Hypertension and Risk of Stroke: A Systematic Review and Meta-Analysis

Abstract

Despite strong evidence linking hypertension (HTN) to stroke, updated syntheses are needed to refine risk estimates by stroke subtype and population group. This systematic review quantified HTN-associated stroke risk and examined variations across subtypes. Across 24 studies (n = 1.8 million), HTN increased overall stroke risk by approximately twofold (odds ratio (OR)/hazard ratio (HR)/risk ratio (RR): 1.3-2.1), with the strongest association observed for hemorrhagic stroke (OR = 2.1) and among Asian populations (RR = 2.0). Women had a higher risk (HR = 1.5) than men (HR = 1.3). Each 5-mmHg reduction in systolic blood pressure (SBP) lowered stroke risk by 22% (RR = 0.78), while intensive control (SBP < 120 mmHg) reduced incidence by 41% among people with diabetes. Post-stroke BP management (SBP < 140 mmHg) decreased recurrence by 35% (HR = 0.65). Considerable heterogeneity (I² = 93.2%) was attributed to variations in HTN definitions and population characteristics. Overall, HTN remains a potent and modifiable stroke risk factor, with differential effects by subtype and sex. Intensive and targeted BP control, particularly in high-risk groups, significantly reduces stroke burden. Standardized methods and tailored interventions are needed to address heterogeneity and optimize prevention strategies.