Five year follow-up of effects of treatment of mild and moderate hypertension.

Trafford, J. A. P.; Horn, Corinne; O’Neal, Hollis R.; McGonigle, R; Halford-Maw, L; Evans, Robert M.

doi:10.1136/bmj.282.6270.1111

Cited by 41 publications

(19 citation statements)

References 6 publications

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“…This difference may have been due to the smaller number of BP measurements in our study (3 during 1 year) compared with the NHANES-III survey (6 during 2 visits), which would tend to overestimate the prevalence of hypertension. 14a This study not only confirms the strong association between achieved BP and risk of stroke among treated hypertensive patients 5,[15][16][17] but also provides separate estimates for ischemic and hemorrhagic stroke and the proportion of these strokes that may have been attributable to inadequate control of BP. SBP was more strongly associated with the risk of hemorrhagic stroke than DBP, whereas DBP and SBP were similarly associated with the risk of ischemic stroke.…”

Section: Discussionsupporting

confidence: 62%

Control of Blood Pressure and Risk of Stroke Among Pharmacologically Treated Hypertensive Patients

Klungel

Kaplan

Heckbert

et al. 2000

Stroke

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Background and Purpose-Despite improved control of blood pressure during the last decades in the United States, a considerable proportion of treated hypertensives have not achieved target blood pressure levels. We estimated the proportion of strokes occurring among treated hypertensive patients that may be attributable to uncontrolled blood pressure. Methods-A population-based case-control study was conducted among treated hypertensive members of Group Health Cooperative of Puget Sound. Cases were treated hypertensive patients who sustained a first fatal or nonfatal, ischemic (nϭ460) or hemorrhagic (nϭ95) stroke during 1989 -1996. Controls were a random sample of stroke-free, treated hypertensive Group Health Cooperative enrollees (nϭ2966), similar in age to the stroke cases. Multiple measurements of blood pressure and other cardiovascular risk factors were collected from medical records. Logistic regression was used to estimate the risk of ischemic stroke and hemorrhagic stroke associated with uncontrolled blood pressure, defined as diastolic blood pressure Ͼ90 mm Hg or systolic blood pressure Ͼ140 mm Hg. The fraction of strokes attributable to uncontrolled blood pressure among treated hypertensives was calculated. Results-Blood pressure was uncontrolled in 78% of ischemic stroke cases, 85% of hemorrhagic stroke cases, and 65% of controls. After adjustment for potential confounders, uncontrolled blood pressure among treated hypertensive patients was moderately associated with ischemic stroke (risk ratioϭ1.5 [95% CI, 1.2 to 1.9]) and strongly related to hemorrhagic stroke (risk ratioϭ3.0 [95% CI, 1.7 to 5.4]). We estimated that 27% (95% CI, 11% to 39%) of the ischemic strokes and 57% (95% CI, 26% to 75%) of the hemorrhagic strokes among treated hypertensive patients were attributable to uncontrolled blood pressure. Overall, 32% (95% CI, 14% to 45%) of all strokes were attributable to uncontrolled blood pressure. Conclusions-A considerable proportion of incident strokes among treated hypertensive patients may be prevented by achieving control of blood pressure. (Stroke. 2000;31:420-424.)

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Section: Discussionsupporting

confidence: 62%

Control of Blood Pressure and Risk of Stroke Among Pharmacologically Treated Hypertensive Patients

Klungel

Kaplan

Heckbert

et al. 2000

Stroke

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“…14 Few studies did not find any effect of hypertension treatment on CVD mortality. 11,13,15 However, their follow-up times were rather short, 7 years 11 and 5 years, 13 respectively, and it may be argued that exposure time was not sufficient to show any beneficial effect of antihypertensive therapy. It is also possible that changes in hypertension care have influenced outcomes obtained during the long-term follow-up.…”

Section: Control Of Hypertension Nc Barengo Et Almentioning

confidence: 99%

“…[6][7][8][9] Controversial results have been published regarding health outcomes in normotensive people with health outcomes in treated and untreated hypertensive patients. [10][11][12][13][14][15] Furthermore studies including women are rare. 10,12,15 The aim of this study was to investigate whether there are differences in CVD and all-cause mortality among hypertensive men and women by awareness, treatment and the BP control status at baseline.…”

