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The modifying effects of HS-CRP on the association between blood pressure and stroke risk in a non-hypertensive

Fanghua Liu1, Xiaowei Zheng2, Suwen Shen3

  • 1The First Department of Chronic Disease Prevention and Control, Baoshan District Center for Disease Control and Prevention, Shanghai, 201901, China.

Nutrition, Metabolism, and Cardiovascular Diseases : NMCD
|August 31, 2025
PubMed

Insights

High-sensitivity C-reactive protein (HS-CRP) modifies the association between normal blood pressure (BP) and stroke risk. Elevated BP in individuals with high HS-CRP levels, but not low levels, significantly increased stroke risk.

Area of Science:

  • Cardiovascular Epidemiology
  • Biomarkers and Disease Risk
  • Preventive Cardiology

Background:

  • Blood pressure (BP) and high-sensitivity C-reactive protein (HS-CRP) are known stroke risk factors.
  • The combined impact of BP and HS-CRP on stroke risk in normotensive individuals is not well understood.

Purpose of the Study:

  • To investigate the role of HS-CRP in modifying the relationship between BP and stroke risk.
  • To examine this association in a Chinese adult population without hypertension.

Main Methods:

  • Analysis of 4509 Chinese adults aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS).
  • Baseline BP and HS-CRP levels were measured, with stroke events tracked over 9 years.
  • Multivariate Cox proportional hazards regression models were used to assess stroke risk, stratified by HS-CRP levels.

Main Results:

  • Elevated systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were associated with increased stroke risk only in participants with high HS-CRP levels.
  • Linear dose-response relationships were observed between higher BP and stroke risk among those with high HS-CRP.
  • No significant association between elevated BP and stroke risk was found in individuals with low HS-CRP levels.

Conclusions:

  • High HS-CRP levels appear to potentiate the risk of stroke associated with elevated normal BP.
  • HS-CRP may serve as a crucial biomarker in identifying normotensive individuals at higher risk of stroke due to elevated BP.
Abstract

Keywords:
Blood pressureCHARLSHS-CRPStroke

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