Key result
High SBP-attributable mortality in China rises for ischemic but falls for hemorrhagic strokes.
Why the study?
It was unknown whether high systolic blood pressure had a similar effect on the disease burden across different stroke subtypes.
Observational
Effect estimate: EAPC 0.56 for IS, -1.52 for ICH, -7.02 for SAH (95% CI 0.37-0.74 for IS, -1.97 to -1.07 for ICH, -7.86 to -6.17 for SAH)
From 1990 to 2019 in China, the mortality and disease burden of hemorrhagic stroke attributable to high systolic blood pressure decreased, while the burden of ischemic stroke increased, particularly in males.
Shifting SBP-attributable stroke mortality trends in China may warrant subtype-specific prevention; extends GBD data but leaves causal mechanisms open.
BACKGROUND: It is unknown whether high systolic blood pressure had a similar effect on the disease burden of stroke subtypes. The aim of our study is to compare the long-term trends of stroke subtypes and sex groups attributable to high systolic blood pressure in China from 1990 to 2019. METHODS: Data about the age-standardized mortality rate and the age-standardized disability-adjusted life-year rate of stroke subtypes attributable to high systolic blood pressure in China were extracted in GBD (Global Burden of Disease) 2019. The trends in the age-standardized mortality rate and the age-standardized disability-adjusted life-year rate were calculated using the liner regression and age-period-cohort method, adjusted for age, period, and cohort. RESULTS: The estimated annual percentage change for mortality of stroke attributable to high systolic blood pressure was different from subtypes, with an estimated annual percentage change and 95% CI of 0.56 (0.37–0.74) for ischemic stroke (IS), −1.52 (−1.97 to −1.07) for intracerebral hemorrhage, and −7.02 (−7.86 to −6.17) for subarachnoid hemorrhage (SAH). The curve of the net drifts showed a downward trend for intracerebral hemorrhage and SAH, but that showed a stable trend for IS. The curve of local drifts showed a slow upward trend with age for IS, a slow downward trend for intracerebral hemorrhage, and a sharp downward trend for SAH. The drift curves showed different trends for males and females. The proportion of stroke mortality in young males was gradually increasing. The cohort rate ratio varied by subtypes, with the greatest decline for SAH, a slight decrease for intracerebral hemorrhage, and a slight increase for IS. The period rate ratio had decreased over the past 3 decades, with the greatest decline for SAH and the weakest decrease for IS. Moreover, both the period and cohort rate ratios for IS mortality due to high systolic blood pressure in males have increased significantly over the past 3 decades. CONCLUSIONS: Our results provided strong evidence that the disease burden of stroke attributable to high systolic blood pressure varied by subtypes and sex in China from 1990 to 2019. The age-standardized mortality rate and the age-standardized disability-adjusted life-year rate decreased for hemorrhagic stroke but increased for IS. Males had a higher mortality and exposure risk but a slighter decreasing trend than females. Our study suggested that greater attention should be given to the prevention of the burden of IS attributable to systolic blood pressure in China, especially for males.
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Gao et al. (2023) conducted an observational in Stroke and subtypes attributable to high systolic blood pressure. High systolic blood pressure was evaluated on Age-standardized mortality rate and disability-adjusted life-year rate (EAPC 0.56 for IS, -1.52 for ICH, -7.02 for SAH, 95% CI 0.37-0.74 for IS, -1.97 to -1.07 for ICH, -7.86 to -6.17 for SAH). Mortality attributable to high systolic blood pressure in China increased for ischemic stroke (EAPC 0.56; 95% CI 0.37-0.74) but decreased for hemorrhagic stroke subtypes from 1990 to 2019.
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