{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:58:21Z","timestamp":1780898301742,"version":"3.54.1"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["ebm-journal.org"],"crossmark-restriction":true},"short-container-title":["Exp. Biol. Med."],"abstract":"<jats:p>High systolic blood pressure (HSBP) is a major modifiable risk factor for stroke, but trends in disease burden and causal associations related to HSBP in the United States require further investigation using multidimensional approaches. This study aims to elucidate this relationship by utilizing data from the Global Burden of Disease (GBD) database, the National Health and Nutrition Examination Survey (NHANES). This study integrated data from the GBD 2021 database and the NHANES. The GBD data provided macro-level estimates of stroke-related mortality and disability-adjusted life years (DALYs) attributable to various risk factors within the United States. By employing multivariable logistic regression models on individual-level NHANES data, the study assessed the association between HSBP history and stroke risk after adjusting for multiple confounding factors. GBD analysis revealed HSBP as the leading risk factor for U.S. stroke burden in 2021, with an increasing attributable burden since 2010, particularly among the elderly and women. NHANES analysis showed that HSBP significantly increased the risk of stroke (fully adjusted OR = 1.33, 95% CI: 1.17\u20131.51). Elevated SBP was additionally associated with increased all-cause mortality risk in stroke survivors (HR = 1.01). A novel U-shaped relationship emerged: stroke risk decreased below an SBP of 100\u00a0mmHg but increased sharply above this threshold. HSBP is the core driver and modifiable risk factor behind the persistently increasing stroke burden in the United States. The findings of this study highlight the critical importance of HSBP in stroke prevention and management.<\/jats:p>","DOI":"10.3389\/ebm.2026.10868","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:10:05Z","timestamp":1780895405000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["High systolic blood pressure and stroke: evidence from the NHANES 1999\u20132023 and global burden of disease 2021"],"prefix":"10.3389","volume":"251","author":[{"given":"LuYi","family":"Tang","sequence":"first","affiliation":[{"name":"Dongguan Hospital of Guangzhou University of Chinese Medicine","place":["Dongguan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BoWen","family":"Yang","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Guangzhou University of Chinese Medicine","place":["Dongguan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PeiWen","family":"Li","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Guangzhou University of Chinese Medicine","place":["Dongguan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YingQi","family":"Chen","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Guangzhou University of Chinese Medicine","place":["Dongguan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Liu","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Guangzhou University of Chinese Medicine","place":["Dongguan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Guangzhou University of Chinese Medicine","place":["Dongguan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohan","family":"Ye","sequence":"additional","affiliation":[{"name":"Dongguan Hospital of Guangzhou University of Chinese Medicine","place":["Dongguan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S1474-4422(19)30034-1","article-title":"National burden of stroke, 1990-2016: a systematic analysis for the global burden of disease study 2016","volume":"18","year":"2019","journal-title":"Lancet Neurol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1161\/CIRCRESAHA.116.308398","article-title":"Stroke risk factors, genetics, and prevention","volume":"120","author":"Boehme","year":"2017","journal-title":"Circ Res"},{"key":"B3","doi-asserted-by":"publisher","first-page":"19083","DOI":"10.1038\/s41598-021-98072-y","article-title":"Age-period-cohort analysis of stroke mortality attributable to high systolic blood pressure in China and Japan","volume":"11","author":"Cao","year":"2021","journal-title":"Sci Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019","volume":"20","year":"2021","journal-title":"Lancet Neurol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1111\/jch.13525","article-title":"Blood pressure and stroke: from incidence to outcome","volume":"21","author":"Lattanzi","year":"2019","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000004336","article-title":"Global, regional, and national burden of stroke and associated risk factors among adults aged \u226560 years, 1990-2021: a multidimensional analysis leveraging GBD, NHANES, and mendelian