Correlation between Stroke Risk and Systolic Blood Pressure in Patients over 50 Years with Uncontrolled Hypertension: Results from the SYSTUP-India Study

Objectives. To assess mean systolic and diastolic blood pressure (SBP and DBP) levels in patients ≥50 years with uncontrolled hypertension (HTN) and evaluate the correlation between BP and stroke risk. It also assessed therapeutic drug classes prescribed in these patients. Methods. A cross-sectional, observational study was conducted at 176 outpatient centers across India, including patients aged ≥50 years with elevated SBP (≥140 mmHg). The relationship between stroke risk, calculated using Stroke Riskometer™, and mean SBP, mean DBP, and other risk factors was evaluated using Pearson correlation coefficient and logistic regression analysis. Results. The study included 3791 patients (men, 60.0%; mean age: <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mn>62.1</a:mn> <a:mo>±</a:mo> <a:mn>8.3</a:mn> </a:math> years; mean BMI: 27 kg/m2) with mean SBP <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mn>157.3</c:mn> <c:mo>±</c:mo> <c:mn>12.8</c:mn> <c:mtext> </c:mtext> <c:mtext>mmHg</c:mtext> </c:math> and mean DBP <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mn>89.8</e:mn> <e:mo>±</e:mo> <e:mn>9.7</e:mn> <e:mtext> </e:mtext> <e:mtext>mmHg</e:mtext> </e:math> . Five-year stroke risk in 33.9% and 10-year stroke risk in 70% patients were moderate to severe. A ~4% increase in both 5- and 10-year stroke risk with each 1 mmHg increase in mean SBP ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>p</g:mi> <g:mo><</g:mo> <g:mn>0.0001</g:mn> </g:math> ) was seen. However, mean DBP did not exhibit any significant correlation with 5-year ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>p</i:mi> <i:mo>=</i:mo> <i:mn>0.242</i:mn> </i:math> ) or 10-year ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>p</k:mi> <k:mo>=</k:mo> <k:mn>0.8038</k:mn> </k:math> ) stroke risk. There was a positive correlation between mean SBP and patient age, comorbid diabetes, and smoking and alcohol habits ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>p</m:mi> <m:mo><</m:mo> <m:mn>0.0001</m:mn> </m:math> ). Comorbid diabetes and smoking increased 5- and 10-year stroke risk by 2- to 5-fold. Irrespective of the risk category, most patients received antihypertensive therapy with an angiotensin receptor blocker. Conclusion. Findings corroborate an association between stroke risk and mean SBP. These real-world clinical findings indicate that efforts are required to improve primary prevention of stroke and reduce the prevalence of recurrent stroke in India.