Abstract
Background The 2017 American College of Cardiology and American Heart Association hypertension guideline updated stage 1 hypertension definition as systolic blood pressure range from 130 to 139 mmHg or diastolic blood pressure from 80 to 89 mmHg. However, the association of stage 1 hypertension with stroke and its subtypes among the older population in rural China remains unclear. Methods This population-based cohort study consisted of 7,503 adults aged ≥60 years with complete data and no cardiovascular disease at baseline from rural areas of Fuxin County, Liaoning province, China. Follow-up for the new cases of stroke was conducted from the end of the baseline survey to the end of the third follow-up survey (January 1, 2007–December 31, 2017). Adjusted Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals with the normal blood pressure as a reference, and calculated population attributable risk was based on prevalence and hazard ratios. Results During a median follow-up of 12.5 years, we observed 1,159 first-ever incident stroke (774 ischemic, 360 hemorrhagic, and 25 uncategorized). With the blood pressure <120/<80 mmHg as a reference, stage 1 hypertension showed the adjusted hazard ratios (95% confidence intervals) of 1.45 (1.11–1.90) for all stroke, 1.65 (1.17–2.33) for ischemic stroke, and 1.17 (0.74–1.85) for hemorrhagic stroke, respectively. In this study, the population attributable risk values of stage 1 hypertension were 10.22% (2.64%–18.56%) for all stroke and 14.34% (4.23%–25.41%) for ischemic stroke. Conclusion Among adults aged ≥60 years in rural China, stage 1 hypertension defined by 2017 American College of Cardiology and American Heart Association hypertension guideline was independently associated with the increased risk of all stroke and ischemic stroke, excluding hemorrhagic stroke.
Highlights
Stroke is the leading cause of death in China [1, 2]
The research protocol was approved by the China Medical University Research Ethics Committee, and written informed consent was formally obtained from all the participants or their guardians
1,902 (25.3%) were diagnosed as stage 1 hypertension according to the 2017 ACC/AHA hypertension guideline
Summary
Stroke is the leading cause of death in China [1, 2]. In China, recent studies have found that hemorrhagic stroke mortality has decreased; morbidity and mortality of hemorrhagic stroke are nearly twice as the global average, and the burden of ischemic stroke is still increasing [3, 4]. The prevalence of hypertension positively increased with age [7, 8] For this reason, China should pay more attention to blood pressure (BP) in the elderly. The 2017 American College of Cardiology and American Heart Association hypertension guideline updated stage 1 hypertension definition as systolic blood pressure range from 130 to 139 mmHg or diastolic blood pressure from 80 to 89 mmHg. the association of stage 1 hypertension with stroke and its subtypes among the older population in rural China remains unclear. This population-based cohort study consisted of 7,503 adults aged ≥60 years with complete data and no cardiovascular disease at baseline from rural areas of Fuxin County, Liaoning province, China. Among adults aged ≥60 years in rural China, stage 1 hypertension defined by 2017 American College of Cardiology and American Heart Association hypertension guideline was independently associated with the increased risk of all stroke and ischemic stroke, excluding hemorrhagic stroke
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