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Impact of Achieved Blood Pressure on First Stroke in Uncomplicated Grade 1 Hypertension.

Impact of Achieved Blood Pressure on First Stroke in Uncomplicated Grade 1 Hypertension.
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Qin X, Li Y, Sun N, He M, Tang G, Yin D, Wang J, Liang M, Wang B, Huo Y, Xu X, Xu X, Hou FF,


Qin X, Li Y, Sun N, He M, Tang G, Yin D, Wang J, Liang M, Wang B, Huo Y, Xu X, Xu X, Hou FF, (click to view)

Qin X, Li Y, Sun N, He M, Tang G, Yin D, Wang J, Liang M, Wang B, Huo Y, Xu X, Xu X, Hou FF,

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Journal of the American Heart Association 2017 03 086(3) pii e005247
Abstract
BACKGROUND
We aimed to test the impact of achieved blood pressure (BP) on first stroke among patients with grade 1 hypertension and without cardiovascular diseases in the China Stroke Primary Prevention Trial.

METHODS AND RESULTS
A total of 3187 patients with uncomplicated grade 1 hypertension were included. The risk of outcomes was assessed according to: (1) the proportion of visits in which BP was reduced to <140/90 mm Hg, and (2) the time-averaged systolic BP (SBP) or diastolic BP levels during the study treatment period. The median antihypertensive treatment duration was 4.6 years. Only 1.5% of the participants discontinued the treatments because of adverse reaction. Overall, the risk of stroke decreased with the increase of the proportion of study visits with BP <140/90 mm Hg (for per 5% increase; hazard ratio, 0.92 [95% CI, 0.87-0.98]). Consistently, compared with patients with time-averaged SBP ≥140 or diastolic BP ≥90 mm Hg, the risk of stroke was lower in patients with time-averaged SBP of 120 to <140 mm Hg (1.1% versus 2.9%; hazard ratio, 0.39 [95% CI, 0.22-0.69]) or diastolic BP <90 mm Hg (1.5% versus 2.7%; hazard ratio, 0.41 [95% CI, 0.17-0.98]). The beneficial results were consistent across age (<60 versus ≥60 years), sex, baseline SBP (<150 versus 150 to <160 mm Hg), study treatment groups (enalapril or enalapril-folic acid), and hypertension subtypes (isolated systolic hypertension or systolic-diastolic hypertension). However, a time-averaged SBP <120 mm Hg (versus 120-140 mm Hg) was associated with an increased risk for stroke. Similar results were observed for composite cardiovascular events or all-cause death. CONCLUSIONS
Achieved BP <140/90 mm Hg was significantly associated with a decreased risk of stroke or all-cause death in patients with uncomplicated grade 1 hypertension.

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