In Japan, the mortality rate for stroke reached a peak around 1965, and it has been declining since then. The major reason is a decrease in the mortality rate of intracerebral hemorrhage (ICH), and this has started from 1960.1 From a global standpoint, Japan had the highest mortality of stroke worldwide in 1965 with the mortality rate of ICH being quite high among all stroke types.2 Thereafter, the mortality rate of ICH dramatically decreased as a result of the dissemination of the treatment for hypertension and the improvement in dietary habits. In 1975, the ICH mortality rate was lower than that of cerebral infarction. The decline in the mortality rate of ICH continued until the 1980s, whereafter it plateaued and has remained on the same level to this date. The incidence of stroke was revealed in a study on morbidity conducted in Hisayama-machi, Fukuoka prefecture. It showed that the occurrence of ICH in Japan was also lower than that of cerebral infarction.3 Based on the summary of comparison of case registration in all of Akita prefecture and the incidence of stroke worldwide, the incidence of stroke in Japan is equivalent to or lower than in Western countries, but the incidence of ICH among all stroke types is 2- to 3-fold higher in Japan.4,5 In addition, there has been no remarkable change in the incidence of ICH during the last 10 years, but 46% occurred in ICH patients who were under treatment for hypertension, and 24% occurred in patients not undergoing such treatment.6 It has also been reported that even if the maximum blood pressure is ≤140 mmHg, which is considered to be the target systolic pressure, when it is ≥120 mmHg, the incidence of ICH is significantly higher than patients with the optimal blood pressure of ≤120 mmHg.7 Therefore, it is absolutely important to identify patients with hypertension through regular physical check-ups without fail and to strictly control blood pressure in accordance with the Japanese Society of Hypertension Guidelines for the Management of Hypertension.8
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© 2011 Published by Elsevier Inc.