Effect Of Diastolic Blood Pressure Research Articles

Threshold-modifying effect of the systemic inflammatory response index on kidney function decline in hypertensive patients

BackgroundChronic kidney disease (decreased kidney function) is common in hypertensive patients. The SIRI is a novel immune biomarker. We investigated the correlation between the SIRI and kidney function in hypertensive patients.MethodsThe present study analyzed data from participants who suffered from hypertension in the NHANES from 2009 to 2018. Multivariate regression analysis and subgroup analysis were used to clarify whether the SIRI was an independent risk factor for decreased kidney function. RCSs were utilized to evaluate the correlation between the SIRI and the eGFR and between the SIRI and the ACR. In addition, we modeled the mediating effect of the SIRI on the eGFR and the ACR using blood pressure as a mediating variable.ResultsThe highest SIRI was an independent risk factor for a decreased eGFR [odds ratio (OR) = 1.46, 95% CI (1.15, 1.86)] and an increased ACR [OR = 2.26, 95% CI (1.82, 2.82)] when the lowest quartile was used as the reference. The RCS results indicated an inverted U-shaped relationship between the SIRI and the eGFR and between the SIRI and the ACR (the inflection points were 1.86 and 3.09, respectively). The mediation effect analysis revealed that the SIRI was the main factor influencing kidney function, and diastolic blood pressure was a mediating variable. In particular, there was a fully mediating effect between the SIRI and UCr, with a mediating effect value of -0.61 (-0.90, -0.36).ConclusionsThe association between the SIRI and renal function in hypertensive patients was significant and was particularly dominated by the association between the SIRI and the ACR. This difference may be due to the mediating effect of diastolic blood pressure.

The Effect of Music Intervention on Anxiety and Pain During Cesarean Delivery: A Meta-Analysis of 1513 Patients

Background: A cesarean section (CS) is one of the most common operations globally, with an estimated 18.5 million surgical procedures each year. Accordingly, music therapy has become a trendy possible solution in many clinical conditions and surgical procedures. However, most previous studies have shown conflicting findings regarding the efficacy of music in reducing pain and anxiety in women with cesarean delivery. Therefore, in this meta-analysis, we aimed to investigate whether music intervention has a beneficial effect on preoperative, intraoperative, and postoperative anxiety, pain, and vital signs in women with cesarean section. Method: We conducted a comprehensive search of Scopus, Web of Science, PubMed, and Cochrane Central was conducted for relevant randomized controlled trials (RCTs) from inception until August 2022. Data were extracted from eligible studies and pooled as standardized mean difference (SMD) or mean difference (MD) values in a random-effect model meta-analysis, using RevMan software. All the steps of this study were performed according to the PRISMA statement guidelines. Results: Thirteen RCTs were included in this meta-analysis with a total of 1513 patients. Our study showed that music was superior to control in terms of overall anxiety score (SMD = - 0.26, 95% CI [- 0.39, - 0.14], p <0.0001), postoperative pain (SMD = - 0.50, 95% CI [- 0.74, - 0.26], p < 0.0001), and the overall effect of diastolic blood pressure (DBP) (MD = -1.58, 95% CI [- 3.11, - 0.04], p = 0.04). The overall effect did not favor either of the two groups in terms of systolic blood pressure (SBP) and heart rate ((MD = - 1.87, 95% CI [-4.04, 0.30], p = 0.09), (MD = - 2.10, 95% CI [- 4.78, 0.58], p = 0.12); respectively). Conclusion: Ultimately, the current evidence supports using music to alleviate the anxiety and pain of women during and after cesarean sections. In addition, our analysis revealed that music has a beneficial effect on DBP and intraoperative heart rate over control in patients with CS. However, the music did not differ significantly from the placebo in preoperative anxiety, postoperative heart rate, as well as SBP. Future RCTs are recommended to confirm the efficacy of music in the preoperative period and vital signs among women undergoing cesarean section.

Longitudinal Trends in Blood Pressure Associated with The Changes in Living Environment Caused by the Great East Japan Earthquake: The Fukushima Health Management Survey.

