Correlation between Stroke Risk and Systolic Blood Pressure in Patients over 50 Years with Uncontrolled Hypertension: Results from the SYSTUP-India Study
Rishi Sethi, Jagdish Hiremath, V. Ganesh, Sunip Banerjee, Mahesh Shah, Ashwani Mehta, Preeti Nikam, Minakshi Jaiswal, Nishita Shah
Abstract
Objectives. To assess mean systolic and diastolic blood pressure (SBP and DBP) levels in patients ≥50 years with uncontrolled hypertension (HTN) and evaluate the correlation between BP and stroke risk. It also assessed therapeutic drug classes prescribed in these patients. Methods. A cross-sectional, observational study was conducted at 176 outpatient centers across India, including patients aged ≥50 years with elevated SBP (≥140 mmHg). The relationship between stroke risk, calculated using Stroke Riskometer™, and mean SBP, mean DBP, and other risk factors was evaluated using Pearson correlation coefficient and logistic regression analysis. Results. The study included 3791 patients (men, 60.0%; mean age: <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mn>62.1</a:mn> <a:mo>±</a:mo> <a:mn>8.3</a:mn> </a:math> years; mean BMI: 27 kg/m2) with mean SBP <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mn>157.3</c:mn> <c:mo>±</c:mo> <c:mn>12.8</c:mn> <c:mtext> </c:mtext> <c:mtext>mmHg</c:mtext> </c:math> and mean DBP <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mn>89.8</e:mn> <e:mo>±</e:mo> <e:mn>9.7</e:mn> <e:mtext> </e:mtext> <e:mtext>mmHg</e:mtext> </e:math> . Five-year stroke risk in 33.9% and 10-year stroke risk in 70% patients were moderate to severe. A ~4% increase in both 5- and 10-year stroke risk with each 1 mmHg increase in mean SBP ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>p</g:mi> <g:mo><</g:mo> <g:mn>0.0001</g:mn> </g:math> ) was seen. However, mean DBP did not exhibit any significant correlation with 5-year ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>p</i:mi> <i:mo>=</i:mo> <i:mn>0.242</i:mn> </i:math> ) or 10-year ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>p</k:mi> <k:mo>=</k:mo> <k:mn>0.8038</k:mn> </k:math> ) stroke risk. There was a positive correlation between mean SBP and patient age, comorbid diabetes, and smoking and alcohol habits ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>p</m:mi> <m:mo><</m:mo> <m:mn>0.0001</m:mn> </m:math> ). Comorbid diabetes and smoking increased 5- and 10-year stroke risk by 2- to 5-fold. Irrespective of the risk category, most patients received antihypertensive therapy with an angiotensin receptor blocker. Conclusion. Findings corroborate an association between stroke risk and mean SBP. These real-world clinical findings indicate that efforts are required to improve primary prevention of stroke and reduce the prevalence of recurrent stroke in India.