Yukako Tatsumi

Little is known about biological markers, at levels within their normal ranges which might predict future mortality. We aimed at identifying possible predictors of future death in participants before pathological conditions manifest. We analyzed data from a population-based prospective cohort study (the Ohasama study), comprised of 993 participants who underwent 75-g oral glucose tolerance tests (OGTTs). We collected blood parameters, including those measured during OGTTs, and divided the study population into two groups based on the median value of each parameter, followed by analyses of mortality during follow-up in both groups. In addition, we extracted subjects with normal glucose tolerance (NGT) (n = 595) and analyzed the association between 1-h postload plasma glucose during OGTTs (1-hrPG) and mortality as well as the causes of death. Among all parameters evaluated, 1-hrPG was found to be most significantly associated with all-cause mortality during the mean follow-up of 14.3 years. When we focused on subjects with NGT, Harrell's C concordance index analysis revealed a cut-off of 1-hrPG ≥170 mg/dL to be most strongly associated with all-cause mortality (0.8066). The Kaplan–Meier plots showed nearly double the proportion of the 1-hrPG ≥170 group to have died as compared with the 1-hrPG <170 group throughout the follow-up period after the third year. Cardiovascular diseases and malignant neoplasms both strongly contributed to the increased mortality in the high 1-hrPG group. Thus, 1-hrPG ≥170 is a powerful predictor of future death in subjects with NGT. Atherosclerotic and malignant diseases both contributed to the increased mortality.

This study aimed to investigate the association between the frequency of home blood pressure (HBP) measurement and hypertension control in a middle-aged working population. This study included 627 employees aged 40 years or older who underwent health check-ups for 2 consecutive years from 2019 to 2022 and had blood pressure (BP) ≥ 140/90 mmHg at the health check-up in the first year. The participants were stratified by the length of antihypertensive treatment (within 1 year, >1 year) using data in the first and second years, and were classified by the frequency of HBP measurement (<6 times/week, almost every day) using data in the second year. In each treatment length, logistic regression analyses were used to estimate multivariable adjusted odds ratios (ORs) of controlled hypertension (BP at health check-ups <140/90 mmHg in the second year) in those who measured HBP almost every day compared with those who measured HBP < 6 times/week. The ORs (95% confidence intervals) were 1.56 (0.94–2.73) in those within 1 year of starting treatment and 0.74 (0.44–1.22) in those with more than 1 year of starting treatment. In participants with BP ≥ 160/100 mmHg in the first year, the corresponding ORs were 1.94 (1.04–3.64) and 0.41 (0.13–1.23), respectively. In conclusion, in individuals within 1 year of starting treatment, those who measure HBP almost every day tend to have good control of hypertension. In particular, in those who have BP ≥ 160/100 mmHg before starting antihypertensive medication, measuring HBP almost every day is associated with good control of hypertension. Among those within 1 year of starting the treatment (Group1) especially in those with blood pressure ≥160/100 mmHg, the frequency of home blood pressure measurement was associated with hypertension control. It was not associated among those with more than 1 year of starting the treatment (Group 2).

Context: Existing differences in persons with lower 30- or 60-minute plasma glucose (PG) levels during 75-g oral glucose tolerance test (OGTT) than fasting PG remain unclear. Objective: To clarify the characteristics of persons whose PG levels decrease after glucose administration during OGTT and their risk of incidence of diabetes in a Japanese general population. Methods: In this cohort study, a total of 3995 men and 3500 women (mean age 56.7 years) without diabetes were classified into 3 groups: (1) PG at both 30 and 60 minutes ≥ fasting PG; (2) PG at 30 minutes ≥ fasting PG and PG at 60 minutes < fasting PG; (3) PG at 30 minutes < fasting PG. The characteristics and the risk of diabetes onset were analyzed using ordered logistic regression and Cox proportional hazard regression, respectively. Results: Among 7495 participants, the numbers of individuals in the group 1, 2, and 3 were 6552, 769, and 174, respectively. The glucose response curve of the group 3 was boat shaped. Group 3 had the youngest age, lowest percentage of men, and best health condition, followed by groups 2 and 1. Among 3897 participants analyzed prospectively, 434 developed diabetes during the mean follow-up period of 5.8 years. The hazard ratio for diabetes onset in the group 2 was 0.30 with reference to the group 1. No-one in group 3 developed diabetes. Conclusion: People with lower 30-minute PG than fasting PG tended to be women, young, healthy, and at low risk of diabetes onset.