randomization","author":"Zhang","year":"2025","journal-title":"Int J Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1524352","DOI":"10.3389\/fendo.2025.1524352","article-title":"Association of body roundness index with cardiovascular disease in patients with cardiometabolic syndrome: a cross-sectional study based on NHANES 2009-2018","volume":"16","author":"He","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/S1474-4422(14)70031-6","article-title":"Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: a population-based study","volume":"13","author":"Fischer","year":"2014","journal-title":"Lancet Neurol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"i708","DOI":"10.1136\/bmj.i708","article-title":"Different systolic blood pressure targets for people with history of stroke or transient ischaemic attack: PAST-BP (prevention after Stroke--Blood pressure) randomised controlled trial","volume":"352","author":"Mant","year":"2016","journal-title":"Bmj"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"102758","DOI":"10.1016\/j.eclinm.2024.102758","article-title":"Global, regional, and national burden of ischemic stroke, 1990-2021: an analysis of data from the global burden of disease study 2021","volume":"75","author":"Li","year":"2024","journal-title":"EClinicalMedicine"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e897","DOI":"10.1016\/S2468-2667(21)00228-0","article-title":"Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the global burden of disease study 2019","volume":"6","author":"Ma","year":"2021","journal-title":"Lancet Public Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1186\/s12872-025-04807-4","article-title":"Trends in the global, regional, and national burden of cardiovascular diseases attributed to high systolic blood pressure from 1990 to 2021 and projections to 2045: a systematic analysis based on GBD 2021 data","volume":"25","author":"Hu","year":"2025","journal-title":"BMC Cardiovasc Disord"},{"key":"B14","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s12889-023-17556-w","article-title":"Association between dietary inflammatory index and stroke in the US population: evidence from NHANES 1999-2018","volume":"24","author":"Mao","year":"2024","journal-title":"BMC Public Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"15579883241311218","DOI":"10.1177\/15579883241311218","article-title":"Relative fat mass, A better predictor of erectile dysfunction: insights from the NHANES 2001-2004","volume":"19","author":"Yang","year":"2025","journal-title":"Am J Mens Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1191130","DOI":"10.3389\/fimmu.2023.1191130","article-title":"Higher systemic immune-inflammation index and systemic inflammation response index levels are associated with stroke prevalence in the asthmatic population: a cross-sectional analysis of the NHANES 1999-2018","volume":"14","author":"Cheng","year":"2023","journal-title":"Front Immunol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1161\/STROKEAHA.119.024157","article-title":"Inflammation, autoimmunity, infection, and stroke: epidemiology and lessons from therapeutic intervention","volume":"51","author":"Parikh","year":"2020","journal-title":"Stroke"},{"key":"B18","doi-asserted-by":"crossref","first-page":"5409","DOI":"10.1097\/JS9.0000000000001795","article-title":"Association of triglyceride glucose index with stroke: from two large cohort studies and Mendelian randomization analysis","volume":"110","author":"Jiang","year":"2024","journal-title":"Int J Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1097\/JS9.0000000000001795","article-title":"ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology\/american heart association task force on clinical practice guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2979","DOI":"10.1210\/clinem\/dgab415","article-title":"Relationship between insulin sensitivity and menstrual cycle is modified by BMI, fitness, and physical activity in NHANES","volume":"106","author":"MacGregor","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3151","DOI":"10.1097\/JS9.0000000000001268","article-title":"The STROCSS 2024 guideline: strengthening the reporting of cohort, cross-sectional, and case-control studies in surgery","volume":"110","author":"Rashid","year":"2024","journal-title":"Int J Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2394","DOI":"10.1161\/STROKEAHA.113.001624","article-title":"Comparison of the sex-specific associations between systolic blood pressure and the risk of cardiovascular disease: a systematic review and meta-analysis of 124 cohort studies, including 1.2 million individuals","volume":"44","author":"Peters","year":"2013","journal-title":"Stroke"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2859","DOI":"10.1161\/STROKEAHA.108.546499","article-title":"Stroke risk of blood