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Strict target blood pressure management for reducing the stroke risk according to 2017 ACC/AHA blood pressure
Peng Zhao1, Jie Liu1,2,3, Conglin Wang4
1Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.
Insights
New blood pressure guidelines reveal elevated blood pressure significantly increases stroke risk, especially in younger men. Over 60% of strokes in men under 60 were linked to systolic blood pressure (SBP) of 120mmHg or higher.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- The 2017 ACC/AHA hypertension guidelines introduced new blood pressure thresholds.
- Understanding the impact of these new thresholds on stroke risk is crucial for public health.
- Previous studies may not fully reflect the implications of the updated guidelines.
Purpose of the Study:
- To investigate the association between new blood pressure (BP) categories and the risk of first-ever stroke.
- To determine how elevated BP, under the new guidelines, affects stroke risk in different age and gender groups.
- To quantify the proportion of strokes attributable to specific BP levels in younger men.
Main Methods:
- A population-based cohort study was conducted from October 1991 to January 2018.
- Cox regression models were used to assess the association between BP categories (defined by the 2017 ACC/AHA guideline) and first-ever stroke risk.
- Covariates were adjusted for in the analysis.
Main Results:
- During a mean follow-up of 21.85 years, 638 first-ever strokes occurred among 3906 participants.
- In men under 60, elevated BP, stage 1, and stage 2 hypertension were significantly associated with higher ischemic stroke (IS) risk.
- Stage 2 hypertension increased intracerebral hemorrhage (ICH) risk in men under 60 and stroke risk in women across age groups.
Conclusions:
- Elevated blood pressure significantly increases stroke risk, particularly when hypertension is untreated.
- A strict blood pressure management target (systolic BP <120 mmHg; diastolic BP <80 mmHg) is recommended for young and middle-aged men.
- These findings underscore the importance of adhering to updated BP guidelines for stroke prevention.
Background And Purpose:
We explored the new BP thresholds and their impact on first-ever stroke risk determinations.
Results:
During a mean following-up period of 21.85 years, 638 first-ever strokes occurred among 3906 participants. After adjusting for covariates, the hazard ratios for ischemic stroke (IS) in men aged <60 years were significant higher in participants with elevated BP, stage 1 hypertension, and stage 2 hypertension than normal BP (all P<0.05); an increased risk of intracerebral hemorrhage (ICH) was also observed for those with stage 2 hypertension. Similarly, in women aged, the risk of stroke increased for those with stage 2 hypertension both in <60 years and in ≥60 years. Moreover, more than 60% of incident strokes were attributed to systolic BP (SBP) ≥120mmHg and diastolic BP (DBP) <80mmHg in men aged <60 years.
Conclusions:
Elevated BP increases the risk of developing stroke, particularly in the absence of routine BP measurements and hypertension treatment. A strict BP management target (SBP, <120 mmHg; DBP, <80 mmHg) should be adopted for young and middle-aged men.
Methods:
This population-based cohort study was conducted between October 1991 and January 2018. The association of BP categories, defined by the 2017 ACC/AHA BP guideline, with first-ever stroke risk was assessed using Cox regression models.
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