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Validity of the JNC VI Recommendations for the Management of Hypertension in a General Population of Japanese Elderly
The Hisayama Study
Hisatomi Arima, MD;
Yumihiro Tanizaki, MD;
Yutaka Kiyohara, MD;
Takuya Tsuchihashi, MD;
Isao Kato, MD;
Michiaki Kubo, MD;
Keiichi Tanaka, MD;
Ken Ohkubo, MD;
Hidetoshi Nakamura, MD;
Isao Abe, MD;
Masatoshi Fujishima, MD;
Mitsuo Iida, MD
Arch Intern Med. 2003;163:361-366.
Background It is not known whether the treatment recommendations presented in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure are applicable to the Japanese elderly population.
Methods We followed up 588 cardiovascular disease–free residents of a Japanese community who were 60 years or older from November 1, 1961, through October 31, 1993. Treated hypertensive patients were excluded from the analysis. During this period, CVD occurred in 179 subjects. The incidences were estimated by the pooling of repeated observations method.
Results The age- and sex-adjusted incidences of cardiovascular disease significantly increased with elevated blood pressure levels. The hazard ratio for stage 3 hypertension was 5.34 (95% confidence interval, 2.66-10.71; P<.001) compared with optimal blood pressure after adjustment for other covariates. Among subjects aged 60 to 79 years, the incidences for stages 1 through 3 hypertension were significantly higher than for those with optimal and normal blood pressure. In comparison, among those 80 years or older, the incidence was significantly higher only in patients with stage 3 hypertension. We further estimated the incidences according to the risk stratification system. In the younger elderly subjects, the incidences increased with rising blood pressure levels in each risk stratum. Similar relationships were not observed among the older elderly subjects.
Conclusions Our findings demonstrate that the recommendations of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure were potentially applicable to the Japanese elderly subjects 79 years or younger. Based on our findings, however, hypertension might not be a risk factor for cardiovascular disease among very old hypertensive patients with advanced atherosclerosis.
From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. The authors have no financial or proprietary interest in the subject matter or in the materials discussed in the article.
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