pressure indices determined by home blood pressure measurement: the ohasama study","volume":"40","author":"Inoue","year":"2009","journal-title":"Stroke"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1001\/archinte.161.9.1183","article-title":"Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality: the cardiovascular health study","volume":"161","author":"Psaty","year":"2001","journal-title":"Arch Intern Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1899","DOI":"10.1016\/S0140-6736(14)60685-1","article-title":"Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1\u00b725 million people","volume":"383","author":"Rapsomaniki","year":"2014","journal-title":"Lancet"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1161\/STROKEAHA.121.035852","article-title":"Blood pressure and stroke: a review of Sex- and Ethnic\/racial-specific attributes to the epidemiology, pathophysiology, and management of raised blood pressure","volume":"53","author":"Wang","year":"2022","journal-title":"Stroke"},{"key":"B27","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1161\/01.hyp.12.2.89","article-title":"Cerebral circulation in chronic arterial hypertension","volume":"12","author":"Baumbach","year":"1988","journal-title":"Hypertension"},{"key":"B28","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1161\/HYPERTENSIONAHA.107.095513","article-title":"Pulse pressure is an age-independent predictor of stroke development after cardiac surgery","volume":"50","author":"Benjo","year":"2007","journal-title":"Hypertension"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1161\/01.HYP.0000164580.39991.3d","article-title":"Structural and genetic bases of arterial stiffness","volume":"45","author":"Laurent","year":"2005","journal-title":"Hypertension"},{"key":"B30","doi-asserted-by":"publisher","first-page":"S94","DOI":"10.1097\/00005344-198507002-00018","article-title":"Cerebral blood flow in hypertension","volume":"7","author":"Barry","year":"1985","journal-title":"J Cardiovasc Pharmacol"},{"key":"B31","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s11883-018-0739-5","article-title":"Cerebral autoregulation in stroke","volume":"20","author":"Castro","year":"2018","journal-title":"Curr Atheroscler Rep"},{"key":"B32","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1161\/01.ATV.0000253885.41509.25","article-title":"Cerebrovascular nitrosative stress mediates neurovascular and endothelial dysfunction induced by angiotensin II","volume":"27","author":"Girouard","year":"2007","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1038\/ncpneph0283","article-title":"Mechanisms of disease: oxidative stress and inflammation in the pathogenesis of hypertension","volume":"2","author":"Vaziri","year":"2006","journal-title":"Nat Clin Pract Nephrol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1148768","DOI":"10.3389\/fcell.2023.1148768","article-title":"Clinical implications of inflammation in atheroma formation and novel therapies in cardiovascular diseases","volume":"11","author":"Barungi","year":"2023","journal-title":"Front Cell Dev Biol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1161\/CIRCULATIONAHA.106.635029","article-title":"Relative value of inflammatory, hemostatic, and rheological factors for incident myocardial infarction and stroke: the Edinburgh artery study","volume":"115","author":"Tzoulaki","year":"2007","journal-title":"Circulation"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1016\/j.neuroscience.2008.08.019","article-title":"Systemic infection, inflammation and acute ischemic stroke","volume":"158","author":"McColl","year":"2009","journal-title":"Neuroscience"},{"key":"B37","doi-asserted-by":"publisher","first-page":"3074","DOI":"10.1097\/CCM.0b013e31818b306d","article-title":"Impaired baroreflex sensitivity predicts outcome of acute intracerebral hemorrhage","volume":"36","author":"Sykora","year":"2008","journal-title":"Crit Care Med"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1916","DOI":"10.1161\/STROKEAHA.106.480061","article-title":"Arterial baroreflex: a novel target for preventing stroke in rat hypertension","volume":"38","author":"Liu","year":"2007","journal-title":"Stroke"}],"container-title":["Experimental Biology and Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ebm-journal.org\/articles\/10.3389\/ebm.2026.10868\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:10:06Z","timestamp":1780895406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ebm-journal.org\/articles\/10.3389\/ebm.2026.10868\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":38,"alternative-id":["10.3389\/ebm.2026.10868"],"URL":"https:\/\/doi.org\/10.3389\/ebm.2026.10868","relation":{},"ISSN":["1535-3699"],"issn-type":[{"value":"1535-3699","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"article-number":"10868"}}