Related Experiment Video
Updated: Jun 27, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity
Kimson E Johnson1,2, Hanyu Li3, Min Zhang4
1Department of Health Management and Policy, University of Michigan, Ann Arbor.
Insights
Higher cumulative mean systolic blood pressure (SBP) increases stroke risk, including ischemic stroke and intracerebral hemorrhage. These associations did not vary by race or ethnicity in this large US cohort study.
Area of Science:
- Cardiovascular Epidemiology
- Neurology
- Public Health
Background:
- Stroke risk is influenced by systolic blood pressure (SBP), race, and ethnicity.
- The relationship between cumulative mean SBP and specific stroke types, and its variation across racial and ethnic groups, requires further investigation.
Purpose of the Study:
- To analyze the association between cumulative mean SBP and the risk of first incident ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).
- To explore potential differences in these associations based on race and ethnicity.
Main Methods:
- Pooled individual participant data from 6 US longitudinal cohorts (1971-2019).
- Analysis included 38,267 participants, assessing time-dependent cumulative mean SBP as the exposure.
- Outcomes included time to first incident stroke, IS, ICH, and SAH.
Main Results:
- A 10-mm Hg increase in cumulative mean SBP was linked to higher risks of overall stroke (HR, 1.20), IS (HR, 1.20), and ICH (HR, 1.31), but not SAH (HR, 1.13).
- Black participants showed higher risks for IS and ICH compared to White participants.
- Hispanic participants had a significantly higher risk for SAH compared to White participants.
Conclusions:
- Cumulative mean SBP is associated with incident stroke types, independent of race and ethnicity.
- Stroke prevention strategies should incorporate SBP management alongside addressing social determinants of health and societal inequities.
Importance:
Stroke risk varies by systolic blood pressure (SBP), race, and ethnicity. The association between cumulative mean SBP and incident stroke type is unclear, and whether this association differs by race and ethnicity remains unknown.
Objective:
To examine the association between cumulative mean SBP and first incident stroke among 3 major stroke types-ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)-and explore how these associations vary by race and ethnicity.
Design, Setting, And Participants:
Individual participant data from 6 US longitudinal cohorts (January 1, 1971, to December 31, 2019) were pooled. The analysis was performed from January 1, 2022, to January 2, 2024. The median follow-up was 21.6 (IQR, 13.6-31.8) years.
Exposure:
Time-dependent cumulative mean SBP.
Main Outcomes And Measures:
The primary outcome was time from baseline visit to first incident stroke. Secondary outcomes consisted of time to first incident IS, ICH, and SAH.
Results:
Among 40 016 participants, 38 167 who were 18 years or older at baseline with no history of stroke and at least 1 SBP measurement before the first incident stroke were included in the analysis. Of these, 54.0% were women; 25.0% were Black, 8.9% were Hispanic of any race, and 66.2% were White. The mean (SD) age at baseline was 53.4 (17.0) years and the mean (SD) SBP at baseline was 136.9 (20.4) mm Hg. A 10-mm Hg higher cumulative mean SBP was associated with a higher risk of overall stroke (hazard ratio [HR], 1.20 [95% CI, 1.18-1.23]), IS (HR, 1.20 [95% CI, 1.17-1.22]), and ICH (HR, 1.31 [95% CI, 1.25-1.38]) but not SAH (HR, 1.13 [95% CI, 0.99-1.29]; P = .06). Compared with White participants, Black participants had a higher risk of IS (HR, 1.20 [95% CI, 1.09-1.33]) and ICH (HR, 1.67 [95% CI, 1.30-2.13]) and Hispanic participants of any race had a higher risk of SAH (HR, 3.81 [95% CI, 1.29-11.22]). There was no consistent evidence that race and ethnicity modified the association of cumulative mean SBP with first incident stroke and stroke type.
Conclusions And Relevance:
The findings of this cohort study suggest that cumulative mean SBP was associated with incident stroke type, but the associations did not differ by race and ethnicity. Culturally informed stroke prevention programs should address modifiable risk factors such as SBP along with social determinants of health and structural inequities in society.
Related Concept Videos
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:28Factors affecting Blood pressure
Physiological Factors:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:18Hypertension and Regulation of Blood Pressure
01:23Assessment of blood pressure in brachial artery(two-step method)
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure: