December 9, 2024Stroke12 citationsOpen Access
Association of Duration of Recognized Hypertension and Stroke Risk: The REGARDS Study
Key Result
Longer duration of recognized hypertension was associated with increased incident stroke risk, reaching a hazard ratio of 1.67 (95% CI 1.32-2.10) for 21+ years duration compared to normotension.
Study Design
Type
Cohort (n=27,310)
Multicenter
Yes
Structured PICO
Does a longer duration of recognized hypertension increase the risk of incident stroke in stroke-free adults?
P
Population
27,310 stroke-free Black and White participants from the REGARDS cohort study (recruited 2003-2007), mean age 65 years, 45% male.
I
Intervention
Duration of recognized hypertension (stratified as ≤5 years, 6 to 20 years, or 21+ years)
C
Comparator
Normotensive individuals (0 years duration of recognized hypertension)
O
Outcome
Incident stroke eventshard clinical
Longer duration of recognized hypertension is associated with a progressively higher risk of incident stroke, independent of age and systolic blood pressure.
Main Result
Effect estimate: HR 1.67 (95% CI 1.32-2.10)
Abstract
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.
Cite This Study
Howard et al. (2024) conducted a cohort in Hypertension (n=27,310). Duration of recognized hypertension vs. Normotensive (0 years) was evaluated on Incident stroke events (HR 1.67, 95% CI 1.32-2.10). Longer duration of recognized hypertension was associated with increased incident stroke risk, reaching a hazard ratio of 1.67 (95% CI 1.32-2.10) for 21+ years duration compared to normotension.