Comparison of the effect of blood pressure on the development of stroke, acute myocardial infarction, and end-stage renal disease

Hypertension is a known risk factor for cardiovascular disease, but few epi demiological studies have examined simultaneously the effect of baseline bl ood pressure on the development of stroke, acute myocardial infarction (AMI ), and end-stage renal disease (ESRD). In 1983, a large, community-based ma ss screening covered about 14% of the adult population in Okinawa, Japan. T he total number of people screened was 107,192 (51,122 men, 56,070 women). We had access to two independent registries of end-organ damage: the Go-ope rative Study Group of Morbidity and Mortality of Cardiovascular Diseases in Okinawa (COSMO) registry for stroke and AMI, and the Okinawa Dialysis Stud y (OKIDS) registry for ESRD. The total number of people registered was 4,75 6 with stroke, 1,059 with AMI, and 641 with ESRD during the study period fr om April 1, 1988, to March 31, 1991. By using the name, sex, birth date, an d ZIP code of registrants, we identified those registrants who were screene d in 1983 and had developed stroke, AMI, or ESRD. Hypertension was defined as systolic blood pressure(SBP) of 140 mmHg or higher or diastolic blood pr essure (DBP) of 90 mmHg or higher. Other readings were regarded as normoten sive. The prevalence of hypertension was 35.8% (N = 37,299). The cumulative incidence of stroke, AMI, and ESRD was 154, 21, and 19 subjects among thos e with SBP less than or equal to 119 mmHg, and 1933, 315, and 71 subjects a mong those with SBP greater than or equal to 160 mmHg. Similarly, the incid ence of stroke, AMI, and ESRD was 234, 44, and 25 subjects among those with DBP less than or equal to 69 mmHg and 1980, 381, and 364 subjects among th ose with DBP greater than or equal to 110 mmHg. Hypertension was prevalent in the adult population in Okinawa, Japan, and was a significant predictor of stroke, AMI, and ESRD. However, the effect of blood pressure on target o rgans differed and was more evident in those with stroke than in those with AMI and ESRD. (Hypertens Res 2000; 23: 143-149).