Longitudinal blood pressure trajectories and time to stroke among hypertensive patients: A Bayesian multivariate joint modeling study in Benishangul-Gumuz, Ethiopia
8 affiliations
- 1Department of Public Health, Pawi Health Science College, Pawi, Ethiopia.
- 2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia.
- 3Department of Nursing, Pawi Health Science College, Pawi, Ethiopia.
- 4Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 5Department of Veterinary Science, School of Veterinary Medicine, Bahir Dar University, Bahir Dar, Ethiopia.
- 6Benishangul Gumuz Regional health bureaus, Assosa, Ethiopia.
- 7Department of Medicine, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
- 8Department of Public Health, College of Medicine and Health Science, Samara University, Samara, Ethiopia.
Abstract
Background: Stroke is a major cause of morbidity and mortality worldwide, with hypertension being its most important modifiable risk factor. Although the association between elevated blood pressure and stroke is well established, the extent to which longitudinal blood pressure patterns influence the timing of stroke remains poorly understood, particularly in low-resource settings. We investigated the association between longitudinal systolic and diastolic blood pressure trajectories and time to stroke among hypertensive patients in Ethiopia. Methods: We conducted a retrospective cohort study of 494 newly diagnosed hypertensive patients receiving follow-up care at two general hospitals in Benishangul-Gumuz, Ethiopia, between January 1, 2015, and September 1, 2024. Time to stroke was analyzed using a Cox proportional hazards model, while repeated systolic and diastolic blood pressure measurements were modelled using linear mixed-effects models. The longitudinal and survival processes were jointly estimated using a Bayesian multivariate joint modelling framework. Posterior adjusted hazard ratios (AHRs) with 95% credible intervals (CrIs) were estimated. Results: The incidence of stroke was 2.19 per 100 person-years (95% CI: 1.60–2.64). Higher current underlying systolic and diastolic blood pressure levels were associated with increased stroke risk, with posterior AHRs of 3.25 (95% CrI: 1.85–5.83) and 2.32 (95% CrI: 1.35–4.27), respectively. Older age (≥65 years; AHR: 6.18; 95% CrI: 2.32–18.05), comorbidity (AHR: 4.00; 95% CrI: 1.72–10.25), and stage II hypertension (AHR: 4.06; 95% CrI: 1.49–16.36) were associated with earlier stroke occurrence. Rural residence was associated with a lower hazard of stroke (AHR: 0.16; 95% CrI: 0.05–0.40). Conclusions: Higher longitudinal systolic and diastolic blood pressure trajectories were associated with earlier stroke occurrence. These findings support regular blood pressure monitoring and targeted prevention strategies among older adults and patients with comorbidities in similar resource-limited settings.
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BibTeX
@article{assefa2026longitudinal,
title = {{Longitudinal blood pressure trajectories and time to stroke among hypertensive patients: A Bayesian multivariate joint modeling study in Benishangul-Gumuz, Ethiopia}},
author = {Solomon Keflie Assefa and Kebebe Tadesse and Sani Yenus and Tewodros Tegene and Solomon Debela Bekeko and Helina Mebratu Abegaz and Simachew Getaneh Endalemew and Dinkinshe Beyene Feleke and Asfaw Bessie Bemgako and Abiyu Eshetu Gobena and Bruktaut Addisu Redi and Dejen Kahsay Asgedom},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359435},
url = {https://doi.org/10.1371/journal.pone.0359435},
note = {CC BY},
}
RIS
TY - JOUR
TI - Longitudinal blood pressure trajectories and time to stroke among hypertensive patients: A Bayesian multivariate joint modeling study in Benishangul-Gumuz, Ethiopia
AU - Solomon Keflie Assefa
AU - Kebebe Tadesse
AU - Sani Yenus
AU - Tewodros Tegene
AU - Solomon Debela Bekeko
AU - Helina Mebratu Abegaz
AU - Simachew Getaneh Endalemew
AU - Dinkinshe Beyene Feleke
AU - Asfaw Bessie Bemgako
AU - Abiyu Eshetu Gobena
AU - Bruktaut Addisu Redi
AU - Dejen Kahsay Asgedom
PY - 2026
DA - 2026/10/23
JO - PLOS One
DO - 10.1371/journal.pone.0359435
UR - https://doi.org/10.1371/journal.pone.0359435
AB - Background: Stroke is a major cause of morbidity and mortality worldwide, with hypertension being its most important modifiable risk factor. Although the association between elevated blood pressure and stroke is well established, the extent to which longitudinal blood pressure patterns influence the timing of stroke remains poorly understood, particularly in low-resource settings. We investigated the association between longitudinal systolic and diastolic blood pressure trajectories and time to stroke among hypertensive patients in Ethiopia. Methods: We conducted a retrospective cohort study of 494 newly diagnosed hypertensive patients receiving follow-up care at two general hospitals in Benishangul-Gumuz, Ethiopia, between January 1, 2015, and September 1, 2024. Time to stroke was analyzed using a Cox proportional hazards model, while repeated systolic and diastolic blood pressure measurements were modelled using linear mixed-effects models. The longitudinal and survival processes were jointly estimated using a Bayesian multivariate joint modelling framework. Posterior adjusted hazard ratios (AHRs) with 95% credible intervals (CrIs) were estimated. Results: The incidence of stroke was 2.19 per 100 person-years (95% CI: 1.60–2.64). Higher current underlying systolic and diastolic blood pressure levels were associated with increased stroke risk, with posterior AHRs of 3.25 (95% CrI: 1.85–5.83) and 2.32 (95% CrI: 1.35–4.27), respectively. Older age (≥65 years; AHR: 6.18; 95% CrI: 2.32–18.05), comorbidity (AHR: 4.00; 95% CrI: 1.72–10.25), and stage II hypertension (AHR: 4.06; 95% CrI: 1.49–16.36) were associated with earlier stroke occurrence. Rural residence was associated with a lower hazard of stroke (AHR: 0.16; 95% CrI: 0.05–0.40). Conclusions: Higher longitudinal systolic and diastolic blood pressure trajectories were associated with earlier stroke occurrence. These findings support regular blood pressure monitoring and targeted prevention strategies among older adults and patients with comorbidities in similar resource-limited settings.
SN - 1932-6203
ER -