Optimal Systolic Blood Pressure Levels for Primary Prevention of Stroke in General Hypertensive Adults: Findings From the CSPPT (China Stroke Primary Prevention Trial)

Fangfang Fan¹, Ziwen Yuan¹, Xianhui Qin¹, Jianping Li¹, Yan Zhang¹, Youbao Li¹, Tao Yu¹, Meng Ji¹, Junbo Ge¹, Meili Zheng¹, Xinchun Yang¹, Huihui Bao¹, Xiaoshu Cheng¹, Dongfeng Gu¹, Dong Zhao¹, Jiguang Wang¹, Ningling Sun¹, Yundai Chen¹, Hong Wang¹, Xiaobin Wang¹, Gianfranco Parati¹, Fanfan Hou¹, Xiping Xu¹, Xian Wang², Gang Zhao², Yong Huo²

Affiliations

¹ From the Department of Cardiology, Peking University First Hospital, Beijing, China (F.F., J.L., Y.Z., Y.H.); Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China (Z.Y., G.Z.); National Clinical Research Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.Q., Y.L., F.H., X.X.); Institute for Biomedicine, Anhui Medical University, Hefei, China (X.Q., T.Y.); Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital (M.J., J.G.), and Institutes of Biomedical Sciences (M.J., J.G.), Fudan University, Shanghai, China; Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, China (M.Z., X.Y.); Department of Cardiology, Second Affiliated Hospital, Nanchang University, China (H.B., X.C.); Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (D.G.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital-Beijing Institute of Heart, Lung & Blood Vessel Diseases, China (D.Z.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, The Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, China (J.W.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China (Y.C.); Centers for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA (H.W.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Xiaobin Wang); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.P.); Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.); and Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China (Xian Wang).
² From the Department of Cardiology, Peking University First Hospital, Beijing, China (F.F., J.L., Y.Z., Y.H.); Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China (Z.Y., G.Z.); National Clinical Research Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.Q., Y.L., F.H., X.X.); Institute for Biomedicine, Anhui Medical University, Hefei, China (X.Q., T.Y.); Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital (M.J., J.G.), and Institutes of Biomedical Sciences (M.J., J.G.), Fudan University, Shanghai, China; Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, China (M.Z., X.Y.); Department of Cardiology, Second Affiliated Hospital, Nanchang University, China (H.B., X.C.); Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (D.G.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital-Beijing Institute of Heart, Lung & Blood Vessel Diseases, China (D.Z.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, The Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, China (J.W.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China (Y.C.); Centers for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA (H.W.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Xiaobin Wang); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.P.); Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.); and Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China (Xian Wang). huoyong@263.net.cn zhaogang@fmmu.edu.cn xwang@bjmu.edu.cn.

PMID: 28242714
DOI: 10.1161/HYPERTENSIONAHA.116.08499

Randomized Controlled Trial

Optimal Systolic Blood Pressure Levels for Primary Prevention of Stroke in General Hypertensive Adults: Findings From the CSPPT (China Stroke Primary Prevention Trial)

Fangfang Fan et al. Hypertension. 2017 Apr.

. 2017 Apr;69(4):697-704.

doi: 10.1161/HYPERTENSIONAHA.116.08499. Epub 2017 Feb 27.

Authors

Affiliations

¹ From the Department of Cardiology, Peking University First Hospital, Beijing, China (F.F., J.L., Y.Z., Y.H.); Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China (Z.Y., G.Z.); National Clinical Research Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.Q., Y.L., F.H., X.X.); Institute for Biomedicine, Anhui Medical University, Hefei, China (X.Q., T.Y.); Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital (M.J., J.G.), and Institutes of Biomedical Sciences (M.J., J.G.), Fudan University, Shanghai, China; Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, China (M.Z., X.Y.); Department of Cardiology, Second Affiliated Hospital, Nanchang University, China (H.B., X.C.); Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (D.G.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital-Beijing Institute of Heart, Lung & Blood Vessel Diseases, China (D.Z.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, The Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, China (J.W.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China (Y.C.); Centers for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA (H.W.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Xiaobin Wang); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.P.); Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.); and Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China (Xian Wang).
² From the Department of Cardiology, Peking University First Hospital, Beijing, China (F.F., J.L., Y.Z., Y.H.); Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China (Z.Y., G.Z.); National Clinical Research Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.Q., Y.L., F.H., X.X.); Institute for Biomedicine, Anhui Medical University, Hefei, China (X.Q., T.Y.); Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital (M.J., J.G.), and Institutes of Biomedical Sciences (M.J., J.G.), Fudan University, Shanghai, China; Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, China (M.Z., X.Y.); Department of Cardiology, Second Affiliated Hospital, Nanchang University, China (H.B., X.C.); Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (D.G.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital-Beijing Institute of Heart, Lung & Blood Vessel Diseases, China (D.Z.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, The Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, China (J.W.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China (Y.C.); Centers for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA (H.W.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Xiaobin Wang); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.P.); Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.); and Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China (Xian Wang). huoyong@263.net.cn zhaogang@fmmu.edu.cn xwang@bjmu.edu.cn.

PMID: 28242714
DOI: 10.1161/HYPERTENSIONAHA.116.08499

Abstract

We aimed to investigate the relationship of time-averaged on-treatment systolic blood pressure (SBP) with the risk of first stroke in the CSPPT (China Stroke Primary Prevention Trial). A post hoc analysis was conducted using data from 17 720 hypertensive adults without cardiovascular disease, diabetes mellitus, and renal function decline from the CSPPT, a randomized double-blind controlled trial. The primary outcome was first stroke. Over a median follow-up duration of 4.5 years, the association between averaged on-treatment SBP and risk for first stoke followed a U-shape curve, with increased risk above and below the reference range of 120 to 130 mm Hg. Compared with participants with time-averaged on-treatment SBP at 120 to 130 mm Hg (mean, 126.2 mm Hg), the risk of first stroke was not only increased in participants with SBP at 130 to 135 mm Hg (mean, 132.6 mm Hg; 1.5% versus 0.8%; hazard ratio, 1.63; 95% confidence interval, 1.01-2.63) or 135 to 140 mm Hg (mean, 137.5 mm Hg; 1.9% versus 0.8%; hazard ratio, 1.85; 95% confidence interval, 1.17-2.93), but also increased in participants with SBP <120 mm Hg (mean, 116.7 mm Hg; 3.1% versus 0.8%; hazard ratio, 4.37; 95% confidence interval, 2.10-9.07). Similar results were found in various subgroups stratified by age, sex, and treatment group. Furthermore, lower diastolic blood pressure was associated with lower risk of stroke, with a plateau at a time-average on-treatment diastolic blood pressure <80 mm Hg. In conclusion, among adults with hypertension and without a history of stroke or myocardial infarction, diabetes mellitus, or renal function decline, a lower SBP goal of 120 to 130 mm Hg, as compared with a target SBP of 130 to 140 mm Hg or <120 mm Hg, resulted in the lowest risk of first stroke.

Keywords: general hypertensives; goal blood pressure; hypertension; primary prevention; stroke.

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Optimal Systolic Blood Pressure Levels for Primary Prevention of Stroke in General Hypertensive Adults: Findings From the CSPPT (China Stroke Primary Prevention Trial)

Affiliations

Optimal Systolic Blood Pressure Levels for Primary Prevention of Stroke in General Hypertensive Adults: Findings From the CSPPT (China Stroke Primary Prevention Trial)

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