Stroke risk and antihypertensive drug treatment in the general population: The Japan arteriosclerosis longitudinal study

Kei Asayama, Takayoshi Ohkubo, Seitaro Yoshida, Kazuo Suzuki, Hirohito Metoki, Akiko Harada, Yoshitaka Murakami, Yasuo Ohashi, Hirotsugu Ueshima, Yutaka Imai

Research output: Contribution to journalArticlepeer-review

55 Citations (Scopus)


OBJECTIVE: To evaluate the association between stroke risk and blood pressure (BP) levels with regard to the usage of antihypertensive medications. METHODS: From the Japan arteriosclerosis longitudinal study, 11 371 participants from the four population-based cohort studies (aged 40-89) were followed up for a mean of 9.5 years. A Poisson regression model, adjusting for possible confounding factors, was used to investigate the risk of first stroke among six BP-based categories (BP defined according to recent guidelines), in relation to the use of antihypertensive medications. RESULTS: There were 324 incident cases of first stroke. Among untreated groups, the relative hazard increased linearly with the elevation of BP grade (trend P ≤ 0.0001). The untreated group with normal BP had a significantly higher stroke risk [relative hazard 2.09, 95% confidence interval 1.09-4.01] than the untreated group with optimal BP. There was no stepwise increase in stroke risk observed among treated groups (trend P ≤ 0.1). The stroke risk among treated groups, even among those with optimal BP (relative hazard 4.10, 95% confidence interval 1.17-14.4), was significantly higher than that in the untreated groups with the same BP level. CONCLUSION: Treated individuals with optimal BP had a higher stroke risk than untreated ones with optimal BP. Healthcare providers need to be vigilant for residual cardiovascular risks in treated hypertensive patients.

Original languageEnglish
Pages (from-to)357-364
Number of pages8
JournalJournal of hypertension
Issue number2
Publication statusPublished - 2009 Feb


  • Antihypertensive medication
  • Blood pressure
  • Epidemiology
  • Hypertension
  • Risk classification
  • Stroke

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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