title: Impact of Achieved Blood Pressure on First Stroke in Uncomplicated Grade 1 Hypertension.
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.
  
  
  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.
authors.affiliation: State Key Laboratory of Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Xianhui
authors.initials: X
authors.lastname: Qin
authors.affiliation: State Key Laboratory of Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Youbao
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Cardiology, Peking University People's Hospital, Beijing, China.
authors.forename: Ningling
authors.initials: N
authors.lastname: Sun
authors.affiliation: Department of Neurology, First People's Hospital, Lianyungang, China.
authors.forename: Mingli
authors.initials: M
authors.lastname: He
authors.affiliation: Institute for Biomedicine, Anhui Medical University, Hefei, China.|School of Health Administration, Anhui Medical University, Hefei, China.
authors.forename: Genfu
authors.initials: G
authors.lastname: Tang
authors.affiliation: Department of Cardiology, First People's Hospital, Lianyungang, China.
authors.forename: Delu
authors.initials: D
authors.lastname: Yin
authors.affiliation: Shanghai Key Laboratory of Hypertension, Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: JiGuang
authors.initials: J
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Min
authors.initials: M
authors.lastname: Liang
authors.affiliation: State Key Laboratory of Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Binyan
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Peking University First Hospital, Beijing, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Huo
authors.affiliation: State Key Laboratory of Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: State Key Laboratory of Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China ffhouguangzhou@163.com xipingxu126@126.com.|AUSA Research Institute, Shenzhen AUSA Pharmed Co Ltd, Shenzhen, China.
authors.forename: Xiping
authors.initials: X
authors.lastname: Xu
authors.affiliation: State Key Laboratory of Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China ffhouguangzhou@163.com xipingxu126@126.com.
authors.forename: Fan Fan
authors.initials: FF
authors.lastname: Hou
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002423:Cause of Death; D002681:China; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D014803:Vitamin B Complex; D004656:Enalapril; D005492:Folic Acid
keywords: achieved blood pressure; all‐cause death; cardiovascular disease prevention; grade 1 hypertension; high blood pressure; hypertension; primary prevention; stroke