Additional predisposing risk factors for atherothrombotic cerebrovascular disease among treated hypertensive volunteers.

Abstract

A 7-year prospective study of a cohort of 107 neurologically normal elderly hypertensive volunteers (mean age, 65.8 ± 8.3 years) was undertaken to investigate the predictive validities of additional risk factors for atherothrombotic cerebrovascular disease including stroke, transient ischemic attacks, reversible ischemic neurological deficits, and multi-infarct dementia. This longitudinal study has been in progress now for 7 years with a mean follow-up interval of 50.12 ± 5.76 months. Among 107 formerly symptom-free, normal hypertensive volunteers, 25 (23%) have developed cerebrovascular disease, 7 (6.5%) sustained a stroke, 10 (9.3%) developed multi-infarct dementia, and 18 (16.8%) have transient ischemic attacks. None have suffered intracranial hemorrhage. Mean gray matter cerebral blood flow (CBF) values measured at the initial visit were sensitive predictors of cerebrovascular disease. Eight of 16 hypertensives (50%) with initial CBF values below 60.0 ml/100 g/min now exhibit signs and symptoms of cerebrovascular disease, while 11 of 43 hypertensives (25.6%) with initial CBF values between 60.1 and 69.9 ml/100 g/min and only 6 of 48 (12.5%) with initial CBF levels above 70.0 developed cerebrovascular disease. Incidence of cerebrovascular disease among cigarette smoking hypertensive volunteers (32.5%) was significantly greater than among nonsmokers (17.2% Longitudinal studies confirmed these results. 3 Hypertension is also implicated as a risk factor for lacunar infarct, multi-infarct dementia (MID),** and atheromatous occlusion or stenosis of the internal carotid and other major aortocranial arteries, 6 particularly among patients complaining of transient ischemic attacks (TIAs).7 Heart disease, cardiac dysrhythmia, and diabetes mellitus are other well established risk factors for stroke. Cigarette smoking, obesity, and elevated serum lipid levels are less well defined as risk factors for atherothrombotic stroke.As soon as hypertension emerged as the major risk factor predisposing to signs and symptoms of atherothrombotic CVD, emphasis was logically placed on treatment of hypertension to prevent stroke, TIAs, and MID. The Veterans Administration Cooperative Study 8 clearly showed that careful reduction of elevated diastolic blood pressure (above 105 mm Hg) reduced the number of strokes occurring within a 4-year Received May 13, 1986; accepted October 27, 1986. follow-up interval by 75% compared with a group of untreated hypertensive controls. The Hypertension Detection and Follow-up Program 9 likewise demonstrated reduced incidence of stroke in a group of asymptomatic individuals with mild diastolic hypertension (90-104 mm Hg) when diastolic blood pressure was restored to normal levels. Numerous epidemiologic surveys have reported decreased morbidity and mortality from cerebral hemorrhage, stroke, and other manifestations of atherothrombotic CVD. 1011Factors that have contributed to the declining incidence of stroke are control of identifiable risk factors for atherothrombotic CVD, of which hypertension a...

After Reaching Retirement Age Physical Activity Sustains Cerebral Perfusion and Cognition

“…Age‐related CBF declines are accelerated by risk factors for stroke, including hypertension, heart disease, diabetes mellitus, hyperlipidemia, and cigarette smoking 8,9 . Longitudinal studies of neurologically normal elderly volunteers with a history of hypertension have demonstrated that severely decreased CBF levels are a biological marker for impending atherosclerotic stroke, 10 and that among risk‐factored neurologically normal elderly volunteers, reduced CBF levels are present for at least two years prior to clinical manifestations of stroke and multiinfarct dementia, 11,12 but follows onset of clinical symptoms in patients with Alzheimer's disease 13 …”

Randomized Clinical Trial of Daily Aspirin Therapy in Multi‐Infarct Dementia

“…Prospective trials among neurologically normal elderly volunteers with risk factors for stroke have shown that CBF measurements detect declines in cerebral perfusion, due to cerebrovascular atherosclerosis, for as long as two or more years before the onset of strokes and MID 11–14 . For example, a seven‐year longitudinal study of elderly but neurologically normal hypertensive volunteers indicated that patients with initial bihemispheric gray matter CBF values below 60.0 mL/100 g brain per minute predicted an increased incidence of stroke 2.5 times greater than among hypertensive volunteers whose initial CBF levels were higher than 60.0 mL/100 g brain per minute 15 …”

Relation of Left Ventricular Hypertrophy to Regional Cerebral Blood Flow: Single Photon Emission Computed Tomography Abnormalities in Essential Hypertension

“…[4][5][6][7] In this sense, Verdecchia et al 31 have shown that interindividual variation in LVM is explained only slightly by BP, and that LVM might reflect long-term exposure to several factors in addition to BP, such as genetic, hormonal, or metabolic factors. 4,31,32 On the other hand, Rogers et al 33 showed in a longitudinal study (mean follow-up, 50.12 months) performed in asymptomatic elderly hypertensive volunteers (mean age, 65.8 years) that patients with initial lowest CBF values showed a greater incidence of cerebrovascular disease than patients with higher values of CBF, despite the fact that there were no differences in BP.…”