Intensive Blood Pressure Management to Below 140 mmHg Reduces Stroke Risk, Regardless of Medication Dosage
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Intensive Blood Pressure Management to Below 140 mmHg Reduces Stroke Risk, Regardless of Medication Dosage
JAHA Study: Achieving Blood Pressure <140 mmHg Significantly Reduces Stroke Risk in Hypertensive Patients.
Hypertension is a modifiable risk factor for stroke (commonly known as “stroke”), coronary heart disease, and cognitive decline, with stroke being the second leading cause of death globally. While antihypertensive medications can lower the risk of stroke, there remains a residual risk.
This residual risk seems to increase as the number of different antihypertensive drug classes used increases. However, simply counting the number of drug classes does not account for the effects of increasing the dosage of individual drugs.
The “Hypertension Daily Dose” (HDD) is a comprehensive measure that quantifies the intensity of antihypertensive medication use. It takes into account both the number of drug classes and the dosage of individual drugs. One standardized unit of HDD is defined as 50% of the dose required to achieve full therapeutic effectiveness.
A recent prospective study published in the Journal of the American Heart Association (JAHA) demonstrated that among adults with no prior history of stroke, those with systolic blood pressure (SBP) ≥140 mmHg and who had medium to high levels of HDD were associated with a higher stroke risk.
In contrast, for adults with SBP <140 mmHg, the risk of stroke was similar regardless of whether they were treated with low or high doses of antihypertensive medications. The study supports the importance of aggressive blood pressure management to achieve an SBP of <140 mmHg, at which point the concern about medication dosage in relation to stroke risk becomes less significant.
The study utilized data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, which was conducted between 2003 and 2007 across 48 states in the U.S., involving 30,239 participants without a history of stroke. Follow-up home visits between 2013 and 2016 collected information on the types, dosages, and frequencies of antihypertensive medications used by participants, along with basic health assessments, including measurements of height, weight, and blood pressure. New stroke events were confirmed through semi-annual telephone interviews and medical record reviews.
Each participant’s medication list was consolidated and converted into an HDD score. HDD scores were divided into four categories: the first group included participants who were not taking any antihypertensive medication (HDD=0), while the remaining participants were grouped into three categories ranging from HDD1 to HDD3.
Participants were also classified into four SBP groups according to the JNC-7 (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) guidelines: <120 mmHg, 120-139 mmHg, 140-159 mmHg, and ≥160 mmHg.
A total of 13,265 participants with complete data (average age 72 years) were included in the analysis. During a median follow-up period of 5.5 years, 344 new stroke events were recorded. The analysis revealed that:
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For participants with SBP <120 mmHg and 120-139 mmHg, the risk of new strokes was similar across different HDD groups.
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Among participants with SBP ≥140 mmHg, medium and high levels of HDD were associated with a higher stroke risk. Specifically:
- Compared to the baseline group with SBP <120 mmHg and no antihypertensive medication use, participants with SBP 140-159 mmHg and medium HDD had a 186% higher risk of stroke (HR 2.86; 95% CI, 1.68-4.85), while those with high HDD had a 133% higher risk of stroke (HR 2.33; 1.37–3.97).
- For participants with SBP ≥160 mmHg, those with medium HDD had a 208% higher risk of stroke (HR 3.08; 1.20–7.88), and those with high HDD had a 266% higher risk of stroke (HR 3.66; 1.61–8.30).
Secondary analyses showed that for participants with SBP <140 mmHg, the risk of stroke was similar across different HDD groups. Sensitivity analyses yielded similar results.
Based on these findings, the research team emphasized the importance of aggressive blood pressure management. Once blood pressure is controlled to <140 mmHg, the risk of stroke remains similar regardless of the intensity of medication used.
References:
(source:internet, reference only)
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