Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Fast track – JSH2023 OSAKA: Current evidence and perspectives for hypertension management in Asia
  • Published:

High blood pressure and colorectal cancer mortality in a 29-year follow-up of the Japanese general population: NIPPON DATA80

Hypertension Research volume 47, pages 206–214 (2024)Cite this article

Abstract

Onco-hypertension has been proposed, although associations of high blood pressure (BP) with cancer risk remain inconsistent. We examined associations of high BP with risk of mortality from stomach, lung, colorectal, liver, and pancreatic cancers independent of possible confounders in an analysis that excluded deaths within the first 5 years of follow-up to consider the reverse causality. In a prospective cohort representative of the general Japanese population (1980–2009), we studied 8088 participants (mean age, 48.2 years; 56.0% women) without clinical cardiovascular disease or antihypertensive medication at baseline. Fine-Gray competing risks regression was used to estimate hazard ratios for 10 mmHg higher BP adjusted for confounders including smoking, alcohol-drinking, obesity, and diabetes mellitus. During 29-year follow-up, 159 (2.0%), 159 (2.0%), 89 (1.1%), 86 (1.1%), and 68 (0.8%) participants died from stomach, lung, colorectal, liver, and pancreatic cancers, respectively. We observed a positive association of high BP with risk of colorectal cancer mortality but not with mortality risks from any other cancers. The association with colorectal cancer mortality for systolic and diastolic BP was evident in those aged 30–49 years (hazard ratios 1.43 [95% confidence interval, 1.22–1.67] and 1.86 [1.32–2.62], respectively) but not in those aged 50–59 years and ≥60 years (P for age interaction <0.01 for systolic and diastolic BP). The associations with colorectal cancer mortality were similar in the analyses stratified by smoking, alcohol-drinking, obesity, and diabetic status. In conclusion, high BP among young to middle-aged adults was independently associated with risk of colorectal cancer mortality later in life.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kidoguchi S, Sugano N, Tokudome G, Yokoo T, Yano Y, Hatake K, et al. New concept of onco-hypertension and future perspectives. Hypertension. 2021;77:16–27.

    Article  CAS  PubMed  Google Scholar 

  2. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hisamatsu T, Miura K. Epidemiology and control of hypertension in Japan: a comparison with Western countries. J Hum Hypertens. 2021; https://doi.org/10.1038/s41371-021-00534-3.

  4. Stocks T, Van Hemelrijck M, Manjer J, Bjorge T, Ulmer H, Hallmans G, et al. Blood pressure and risk of cancer incidence and mortality in the Metabolic Syndrome and Cancer Project. Hypertension. 2012;59:802–10.

    Article  CAS  PubMed  Google Scholar 

  5. Seretis A, Cividini S, Markozannes G, Tseretopoulou X, Lopez DS, Ntzani EE, et al. Association between blood pressure and risk of cancer development: a systematic review and meta-analysis of observational studies. Sci Rep. 2019;9:8565.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sun LM, Kuo HT, Jeng LB, Lin CL, Liang JA, Kao CH. Hypertension and subsequent genitourinary and gynecologic cancers risk: a population-based cohort study. Medicine. 2015;94:e753.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nakamura Y, Okamura T, Higashiyama A, Watanabe M, Kadota A, Ohkubo T, et al. Prognostic values of clockwise and counterclockwise rotation for cardiovascular mortality in Japanese subjects: a 24-year follow-up of the National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in the Aged, 1980-2004 (NIPPON DATA80). Circulation. 2012;125:1226–33.

    Article  PubMed  Google Scholar 

  8. Okamura T, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H, et al. What cause of mortality can we predict by cholesterol screening in the Japanese general population? J Intern Med. 2003;253:169–80.

    Article  CAS  PubMed  Google Scholar 

  9. Ministry of Health, Labour and Welfare. List of causes of death for Japan (Japanese) https://www.mhlw.go.jp/toukei/saikin/hw/jinkou/houkoku17/dl/08.pdf. (Accessed 11 Sep 2023).

  10. Hisamatsu T, Miura K, Ohkubo T, Kadota A, Kondo K, Kita Y, et al. Isolated systolic hypertension and 29-year cardiovascular mortality risk in Japanese adults aged 30-49 years. J Hypertens. 2020;38:2230–6.

    Article  CAS  PubMed  Google Scholar 

  11. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.

    Article  Google Scholar 

  12. Veettil SK, Wong TY, Pharm B, Loo YS, Pharm B, Playdon MC, et al. Role of diet in colorectal cancer incidence umbrella review of meta-analyses of prospective observational studies. JAMA Netw Open. 2021;4:e2037341.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Pelucchi C, Negri E, Talamini R, Levi F, Giacosa A, Crispo A, et al. Metabolic syndrome is associated with colorectal cancer in men. Eur J Cancer. 2010;46:1866–72.

