The Association Of Stage 1 Hypertension Defined By The 2017 ACC/AHA Guideline With Stroke And Its Subtypes Among Rural Elderly Population In Liaoning Province

Objectives: Stroke is the leading cause of death in China.Hypertension is a major risk factor for stroke.In 2017,the American College of Cardiology and American Heart Association(ACC/AHA)hypertension guideline was published,which changed the diagnostic criteria for hypertension from the original blood pressure ≥140/90 mm Hg to the present blood pressure ≥130/80 mm Hg.Meanwhile,the guidelines define blood pressure in the range of 130-139 mm Hg/80-89 mm Hg as stage 1hypertension.However,blood pressure in the range of 130-139 mm Hg/80-89 mm Hg was defined as high-normal blood pressure in China.According to the 2017ACC/AHA guideline,blood pressure control in patients with stage 1 hypertension may be beneficial to reduce the risk of stroke.Due to the number of the elderly population has increased substantially and the prevalence of hypertension positively increased with age,China should pay more attention to blood pressure in the elderly.Therefore,this study aimed to investigate the association between stage 1hypertension defined by the 2017 ACC/AHA guideline and the risk of stroke and its subtypes among in rural elderly Chinese.Methods: This population-based cohort study consisted of 7,503 adults aged ≥ 60 years with complete data and no cardiovascular disease at baseline from rural areas of Fuxin County,Liaoning province,China.Follow-up for the new cases of stroke was conducted from the end of the baseline survey(2004-2006)to the end of the third follow-up survey(January to July 2008,July to December 2010,March to December2017).The incidence of stroke were expressed as the number of events per 1,000person-years.Adjusted Cox proportional hazards models were used to estimate hazard ratios(HR)and 95% confidence intervals(CI).Results: During a median follow-up of 12.5 years,we observed 1,159 first-ever incident stroke(774 ischemic,360 hemorrhagic,and 25 uncategorized).With the blood pressure < 120/< 80 mm Hg as a reference,stage 1 hypertension increased the risk of alll stroke and ischemic stroke,but did not increase the risk of hemorrhagic stroke.The multivariate adjusted HR(95% CI)for stage 1 hypertension and all stroke,ischemic stroke,and hemorrhagic stroke were 1.45(1.11-1.90),1.65(1.17-2.33)and1.17(0.74-1.85),respectively.Conclusion: Among adults aged ≥ 60 years in rural China,stage 1 hypertension defined by 2017 ACC/AHA hypertension guideline was independently associated with the increased risk of all stroke and ischemic stroke,excluding hemorrhagic stroke.