The association of conventionally medicated systolic and diastolic blood pressure level and mortality from cardiovascular disease: is the lower the better in high stroke population?

  • Ryoto Sakaniwa
  • Jasper Tromp
  • Kokoro Shirai
  • Kazumasa Yamagishi
  • Akiko Tamakoshi
  • Hiroyasu IsoEmail author
Letter to the Editors


Hypertension has become majority morbidity and a leading factors for the cardiovascular disease mortalities in the current society [1, 2]. While hypertensive managements has improved since the twentieth century [3], the optimal blood pressure (BP) among hypertensive patients remains in question. The new American Heart Association/American College of Cardiology (AHA/ACC) guidelines suggest health benefit for systolic blood pressure (SBP)  below 130 mmHg and diastolic blood pressure (DBP) below 80 mmHg [4]. It remains unclear whether this is also favorable for Asian and East-European population where, in contrast to Western countries, mortality from stroke has been higher than that from coronary heart disease (CHD) [2]. We recently examined an association of the combined category of SBP/DBP with mortality from cardiovascular disease (CVD); the results showed J-curved CVD mortality association among the participants with ongoing antihypertensive treatment but not normotensive...


Hypertension Conventional blood pressure Cardiovascular disease Coronary heart disease Stroke 



This article was supported by young investigator award of Kishimoto foundation grant. We thank our colleagues from Osaka University Center of Medical Data Science, Advanced Clinical Epidemiology Investigator's Research Project for providing theirinsight and expertise for our research. This article was supported by Erasmus+ International Credit Mobility Grant. The JACC Study has been supported by the Grants-in-Aid for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan (61010076, 62010074, 63010074, 1010068, 2151065, 3151064, 4151063, 5151069, 6279102, and 11181101). The authors express their appreciation to Dr. Kunio Aoki, Professor Emeritus, Nagoya University School of Medicine and former chairman of the JACC Study Group, and also to by guest on May 18, 2011 Downloaded from 178 Iso et al. Am J Epidemiol 2005;161:170–179 Dr. Haruo Sugano, former Director of the Cancer Institute of the Japanese Foundation for Cancer Research, who greatly contributed to initiating the study. They also thank Dr. Aaron R. Folsom, Professor, University of Minnesota, for his valuable scientific suggestions. The present members of the JACC Study Group and their affiliations are as follows: Dr. Akiko Tamakoshi (current chairman), Nagoya University Graduate School of Medicine; Dr. Mitsuru Mori, Sapporo Medical University School of Medicine; Dr. Yutaka Motohashi, Akita University School of Medicine; Dr. Ichiro Tsuji, Tohoku University Graduate School of Medicine; Dr. Yosikazu Nakamura, Jichi Medical School; Dr. Hiroyasu Iso, Institute of Community Medicine, University of Tsukuba; Dr. Haruo Mikami, Chiba Cancer Center; Dr. Shuji Hashimoto, Fujita Health University School of Medicine; Dr. Yutaka Inaba, Juntendo University School of Medicine; Dr. Yoshiharu Hoshiyama, Showa University School of Medicine; Dr. Hiroshi Suzuki, Niigata University School of Medicine; Dr. Hiroyuki Shimizu, Gifu University School of Medicine; Dr. Hideaki Toyoshima, Nagoya University Graduate School of Medicine; Dr. Shinkan Tokudome, Nagoya City University Graduate School of Medicine; Dr. Yoshinori Ito, Fujita Health University School of Health Sciences; Dr. Shogo Kikuchi, Aichi Medical University School of Medicine; Dr. Akio Koizumi, Graduate School of Medicine and Faculty of Medicine, Kyoto University; Dr. Takashi Kawamura, Kyoto University Center for Student Health; Dr. Yoshiyuki Watanabe, Kyoto Prefectural University of Medicine, Research Institute for Neurological Diseases and Geriatrics; Dr. Tsuneharu Miki, Kyoto Prefectural University of Medicine; Dr. Chigusa Date, Faculty of Human Environmental Sciences, Mukogawa Women’s University; Dr. Kiyomi Sakata, Wakayama Medical University; Dr. Takayuki Nose, Tottori University Faculty of Medicine; Dr. Norihiko Hayakawa, Research Institute for Radiation Biology and Medicine, Hiroshima University; Dr. Takesumi Yoshimura, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan; Dr. Katsuhiro Fukuda, Kurume University School of Medicine; Dr. Naoyuki Okamoto, Kanagawa Cancer Center; Dr. Hideo Shio, Shiga Medical Center; Dr. Yoshiyuki Ohno, Nagoya University Graduate School of Medicine; Dr. Tomoyuki Kitagawa, Cancer Institute of the Japanese Foundation for Cancer Research; Dr. Toshio Kuroki, Gifu University; and Dr. Kazuo Tajima, Aichi Cancer Center Research Institute. The past Study Group investigators are listed in reference 22, except for the following seven members (affiliations reflect where they participated in the study): Dr. Takashi Shimamoto, Institute of Community Medicine, University of Tsukuba; Dr. Heizo Tanaka, Medical Research Institute, Tokyo Medical and Dental University; Dr. Shigeru Hisamichi, Tohoku University Graduate School of Medicine; Dr. Masahiro Nakao, Kyoto Prefectural University of Medicine; Dr. Takaichiro Suzuki, Research Institute, Osaka Medical Center for Cancer and Cardiovascular Diseases; Dr. Tsutomu Hashimoto, Wakayama Medical University; and Dr. Teruo Ishibashi, Asama General Hospital. We thank Hugh McGonigle, from Edanz Group (, for editing a draft of the manuscript.

Compliance with ethical standards

Conflict of interest

We declare no competing interests.

Supplementary material

392_2019_1587_MOESM1_ESM.pdf (233 kb)
Supplementary file1 (PDF 233 kb)


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© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Public Health, Department of Social MedicineOsaka University Graduate School of MedicineSuitaJapan
  2. 2.Department of CardiologyUniversity Medical Centre Groningen, University of GroningenGroningenThe Netherlands
  3. 3.National Heart Centre SingaporeSingaporeSingapore
  4. 4.Duke-NUS Medical SchoolSingaporeSingapore
  5. 5.Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development CenterUniversity of TsukubaTsukubaJapan
  6. 6.Department of Public HealthHokkaido University Graduate School of MedicineSapporoJapan

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