Racial differences in the impact of elevated systolic blood pressure on stroke risk.
Racial differences in the impact of elevated systolic blood pressure on stroke risk.
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DOI：
10.1001/2013.jamainternmed.857
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发表时间：
2013-01-14
影响因子：
39
通讯作者：
Howard, Virginia J.
中科院分区：
文献类型：
--
作者：
Howard, George;Lackland, Daniel T.;Kleindorfer, Dawn O.;Kissela, Brett M.;Moy, Claudia S.;Judd, Suzanne E.;Safford, Monika M.;Cushman, Mary;Glasser, Stephen P.;Howard, Virginia J.
在45岁至65岁之间，黑人中风发病率是白人的2至3倍，传统的中风风险因素无法解释这种差异。在卒中的地理和种族差异原因（REGARDS）研究中，对2003年至2007年招募的27748名黑人和白色参与者进行了卒中风险评估，这些参与者随访至2011年。使用比例风险模型评估收缩压（SBP）影响的种族差异。根据年龄（<65岁、65-74岁和≥75岁）和SBP（<120 mm Hg、120-139 mm Hg和140-159 mm Hg）分层评估卒中风险的种族差异。在4.5年的随访中，发生了715起中风事件。SBP差异10 mm Hg与白人卒中风险增加8%（95% CI，0%-16%）相关，但与黑人卒中风险增加24%（95% CI，14%-35%）相关（相互作用P值，0.02）。对于45 - 64岁的参与者（差异最大），黑人与白色人的风险比在血压正常的参与者中为0.87（95%CI，0.48-1.57），在高血压前期的参与者中为1.38（95%CI，0.94-2.02），在高血压1期的参与者中为2.38（95%CI，1.19-4.72）。这些发现表明，血压升高对中风风险的影响存在种族差异。当这些种族差异与先前记录的黑人高血压患病率较高和高血压控制较差相结合时，它们可能是卒中风险的种族差异的主要原因。
Between the ages 45 and 65 years, incident stroke is 2 to 3 times more common in blacks than in whites, a difference not explained by traditional stroke risk factors. Stroke risk was assessed in 27 748 black and white participants recruited between 2003 and 2007, who were followed up through 2011, in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Racial differences in the impact of systolic blood pressure (SBP) was assessed using proportional hazards models. Racial differences in stroke risk were assessed in strata defined by age (<65 years, 65–74 years, and ≥75 years) and SBP (<120 mm Hg, 120–139 mm Hg, and 140–159 mm Hg). Over 4.5 years of follow-up, 715 incident strokes occurred. A 10–mm Hg difference in SBP was associated with an 8% (95% CI, 0%-16%) increase in stroke risk for whites, but a 24% (95% CI, 14%-35%) increase for blacks (P value for interaction, .02). For participants aged 45 to 64 years (where disparities are greatest), the black to white hazard ratio was 0.87 (95% CI, 0.48–1.57) for normotensive participants, 1.38 (95% CI, 0.94–2.02) for those with prehypertension, and 2.38 (95% CI, 1.19–4.72) for those with stage 1 hypertension. These findings suggest racial differences in the impact of elevated blood pressure on stroke risk. When these racial differences are coupled with the previously documented higher prevalence of hypertension and poorer control of hypertension in blacks, they may account for much of the racial disparity in stroke risk.
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影响因子：
11.2
作者：
Cushman, Mary;Cantrell, Ronald A.;McClure, Leslie A.;Howard, George;Prineas, Ronald J.;Moy, Claudia S.;Temple, Ella M.;Howard, Virginia J.
通讯作者：
Howard, Virginia J.
影响因子：
8.3
作者：
Howard G;Cushman M;Kissela BM;Kleindorfer DO;McClure LA;Safford MM;Rhodes JD;Soliman EZ;Moy CS;Judd SE;Howard VJ;REasons for Geographic And Racial Differences in Stroke (REGARDS) Investigators
通讯作者：
REasons for Geographic And Racial Differences in Stroke (REGARDS) Investigators
影响因子：
8.3
作者：
Rosamond, WD;Folsom, AR;Shahar, E
通讯作者：
Shahar, E
影响因子：
8.3
作者：
WOLF, PA;ABBOTT, RD;KANNEL, WB
通讯作者：
KANNEL, WB
影响因子：
8.3
作者：
Howard, G;Prineas, R;Howard, V
通讯作者：
Howard, V