    Article  PubMed  Google Scholar 

  14. Christakoudi S, Kakourou A, Markozannes G, Tzoulaki I, Weiderpass E, Brennan P, et al. Blood pressure and risk of cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2020;146:2680–93.

    Article  CAS  PubMed  Google Scholar 

  15. Kaneko H, Yano Y, Itoh H, Morita K, Kiriyama H, Kamon T, et al. Untreated hypertension and subsequent incidence of colorectal cancer: analysis of a nationwide epidemiological database. J Am Heart Assoc. 2021;10:e022479.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Brenner H, Hoffmeister M, Arndt V, Haug U. Gender differences in colorectal cancer: implications for age at initiation of screening. Br J Cancer. 2007;96:828–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Dinh QN, Drummond GR, Sobey CG, Chrissobolis S. Roles of inflammation, oxidative stress, and vascular dysfunction in hypertension. Biomed Res Int. 2014;2014:406960.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gago-Dominguez M, Castelao JE, Yuan JM, Ross RK, Yu MC. Lipid peroxidation: a novel and unifying concept of the etiology of renal cell carcinoma (United States). Cancer Causes Control. 2002;13:287–93.

    Article  PubMed  Google Scholar 

  20. George AJ, Thomas WG, Hannan RD. The renin-angiotensin system and cancer: old dog, new tricks. Nat Rev Cancer. 2010;10:745–59.

    Article  CAS  PubMed  Google Scholar 

  21. Koene RJ, Prizment AE, Blaes A, Konety SH. Shared risk factors in cardiovascular disease and cancer. Circulation. 2016;133:1104–14.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chow WH, Gridley G, Fraumeni JF Jr, Jarvholm B. Obesity, hypertension, and the risk of kidney cancer in men. N Engl J Med. 2000;343:1305–11.

    Article  CAS  PubMed  Google Scholar 

  23. Abbott RD, Curb JD, Rodriguez BL, Masaki KH, Yano K, Schatz IJ, et al. Age-related changes in risk factor effects on the incidence of coronary heart disease. Ann Epidemiol. 2002;12:173–81.

    Article  PubMed  Google Scholar 

  24. Fujiyoshi A, Ohkubo T, Miura K, Murakami Y, Nagasawa SY, Okamura T, et al. Blood pressure categories and long-term risk of cardiovascular disease according to age group in Japanese men and women. Hypertens Res. 2012;35:947–53.

    Article  PubMed  Google Scholar 

  25. Lind L, Sundstrom J, Arnlov J, Lampa E. Impact of aging on the strength of cardiovascular risk factors: a longitudinal study over 40 years. J Am Heart Assoc. 2018;7:e007061.

  26. Zhang ZF, Kurtz RC, Sun M, Karpeh M Jr, Yu GP, Gargon N, et al. Adenocarcinomas of the esophagus and gastric cardia: medical conditions, tobacco, alcohol, and socioeconomic factors. Cancer Epidemiol Biomarkers Prev. 1996;5:761–8.

    CAS  PubMed  Google Scholar 

  27. Lee SY, Kim MT, Jee SH, Im JS. Does hypertension increase mortality risk from lung cancer? A prospective cohort study on smoking, hypertension and lung cancer risk among Korean men. J Hypertens. 2002;20:617–22.

    Article  CAS  PubMed  Google Scholar 

  28. Lindgren A, Pukkala E, Nissinen A, Tuomilehto J. Blood pressure, smoking, and the incidence of lung cancer in hypertensive men in North Karelia, Finland. Am J Epidemiol. 2003;158:442–7.

    Article  PubMed  Google Scholar 

  29. Berger SM, Gislason G, Moore LL, Andersson C, Torp-Pedersen C, Denis GV, et al. Associations between metabolic disorders and risk of cancer in Danish men and women–a nationwide cohort study. BMC Cancer. 2016;16:133.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mieno MN, Tanaka N, Arai T, Kawahara T, Kuchiba A, Ishikawa S, et al. Accuracy of death certificates and assessment of factors for misclassification of underlying cause of death. J Epidemiol. 2016;26:191–8.

    Article  PubMed  Google Scholar 

  31. Peduzzi P, Concato J, Feinstein AR, Holford TR. Importance of events per independent variable in proportional hazards regression analysis II. Accuracy and precision of regression estimates. J Clin Epidemiol. 1995;48:1503–10.