The Great East Japan Earthquake occurred on 11 March 2011, forcing Fukushima Prefecture residents to change their living environment. Such sudden changes possibly have long-term effects on cardiovascular-related diseases. We therefore sought to identify temporal relationships between living environment changes and blood pressure levels over three years following the earthquake. Participants included 14,941 men and 21,533 women aged 16 years or older who answered self-administered questionnaires, including questions on living environment changes at baseline (2012). Blood pressure levels were measured each year from 2012 to 2015. Linear mixed-effects models were used to analyze associations between living environment changes and blood pressure levels. Men with changes in living environment (i.e., those living in shelters or in temporary housing, rental apartments, relatives' houses, or others) showed significantly higher diastolic blood pressure levels than those who lived in their home at baseline (77.3 mmHg vs. 77.8 mmHg; p < 0.001). The time-dependent effect of diastolic blood pressure levels associated with living environment was not statistically significant, indicating a sustained difference in diastolic blood pressure associated with living environment changes at baseline after three years. The effect of living environment changes on diastolic blood pressure increment was also evident in men without antihypertensive medication use during the study period and in men who were current drinkers at baseline. There were no associations between living environment changes and diastolic blood pressure levels among women. Sudden changes in living environment due to the disaster had an impact on the long-term effects of higher diastolic blood pressure among middle-aged men.

Effects of Diastolic Blood Pressure on Brain Structures and Cognitive Functions in Middle and Old Ages: Longitudinal Analyses.

Hypertension is a pervasive public health concern due to strong associations with cardiovascular diseases and stroke. Alternatively, the associations between hypertension and the risk of Alzheimer’s disease are complex and recent large sample studies reported positive associations. In this paper, we examine the associations between diastolic blood pressure (BP) and subsequent changes in brain structure and cognitive function over several years by multiple regression analyses (with adjustment for a wide range of potential confounding variables) among a large cohort from the UK Biobank. Higher baseline diastolic BP was associated with a slightly smaller relative increase (relative improvements) in reaction time and a slightly greater reduction in depression scores. Higher baseline diastolic BP was also associated with a greater total gray matter volume (GMV) retention, while aging alone was associated with GMV reduction. White matter microstructural analyses revealed that a greater diastolic BP was associated with reduced longitudinal mean and regional fractional anisotropy, greater increases in mean and regional mean diffusivity, radial diffusivity, and axial diffusivity, a greater decline in mean intracellular volume fraction, and greater increases in mean and regional isotropic volume fraction. These white matter microstructural changes were consistent with those seen in the aging process. Additional analyses revealed a greater cheese intake level at baseline, which is associated with a subsequent decline in diastolic BP and a relative subsequent increase in depressive tendency together with a relative increase in fluid intelligence and visuospatial memory performance. These results are congruent with the view that a higher BP in the aging brain has a complex role.