We investigated the association between ambulatory blood pressure (BP) and the risk of home hypertension in a normotensive population and whether considering ambulatory BP improves the 10-year prediction model for home hypertension risk, which was developed in the previous Ohasama Study. In this prospective study, we followed up 410 participants (83.2% women; age, 53.6 years) without home and ambulatory hypertension in the general population of Ohasama, Japan. The Cox model was used to assess the hazard ratios for home hypertension (home BP ≥135/≥85 mmHg or initiation of antihypertensive treatment) and model improvement. During a mean 14.2-year follow-up, 225 home hypertension incidences occurred. The hazard ratio (95% confidence interval) for home hypertension incidence per 1-standard deviation higher (=6.76 mmHg) 24-h systolic BP was 1.59 (1.33–1.90), after adjustments for possible confounding factors, including baseline home systolic BP. Harrell’s C-statistics increased from 0.72 to 0.73 (P=0.11) when 24-h systolic BP was added to the basic 10-year home hypertension prediction model, which includes sex, age, body mass index, smoking status, office systolic BP, and baseline home systolic BP. Continuous net reclassification improvement (0.53, PP=0.0014) revealed improvement in the model. 24-h systolic BP could be an independent predictor of future home hypertension. Home BP and 24-h BP can longitudinally influence each other in the long term.

Objective: This study was performed to investigate the association of hypertension subtypes with glucose metabolism among the Japanese general population. Methods: The study involved 646 residents (mean age: 62.4 years) without treatment for hypertension or a history of diabetes from Ohasama, a rural Japanese community, who underwent an oral glucose tolerance test. Hypertension subtypes [normotension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic and diastolic hypertension (SDH)] were defined on the basis of home and office SBP and DBP (HBP and OBP, respectively). The estimated means of blood glucose related indices among the groups were compared by analysis of covariance adjusted for possible confounding factors. Results: Blood glucose related indices were not different among the morning HBP-defined hypertension subtypes. Participants with evening HBP-defined ISH had a significantly higher estimated mean BG at 120 min, higher homeostasis model assessment-insulin resistance (HOMA-IR) and lower Matsuda–DeFronzo index than participants with NT (all P < 0.021). Participants with OBP-defined SDH had a significantly higher estimated mean fasting blood glucose; blood glucose at 30, 60 and 120 min; and HOMA-IR and a lower Matsuda–DeFronzo index than participants with NT (all P < 0.0025). Conclusion: The blood glucose related indices were different among hypertension subtypes. Participants with evening HBP-defined ISH and OBP-defined SDH had higher blood glucose levels and insulin resistance than participants with correspondingly defined normotension, while those with morning HBP did not. These findings suggest the importance of measuring evening HBP and office blood pressure for early detection of coexisting hypertension and diabetes.

Objective: Objective: Previous studies suggest that parity and menstrual factors were associated with an increased risk of cerebrocardiovascular diseases. We aimed to investigate if parity and menstrual factors are associated with brain ischemic lesions diagnosed by magnetic resonance imaging (MRI). Design and method: Materials and Methods: We identified 511 women aged 60 years or older from the general population of Ohasama, a rural Japanese community, who answered a questionnaire on parity and gravidity and age at menarche and menopause, were free of previous cardiocerebrovascular disease including atrial fibrillation, and underwent MRI. Silent cerebrovascular lesions were diagnosed by MRI and assessed by the presence of either lacunar infarcts or white matter hyperintensity, or both. Logistic regression model was used to investigate an association between any of quartiles of parity, gravidity, and age at menarche and menopause, and silent cerebrovascular lesions with adjustment for possible confounding factors including self-measured blood pressure values at home (home BP). Results: Results: Silent cerebrovascular lesion was observed in 269 subjects (53%) including lacunar infarcts (26%) and white matter hyperintensity (49%). Means of home systolic and diastolic BP levels were 128.9 ± 14.8 mmHg and 74.2 ± 8.6mmHg, respectively. Approximately 31% of subjects were under antihypertensive medication and 36 % had hypertension defined by home BP levels greater than or equal to 135/85. Age adjusted odds ratio of the highest quartile of parity (4- vs. 2 as reference) was 1.84 (1.10–3.06) for having silent cerebrovascular lesions and 1.83 (1.11–3.01) for white matter hyperintensity. Adjusting for age (p < 0.001), body mass index (p = 0.005), home systolic BP level (p = 0.039), hypertensive drug use (p = 0.001), impaired glucose tolerance (p = 0.418), hyperlipidemia (p = 0.103), and current smoker (p = 0.938) and drinker (p = 0.716), compared with women who had two children, women who had four or more children were more likely to have an increased risk with silent ischemic lesions (OR 1.88, 95%CI, 1.11–3.20). Similar association was also observed with white matter hyperintensity (OR 1.86, 95%CI, 1.11–3.12). Conclusions: Conclusion: Higher parity was associated with silent brain ischemic lesions and white matter hyperintensity diagnosed by MRI, independent of confounding factors including age and home BP levels.

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