Objective To explore the risk probability and influencing factors of stroke in elderly hypertension patients through an analysis on long-term retrospective followed-up data, and to provide a reference for hypertension management and stroke prevention and control in communities.
Methods Using the data from a hypertension patients followed-up management system, a retrospective observation from January 2002 through September 2020 was conducted among 138 284 community hypertension patients aged 60 years and above in Jiading district, Shanghai city. Kaplan-Meier method was used to analyze the risk probability of stroke incidence in the patients, and the influencing factors of stroke incidence were analyzed with Cox proportional risk model.
Results During 3 754 812 person years′ follow-up, totally 13 824 stroke incidents were observed among all the participants, with a cumulative incidence of 10% and an incidence density of 0.00368/person year. The participants′ cumulative probability of stroke increased unevenly with the increment of follow-up years. The estimated median risk probability was 0.5 (50%) for the participants with a hypertension duration of 23.89 ± 0.24 years. The cumulative risk probability was 0.817 (81.7%) for all the participants and the probability was 0.952 (95.2%) and 0.728 (72.8%) for the male and female participants. During the whole follow-up period, four peaks of risk probability of stroke incidence were observed among the participants with the hypertension duration of 8, 15, 22, and 26 years, with the probability risk values of 0.044 (4.4%), 0.143 (14.3%), 0.062 (6.2%), and 0.143 (14.3%), respectively, and there was a disparity in the risk probability between the male and female participants. The results of multivariate Cox proportional hazards model analysis showed that age over 70 years, with the hypertension stage of grade 2 or higher, smoking (regular smoking, daily smoking), daily alcohol drinking, family history of diabetes, family history of stroke, overweight/ obesity and with a follow up period of one year and longer were risk factors for stroke in the participants; being female, having occasional/regular/daily physical exercise, with occasional or regular alcohol drinking, and low body weight are protective factors against stroke incidence.
Conclusion Among community elderly hypertension patients, the risk probability of stroke increases with the increment of disease duration and the peak cumulate risk probability could be greater than 0.5. The main factors influencing stroke risk probability include gender, age, hypertension state, smoking, alcohol drinking, physical exercise, family history of diabetes/hypertension/stroke, body mass index, and hypertension duration.
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