Self-perceived psychological stress and risk of first stroke in treated hypertensive patients.

Abstract

OBJECTIVE\nWe aimed to investigate the prospective association between self-perceived psychological stress and first stroke, and examine possible effect modifiers among adults with hypertension.\n\n\nMETHODS\nA total of 20,688 hypertensive adults with information on self-perceived psychological stress at baseline were included from the China Stroke Primary Prevention Trial (CSPPT). Participants were randomly assigned to a double-blind treatment of receiving a single tablet daily with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. Follow up visits occurred every 3 months after randomization. Psychological stress was measured with a one-item 3-point rating scale. The primary outcome was first stroke (fatal or nonfatal).\n\n\nRESULTS\nThe median treatment period was 4.5 years. Compared with participants with low levels of psychological stress, those with high psychological stress had a significantly higher risk of first stroke (adjusted HR, 1.40; 95%CI: 1.01, 1.94) or first ischemic stroke (adjusted HR, 1.45; 95%CI: 1.01, 2.09). Moreover, a stronger positive relationship between psychological stress and first stroke was found in participants with time-averaged mean arterial pressure (MAP) <101 mmHg (median) (P-interaction = 0.004) during the treatment period. However, our study did not find a significant association between psychological stress and first hemorrhagic stroke.\n\n\nCONCLUSIONS\nHigher psychological stress was associated with an increased risk of first stroke among treated hypertensive patients, especially in those with lower MAP during the treatment period.