4 STROKECONNECTION Winter 2017
nowing the path of a person’s blood pressure from
middle age onward may help doctors better assess
the health risks posed by high blood pressure and
could lead to earlier interventions to prevent stroke
and other diseases linked to high blood pressure,
according to research in the American Heart Association’s
“[M]ost studies looking at the relationship between high
blood pressure and stroke have relied on a blood pressure
measurement at a single point in time, rather than looking
at the course of blood pressure and stroke risk,” said M.
Arfan Ikram, M.D., Ph.D., senior study author and associate
professor of neuroepidemiology at Erasmus University
Medical Center in Rotterdam, the Netherlands.
Dutch researchers tracked the systolic (top number) blood
pressure of 6,745 participants, age 55-106, living in a suburb
of Rotterdam for over two decades.
Researchers identified four distinct blood pressure
trajectories in people 55 and older:
• Class 1 experienced gradually increasing blood pressure
from normal systolic blood pressure (120 mm Hg) in
middle age to high systolic blood pressure (160 mm Hg)
at age 95. Class 1 was the most common trajectory.
• Class 2 began with normal blood pressures in middle
age but experienced a steep increase to very high
systolic blood pressure (200 mm Hg) over the same
• Class 3 had moderate high systolic blood pressure
(140 mm Hg) in middle age that did not change much
• Class 4 had high systolic blood pressure (160 mm Hg)
in middle age, but their blood pressure decreased after
age 65. Class 4 were more frequently men and more
often used medication.
The study accounted for blood pressure lowering
medications, smoking, alcohol use, body weight and
other factors that might bias results. After adjustment,
• Those whose blood pressure climbed steeply with
time (Class 2) and those with high blood pressure that
decreased after age 65 (Class 4) had the highest risk
of stroke and dying from non-stroke diseases up to the
age of 80.
• People with moderately high blood pressure at mid-life
and throughout (Class 3), had the highest risk of stroke
overall but their risk of dying from non-stroke events,
along with those in Class 1, was the lowest.
• Those with normal baseline and gradually increasing
blood pressure from borderline-high to high (Class 1)
had the lowest risk of stroke and a low risk of death for
During the study period, 1,053 participants experienced a
stroke. Researchers also studied the number of deaths that
occurred from non-stroke health events. High blood pressure
also increases the chances of dying from heart attack, heart
failure, kidney disease and other diseases.
“Blood pressure should be measured regularly because
it can change markedly over the course of a couple years,
and put you at high risk for an adverse event,” said Ikram.
“Since the risk of stroke and death differ across these
trajectory paths, they are potentially important for preventive
Source: American Heart Association News
Blood pressure over time may
better predict stroke, death risk