Background::Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations.Methods::This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis. Results::Among 1696 participants, the average age was 44.38 ± 6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297-4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR= 2.104, 95% CI: 1.632-2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender.Conclusions::In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.

Blood pressure;Stroke;Mortality;Mediation;Cohort study

Wang Shengshu;Yang Shanshan;Jia Wangping;Han Ke;Song Yang;Zeng Jing;Cao Wenzhe;Liu Shaohua;Chen Shimin;Li Zhiqiang;Li Xuehang;Tai Penggang;Kou Fuyin;He Yao;Liu Miao

Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China;Department of Healthcare, Agency for Offices Administration, Central Military Commission, Beijing 100082, China;Department of Disease Prevention and Control, The 1st Medical Center, Chinese PLA General Hospital, Beijing 100853, China;Department of Endocrinology, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China;Department of Medical Service, Chinese People’s Liberation Army General Hospital, Beijing 100853, China;Department of Epidemiology, State Key Laboratory of Kidney Diseases, Chinese People’s Liberation Army General Hospital, Beijing 100853, China;Graduate School of Chinese PLA General Hospital, Beijing 100853, China

中华医学杂志（英文版）

[1]Wang Shengshu;Yang Shanshan;Jia Wangping;Han Ke;Song Yang;Zeng Jing;Cao Wenzhe;Liu Shaohua;Chen Shimin;Li Zhiqiang;Li Xuehang;Tai Penggang;Kou Fuyin;He Yao;Liu Miao-.Role of blood pressure on stroke-related mortality: a 45-year follow-up study in China)[J].中华医学杂志（英文版）,2022(04):419-425

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