    Article  CAS  PubMed  Google Scholar 

  32. Ogundimu EO, Altman DG, Collins GS. Adequate sample size for developing prediction models is not simply related to events per variable. J Clin Epidemiol. 2016;76:175–82.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and cox regression. Am J Epidemiol. 2007;165:710–8.

    Article  PubMed  Google Scholar 

  34. Onyoh EF, Hsu WF, Chang LC, Lee YC, Wu MS, Chiu HM. The rise of colorectal cancer in Asia: epidemiology, screening, and management. Curr Gastroenterol Rep. 2019;21:36.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the participants and the public health centers for their cooperation in this study. The members of the NIPPON DATA80 Research Group can be found at https://hs-web.shiga-med.ac.jp/Nippondata/NIPPONDATA80_90/index.html. We also thank John Daniel from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

for the NIPPON DATA80 Research Group

Chairpersons Hirotsugu Ueshima2, Akira Okayama7, Katsuyuki Miura2, Tomonori Okamura6

Research members Shigeyuki Saitoh, Kiyomi Sakata, Atsushi Hozawa, Yosikazu Nakamura, Nobuo Nishi, Takayoshi Ohkubo, Yoshitaka Murakami, Toshiyuki Ojima, Koji Tamakoshi, Hideaki Nakagawa, Yoshikuni Kita, Aya Kadota, Yasuyuki Nakamura, Naomi Miyamatsu, Takehito Hayakawa, Nagako Okuda, Katsushi Yoshita, Yoshihiro Miyamoto, Makoto Watanabe, Akira Fujiyoshi, Kazunori Kodama, Fumiyoshi Kasagi, Yutaka Kiyohara

Funding

The study was supported by Grants-in-Aid from the Ministry of Health, Labour and Welfare under the auspices of the Japanese Association for Cerebro-cardiovascular Disease Control; a Research Grant for Cardiovascular Diseases (7A-2) from the Ministry of Health, Labour and Welfare; and a Health and Labor Sciences Research Grant, Japan (Comprehensive Research on Aging and Health [H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014] and Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus [H22-Junkankitou-Seishuu-Sitei-017, H25- Junkankitou-Seishuu-Sitei-022, H30-Junkankitou-Seishuu-Sitei-002], 21FA2002).

Author information

Authors and Affiliations

  1. Department of Public Health, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan

    Takashi Hisamatsu

  2. NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan

    Takashi Hisamatsu, Aya Kadota, Akiko Harada, Yukiko Okami, Keiko Kondo, Hirotsugu Ueshima & Katsuyuki Miura

  3. Research Center for Social Studies of Health and Community, Ritsumeikan University, Kyoto, Japan

    Takehito Hayakawa

  4. Science of Nursing, Tsuruga Nursing University, Tsuruga, Japan

    Yoshikuni Kita

  5. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan

    Takayoshi Ohkubo

  6. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan

    Tomonori Okamura

  7. Research Institute of Strategy for Prevention, Tokyo, Japan

    Akira Okayama

Authors
  1. Takashi Hisamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aya Kadota
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takehito Hayakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshikuni Kita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Akiko Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yukiko Okami
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Keiko Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takayoshi Ohkubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tomonori Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Akira Okayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hirotsugu Ueshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Katsuyuki Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the NIPPON DATA80 Research Group

  • Chairpersons

    • Hirotsugu Ueshima
    • , Akira Okayama
    • , Katsuyuki Miura
    •  & Tomonori Okamura

  • Research members

    • Shigeyuki Saitoh
    • , Kiyomi Sakata
    • , Atsushi Hozawa
    • , Yosikazu Nakamura
    • , Nobuo Nishi
    • , Takayoshi Ohkubo
    • , Yoshitaka Murakami
    • , Toshiyuki Ojima
    • , Koji Tamakoshi
    • , Hideaki Nakagawa
    • , Yoshikuni Kita
    • , Aya Kadota
    • , Yasuyuki Nakamura
    • , Naomi Miyamatsu
    • , Takehito Hayakawa
    • , Nagako Okuda
    • , Katsushi Yoshita
    • , Yoshihiro Miyamoto
    • , Makoto Watanabe
    • , Akira Fujiyoshi
    • , Kazunori Kodama
    • , Fumiyoshi Kasagi
    •  & Yutaka Kiyohara

Corresponding author

Correspondence to Takashi Hisamatsu.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hisamatsu, T., Kadota, A., Hayakawa, T. et al. High blood pressure and colorectal cancer mortality in a 29-year follow-up of the Japanese general population: NIPPON DATA80. Hypertens Res 47, 206–214 (2024). https://doi.org/10.1038/s41440-023-01497-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-023-01497-3

Keywords

Search

Advanced search

Quick links