Proactively delaying the onset of hypertension may significantly lower the risk of stroke, according to a new study published in the American Heart Association (AHA) journal Stroke. The findings highlight the urgent need to shift focus from merely managing hypertension to implementing strategies aimed at preventing or delaying its onset.
Hypertension, a critical risk factor for stroke and myocardial infarction, affects nearly half of U.S. adults. It is defined as systolic blood pressure (SBP) ≥130 mmHg or diastolic blood pressure (DBP) ≥80 mmHg, with normal levels being <120/80 mmHg. Despite its significant impact, hypertension often remains undiagnosed due to its asymptomatic presentation.
A longitudinal study involving 27,310 U.S. adults with a median age of 65 years followed participants over a median of 12.4 years. The findings highlighted a progressive need for antihypertensive medications with increasing duration of hypertension. Individuals with a hypertension duration of ≥21 years required an average of 2.28 classes of blood pressure-lowering drugs, compared to 1.68 classes for those with a duration of ≤5 years.
Stroke risk escalated with longer hypertension duration. Compared to normotensive individuals, participants with hypertension for ≤5 years had a 31% increased risk of stroke. This risk rose to 50% for those with hypertension lasting 6–20 years and to 67% for those with a duration exceeding two decades. Importantly, these associations persisted even after adjustments for antihypertensive medication use and other confounding factors.
The key findings of the study include:
- Compared to normotensive individuals, those with hypertension for ≤5 years had a 31% higher stroke risk. This risk rose to 50% for those with 6–20 years of hypertension and 67% for those with hypertension exceeding 21 years, even after adjusting for confounding factors like SBP and medication use.
- Long-standing hypertension required more intensive pharmacological intervention. On average, participants with hypertension ≤5 years used 1.68 classes of medications, while those with 21+ years used 2.28 classes.
- Mean SBP increased with hypertension duration, from 123.9 mmHg in normotensive participants to 132.6 mmHg for those with hypertension lasting 21+ years.
A study by Zheng et al. found that patients with a longer duration of elevated blood pressure had a higher risk of cardiovascular events such as stroke, myocardial infarction, and even all-cause mortality. Additionally, a meta-analysis by Luo et al. reinforced the finding that elevated blood pressure levels are a strong risk factor for cardiovascular events. This analysis demonstrated that the risks increased with prolonged exposure to high blood pressure, particularly in older adults. Even small increases in systolic and diastolic blood pressure levels over extended periods were associated with a greater risk of long-term cardiovascular outcomes, including stroke.
Howard et al. stressed the importance of prioritizing the prevention of hypertension over solely focusing on its treatment. While managing high blood pressure is vital, preventing its onset is even more critical, as prolonged exposure to elevated blood pressure contributes significantly to long-term health damage.
Preventing strokes linked to hypertension benefits both individuals and society by reducing lifelong disabilities, improving quality of life, and easing economic burdens on families. Early detection and control of blood pressure can lower medical costs and improve outcomes.
The American Heart Association recommends a heart-healthy lifestyle to maintain healthy blood pressure, including a nutritious diet, limiting alcohol, maintaining a healthy weight, managing stress, staying active, avoiding smoking, and taking prescribed medications. Proactive strategies targeting lifestyle modifications, early screening, and preventive care may reduce the long-term burden of hypertension-related complications such as stroke. This study reinforces the critical need for public health initiatives that emphasize prevention over treatment to curb the rising prevalence of hypertension.
References
- Howard G, Muntner P, Lackland DT, Plante TB, Cushman M, Stamm B, et al. Association of Duration of Recognized Hypertension and Stroke Risk: The REGARDS Study. Stroke [Internet]. [cited 2024 Dec 10];0(0). Available from: https://www.ahajournals.org/doi/10.1161/STROKEAHA.124.048385
- Zheng Y, Gao X, Jia HY, Li FR, Ye H. Influence of hypertension duration and blood pressure levels on cardiovascular disease and all-cause mortality: A large prospective cohort study. Front Cardiovasc Med [Internet]. 2022 Oct 17 [cited 2024 Dec 10];9. Available from: https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.948707/full
- Luo D, Cheng Y, Zhang H, Ba M, Chen P, Li H, et al. Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis. BMJ. 2020 Sep 9;370:m3222.