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Relationship between diastolic blood pressure and the first ischaemic stroke in elderly patients with hypertension
  1. Chao-Lei Chen1,
  2. Jia-Yi Huang1,
  3. Lin Liu1,
  4. Yu-Ling Yu1,
  5. Geng Shen1,
  6. Kenneth Lo2,
  7. Yu-Qing Huang1,
  8. Song-tao Tang3,
  9. Ying Qing Feng1
  1. 1Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
  2. 2Community Health Center of Liaobu County, Dongguan, Rhode Island, China
  3. 3Department of Epidemiology, Centre for Global Cardiometabolic Health, Brown University, Providence, Rhode Island, United States
  1. Correspondence to Professor Ying Qing Feng, Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangzhou 510080, China; 651792209{at}


Background It is uncertain how diastolic blood pressure (DBP) may associate with ischaemic stroke in elder patients with hypertension. We aimed to explore this relationship in a Chinese community.

Methods A total of 3315 participants aged ≥60 years with essential hypertension were enrolled between January 2010 and December 2011, and being followed up until 31 December 2016. DBP levels were categorised into five groups (<60, 60–70, 70–80, 80–90 and ≥90 mm Hg), using 70–80 mm Hg as referent. We performed Cox regression analysis and subgroup analyses to evaluate the relationship between DBP and the incidence of ischaemic stroke.

Results Among the 3315 participants, 44.49% were men and they were 71.4 years old on average. During a median follow-up period of 5.5 years, there were 206 onset cases of ischaemic stroke. The HRs for the first ischaemic stroke in the fully adjusted model were 1.32 (95% CI 0.73 to 2.40) for DBP <70 mm Hg, 1.50 (95% CI 1.13 to 2.73) for DBP between 80 and 89.9 mm Hg and 2.31 (95% CI 1.14 to 4.68) for DBP ≥90 mm Hg compared with DBP between 70 and 79.9 mm Hg (p=0.020 for trend). Subgroup and interaction analysis showed no significant findings.

Conclusions DBP had a non-linear association with the risk of ischaemic stroke among Chinese elderly patients with hypertension. DBP between 70 and 80 mm Hg may be an appropriate indicator for a lower stroke risk.

  • diastolic blood pressure
  • ischaemic stroke
  • elderly
  • hypertension

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  • Contributors All authors: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content.

  • Funding This work was supported by the Natural Science Foundation of Guangdong Province (No. 2015A030313660), the Science and Technology Program of Guangzhou (No. 201604020143, No. 201604020018, No. 201604020186, No. 201510010254, and No. 201803040012) and the National Key Research and Development Program of China (No. 2017FYC1307603, No. 2016YFC1301305), the Key Area R&D Program of Guangdong Province (No. 2019B020227005).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The survey protocol was approved by the Guangdong Provincial People’s Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.