs associated with them, and their effect by population size is unknown. Methods. In 2007 and 2008, the Japanese Government surveyed breast and cervical cancer screening in every municipality in Japan. From the results, we selected all 1,464 municipalities that carried out both screening types. We examined whether changes in screening attendance rates between 2007 and 2008 were associated with client reminders, number of public health nurses per 100,000 population, financial strength index, and 2007 attendance rates for different population sizes. We then calculated cost-effectiveness estimates of client reminders by population size and screening type. Results: Client reminders were associated with increased attendance rates in populations <100,000. For populations of 50,000-100,000, there was a 2.76% increase in breast cancer screening (95% CI: 0.41, 5.11), and a 2.25% increase in cervical cancer screening (95% CI: 0.89, 3.61). The incremental cost per additional attendance was higher in populations <50,000 than in populations of 50,000-100,000 (breast, $100 versus $54; cervical, $149 versus $67 respectively). Conclusions: Client reminders for breast and cervical cancer screening increased attendance rates in smaller municipalities in Japan. © 2014 Komoto et al.; licensee BioMed Central Ltd.

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[Series: Clinical study from Japan and its reflections; LOX-1 ligands containing apolipoprotein B and carotid intima-media thickness in middle-aged community-dwelling US Caucasian and Japanese men].

Okamura T, Sekikawa A, Sawamura T, Ueshima H

Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 103 ( 1 ) 173 - 80 2014.01

Research paper (scientific journal), ISSN 0021-5384

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[Series: Clinical study from Japan and its reflections; LOX-1 ligands containing apolipoprotein B and carotid intima-media thickness in middle-aged community-dwelling US Caucasian and Japanese men].

Okamura T, Sekikawa A, Sawamura T, Ueshima H

Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 103 ( 1 ) 173 - 80 2014.01

Research paper (scientific journal), ISSN 0021-5384

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Impact of metabolic syndrome on the risk of cardiovascular disease mortality in the united states and in Japan

Liu Longjian, Miura Katsuyuki, Fujiyoshi Akira, Kadota Aya, Miyagawa Naoko, Nakamura Yasuyuki, Ohkubo Takayoshi, Okayama Akira, Okamura Tomonori, Ueshima Hirotsugu

American Journal of Cardiology 113 ( 1 ) 84 - 89 2014.01

Research paper (scientific journal), Accepted, ISSN 0002-9149

The United States has a higher prevalence of metabolic syndrome (MS) and cardiovascular disease (CVD) mortality than Japan, but it is unknown how much of the difference in MS accounts for the mortality difference. The aim of this study was to examine the impact of MS on the excess CVD mortality in the United States compared with that in Japan. Data from the United States Third National Health and Nutrition Examination Survey (NHANES III; n = 12,561) and the Japanese National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in Aged (NIPPON DATA; n = 7,453) were analyzed. MS was defined as ≥3 of 5 risk factors (obesity, high blood pressure, decreased high-density lipoprotein cholesterol, elevated glycosylated hemoglobin, and elevated triglycerides). The results show that after a median of 13.8 years of follow-up in the United States, 1,683 patients died from CVD (11.75 per 1,000 person-years), and after a median of 15 years of follow-up in Japan, 369 patients died from CVD (3.56 per 1,000 person-years). The age-adjusted prevalence of MS was 26.7% in the United States and 19.3% in Japan. Of 5 MS factors, obesity, high blood pressure, elevated triglycerides, and glycosylated hemoglobin in the United States, and high blood pressure and elevated glycosylated hemoglobin in Japan were significant risk factors for CVD mortality. Estimates of 13.3% and 44% of the excess CVD mortality for the United States could be explained by the higher prevalence of MS and MS plus baseline CVD history than in Japan. In conclusion, the present study is the first to quantitatively demonstrate that MS and MS plus baseline CVD history may significantly contribute to the explanation of excess CVD mortality in the United States compared with Japan. © 2014 Elsevier Inc. All rights reserved.