ASSESSMENT OF RE-HOSPITALIZATION PROBABILITY IN PATIENTS WITH POST-INFARCTION CARDIOSCLEROSIS AND COMORBID PATHOLOGY

Abstract. The aim of our research was to examine the risk factors for re-hospitalization in patients with acute myocardial infarction with concomitant diabetes mellitus (DM) 2 type or obesity.&#x0D; Materials and methods. The research involved examination of 262 patients with post-infarction cardiosclerosis in combination with type 2 DM or obesity. They were divided into groups: Group 1 included 96 patients who were not hospitalized for 12 months; comparison group 2 consisted of 166 patients who were hospitalized to an in-patient department. The average age of the first group was 65.13±1.43 years, the comparison group – 63.47 ± 1.28 years. Patients were divided into 3 groups to assess the value of CTRP 3 in chronic heart failure (CHF): Group 1 included 80 patients with post-infarction cardiosclerosis without type 2 DM or obesity, Group 2 consisted of 74 patients with post-infarction cardiosclerosis with type 2 DM, Group 3 comprised 60 patients with post-infarction cardiosclerosis and obesity. The research included patients who were treated at the State Institution “L.T. Malaya National Institute of Therapy of the National Academy of Medical Sciences of Ukraine” and in the first cardiology department of Kharkiv Clinical Hospital or Rail Transport No.1 of the “Healthcare Center” branch of the Joint Stock Company “Ukrainian Railways”. Determination of cartonectin and adropin levels was performed by enzyme-linked immunosorbent assays using the commercial test system Human CTRP 3 (Aviscera Bioscience Inc, Santa Clara, USA) and Human Adropin (Elabscience Biotechnology, USA). Statistical processing of the obtained data was performed using the statistical software package “IBM SPPS Statistics 27.0” and “GraphPad Prism software version 9.0.2”. For all types of analysis, the differences were considered statistically significant at p &lt;0.05. One-factor analysis of variance was used to characterize the influence of factors on the indicators. The method of discriminant analysis was used to assess the occurrence of re-hospitalization.&#x0D; Results. The research revealed a decrease in CTRP 3 in the progression of CHF in patients with post-infarction cardiosclerosis in the presence and absence of concomitant type 2 DM or obesity. The effect of diastolic blood pressure, CHF, glucose, the presence of type 2 DM and obesity on the content of CTRP 3 and adropin was determined. Cartonectin has been shown to be a risk factor for re-hospitalization. An assessment scale for the likelihood of re-hospitalization in patients with post-infarction cardiosclerosis and concomitant type 2 DM or obesity has been developed. We analyzed clinical cases of re-hospitalization among patients with post-infarction cardiosclerosis in the presence of concomitant pathology.&#x0D; Conclusions: CTRP 3 has been shown to be associated with the progression of CHF in patients with post-infarction cardiosclerosis and comorbid pathology. The results indicate the effect of hypertension, CHF, type 2 DM and obesity on the content of cartonectin and adropin. As a result, it has been shown that cartonectin is a factor influencing the occurrence of re-hospitalization in patients with post-infarction cardiosclerosis in the presence of syntropic pathology. The proposed method allows to assess the likelihood of re-hospitalization in patients with post-infarction cardiosclerosis with comorbid pathology.

Effect of Low Diastolic Blood Pressure to Cardiovascular Risk in Patients With Ischemic Stroke or Transient Ischemic Attacks Under Different Systolic Blood Pressure Levels.

Background: In the context of recently updated strategies of pressure management, there is a paucity of evidence on the effect of diastolic blood pressure (DBP) level on adverse events among stroke patients. This study aimed to examine the effect of low DBP (<60 mmHg) under different levels of systolic blood pressure (SBP) on the risk of composite events and stroke recurrence among patients with ischemic stroke (IS) or transient ischemic attack (TIA).Material and Methods: This study was conducted in 2,325 patients with IS or TIA. DBP values were categorized into <60, 60–70, 70–80 (reference), 80–90, and ≥90 mmHg in the main sample and were further categorized as <60 and ≥60 mmHg (reference) when patients were stratified according to SBP levels (<140, <130, and <120 mmHg). The outcomes were defined as recurrent stroke and cumulative composite events (defined as the combination of nonfatal myocardial infarction, nonfatal congestive heart failure, and death) at 1 year.Results: During 1 year of follow-up, a total of 95 composite events and 138 stroke recurrences were identified. The patients with low DBP showed a significantly higher risk of composite events [hazard ratio (HR) = 4.86, 95% confidence interval (CI) = 2.54–8.52], especially the elderly patients (≥60 years); however, this result was not observed for stroke recurrence (HR = 0.90, 95% CI = 0.46–1.74). With the reduction of the SBP levels, the proportion of patients with low DBP increased (6.87, 12.67, and 34.46%), and the risk for composite events persisted.Conclusions: Along with the new target levels of SBP suggested by updated criteria, there is a trend for DBP to be reduced to a harmfully low level, which was associated with an increased risk of composite events among patients with IS or TIA.

Factors Associated With Retinal Vessel Diameters in an Elderly Population: the Thessaloniki Eye Study.

