Abstract
Association of stroke risk with new blood pressure criterion 2017 is unknown in China. We assessed the association between blood pressure (BP) values and stroke risk in a low-income population in Tianjin, China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were categorized into five strata and strokes were recorded as stroke, ischemic stroke, and hemorrhagic stroke. Stroke risk was analyzed according to blood pressure stratum using Cox regression analysis. Overall, 4,017 residents (age, ≥18 years) were included in this prospective cohort study. Over a 27-year follow-up period (total, 86,515.78 person-years), 638 participants experienced first-ever strokes. The stroke risk was higher among individuals with SBPs ≥140 mmHg or DBPs ≥90 mmHg than among those with SBPs < 130 mmHg or DBPs < 80 mmHg (reference group), after adjusting for covariates. However, hemorrhagic stroke risk increased only in participants with SBPs ≥160 mmHg. The stroke risk increased for individuals < 65-years-old having BP values ≥130/80 mmHg and for individuals ≥65-years-old with BP values ≥160/90 mmHg. To reduce the stroke burden in China, target BP goals must be established for adults, with different targets for the middle-aged and the elderly segments of the population. These results are very important for guiding clinical practice and may be generalized to other developing countries experiencing rapid economic development and where transitions in the spectrum of prevalent diseases have occurred.
Highlights
Elevated blood pressure (BP) is the strongest modifiable risk factor for cardiovascular disease (CVD) and related disabilities; CVD caused almost 10 million deaths, worldwide, in 2013 [1]
For except for the interaction of age, BP, and stroke types on the stroke risk, we evaluated the interaction of BP, age, and stroke subtype for stroke risk using the Cox regression model, with hazard ratios (HRs) (95%confidence intervals (CIs)) of 1.021 (1.020, 1.023; P = 0.021)
During the course of the study, 108 participants were lost to follow-up, and three with missing baseline BP data were removed from the BP analysis
Summary
Elevated blood pressure (BP) is the strongest modifiable risk factor for cardiovascular disease (CVD) and related disabilities; CVD caused almost 10 million deaths, worldwide, in 2013 [1]. In China, in 2013, CVD (primarily stroke and ischemic heart disease) accounted for 2.5 million deaths (28% of overall deaths) and 15% of total disability-adjusted life-years [1, 2]. The rates of hypertension awareness, treatment, and control remain extremely low, suggestive of a substantial and unnecessary future disease burden [3]. China is an agricultural country, with approximately half of the population living in underdeveloped rural areas where the prevalence of hypertension is high and treatment and control rates are low. Our previous study showed that the agestandardized prevalence of hypertension, among rural residents 35–74-years-old, was 51.7% in 2011, but its treatment (43.5%) and control (12%) rates were poor [4]. Between 1992 and 2012, the annual increase in the overall incidence of first-ever stroke was 6.5% [5]
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