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Coronary Artery Disease

Teramoto Tamio, Sasaki Jun, Ishibashi Shun, Birou Sadatoshi, Daida Hiroyuki, Dohi Seitaro, Egusa Genshi, Hiro Takafumi, Hirobe Kazuhiko, Iida Mami, Kihara Shinji, Kinoshita Makoto, Maruyama Chizuko, Ohta Takao, Okamura Tomonori, Yamashita Shizuya, Yokode Masayuki, Yokote Koutaro

Journal of Atherosclerosis and Thrombosis 21 ( 2 ) 86 - 92 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Vegetarian diets and blood pressure ameta-analysis

Yokoyama Yoko, Nishimura Kunihiro, Barnard Neal D., Takegami Misa, Watanabe Makoto, Sekikawa Akira, Okamura Tomonori, Miyamoto Yoshihiro

JAMA Internal Medicine 174 ( 4 ) 577 - 587 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 2168-6106

IMPORTANCE Previous studies have suggested an association between vegetarian diets and lower blood pressure (BP), but the relationship is not well established. OBJECTIVE To conduct a systematic review and meta-analysis of controlled clinical trials and observational studies that have examined the association between vegetarian diets and BP. DATA SOURCES MEDLINE andWeb of Science were searched for articles published in English from 1946 to October 2013 and from 1900 to November 2013, respectively. STUDY SELECTION All studiesmet the inclusion criteria of the use of (1) participants older than 20 years, (2) vegetarian diets as an exposure or intervention, (3) mean difference in BP as an outcome, and (4) a controlled trial or observational study design. In addition, none met the exclusion criteria of (1) use of twin participants, (2) use of multiple interventions, (3) reporting only categorical BP data, or (4) reliance on case series or case reports. DATA EXTRACTION AND SYNTHESIS Data collected included study design, baseline characteristics of the study population, dietary data, and outcomes. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Net differences in systolic and diastolic BP associated with the consumption of vegetarian diets were assessed. RESULTS Of the 258 studies identified, 7 clinical trials and 32 observational studiesmet the inclusion criteria. In the 7 controlled trials (a total of 311 participants; mean age, 44.5 years), consumption of vegetarian diets was associated with a reduction in mean systolic BP (?4.8 mmHg; 95%CI, ?6.6 to ?3.1; P < .001; I2 = 0; P = .45 for heterogeneity) and diastolic BP (?2.2 mmHg; 95%CI, ?3.5 to ?1.0; P < .001; I2 = 0; P = .43 for heterogeneity) compared with the consumption of omnivorous diets. In the 32 observational studies (a total of 21 604 participants; mean age, 46.6 years), consumption of vegetarian diets was associated with lower mean systolic BP (?6.9mmHg; 95%CI, ?9.1 to ?4.7; P < .001; I2 = 91.4; P < .001 for heterogeneity) and diastolic BP (?4.7mmHg; 95%CI, ?6.3 to ?3.1; P < .001; I2 = 92.6; P < .001 for heterogeneity) compared with the consumption of omnivorous diets. CONCLUSIONS AND RELEVANCE Consumption of vegetarian diets is associated with lower BP. Such diets could be a useful nonpharmacologic means for reducing BP. Copyright © 2014 American Medical Association. All rights reserved.

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Relationship between shift work and clustering of the metabolic syndrome diagnostic components

Kawabe Yuri, Nakamura Yasuyuki, Kikuchi Sayuri, Murakami Yoshitaka, Tanaka Taichiro, Takebayashi Toru, Okayama Akira, Miura Katsuyuki, Okamura Tomonori, Ueshima Hirotsugu

Journal of Atherosclerosis and Thrombosis 21 ( 7 ) 703 - 711 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