To identify the factors associated with retinal vessel diameters in the population of the Thessaloniki Eye Study. Cross-sectional population-based study (age ≥ 60 years). Subjects with glaucoma, late age-related macular degeneration, and diabetic retinopathy were excluded from the analyses. Retinal vessel diameters were measured using the IVAN software, and measurements were summarized to central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole to venule ratio (AVR). The analysis included 1614 subjects. The hypertensive group showed lower values of CRAE (P = 0.033) and AVR (P = 0.0351) compared to the normal blood pressure (BP) group. On the contrary, the group having normal BP under antihypertensive treatment did not have different values compared to the normal BP group. Diastolic BP (per mm Hg) was negatively associated with CRAE (P < 0.0001) and AVR (P < 0.0001), while systolic BP (per mm Hg) was positively associated with CRAE (P = 0.001) and AVR (P = 0.0096). Other factors significantly associated included age, sex, alcohol, smoking, cardiovascular disease history, ophthalmic medication, weight, and IOP; differences were observed in a stratified analysis based on BP medication use. Our study confirms previous reports about the association of age and BP with vessel diameters. The negative correlation between BP and CRAE seems to be guided by the effect of diastolic BP as higher systolic BP is independently associated with higher values of CRAE. The association of BP status with retinal vessel diameters is determined by diastolic BP status in our population. Multiple other factors are also independently associated with retinal vessel diameters.

Effectiveness of dietary inorganic nitrate for lowering blood pressure in hypertensive adults: a systematic review.

The objective of this review was to evaluate the effectiveness of inorganic nitrate on blood pressure in hypertensive adults. Hypertension is associated with increased risk of morbidity and mortality in adults. Inorganic nitrate could be beneficial for lowering blood pressure and reducing cardiovascular disease risks. Evidence related to the treatment of hypertension through sources of inorganic nitrate has been presented. The review considered studies on adults aged 18 years and over, with blood pressure greater than 120/80 mmHg, undergoing interventions focusing on the effects of inorganic nitrate on blood pressure. Studies that included inorganic nitrate intake via dietary modification, in the form of a dietary supplement, and/or by the consumption of beetroot juice were considered. The comparator was no intervention of inorganic nitrate; different dosage, frequency, duration of inorganic nitrate; and other interventions that are administered to reduce and manage blood pressure. The primary outcomes were systolic and diastolic blood pressure effects. Experimental, quasi-experimental, analytical observational and pilot study designs were considered for inclusion. Databases were searched for published and unpublished studies, available in English, from January 2013 to January 2018. Critical appraisal was conducted using standardized instruments from the Joanna Briggs Institute (JBI) and the methodological quality of included studies was considered to be moderate. Data were extracted using the JBI data extraction instrument. Data were presented in a narrative form due to the heterogeneity of included studies. Twelve papers were included in the systematic review with a total of 321 participants. Ten were randomized controlled trials and two were quasi-experimental studies. All participants had baseline blood pressures greater than 120/80 mmHg. Some studies included participants with comorbidities such as diabetes or heart failure with preserved ejection fraction. Inorganic nitrate was administered multiple ways throughout the studies including the following: beetroot juice, beetroot gel, nitric oxide lozenge, high nitrate diet, and raw and cooked beet juice. Doses and treatment intervals varied. Some studies included exercise as part of the intervention protocol.Meta-analysis was not conducted due to heterogeneity that existed within the studies. Blood pressure was measured in multiple settings by manual, digital or ambulatory means. The noted outcome patterns were as follows: no change in systolic blood pressure and diastolic blood pressure, decrease in systolic blood pressure and diastolic blood pressure, or decrease in systolic blood pressure with no change in diastolic blood pressure. Possible reasons for the diverse findings include the following: age, comorbidities, use of antihypertensives by participants; source and dose of nitrate; and intervention and follow-up time frames. There is insufficient evidence to support or refute the use of inorganic nitrate for any effect on blood pressure at this time. Therefore, there is no concrete base for the development of practice guidelines until stronger evidence becomes available. The gaps in the literature along with the study limitations identified necessitate the need for more research on inorganic nitrate and how it relates to blood pressure.

