Sex-Specific Optimal Blood Pressure Targets to Prevent Primary Stroke: A Nationwide Observational Study

Abstract

Abstract There are few reports on the preventative value of intensive blood pressure (BP) management for stroke in the literature since the new criteria for hypertension (HTN) were announced by the American College of Cardiology/American Heart Association in 2017. To identify the optimal BP for the primary prevention of stroke in a healthy population aged between 19 and 65 years, we conducted a 10-year observational study on the risk of stroke, subclassified as hemorrhagic stroke (hSTK) and ischemic stroke (iSTK), according to BP categories (e.g., low-normal BP, high-normal BP, elevated BP, stage 1 HTN and stage 2 HTN) using the National Health Insurance Service Database. Of the 8,327,751 participants who had a health checkup in 2008, 949,551 were ultimately enrolled in this study and observed from 2009 to 2018. The risk of hSTK was significantly increased from stage 2 HTN (adjusted hazard ratio (AHR) 3.036 [95% confidence interval (CI), 2.159–4.252]) in men and from stage 1 HTN (AHR 2.972 [95% CI, 2.256–3.897]) in women. The risk of iSTK was significantly increased among both men (AHR 1.404 [95% CI, 1.164–1.693]) and women (AHR 2.012 [95% CI, 1.603–2.526]) with stage 1 HTN. The risk of overall stroke was significantly increased in men (AHR 1.386 [95% CI, 1.180–1.629]) and women (AHR 2.363 [95% CI, 1.973–2.830]) from stage 1 HTN. Therefore, for the primary prevention of overall stroke, adults under the age of 65 should manage their BP from stage 1 HTN.