The Role of Cumulative Mean Arterial Pressure Levels in First Stroke Events Among Adults with Hypertension: A 10-Year Prospective Cohort Study

Figures & data

Figure 1 Flow chart of the study.

Table 1 Baseline Characteristics of the Study Sample

Characteristics*	Entire Population (n=9136)	Quartiles of Cumulative MAP				P value
		First Quartile (Q1) cum MAP ≤1050.08 mm Hg (n=2284)	Second Quartile (Q2) 1050.08 <cum MAP ≤1103.76 mm Hg (n=2284)	Third Quartile (Q3) 1103.76 <cum MAP ≤1156.35 mm Hg (n=2284)	Fourth Quartile (Q4) cum MAP >1156.35 mm Hg (n=2284)
Baseline SBP, mm Hg	151.3±12.2	147.3±8.7	148.2±9.7	151.3±10.8	158.5±15.2
Baseline DBP, mm Hg	94.5±7.3	91.4±5.7	93.3±6.0	94.6±6.7	98.7±8.6
Demographics
Sex, male	3880(42.5)	855(37.4)	935(40.9)	1006(44.0)	1084(47.5)	<0.001
Age, year	58.2±7.7	57.6±8.1	58.0±7.7	58.8±7.3	58.4±7.6	<0.001
Age, %
<60	4582(50.2)	1204(52.7)	1175(51.4)	1086(47.5)	1117(48.9)	0.002
≥60	4554(49.8)	1080(47.3)	1109(48.6)	1198(52.5)	1167(51.1)
Clinical variables
BMI, %
Underweight <18.5	85(0.9)	48(2.1)	13(0.6)	15(0.7)	9(0.4)	<0.001
Normal 18.5–23.9	2508(27.5)	797(34.9)	659(28.9)	552(24.2)	500(21.9)
Overweight 24.0–27.9	3892(42.6)	929(40.7)	980(42.9)	1015(44.4)	968(42.4)
Obese ≥28.0	2651(29.0)	510(22.3)	632(27.7)	702(30.7)	807(35.3)
WC, cm	89.8±10.1	86.5±9.9	88.9±9.8	90.8±9.4	92.8±10.0	<0.001
FPG, mmol/L	5.5±1.8	5.1±1.1	5.6±2.0	5.7±1.7	5.8±2.2	<0.001
TC, mmol/L	4.8±1.0	4.6±0.9	4.8±1.0	4.9±1.0	5.0±1.1	<0.001
TG, mmol/L	1.8±1.3	1.7±1.1	1.7±1.1	1.9±1.3	2.0±1.6	<0.001
HDL-C, mmol/L	1.6±0.5	1.7±0.5	1.7±0.5	1.6±0.5	1.6±0.4	<0.001
LDL-C, mmol/L	2.8±1.0	2.6±0.9	2.8±1.0	2.9±1.0	3.0±1.1	<0.001
Cr, μmol/L	80.2±22.0	75.2±17.0	79.7±23.3	82.1±25.6	84.0±20.4	<0.001
Lifestyle variables
Smoking, %	1810(19.8)	309(13.5)	400(17.5)	540(23.6)	561(24.6)	<0.001
Drinking, %	1515(16.6)	261(11.4)	370(16.2)	428(18.7)	456(20.0)	<0.001
Adequate daily intake of vegetable and fruit, %	3027(33.1)	736(32.2)	807(35.3)	783(34.3)	701(30.7)	0.004
limiting intake of high fat cholesterol foods, %	4777(52.3)	1129(49.4)	1249(54.7)	1213(53.1)	1186(51.9)	0.004
Dietary taste, %
Light	1478(16.2)	381(16.7)	366(16.0)	340(14.9)	391(17.1)	<0.001
Medium	4812(52.7)	1321(57.8)	1245(54.5)	1188(52.0)	1058(46.3)
Salty	2846(31.2)	582(25.5)	673(29.5)	756(33.1)	835(36.6)
Physical exercise, %
<3 times/week	3937(43.1)	681(29.8)	904(39.6)	1088(47.6)	1264(55.3)	<0.001
≥3 times/week	5199(56.9)	1603(70.2)	1380(60.4)	1196(52.4)	1020(44.7)
Poor mental state, %	950(10.4)	132(5.8)	261(11.4)	241(10.6)	316(13.8)	<0.001
Disease history variables
Diabetes, %	523(5.7)	43(1.9)	142(6.2)	161(7.0)	177(7.7)	<0.001
Dyslipidemia, %	3108(34.0)	579(25.4)	750(32.8)	858(37.6)	921(40.3)	<0.001
Hypertension duration, %
< 5 years	4497(49.2)	1410(61.7)	1187(52.0)	1061(46.5)	839(36.7)	<0.001
≥5 years	4639(50.8)	874(38.3)	1097(48.0)	1223(53.5)	1445(63.3)
Self-assessment of health status, %
Good	4589(50.2)	1365(59.8)	1231(53.9)	1093(47.9)	900(39.4)	<0.001
Fair	4231(46.3)	884(38.7)	973(42.6)	1107(48.5)	1267(55.5)
Poor	316(3.5)	35(1.5)	80(3.5)	84(3.7)	117(5.1)

Note: *Data are expressed as the means ± SD or n (%).

