| Co-Investigator(Kenkyū-buntansha) |
YANAGAWA Hiroshi Jichi Medical School, Professor, 医学部, 教授 (30077169)
NAKAMURA Yoshikazu Jichi Medical School, Associated professor, 医学部, 助教授 (50217915)
SHIMADA Kazuyuki Jichi Medical School, Professor, 医学部, 教授 (90145128)
MITSUHASHI Takeshi Jichi Medical School, Assistant, 医学部, 講師 (60275675)
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| Research Abstract |
Abnormal patterns of diurnal blood pressure (BP) variation have been reported to be associated with both clinically overt and silent target organ damage of BP level. In Japan, compared to Western Societies, coronary artery disease is a much less common consequence of hypertension, but stroke is more common. To investigate the relationship between diurnal BP variations and stroke in older Japanese hypertensive patients. We performed 24-hr ambulatory BP monitoring (ABPM) in 821 older hypertensive patients (mean age : 72 years ; 315 men and 506 women) of WHO hypertension stages I and II, who were untreated for at least 2 weeks, and assessed the incidence of cerebrovascular diseases including transient ischemic attack. The follow-up was accomplished in 811 (99%) out of 821 hypertensive patients. Among these, 236 (29%) were classified as having white coat hypertension (24-hr BP less than 130/80 mmHg). The remaining 575 sustained hypertensive patients were subclassified based on the nocturna
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l SBP fall, as follows : 97 extreme-dippers (17%) with * 20% nocturnal BP fall ; 230 dippers (40%) with * 10% but <(20% fall 185 non-dippers (32%) with *0% but (10% fall ; 63 reverse dippers (11%) with <0% fall. Seventy five stroke events were observed during the follow-up period (mean : 41.2 months ; range : 1-68 months). The stroke incidence rate (/1000 person-years) was 32.8 in the sustained hypertension group, while it was 13.1 in the white coat hypertensive group. The incidence rate of stroke in the sustained hypertensive subgroups was 74.8 for reverse-dippers, 39.7 foi extreme-dippers, 28.1 for non-dippers, and 22.1 for dippers. There is a J-shaped relationships. between the nocturnal BP fall and stroke incidence in older Japanese hypertensive patients Both the extreme-dipping and reversed-dipping patterns of nocturnal BP fall may be a risk factor for stroke in older Japanese hypertensive patients. The risk of stroke is lower in the patients with white coat hypertension than those with sustained hypertension. Less
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