Effect of Treating Isolated Systolic Hypertension on the Risk of Developing Various Types and Subtypes of Stroke&lt;SUBTITLE&gt;The Systolic Hypertension in the Elderly Program (SHEP)&lt;/SUBTITLE&gt;

Hm, Perry; Davis, Bonnie; Tr, Price; Wb, Applegate; Ws, Fields; Jm, Guralnik; Kuller, Lewis H.; Pressel, Sara L.; Stamler, Jeremiah; Jl, Probstfield

doi:10.1001/jama.284.4.465

Cited by 287 publications

(148 citation statements)

References 16 publications

Supporting

Mentioning

139

Contrasting

Unclassified

Order By: Relevance

“…Heterogeneity in the effects of each BP category in the present analyses are also consistent with the results of randomized, controlled trials, which demonstrated heterogeneity in the magnitude of the effects of BP-lowering treatment on different types of CVD or across subgroups defined by age or region. [35][36][37][38][39][40] The strengths of APCSC include the large amount of data and the strong collaboration, involving several ethnic groups. Hazard ratio 0.5 8 Figure 2.…”

Section: Discussionmentioning

confidence: 99%

Effects of Prehypertension and Hypertension Subtype on Cardiovascular Disease in the Asia-Pacific Region

et al. 2012

View full text Add to dashboard Cite

Abstract-The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure defined blood pressure (BP) levels of 120 to 139/80 to 89 mm Hg as prehypertension and those of Ն140/90 mm Hg as hypertension. Hypertension can be divided into 3 categories, isolated diastolic (IDH; systolic BP Ͻ140 mm Hg and diastolic BP Ն90 mmHg), isolated systolic (systolic BP Ն140 mm Hg and diastolic BP Ͻ90 mmHg), and systolic-diastolic hypertension (systolic BP Ն140 mm Hg and diastolic BP Ն90 mmHg). Although there is clear evidence that isolated systolic hypertension and systolic-diastolic hypertension increase the risks of future vascular events, there remains uncertainty about the effects of IDH. The objective was to determine the effects of prehypertension and hypertension subtypes (IDH, isolated systolic hypertension, and systolic-diastolic hypertension) on the risks of cardiovascular disease (CVD) in the Asia-Pacific Region. The Asia Pacific Cohort Studies Collaboration is an individual participant data overview of cohort studies in the region. This analysis included a total of 346570 participants from 36 cohort studies. Outcomes were fatal and nonfatal CVD. The relationship between BP categories and CVD was explored using a Cox proportional hazards model adjusted for age, cholesterol, and smoking and stratified by sex and study. Compared with normal BP (Ͻ120/80 mmHg), hazard ratios (95% CIs) for CVD were 1.41 (1.31-1.53) for prehypertension, 1.81 (1.61-2.04) for IDH, 2.18 (2.00 -2.37) for isolated systolic hypertension, and 3.42 (3.17-3.70) for systolic-diastolic hypertension. Separately significant effects of prehypertension and hypertension subtypes were also observed for coronary heart disease, ischemic stroke, and hemorrhagic stroke. In the Asia-Pacific region, prehypertension and all hypertension subtypes, including IDH, thus clearly predicted increased risks of CVD. Key Words: prehypertension Ⅲ hypertension Ⅲ hypertension subtype Ⅲ isolated diastolic hypertension Ⅲ cardiovascular disease Ⅲ coronary heart disease Ⅲ stroke C ardiovascular disease (CVD) is a leading cause of premature death and disability globally.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of Prehypertension and Hypertension Subtype on Cardiovascular Disease in the Asia-Pacific Region

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Epidemiologically, it is well known that the risks for BP and CV are linearly related and that elderly people with lower BPs are at less risk for CV events (20). A sub-analysis of the SHEP study, however, showed that the incidence of stroke was less frequent in patients with SBP levels lower than 150 mmHg compared with those with SBP levels lower than 140 mmHg (10) and that the risk of stroke increased in patients with DBP levels lower than 55 mmHg (21). Additionally, sub-analysis of the HOT study, which examined patients aged 65 years or older, did not identify any significant differences in the CV risk of groups with different BPs obtained in response to antihypertensive treatment with felodipine (22).…”

Section: Discussionmentioning

confidence: 89%

“…Although lower target BPs are epidemiologically associated with better outcomes, one intervention trial indicated that a systolic BP (SBP) lower than 150 mmHg is optimal (10), whereas other results have suggested the existence of a Jshaped phenomenon (11,12). Thus, a consensus regarding the optimal target BP for elderly hypertensive patients has not yet been determined.…”

Section: Introductionmentioning

confidence: 99%

The Optimal Target Blood Pressure for Antihypertensive Treatment in Japanese Elderly Patients with High-Risk Hypertension: A Subanalysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) Trial

et al. 2008

View full text Add to dashboard Cite

“…The strength of association between BP and haemorrhagic stroke appears to be greater than that observed for ischaemic stroke. A study on 17 cohorts from the People's Republic of China and Japan 9 involving 115 757 participants showed a significantly stronger association of usual diastolic BP with haemorrhagic stroke than with nonhaemorrhagic stroke, and the odds ratio for The Systolic Hypertension in the Elderly Program (SHEP) Study 25 determined the effects, on stroke, of treating isolated systolic hypertension in 4736 elderly patients. Antihypertensive treatment appears to be more protective against haemorrhagic stroke than ischaemic stroke, the relative risk reduction for haemorrhagic stroke being 0.46 (95% CI: 0.21-1.02) compared to 0.63 (95% CI: 0.48-0.82) for ischaemic stroke.…”

Section: Bp and The Risk Of Primary And Secondary Ichmentioning

confidence: 99%

Blood pressure in acute intracerebral haemorrhage

et al. 2004

View full text Add to dashboard Cite

Stroke is one of the leading causes of death worldwide, and spontaneous bleeding into the brain parenchyma, intracerebral haemorrhage (ICH), is a stroke subtype associated with high morbidity and mortality. Overall, it comprises about 15% of all stroke in Caucasians, this figure being much higher in Asians and black people. Blood pressure (BP) appears to play an important role in this disease. We have reviewed available literature on the relationship of BP to the occurrence of primary and secondary ICH, the association of BP levels measured early after stroke with prognosis and complications, and evidence about the effects of early BP lowering treatments on post-stroke outcomes. BP appears to be an important risk factor for primary and secondary ICH. In addition, high BP early after ICH may be detrimental to outcome, possibly contributing to complications such as rebleeding and haematoma enlargement. Few data are available about the effects of early lowering of BP on outcome after ICH with no reliable trial yet conducted. Proper randomised trials are required to establish the effect of early lowering of BP on outcome after ICH.

show abstract

Effect of Treating Isolated Systolic Hypertension on the Risk of Developing Various Types and Subtypes of Stroke<SUBTITLE>The Systolic Hypertension in the Elderly Program (SHEP)</SUBTITLE>

Abstract: In this study, antihypertensive drug treatment reduced the incidence of both hemorrhagic and ischemic (including lacunar) strokes. Reduction in stroke incidence occurred when specific systolic blood pressure goals were attained. JAMA. 2000;284:465-471

Cited by 287 publications

References 16 publications

Effects of Prehypertension and Hypertension Subtype on Cardiovascular Disease in the Asia-Pacific Region

Effects of Prehypertension and Hypertension Subtype on Cardiovascular Disease in the Asia-Pacific Region

The Optimal Target Blood Pressure for Antihypertensive Treatment in Japanese Elderly Patients with High-Risk Hypertension: A Subanalysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) Trial

Blood pressure in acute intracerebral haemorrhage

Contact Info

Product

Resources

About