Abbreviations: Cum MAP, cumulative MAP; BMI, body mass index; WC, waist; FPG, fasting plasma glucose; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Cr, serum creatinine.

Table 2 Crude and Adjusted Stroke Hazard Ratios for Cumulative MAP Subgroups

	No. of Events	Unadjusted Analysis	Model 1*	Model 2^†
Stroke (n=492)
Q1	100	1.00	1.00	1.00
Q2	111	1.11(0.85–1.45)	1.14(0.86–1.49)	1.13(0.86–1.49)
Q3	129	1.29(0.99–1.68)	1.29(0.99–1.69)	1.29(0.98–1.69)
Q4	152	1.52(1.18–1.96)	1.52(1.16–1.99)	1.53(1.17–2.01)
P for trend		0.006	0.014	0.013
Ischemic stroke (n=418)
Q1	80	1.00	1.00	1.00
Q2	98	1.23(0.91–1.65)	1.24(0.92–1.67)	1.23(0.91–1.67)
Q3	111	1.39(1.04–1.85)	1.35(1.01–1.81)	1.35(1.01–1.82)
Q4	129	1.61(1.22–2.13)	1.54(1.14–2.07)	1.55(1.15–2.10)
P for trend		0.007	0.039	0.035
Hemorrhagic stroke (n=74)
Q1	20	1.00	1.00	1.00
Q2	13	0.65(0.32–1.31)	0.71(0.35–1.44)	0.70(0.34–1.43)
Q3	18	0.90(0.48–1.70)	1.05(0.55–2.03)	1.02(0.52–1.97)
Q4	23	1.15(0.63–2.09)	1.51(0.80–2.87)	1.50(0.78–2.88)
P for trend		0.421	0.194	0.192

Notes: Unadjusted analysis: univariate regression analysis; *Model 1 was adjusted for age, sex, BMI, WC, baseline FPG, TC, TG, HDL-C, LDL-C, Cr, diabetes, dyslipidemia, duration of hypertension, self-assessment of health status; ^†Model 2 was adjusted for Model 1 plus smoking, drinking, physical exercise, adequate daily intake of fruits and vegetables, restriction of high-fat food intake, taste, and mental status (stress or depression).

Table 3 Multivariate Cox Proportional Regression Model Analysis of Stroke Risk Among Different Subjects (Sensitivity Analysis)

Population	Quartiles of Cumulative MAP	HR (95% CI)
Stroke
Received non-pharmacologic treatment (n=7735)	Q1	1.00
	Q2	1.18(0.88–1.60)
	Q3	1.42(1.06–1.91)
	Q4	1.55(1.15–2.09)
	P for trend	0.021
Received antihypertensive drug treatments (n=7041)	Q1	1.00
	Q2	1.15(0.85–1.57)
	Q3	1.36(1.01–1.85)
	Q4	1.64(1.21–2.22)
	P for trend	0.009
Ischemic stroke
Received non-pharmacologic treatment (n=7735)	Q1	1.00
	Q2	1.32(0.95–1.84)
	Q3	1.51(1.09–2.10)
	Q4	1.58(1.13–2.20)
	P for trend	0.039
Received antihypertensive drug treatment (n=7041)	Q1	1.00
	Q2	1.31(0.93–1.83)
	Q3	1.48(1.06–2.07)
	Q4	1.70(1.21–2.38)
	P for trend	0.039

Notes: Adjusted for Model 2.

Table 4 Adjusted Ischemic Stroke Hazard Ratios for Cumulative MAP Subgroups Stratified by Sex, Age and BMI

	Quartiles of Cumulative MAP
	Q1	Q2	Q3	Q4
Entire population	1.00	1.23(0.91–1.67)	1.35(1.01–1.82)	1.55(1.15–2.10)
Stratified by sex
Male (n=3880)	1.00	1.30(0.79–2.13)	1.76(1.10–2.82)	2.05(1.28–3.28)
Female (n=5256)	1.00	1.21(0.83–1.77)	1.13(0.76–1.68)	1.27(0.85–1.89)
Stratified by age
< 60 years (n=4582)	1.00	1.38(0.84–2.28)	1.50(0.90–2.49)	1.42(0.84–2.38)
≥60 years (n=4554)	1.00	1.17(0.81–1.71)	1.31(0.90–1.89)	1.63(1.13–2.35)
Stratified by BMI
<24.0 (n=2593)	1.00	1.27(0.79–2.06)	1.15(0.69–1.93)	1.58(0.96–2.60)
≥24.0 (n=6543)	1.00	1.23(0.83–1.81)	1.48(1.02–2.14)	1.59(1.09–2.32)

Notes: Adjusted for Model 2.

Figure 2 Subgroup analysis of the association between cumulative MAP quartile levels and stroke stratified by sex, age, and BMI.

Notes: Hazard ratios (HRs) and 95% CI of stroke by quartile levels of cumulative MAP (Q1, cum MAP ≤1050.08 mm Hg, n=2284; Q2, 1050.08 <cum MAP ≤1103.76 mm Hg, n=2284; Q3, 1103.76 <cum MAP ≤1156.35 mm Hg, n=2284; Q4, cum MAP >1156.35 mm Hg, n=2284).