Aim: To examine the relationship between the type of work and the number of metabolic syndrome diagnostic componentsS (MetS-DC), as well as the risk of MetS, with adjustment for lifestyle habits in Japanese workers. Methods: We examined the baseline data from 4,427 participants (81.4% male) aged 19 to 69 years old. The physical activity of each participant was classified according to the International Physical Activity Questionnaire (IPAQ). We defined the four MetS-DC in this study as follows: 1) high blood pressure (BP): systolic BP ≥ 130 mmHg, or diastolic BP ≥ 85 mmHg, or the use of antihypertensive drugs; 2) dyslipidemia: high-density lipoprotein-cholesterol concentration <40 mg/dl or triglyceride concentration ≥ 150 mg/dl, or on medication for dyslipidemia; 3) dysglycemia: fasting blood sugar level ≥ 110 mg/dl, or if less than eight hours after meals ≥ 140 mg/dl, or on medication for diabetes mellitus; 4) overweight: a body mass index ≥ 25 kg/m2. We defined MetS as overweight plus two or more of the MetS-DC. Results: There were 3,094 subjects in the daytime work group, 73 in the fixed nighttime work group, 1,017 in the shift work group and 243 in the day-to-night work group. The Poisson regression analysis revealed that fixed nighttime (regression coefficient [b] = -0.233, P=0.028) and shift work (b=0.098, P=0.034) independently contributed to the number of MetS-DC, compared to daytime work. The multivariate logistic analysis not including sleep hours in the model showed that shift work was positively related to MetS (odd ratio = 1.47, P<0.01). Conclusion: Shift work were significantly associated with the number of MetS-DC, and was related to risk of MetS compared to daytime work.

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Worksite wellness for the primary and secondary prevention of cardiovascular disease in Japan

Okamura Tomonori, Sugiyama Daisuke, Tanaka Taichiro, Dohi Seitaro

Progress in Cardiovascular Diseases 56 ( 5 ) 515 - 521 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 0033-0620

In the Japanese workplace, employers are required to provide annual health checkups for workers in accordance with the "Industrial Safety and Health Law," which also mandates that an occupational physician be assigned to companies employing at least 50 workers. The annual medical examination includes testing for the early detection of cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, and the metabolic syndrome. This approach has successfully contributed to the extremely low incidence of coronary artery disease among Japanese workers. However, problems such as poor health and the low rate of participation in health checkups among small-scale companies still persist. Furthermore, although most wellness delivery systems in Japan employ strategies targeting high-risk individuals, instituting a strategy addressing the broader population irrespective of screening may be effective in reducing disease risk in the overall population. As a future direction, we should therefore develop practical methods for implementing a population strategy. © 2014 Elsevier Inc.

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High long-chain n-3 fatty acid intake attenuates the effect of high resting heart rate on cardiovascular mortality risk

Hisamatsu Takashi, Miura Katsuyuki, Ohkubo Takayoshi, Yamamoto Takashi, Fujiyoshi Akira, Miyagawa Naoko, Kadota Aya, Takashima Naoyuki, Okuda Nagako, Yoshita Katsushi, Kita Yoshikuni, Murakami Yoshitaka, Nakamura Yasuyuki, Okamura Tomonori, Horie Minoru, Okayama Akira, Ueshima Hirotsugu

Journal of Cardiology 64 ( 3 ) 218 - 224 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 0914-5087

