Sex-Specific Optimal Target Blood Pressure for the Primary Prevention of Hemorrhagic Stroke: A Nationwide Observational Study

There arefew reports on the preventative value of intensive blood pressure (BP) management for stroke, especially hemorrhagic stroke (hSTK),after new criteria for hypertension (HTN) were announced by theAmerican College of Cardiology/American Heart Association in 2017. To identify the optimal BP for the primary prevention of hSTK in a healthy population aged between 20 and 65 years, we conducted a 10-yearobservational study on the risk of hSTK, subclassified as intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) according to BP categories (e.g.,low normal BP, high normal BP, elevated BP, stage 1 HTN and stage 2 HTN) using the National Health Insurance Service Database. Of the 8,325,579 participants who had a health checkup in 2008, 947,378 were ultimately enrolled in this study and observed from 2009 to 2018. The risk of ICH was significantly increased from stage 2 HTN (adjusted hazard ratio (AHR) 2.002 [95% confidence interval (CI) 1.203-3.332]) and stage 1 HTN (AHR 2.021 [95% CI, 1.251-3.263]) in men and women, respectively. The risk of SAH was significantly increased among both men (AHR 1.637 [95% CI, 1.066-2.514]) and women (AHR 4.217 [95% CI, 2.648-6.715]) from stage 1 HTN. The risk of hSTK was significantly increased among men with stage 2 HTN (AHR 3.034 [95% CI, 2.161-4.260]) and women with stage 1 HTN (AHR 2.976 [95% CI, 2.222-3.986]).Therefore, for the primary prevention of hSTK, including ICH and SAH, adults under the age of 65 should manage their BP from stage 1 HTN.