Role of blood pressure on stroke-related mortality: a 45-year follow-up study in China.
10.1097/CM9.0000000000001949
- Author:
Shengshu WANG
1
;
Shanshan YANG
2
;
Wangping JIA
1
;
Ke HAN
1
;
Yang SONG
1
;
Jing ZENG
3
;
Wenzhe CAO
1
;
Shaohua LIU
1
;
Shimin CHEN
1
;
Zhiqiang LI
1
;
Xuehang LI
1
;
Penggang TAI
4
;
Fuyin KOU
4
;
Yao HE
1
;
Miao LIU
5
Author Information
1. Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
2. Department of Disease Prevention and Control, The 1st Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
3. Department of Endocrinology, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
4. Department of Medical Service, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
5. Graduate School of Chinese PLA General Hospital, Beijing 100853, China.
- Publication Type:Journal Article
- MeSH:
Adult;
Blood Pressure/physiology*;
China/epidemiology*;
Follow-Up Studies;
Humans;
Hypertension;
Male;
Middle Aged;
Risk Factors;
Stroke
- From:
Chinese Medical Journal
2022;135(4):419-425
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations.
METHODS:This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis.
RESULTS:Among 1696 participants, the average age was 44.38 ± 6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297-4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR = 2.104, 95% CI: 1.632-2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender.
CONCLUSIONS:In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.
