The Association of Stage 1 Hypertension Defined by the 2017 ACC/AHA Guideline with Stroke and Its Subtypes among Elderly Chinese

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.

Prevalence and risk factors of pre-hypertension and hypertension among adults in Southeastern Iran: Findings from the baseline survey of the Zahedan adult cohort study

“…Starting at a systolic blood pressure level of 90 mm Hg, there is a 53% higher risk for atherosclerotic cardiovascular disease for each 10-mm Hg systolic blood pressure increase [63,64]. These results were consistent with other studies conducted in Iran and globally that showed that the association between HTN and a history of CVD is continuous and independent of other risk factors [5,15,40,65].…”

Investigating the prevalence of hypertension and its associated risk factors in a population-based study: Fasa PERSIAN COHORT data

“…The results obtained from the study by Saju et al in India and the study by Gao et al in China showed a direct and significant relationship among smoking, lack of physical activity, diabetes, and ischemic heart disease and blood pressure. In addition, in the present study, the above-mentioned factors had significant relationships with blood pressure [24,25]. Rabi stated that since most blood pressure factors are modifiable, lifestyle and diet modifications can be considered as the most important and effective measures for the prevention and subsequent reduction of nasal side effects of hypertension.…”

<p>Estimation of Generalized Impact Fraction and Population Attributable Fraction of Hypertension Based on JNC-IV and 2017 ACC/AHA Guidelines for Cardiovascular Diseases Using Parametric G-Formula: Tehran Lipid and Glucose Study (TLGS)</p>

“…29 Unlike the current results, stage 1 HTN has been reported as a risk factor for CVD in some cohort studies. 27,30 In the study conducted by Qi et al, 19 the HRs for CVD, CHD, and stroke associated with stage 1 HTN were 1.78, 1.77, and 1.79, respectively. A recent meta-analysis of cohort studies also found that CVD was more common in stage 1 HTN compared to normal BP (HR: 1.38, 95% CI 1.28-1.49).…”