Related Experiment Video
Updated: Jun 5, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Association of Duration of Recognized Hypertension and Stroke Risk: The REGARDS Study
George Howard1, Paul Muntner2, Daniel T Lackland3
1Department of Biostatistics (G.H., S.E.J.), School of Public Health, University of Alabama at Birmingham.
Insights
Delaying hypertension onset may reduce stroke risk. Longer hypertension duration correlates with increased medication use, higher blood pressure, and greater stroke hazard, even after adjustments.
Area of Science:
- Cardiovascular Disease Research
- Neurology
- Public Health
Background:
- Hypertension management is key for reducing cardiovascular disease.
- Limited data exist on the benefits of delaying hypertension onset.
Purpose of the Study:
- To investigate the association between the duration of recognized hypertension and the risk of incident stroke.
- To assess the impact of hypertension duration on systolic blood pressure and antihypertensive medication use.
Main Methods:
- Analysis of data from the REGARDS cohort study, including Black and White participants.
- Stratification of participants based on hypertension duration: normotensive, ≤5 years, 6-20 years, and 21+ years.
- Assessment of baseline systolic blood pressure, medication classes, and incident stroke events, with adjustments for relevant risk factors.
Main Results:
- Longer hypertension duration was linked to increased use of antihypertensive medication classes.
- Higher mean systolic blood pressure was observed with increasing duration of hypertension.
- Stroke risk hazard ratios increased significantly with longer hypertension duration compared to normotensive individuals.
Conclusions:
- Prolonged hypertension duration is associated with elevated blood pressure, increased medication needs, and higher stroke risk.
- These findings suggest that delaying the onset of hypertension could potentially mitigate the overall burden of stroke.
Background:
The focus for reducing hypertension-related cardiovascular disease is the management of blood pressure. Limited data are available on the potential benefit of delaying the onset of hypertension.
Methods:
Stroke-free Black and White participants from the REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke; recruited 2003-2007) were followed through 2022 for incident stroke events. Participants were stratified by duration of recognized hypertension: normotensive (0 years), ≤5 years, 6 to 20 years, or 21+ years. The baseline systolic blood pressure (SBP), the number of classes of antihypertensive medications, and the risk of incident stroke were assessed by duration strata adjusting for demographics, cerebrovascular risk factors, SBP, and use of antihypertensive medications (where appropriate).
Results:
Of 30 239 study participants, we included 27 310 participants (mean age, 65 years; 45% male), followed a median of 12.4 years, during which 1763 incident stroke events occurred. On average, participants with hypertension duration ≤5 years, 6 to 20 years, and 21+ years were taking 1.68 (95% CI, 1.65-1.71), 2.04 (95% CI, 2.01-2.07), and 2.28 (95% CI, 2.25-2.31) classes of antihypertensive medications, respectively. The adjusted mean SBP level was higher with each increasing duration of recognized hypertension (0, ≤5, 6-20, and 21+ years): 123.9 mm Hg (95% CI, 123.3-124.6), 129.7 mm Hg (95% CI, 129.1-130.2), 131.7 mm Hg (95% CI, 130.6-131.5), and 132.6 mm Hg (95% CI, 132.0-133.1). Compared with normotensive individuals, the hazard for incident stroke increased from 1.31 (95% CI, 1.05-1.63) for ≤5 years duration, 1.50 (95% CI, 1.21-1.87) for 6 to 20 years duration, and 1.67 (95% CI, 1.32-2.10) for 21+ years duration.
Conclusions:
Longer duration of recognized hypertension was associated with more classes of antihypertensive medications, higher mean SBP, and higher stroke risk even after adjustment for age and SBP. Collectively, this suggests that delaying the onset of hypertension could reduce the burden of stroke.
Related Concept Videos
01:18Hypertension and Regulation of 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.
01:30Alterations in Blood Pressure
Hypertension (High blood pressure)
Hypertension occurs when blood pressure readings consistently exceed the normal range. It is diagnosed when systolic blood pressure (the top number, indicating pressure while the heart...
01:25Errors occurring during blood pressure monitoring
Several factors...
01:18Disorders of the Autonomic Nervous System
Raynaud's disease, also known as Raynaud's...