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European Heart Journal Advance Access published online on May 25, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi330
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received December 4, 2004
Revised March 16, 2005
Accepted April 22, 2005

Clinical research

Use of 2003 European Society of Hypertension-European Society of Cardiology guidelines for predicting stroke using self-measured blood pressure at home: the Ohasama study

Kei Asayama 1, Takayoshi Ohkubo 2, Masahiro Kikuya 3, Hirohito Metoki 4, Taku Obara 4, Haruhisa Hoshi 5, Junichiro Hashimoto 2, Kazuhito Totsune 1, Hiroshi Satoh 6, and Yutaka Imai 7*

1 Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan; Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan
2 Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan; Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan
3 Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan
4 Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan
5 Ohasama Hospital, Iwate, Japan
6 Department of Environmental Health Sciences, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan; Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan
7 Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan; Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan

* To whom correspondence should be addressed.
Yutaka Imai, E-mail: rinsyo{at}bureau.tohoku.ac.jp


  Abstract

Aims To evaluate the predictive power of the risk stratification system proposed in the 2003 European Society of Hypertension-European Society of Cardiology (2003 ESH-ESC) guidelines and to compare self-measured blood pressure at home (HBP) with casual-screening blood pressure (CBP) for prediction of first stroke among a general Japanese population.

Methods and results HBP and CBP were measured in 1702 subjects (≥40 years) who had no history of stroke and who were followed for an average of 11 years. The subjects were assigned to one of five groups with differential risk stratification according to the 2003 ESH-ESC criteria: average risk, low added risk, moderate added risk, high added risk, and very high added risk. Even in the low risk group a significantly high risk for stroke was observed, and there was a linear step up of stroke risk based on HBP, as well as on CBP. On the basis of HBP classification, a higher stroke incidence was observed in the high and very high groups compared with CBP classification.

Conclusion The risk stratification system proposed in the 2003 ESH-ESC guidelines is valid for the prediction of stroke in this Japanese study population, and has a stronger predictive power when based on HBP than on CBP. The results indicate the usefulness of HBP for the prediction of stroke risk in individuals.

Keywords: Blood pressure; Home measurement; Screening measurement; Stroke; ESH-ESC guidelines; Risk stratification.
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