Evolution of silent myocardial ischaemia prevalence and cardiovascular disease risk factor management in Type 2 diabetes over a 10‐year period: an observational study

To assess the evolution of silent myocardial ischaemia prevalence and of cardiovascular disease risk factor management over 10 years in people with Type 2 diabetes. This repeated cross-sectional study prospectively included 770 people with Type 2 diabetes who presented at our centre in the period 1999-2009. All had at least one additional cardiovascular disease risk factor, no history of coronary disease and were screened for silent myocardial ischaemia using myocardial perfusion imaging. The prevalence of silent myocardial ischaemia, clinical and biological variables and treatments were collected and compared among participants screened in three periods: 1999 to 2002; 2003 to 2005; and 2006 to 2009. We also identified predictive factors for silent myocardial ischaemia. Participants had a mean ± sd age of 62.3 ± 9.3 years, 57.4% were men and the mean time from diagnosis of diabetes was 13.4 ± 9.3 years. Overall, silent myocardial ischaemia screening was positive in 13.9% of participants. This prevalence decreased sharply over the 10-year study period (22.6% in 1999-2002, 13.7% in 2003-2005 and 5.9% in 2006-2009; P<0.0001). In parallel, diastolic and systolic blood pressure, HbA1c and LDL cholesterol significantly decreased and glitazone and statin use increased (all P<0.001). Male gender, peripheral artery disease, diastolic blood pressure >80 mmHg and LDL cholesterol >2.6 mmol/l were independently associated with silent myocardial ischaemia. Further adjustment showed the screening period had a significant effect, which erased the effects of diastolic blood pressure and LDL cholesterol. The prevalence of silent myocardial ischaemia decreased sharply over time, and control of the main cardiovascular disease risk factors improved. Although the causality link cannot be established, the present study supports current recommendations advocating glycaemic control and intensive management of cardiovascular factors instead of systematic screening.

Blood pressure-lowering efficacy of reserpine for primary hypertension.

Many antihypertensive agents exist today for the treatment of primary hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or both). Randomised controlled trials (RCTs) have been carried out to investigate the evidence for these agents. There is, for example, strong RCT evidence that thiazides reduce mortality and morbidity. Some of those trials used reserpine as a second-line therapy. However, the dose-related blood pressure reduction with this agent is not known. The primary objective of this review was to quantify the dose-related efficacy of reserpine versus placebo or no treatment in reducing systolic blood pressure (SBP) or diastolic blood pressure (DBP), or both.We also aimed to evaluate the dose-related effects of reserpine on mean arterial blood pressure (MAP) and heart rate (HR), as well as the dose-related effects on withdrawals due to adverse events. We searched the Cochrane Hypertension Group Specialised Register (January 1946 to October 2016), CENTRAL (2016, Issue 10), MEDLINE (January 1946 to October 2016), Embase (January 1974 to October 2016), and ClinicalTrials.gov (all dates to October 2016). We also traced citations in the reference sections of the retrieved studies. Included studies were truly randomised controlled trials (RCTs) comparing reserpine monotherapy to placebo or no treatment in participants with primary hypertension. We assessed methods of randomisation and concealment. We extracted and analysed data on blood pressure reduction, heart rate, and withdrawal due to adverse effects. We found four RCTs (with a total of 237 participants) that met the inclusion criteria, none of which we found through the 2016 update search. The overall pooled effect demonstrates a statistically significant systolic blood pressure (SBP) reduction in participants taking reserpine compared with placebo (weighted mean difference (WMD) -7.92, 95% confidence interval (CI) -14.05 to -1.78). Because of significant heterogeneity across the trials, a significant effect in diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) could not be found. A dose of reserpine 0.5 mg/day or greater achieved the SBP effects. However, we could not determine the dose-response pattern because of the small number of trials. We did not combine data from the trial that investigated Rauwiloid against placebo with reserpine data from the remaining three trials. This is because Rauwiloid is a different alkaloid extract of the plant Rauwolfia serpentina, and the dose used is not comparable to reserpine. None of the included trials reported withdrawals due to adverse effects. Reserpine is effective in reducing SBP roughly to the same degree as other first-line antihypertensive drugs. However, we could not make definite conclusions regarding the dose-response pattern because of the small number of included trials. More RCTs are needed to assess the effects of reserpine on blood pressure and to determine the dose-related safety profile before the role of this drug in the treatment of primary hypertension can be established.

Blood Pressure in Treated Hypertensive Individuals With the MTHFR 677TT Genotype Is Responsive to Intervention With Riboflavin

Intervention with riboflavin was recently shown to produce genotype-specific lowering of blood pressure (BP) in patients with premature cardiovascular disease homozygous for the 677C→T polymorphism (TT genotype) in the gene encoding the enzyme methylenetetrahydrofolate reductase (MTHFR). Whether this effect is confined to patients with high-risk cardiovascular disease is unknown. The aim of this randomized trial, therefore, was to investigate the responsiveness of BP to riboflavin supplementation in hypertensive individuals with the TT genotype but without overt cardiovascular disease. From an available sample of 1427 patients with hypertension, we identified 157 with the MTHFR 677TT genotype, 91 of whom agreed to participate in the trial. Participants were stratified by systolic BP and randomized to receive placebo or riboflavin (1.6 mg/d) for 16 weeks. At baseline, despite being prescribed multiple classes of antihypertensive drugs, &gt;60% of participants with this genotype had failed to reach goal BP (≤140/90 mm Hg). A significant improvement in the biomarker status of riboflavin was observed in response to intervention ( P &lt;0.001). Correspondingly, an overall treatment effect of 5.6±2.6 mm Hg ( P =0.033) in systolic BP was observed, with pre- and postintervention values of 141.8±2.9 and 137.1±3.0 mm Hg (treatment group) and 143.5±3.0 and 144.3±3.1 mm Hg (placebo group), whereas the treatment effect in diastolic BP was not significant ( P =0.291). In conclusion, these results show that riboflavin supplementation targeted at hypertensive individuals with the MTHFR 677TT genotype can decrease BP more effectively than treatment with current antihypertensive drugs only and indicate the potential for a personalized approach to the management of hypertension in this genetically at-risk group. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: ISRCTN23620802.

Is Ambulatory Blood Pressure Monitoring Finally Catching On?

Evaluation of blood pressure (BP) using ambulatory BP monitoring (ABPM) may play an important role in predicting cardiovascular (CV) prognosis and is increasingly being used in clinical practice. ABPM may be particularly useful in assessing BP in patients with discrepancies between office and home BP readings in both patients with white coat hypertension and masked hypertension, in patients with labile hypertension to establish nondipper status, in patients with resistant hypertension and episodic hypotension, and to determine BP control in patients taking multiple medications with early morning surges in BP. ABPM is considered the gold standard in BP measurement and is also increasingly being used to verify BP in large clinical trials. ABPM provides information about BP during daily activities and during sleep. Nighttime BP measured by ABPM is superior to office BP measurement in predicting CV events. BP has a reproducible circadian profile with higher values while awake and active and lower values during rest and sleep and an early morning increase for 3 hours during a transition of sleep to wakefulness. In most people, BP drops by 10% to 20% during the night (nighttime dipping). Those without nighttime dipping appear to be at higher risk of CV disease. Recent studies have drawn attention to the potential importance of controlling not only daytime but also nighttime BP. In this regard, control of the early morning surge may prove to be particularly important in preventing stroke. ABPM is performed by using a device that is easily worn by the patient for 24 to 48 hours, and BP is usually measured every 15 to 20 minutes during the day and every 30 to 60 minutes at night. Patients also record an activity log, which can be correlated with BP changes. These BPs are recorded on the device and the average daytime (awake) or nighttime (sleep) BPs are determined from the data by a computer program. The percentage of BP readings exceeding the upper limit of normal reflects vascular ‘‘load’’ and is considered to provide a more quantifiable measure of systolic and diastolic BP effect than an individual BP measurement. Dipping status is determined by a 10% fall in systolic and diastolic BP comparing daytime with nighttime (and nap time) readings. The diagnosis of hypertension using ABPM depends on the time span over which it is interpreted. The following readings are defined as hypertension on ABPM: a 24-hour average BP >135 ⁄85 mm Hg, a daytime (awake) average BP >140 ⁄90 mm Hg, and a nighttime (asleep) average BP >125 ⁄ 75 mm Hg. ABPM continues to sharpen the relationship between BP profile and CV risk, and this is demonstrated in a report from the International Database of Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes (IDACO). This report provides some useful ‘‘side by side’’ comparisons of ambulatory BP measurements and office BP From the Department of Medicine, Hypertension Program, University of Pennsylvania School of Medicine, Philadelphia, PA Address for correspondence: Debbie L. Cohen, MD, Renal Division, University of Pennsylvania School of Medicine, 210 White Building, Philadelphia, PA 19104 E-mail: cohendl@mail.med.upenn.edu

