A 10-mmHg increase in systolic blood pressure was associated with a greater increase in stroke risk in Asian populations (HR 1.51; 95% CI 1.47-1.55) than in Western populations (HR 1.23; 95% CI 1.16-1.29).
Systematic Review
Yes
Does the association between higher blood pressure and stroke risk differ between Asian and Western populations?
The association between higher blood pressure levels and increased stroke risk is significantly steeper in Asian populations compared to Western populations.
Hazard Ratio: 1.51 (95% CI 1.47–1.55)
Objective: Hypertension remains a major global public health problem, with a higher prevalence in Asia than in Western countries, where salt-sensitive phenotypes are more prevalent, and the association with stroke is stronger. Elucidating this differential risk is crucial for refining predictive models. However, quantitative evidence directly comparing this risk gradient remains limited. This systematic review aims to quantitatively compare the association between blood pressure levels and stroke risk between Asian and Western populations. Design and method: We systematically searched the Cochrane Library, Embase, MEDLINE, Web of Science, and Scopus from inception to July 2025 for cohort studies investigating the association between blood pressure levels or hypertension and stroke. Search terms included “hypertension”, “blood pressure”, “cardiovascular diseases”, and “stroke”. Studies were classified as Asian or Western based on the ethnicity of the study population. Hazard ratios (HRs) or relative risks (RRs) with 95% confidence intervals (CIs) for stroke per blood pressure increment or category were extracted. Subgroup-specific and stratified blood pressure estimates were combined within studies to harmonize blood pressure categories for comparative analyses. Estimates were pooled using random-effects or fixed-effects meta-analysis based on between-study heterogeneity assessed by the I2 statistic. Results: 15 prospective cohort studies were included (10 Asian, 5 Western). Each 10-mmHg increase in SBP was associated with a greater increase in stroke risk in Asian populations (HR 1.51, 95% CI 1.47-1.55) than in Western populations (HR 1.23, 95% CI 1.16-1.29). Similar patterns were observed when SBP =90 mmHg (HR 2.56, 95% CI 1.45-4.53), whereas Western risk peaked at 80-89 mmHg (RR 1.42, 95% CI 1.22-1.66). When SBP and DBP were considered jointly, pooled estimates were higher in Asian populations than in Western populations (HR 3.13, 95% CI 2.53-3.87 vs HR 1.31, 95% CI 1.05-1.63). (Table 1)Conclusions: Although higher blood pressure levels were associated with increased stroke risk in both Asian and Western populations, the association is notably steeper in Asian populations, particularly for systolic hypertension and stage 2 diastolic hypertension (>=90 mmHg).
Tsoi et al. (Fri,) conducted a systematic review in Hypertension and stroke risk. 10-mmHg increase in systolic blood pressure vs. Reference blood pressure levels was evaluated on Stroke risk in Asian populations (HR 1.51, 95% CI 1.47-1.55). A 10-mmHg increase in systolic blood pressure was associated with a greater increase in stroke risk in Asian populations (HR 1.51; 95% CI 1.47-1.55) than in Western populations (HR 1.23; 95% CI 1.16-1.29).