Background: Increased resting heart rate (RHR) independently predicts cardiovascular mortality. Meanwhile, long-chain n-3 fatty acids (LCn3FAs) have a cardioprotective effect. Our aim was to evaluate whether higher LCn3FAs intake attenuates the elevated risk of cardiovascular mortality associated with increased RHR. Methods: We conducted a population-based 24-year prospective cohort study of Japanese, whose LCn3FAs intake is relatively high. Study participants included 8807 individuals aged 30-95 years from randomly selected areas across Japan without cardiovascular diseases and anti-hypertensive drugs at baseline. The primary endpoint was cardiovascular mortality, and the secondary endpoints were cardiac and stroke mortality during 24 years of follow-up. Individual dietary LCn3FAs intake was estimated from household-based 3-day weighed food records. RHR was obtained from 3 consecutive R-wave intervals on 12-lead electrocardiography. Cox models were used to estimate the multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) adjusting for possible confounders. Results: During the follow-up period, 617 cardiovascular deaths were observed. The median daily intake of LCn3FAs was 0.37% kcal (0.86. g/day). The interaction between dietary LCn3FAs intake and RHR in the risk of cardiovascular mortality was statistically significant (p= 0.033). The risk of cardiovascular mortality was significantly higher in the low-intake group (<0.37%. kcal) with an RHR >85. beats/min (bpm) [hazard ratio (HR), 1.67; 95% confidence interval (CI), 1.15-2.43], but not in the high-intake group (≥0.37%. kcal) with an RHR >85. bpm (HR, 0.92; 95% CI, 0.61-1.38), compared with those in the high-intake group with an RHR <70. bpm. Similar results were observed with stroke mortality, but not with cardiac mortality. Conclusions: The risk of cardiovascular mortality associated with increased RHR is elevated in participants with low dietary LCn3FAs intake, but not in participants with high dietary LCn3FAs intake in a representative Japanese general population. These results suggest that high dietary LCn3FAs intake may prevent cardiovascular mortality associated with increased RHR.

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Women

Journal of Atherosclerosis and Thrombosis 21 ( 4 ) 291 - 295 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Chronic kidney disease

Journal of Atherosclerosis and Thrombosis 21 ( 3 ) 173 - 174 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Cerebrovascular diseases

Journal of Atherosclerosis and Thrombosis 21 ( 3 ) 175 - 179 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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The elderly

Journal of Atherosclerosis and Thrombosis 21 ( 3 ) 180 - 185 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Cardiovascular risk with and without antihypertensive drug treatment in the japanese general population

Asayama Kei, Satoh Michihiro, Murakami Yoshitaka, Ohkubo Takayoshi, Nagasawa Sin Ya, Tsuji Ichiro, Nakayama Takeo, Okayama Akira, Miura Katsuyuki, Imai Yutaka, Ueshima Hirotsugu, Okamura Tomonori

Hypertension 63 ( 6 ) 1189 - 1197 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 0194-911X

To evaluate the cardiovascular mortality risk in association with blood pressure level among people with and without antihypertensive treatment, we performed the participant-level meta-analysis that included 39 705 Japanese from 6 cohorts (58.4% women; mean age, 60.1 years; 20.4% treated). Multivariable-adjusted Cox models were used to analyze the risk of cardiovascular mortality and its subtypes among 6 blood pressure levels according to recent guidelines, optimal to Grade 3 hypertension, and the usage of antihypertensive medication at baseline. During median 10.0 years of follow-up, there were 2032 cardiovascular deaths (5.1 per 1000 person-years), of which 410 deaths were coronary heart disease, 371 were heart failure, and 903 deaths were stroke. Treated participants had significantly higher risk for cardiovascular mortality (hazard ratios, 1.50; 95% confidence intervals, 1.36-1.66), coronary heart disease (hazard ratios, 1.53; confidence intervals, 1.23-1.90), heart failure (hazard ratios, 1.39; confidence intervals, 1.09-1.76), and stroke (hazard ratios, 1.48; confidence intervals, 1.28-1.72) compared with untreated people. Among untreated participants, the risks increased linearly with an increment of blood pressure category (P≤0.011). The risk increments per blood pressure category were higher in young participants (<60 years; 22% to 79%) than those in old people (≥60 years; 7% to 15%) with significant interaction for total cardiovascular, heart failure, and stroke mortality (P≤0.026). Among treated participants, the significant linear association was also observed for cardiovascular mortality (P=0.0003), whereas no stepwise increase in stroke death was observed (P=0.19). The risks of cardiovascular mortality were ≈1.5-fold high in participants under antihypertensive medication. More attention should be paid to the residual cardiovascular risks in treated patients. © 2014 American Heart Association, Inc.

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