Impact of blood pressure control on cardiovascular events in 26,512 Japanese hypertensive patients: The Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan Therapy (J-HEALTH) study, a prospective nationwide observational study

The Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan Therapy (J-HEALTH) study was performed to investigate the relationship between blood pressure (BP) and development of stroke or myocardial infarction (MI) in Japanese hypertensive patients. A total of 26,512 hypertensive patients (mean age: 62.2 years, 43.9% men) were analyzed. All patients received open-labelled losartan for a maximum of 5 years. Endpoints were stroke, MI including sudden cardiac death, and all cardiovascular (CV) events (stroke and MI). The mean observation period was 3.0 years. The mean baseline systolic/diastolic BP was 165.8/ 94.8 mmHg and decreased to 141.6/82.0 mmHg during treatment. The incidences of stroke, MI, and total CV events were 3.90, 1.02, and 4.92 per 1,000 patient-years, respectively. Aging, diabetes, a history of CV disease, and smoking were independent risk factors for CV events. The risk of all CV events was positively related to BP level during treatment, and increased significantly when the BP exceeded 140/90 mmHg. Age was a strong contributor to CV events, but about a half of the very elderly patients (≥ 85 years, n=692) had a BP below 140/90 mmHg during treatment and significantly fewer events occurred in these patients than in those with a BP of 140/90 mmHg or higher. These results suggest that BP should be below 140/90 mmHg in Japanese patients with hypertension for reducing the risk of CV events. BP was controlled below 140/90 mmHg in a half of the very elderly hypertensive patients in this study, and these patients also had a lower incidence of CV events.