Cohort profile: the Asia Pacific Cohort Studies Collaboration

Although less well recognized than in the West, cardiovascular disease (CVD) is the leading cause of disease in Asia. This is despite known differences in the distribution of risk factors for CVD in Asia, compared with Europe and North America, such as lower average total cholesterol and body mass index (BMI). The nature of CVD also tends to be different in Asia, where there are more strokes than coronary heart disease (CHD) events, and strokes are more often haemorrhagic than ischaemic, compared with the West. By 1999 the knowledge gap in Asia was a clear impediment to progress in treating and preventing CVD in the continent. Most of the existing studies from Asia were of small size or short duration and, thus, could not provide reliable information as to the way risk factors, well-researched in the West, act upon CVD in Asia. A notable exception was the Eastern Stroke and CHD Collaborative Project, which had studied the effects of diastolic blood pressure and total cholesterol on the risk of stroke and coronary disease in China and Japan. This was the starting point for the Asia Pacific Cohort Studies Collaboration (APCSC), which extended the scope of the Eastern Project in several important ways. APCSC covers a wider geographical area, including studies from Australia and New Zealand (ANZ), which provide a ‘Western’ comparison group, as well as increasing numbers for certain pooled analyses. It uses individual participant, rather than summary, data, which allows for more flexible analyses. Also, it collects data on several risk factors for CVD, not just blood pressure and total cholesterol, and records all deaths, including those due to non-cardiovascular causes. Initial funding was provided by the New Zealand Health Research Council and the Australian National Health and Medical Research Council (NHMRC). Twin Secretariats for APCSC were established at the Clinical Trials Research Unit at the University of Auckland, New Zealand and The George Institute for International Health at the University of Sydney, Australia. In later years, Pfizer Inc. of New York provided two substantial unrestricted educational grants to APCSC. Current funding is a mixture of pharmaceutical industry funding (Pfizer), peer reviewed research council funding (NHMRC; through a programme grant), and university funding (a University of Sydney cancer research award). The Secretariat and database are now solely housed within The George Institute.

Different effects of blood pressure on mortality from stroke subtypes depending on BMI levels: a 19-year cohort study in the Japanese general population—NIPPON DATA80

To evaluate the relationship between blood pressure and cerebrovascular death depending on body mass index (BMI) levels, we analysed a database of 9338 subjects from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged, which was originally conducted a baseline survey in 1980 and followed up in 1999. Relative risk (RR) and a 95% confidence interval (CI) of death from total stroke, cerebral infarction, and intracerebral haemorrhage after adjusting for age, sex, serum cholesterol, albumin, glucose, the use of antihypertensive agents, a past history of diabetes, BMI, smoking, and drinking were estimated with the Cox-proportional hazard model in the BMI tertile groups of a representative Japanese population. Cutoff points of BMI tertiles are 21.2 and 23.8 kg/m2. The results indicated that a 10 mmHg systolic blood pressure (SBP) increase was associated with mortality from intracerebral haemorrhage at low and middle BMI groups (RR= 1.38 and 1.23; 95% CI=1.17-1.62 and 1.03-1.47, respectively). SBP was positively associated with mortality from cerebral infarction in middle and high BMI groups (RR=1.19 and 1.21; 95% CI=1.06-1.33 and 1.06-1.38, respectively). The effects of diastolic blood pressure on intracerebral haemorrhage and infarction had the same tendency as those of SBP. These results suggested that the causal effect of blood pressure on stroke subtypes might be modified by BMI.