Published Online
on November 23, 2005

A more recent version of this article appeared on January 1, 2006

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Submitted on May 8, 2005
Revised on July 29, 2005
Accepted on September 2, 2005

Subtype Hypertension and Risk of Stroke in Middle-Aged and Older Chinese. A 10-Year Follow-Up Study

Xiang-Hua Fang MD, MPH^*; Xin-Hua Zhang MD, PhD; Qi-Dong Yang MD; Xiu-Ying Dai MD; Fang-Zhong Su MD; Ming-Li Rao MD; Sheng-Ping Wu MD; Xiao-Li Du MD; Wen-Zhi Wang MD; and Shi-Chuo Li MD, MPH

From the Department of Epidemiology and Social Medicine (X.-H.F.), Xuanwu Hospital, Capital University of Medical Science, Beijing, China; Department of Community and Family Medicine (X.-H.Z.), The Chinese University of Hong Kong, 4F School of Public Health, Prince of Wales Hospital Shatin, NT, Hong Kong, China; Department of Neurology (Q.-D.Y.), Institute of Neurology, The Xiangya Hospital, Central South University, Changsha, P.R. China; Institute of Neurology (F.-Z.S.), Medical College, University of Henan, Zhengzhou, P.R. China; Department of Neurology (M.-L.R.), Medical College, University of Jilin, P.R. China; and Department of Neuroepidemiolology (S.-P.W., X.-L.D., W.-Z.W., S.-C.L.), Beijing Neurosurgical Institute, P.R. China.

^* To whom correspondence should be addressed. E-mail: xhfang{at}public3.bta.net.cn.

Background and Purpose--Hypertension is the most important indicator of stroke. We aim to compare the long-term effects of the subtypes of hypertension on the risk of stroke in a Chinese cohort.

Methods--A total of 26 587 subjects 35 years of age and free of stroke were recruited in 5 cities in 1987. The subtypes of hypertension were defined as isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic and diastolic hypertension (SDH), as well as managed hypertension (MHT), according to the criteria of systolic blood pressure 140 or diastolic blood pressure >90 mm Hg or under antihypertensive treatment. The relative risks of stroke with the subtypes of hypertension, compared with normotensives, were estimated using the Cox model after adjustments for age, sex, and other confounders.

Results--The prevalence of hypertension was: ISH 7.1%, SDH 18.4%, IDH 6.7%, and MHT 3.9%. During a total of 233 437 person years of follow-up, 1107 subjects developed stroke (614 ischemic and 451 hemorrhagic events and 42 unclassified). SDH patients were at the highest risk of stroke among all the hypertensives. The hazard ratio and 95% CI was 2.96 (2.49 to 3.52) for all stroke, 4.05 (3.10 to 5.30) for hemorrhagic, and 2.33 (1.84 to 2.95) for ischemic stroke. Although the incidence of stroke was higher in the older population, the effect of hypertension, especially SDH, on hemorrhagic stroke is stronger in the middle-aged population.

Conclusion--ISH and IDH are similarly prevalent in the population; both are independent predictors of stroke. Patients with SDH are at the highest risk of stroke and should be treated more aggressively.

Key words: cohort studies • hypertension • incidence • stroke

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