Higher cumulative blood pressure is associated with increased risk of incident stroke but not heart disease among middle-aged and older Chinese adults: A prospective cohort study.

Objective: To examine the associations of cumulative systolic blood pressure (SBP)/diastolic blood pressure (DBP)/pulse pressure (PP) with the incident heart disease and stroke, as well as the dose-response relationship between them.

Methods: Longitudinal prospective cohort study. Methods: The present cohort was drawn from the China Health and Retirement Longitudinal Study during 2011-2018. The Kaplan-Meier method was used to calculate the cumulative incidence of heart disease and stroke by quartiles of cumulative BP among participants, and the hazard ratios (HRs) and 95% confidence intervals (CIs) for heart diseases and stroke risk associated with the cumulative BP were estimated using Cox proportional hazards models. Restricted cubic spline plots were used to elucidate the dose-response relationship.

Results: After adjusting for multiple covariates, higher levels of cumulative SBP/DBP were found to be associated with the increased risk of incident stroke (HR for cumulative SBP: 2.11, 95% CI: 1.31-3.41; HR for cumulative DBP: 1.97, 95% CI: 1.25-3.11), but not heart diseases (HR for cumulative SBP: 1.21, 95% CI: 0.83-1.78; HR for cumulative DBP: 1.17, 95% CI:0.81-1.68). In stratified analyses, we found that age modified the positive association between high cumulative DBP and incident stroke, which more evident in subjects younger than 65 years. Besides, cumulative BP had no nonlinear dose-response relationship with the risk of heart diseases or stroke (P > 0.05).

Conclusions: These findings suggested that higher levels of cumulative SBP/DBP increased the risk of incident stroke, while no significant association was observed for incident heart disease and cumulative BP level.