Section: Introductionmentioning

confidence: 99%

The effects of awareness, treatment and control of hypertension on cardiovascular and all-cause mortality in a community-based population

et al. 2009

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The objective of this prospective follow-up study (median follow-up time 20 years) was to investigate whether there are differences in cardiovascular disease (CVD) and all-cause mortality among hypertensive men and women by awareness, treatment and blood pressure (BP) control status. The study was carried out among 20 358 men and 21 537 women aged 25-64 years living in Eastern and south-western Finland within the framework of the North Karelia Project and the Finrisk studies. Risk factors of CVD and life-style habits were assessed by a self-administered questionnaire, BP and laboratory measurements. The participants were classified into five groups according to their BP status: (i) normotensive, (ii) patients treated with antihypertensive drugs and controlled for HT, (iii) patients treated with antihypertensive drugs but uncontrolled for HT, (iv) hypertensive people aware of their HT but untreated, (v) hypertensive people unaware of their hypertension (HT). In men, all-cause and CVD mortality was significantly higher in all HT subgroups compared with the normotensive group. The risk increase for CVD mortality was 49-125% and 27-79% for all-cause mortality, respectively. Treated and controlled hypertensive women at baseline did not have any increase in CVD (hazard ratio (HR) 1.14; 95% CI 0.89-1.46) or all-cause mortality (HR 1.09; 95% CI 0.72-1.67) compared with normotensive women. In men, however, the corresponding HR were 1.58 (95% CI 1.28-1.96) for CVD and 2.25 (95% CI 1.70-2.99) for all-cause mortality. Treated hypertensive women seem to benefit from achieving normal BP.

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“…3 Hypertension also results in an increased frequency of ischemic and hemorrhagic stroke. 4 A large body of evidence exists based on case series, 5 population studies, 6,7 and clinical trials 8 demonstrating that control of hypertension reduces risk of initial stroke. It has also been demonstrated that treatment of isolated systolic hypertension in the elderly will reduce risk of stroke.…”

mentioning

confidence: 99%

Control of Hypertension and Risk of Stroke Recurrence

Friday

Alter

Lai

2002

Stroke

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Background and Purpose-We investigated whether low blood pressure increases the risk of stroke recurrence. Methods-A cohort of 662 patients, obtaining care at the 8 acute care hospitals serving the Lehigh Valley in Pennsylvania, was enrolled within 1 month of an initial stroke and was followed twice annually for up to 4 years. Cox proportional hazard models were developed to examine the relationship between risk of recurrent stroke and blood pressure, controlling for other significant risk factors. Our analyses investigated both lowest follow-up and average follow-up blood pressures as predictors of stroke recurrence. Results-There were 52 recurrent strokes among the 535 patients (mean age, 71 years; 51% men) with follow-up blood pressure. The risk ratio for stroke recurrence for diastolic blood pressure Ն80 mm Hg compared with Ͻ80 mm Hg was 2.4 (95% CI, 1.38 to 4.27) and for systolic blood pressure Ն140 mm Hg compared with Ͻ140 mm Hg was also 2.4 (95% CI, 1.39 to 4.15). For isolated systolic blood pressure (Ͼ140/Ͻ90 mm Hg), the risk ratio was 2.2 (95% CI, 1.23 to 3.79) relative to Ͻ140/Ͻ90 mm Hg. Using the Cox model, we also showed that patients who had at least 1 measured diastolic blood pressure Ͻ80 mm Hg during follow-up had a reduced risk of stroke recurrence compared with those with diastolic blood pressures 80 to 90 mm Hg (0.4 versus 1.0; 95% CI, 0.21 to 0.88) even after controlling for the possible confounding factors of hypertension and atrial fibrillation on ECG. Myocardial infarction on ECG, history of transient ischemic attack, and diabetes mellitus were not significant predictors of increased risk of recurrent stroke. Conclusions-Our results imply that "lower is better" for blood pressure control as a goal in reducing stroke recurrence risk.

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Five year follow-up of effects of treatment of mild and moderate hypertension.

Cited by 41 publications

References 6 publications

Control of Blood Pressure and Risk of Stroke Among Pharmacologically Treated Hypertensive Patients

Control of Blood Pressure and Risk of Stroke Among Pharmacologically Treated Hypertensive Patients

The effects of awareness, treatment and control of hypertension on cardiovascular and all-cause mortality in a community-based population

Control of Hypertension and Risk of Stroke Recurrence

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