{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:41:15Z","timestamp":1790887275077,"version":"4.1.0"},"reference-count":52,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Stroke risk varies by systolic blood pressure (SBP), race, and ethnicity. The association between cumulative mean SBP and incident stroke type is unclear, and whether this association differs by race and ethnicity remains unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association between cumulative mean SBP and first incident stroke among 3 major stroke types\u2014ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)\u2014and explore how these associations vary by race and ethnicity.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Individual participant data from 6 US longitudinal cohorts (January 1, 1971, to December 31, 2019) were pooled. The analysis was performed from January 1, 2022, to January 2, 2024. The median follow-up was 21.6 (IQR, 13.6-31.8) years.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Time-dependent cumulative mean SBP.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was time from baseline visit to first incident stroke. Secondary outcomes consisted of time to first incident IS, ICH, and SAH.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 40\u202f016 participants, 38\u202f167 who were 18 years or older at baseline with no history of stroke and at least 1 SBP measurement before the first incident stroke were included in the analysis. Of these, 54.0% were women; 25.0% were Black, 8.9% were Hispanic of any race, and 66.2% were White. The mean (SD) age at baseline was 53.4 (17.0) years and the mean (SD) SBP at baseline was 136.9 (20.4) mm Hg. A 10\u2013mm Hg higher cumulative mean SBP was associated with a higher risk of overall stroke (hazard ratio [HR], 1.20 [95% CI, 1.18-1.23]), IS (HR, 1.20 [95% CI, 1.17-1.22]), and ICH (HR, 1.31 [95% CI, 1.25-1.38]) but not SAH (HR, 1.13 [95% CI, 0.99-1.29];\n P<\/jats:italic>\n \u2009=\u2009.06). Compared with White participants, Black participants had a higher risk of IS (HR, 1.20 [95% CI, 1.09-1.33]) and ICH (HR, 1.67 [95% CI, 1.30-2.13]) and Hispanic participants of any race had a higher risk of SAH (HR, 3.81 [95% CI, 1.29-11.22]). There was no consistent evidence that race and ethnicity modified the association of cumulative mean SBP with first incident stroke and stroke type.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The findings of this cohort study suggest that cumulative mean SBP was associated with incident stroke type, but the associations did not differ by race and ethnicity. Culturally informed stroke prevention programs should address modifiable risk factors such as SBP along with social determinants of health and structural inequities in society.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.8502","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T11:32:30Z","timestamp":1714735950000},"page":"e248502","source":"Crossref","is-referenced-by-count":9,"title":["Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity"],"prefix":"10.1001","volume":"7","author":[{"given":"Kimson E.","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Health Management and Policy, University of Michigan, Ann Arbor"},{"name":"Department of Sociology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhang","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mellanie V.","family":"Springer","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej T.","family":"Galecki","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan, Ann Arbor"},{"name":"Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael T.","family":"Whitney","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca F.","family":"Gottesman","sequence":"additional","affiliation":[{"name":"Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney A.","family":"Hayward","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Sidney","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell S. 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