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Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity.
Thursday,2025-07-03 11:53 America/Los_Angeles — ecterry
| Title | Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity. |
| Publication Type | Journal Article |
| Year of Publication | 2024 |
| Authors | Johnson, KE, Li, H, Zhang, M, Springer, MV, Galecki, AT, Whitney, RT, Gottesman, RF, Hayward, RA, Sidney, S, Elkind, MSV, Longstreth, WT, Heckbert, SR, Gerber, Y, Sullivan, KJ, Levine, DA |
| Journal | JAMA Netw Open |
| Volume | 7 |
| Issue | 5 |
| Pagination | e248502 |
| Date Published | 2024 May 01 |
| ISSN | 2574-3805 |
| Keywords | Adult, Aged, Black or African American, Blood Pressure, Cerebral Hemorrhage, Ethnicity, Female, Hispanic or Latino, Humans, Hypertension, Incidence, Ischemic Stroke, Longitudinal Studies, Male, Middle Aged, Racial Groups, Risk Factors, Stroke, Subarachnoid Hemorrhage, United States, White, White People |
| Abstract | <p><b>IMPORTANCE: </b>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.</p><p><b>OBJECTIVE: </b>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.</p><p><b>DESIGN, SETTING, AND PARTICIPANTS: </b>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.</p><p><b>EXPOSURE: </b>Time-dependent cumulative mean SBP.</p><p><b>MAIN OUTCOMES AND MEASURES: </b>The primary outcome was time from baseline visit to first incident stroke. Secondary outcomes consisted of time to first incident IS, ICH, and SAH.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS AND RELEVANCE: </b>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.</p> |
| DOI | 10.1001/jamanetworkopen.2024.8502 |
| Alternate Journal | JAMA Netw Open |
| PubMed ID | 38700866 |
| PubMed Central ID | PMC11069082 |
| Grant List | N01HC95169 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States R01 AG040282 / AG / NIA NIH HHS / United States N01HC95168 / HL / NHLBI NIH HHS / United States N01HC95162 / HL / NHLBI NIH HHS / United States U01 HL096899 / HL / NHLBI NIH HHS / United States N01HC95164 / HL / NHLBI NIH HHS / United States U01 HL096814 / HL / NHLBI NIH HHS / United States N01HC95160 / HL / NHLBI NIH HHS / United States P30 AG015281 / AG / NIA NIH HHS / United States P30 AG024824 / AG / NIA NIH HHS / United States U01 HL096917 / HL / NHLBI NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01HC95161 / HL / NHLBI NIH HHS / United States N01 HC085079 / HC / NHLBI NIH HHS / United States K24 AG052573 / AG / NIA NIH HHS / United States R01 NS102715 / NS / NINDS NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States UL1 TR001420 / TR / NCATS NIH HHS / United States N01HC95165 / HL / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States U01 HL096902 / HL / NHLBI NIH HHS / United States N01HC95167 / HL / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States R37 NS029993 / NS / NINDS NIH HHS / United States N01HC95159 / HL / NHLBI NIH HHS / United States U01 HL096812 / HL / NHLBI NIH HHS / United States N01HC95163 / HL / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States UL1 TR001079 / TR / NCATS NIH HHS / United States U01 HL130114 / HL / NHLBI NIH HHS / United States N01HC95166 / HL / NHLBI NIH HHS / United States N01 HC085080 / HC / NHLBI NIH HHS / United States UL1 TR000040 / TR / NCATS NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States |
ePub date:
24/05