Predictive value of 8-year blood pressure measures in intracerebral haemorrhage risk over 5 years
Authors: Zhang Yiqian , Ding Yinqi , Yu Canqing , Sun Dianjianyi , Pei Pei , Du Huaidong , Yang Ling , Chen Yiping , Schmidt Dan , Avery Daniel , Chen Jianwei , Chen Junshi , Chen Zhengming , Li Liming , Lv Jun ,   China Kadoorie Biobank Collaborative Group, Chen Junshi , Chen Zhengming , Clarke Robert , Collins Rory , Li Liming , Lv Jun , Peto Richard , Walters Robin , Avery Daniel , Barnard Maxim , Bennett Derrick , Belbasis Lazaros , Boxall Ruth , Chan Ka Hung , Chen Yiping , Chen Zhengming , Clarke Charlotte , Clarke Johnathan , Clarke Robert , Du Huaidong , Mohamed Ahmed Edris , Fry Hannah , Gilbert Simon , Im Pek Kei , Iona Andri , Kakkoura Maria , Kartsonaki Christiana , Lam Hubert , Lin Kuang , Liu James , Mazidi Mohsen , Millwood Iona , Morris Sam , Nie Qunhua , Pozarickij Alfred , Rahmati Maryanm , Ryder Paul , Said Saredo , Schmidt Dan , Stevens Becky , Turnbull Iain , Walters Robin , Wang Baihan , Wang Lin , Wright Neil , Yang Ling , Yang Xiaoming , Yao Pang , Han Xiao , Hou Can , Xia Qingmei , Liu Chao , Lv Jun , Pei Pei , Sun Dianjianyi , Yu Canqing , Pan Lang , Pang Zengchang , Gao Ruqin , Li Shanpeng , Duan Haiping , Wang Shaojie , Liu Yongmei , Du Ranran , Zang Yajing , Cheng Liang , Tian Xiaocao , Zhang Hua , Zhai Yaoming , Ning Feng , Sun Xiaohui , Li Feifei , Lv Silu , Wang Junzheng , Hou Wei , Sun Wei , Yan Shichun , Cui Xiaoming , Wang Chi , Wu Zhenyuan , Li Yanjie , Kang Quan , Luo Huiming , Ou Tingting , Zheng Xiangyang , Guo Zhendong , Wu Shukuan , Li Yilei , Li Huimei , Wu Ming , Zhou Yonglin , Zhou Jinyi , Tao Ran , Yang Jie , Su Jian , Liu Fang , Zhang Jun , Hu Yihe , Lu Yan , Ma Liangcai , Tang Aiyu , Zhang Shuo , Jin Jianrong , Liu Jingchao , Lin Mei , Lu Zhenzhen , Zhou Lifang , Xie Changping , Lan Jian , Zhu Tingping , Liu Yun , Wei Liuping , Zhou Liyuan , Chen Ningyu , Qin Yulu , Wang Sisi , Wu Xianping , Zhang Ningmei , Chen Xiaofang , Chang Xiaoyu , Yuan Mingqiang , Wu Xia , Chen Xiaofang , Jiang Wei , Liu Jiaqiu , Sun Qiang , Chen Faqing , Ren Xiaolan , Dong Caixia , Zhang Hui , Mao Enke , Wang Xiaoping , Wang Tao , zhang Xi , Kang Kai , Feng Shixian , Tian Huizi , Fan Lei , Li XiaoLin , Sun Huarong , He Pan , Zhang Xukui , Yu Min , Hu Ruying , Wang Hao , Zhang Xiaoyi , Cao Yuan , Xie Kaixu , Chen Lingli , Shen Dun , Li Xiaojun , Jin Donghui , Yin Li , Liu Huilin , Fu Zhongxi , Xu Xin , Zhang Hao , Chen Jianwei , Peng Yuan , Zhang Libo , Qu Chan , Li Shuya , Qin Haiqiang , Wang Yongjun , Chen Qiling , Wang Jihua , Sun Xiaojia , Wang Lei , Wang Xun , Zhang Liming , Zhou Shanshan , Chen Hongyuan , Chen Li , Gou Haiyan , Wang Weizhi , Zhu Yanmei , Zhu Yulan , Zhang Ning , Cheng Xin , Dong Qiang , Dong Yi , Fang Kun , Mao Yiting , An Yu , Chen Peiling , Chen Yinghua , Liu Zhihong , Chen Xiaohong , Jv Naixin , Li Xiaojiu , Liu Liyang , Lu Yun , Xing Xiaona , You Shihao , Cheng Xiaoli , Gua Chaojun , Jiang Jinping , Liu Jingyi , Ma Shumei , Yang Xuefeng , Du Xiaomo , Xu Jian , Yang Xuecheng , Zhao Xiaodi , Hao Zilong , Liu Ming , Wang Deren , Li Xiaoting , Hui Lili , Liao Zhanling , Liu Feng , Feng Chunning , Ji Dejiang , Qu Fengxia , Yuan Wenwen , Ding Jing , Du Peng , Jin Lirong , Mao Yueshi , Wang Xin 
Published: April 2024

Abstract

Aims
The relationships between long-term blood pressure (BP) measures and intracerebral haemorrhage (ICH), as well as their predictive ability on ICH, are unclear. In this study, we aim to investigate the independent associations of multiple BP measures with subsequent 5-year ICH risk, as well as the incremental value of these measures over a single-point BP measurement in ICH risk prediction.

Methods and results
We included 12 398 participants from the China Kadoorie Biobank (CKB) who completed three surveys every 4–5 years. The following long-term BP measures were calculated: mean, minimum, maximum, standard deviation, coefficient of variation, average real variability, and cumulative BP exposure (cumBP). Cox proportional hazard models were used to examine the associations between these measures and ICH. The potential incremental value of these measures in ICH risk prediction was assessed using Harrell’s C statistics, continuous net reclassification improvement (cNRI), and relative integrated discrimination improvement (rIDI). The hazard ratios (95% confidence intervals) of incident ICH associated with per standard deviation increase in cumulative systolic BP and cumulative diastolic BP were 1.62 (1.25–2.10) and 1.59 (1.23–2.07), respectively. When cumBP was added to the conventional 5-year ICH risk prediction model, the C-statistic change was 0.009 (−0.001, 0.019), the cNRI was 0.267 (0.070–0.464), and the rIDI was 18.2% (5.8–30.7%). Further subgroup analyses revealed a consistent increase in cNRI and rIDI in men, rural residents, and participants without diabetes. Other long-term BP measures showed no statistically significant associations with incident ICH and generally did not improve model performance.

Conclusion
The nearly 10-year cumBP was positively associated with an increased 5-year risk of ICH and could significantly improve risk reclassification for the ICH risk prediction model that included single-point BP measurement.