Implications of Recent Clinical Trials and Hypertension Guidelines on Stroke and Future Cerebrovascular Research

Lackland, Daniel T.; Carey, Robert M.; Conforto, Adriana Bastos; Rosendorff, Clive; Whelton, Paul K.; Gorelick, Philip B.

doi:10.1161/strokeaha.117.019379

Cited by 30 publications

(21 citation statements)

References 72 publications

(82 reference statements)

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“…As a result, CVD events, CVD deaths, and post-CVD Singaporean population 18 years and older is projected to increase. The results from the quantitative simulation suggest that based on the current demographic composition of Singapore and available evidence from randomized control trials on the impact of diabetes, hypertension and smoking cessation interventions on CVD [7–11, 61], aggressive management of diabetes will have the most impact on CVD outcomes, in comparison with aggressive management of hypertension only or smoking cessation management intervention only. Moreover, smoking intervention alone will have the least impact on CVD outcomes compared to diabetes and hypertension management interventions.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the impact of aggressive hypertension, diabetes and smoking cessation management on CVD outcomes at the population level: a dynamic simulation analysis

Ansah¹,

Inn²,

Ahmad³

2019

BMC Public Health

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Background Evidence from randomized control trials suggest that coupled with smoking cessation interventions, CVD events can be reduced significantly if hypertension and diabetes patients are properly managed, raising practical what-if questions at the population level. This research aims to develop a dynamic simulation model using the systems modelling methodology of system dynamics, to evaluate the medium to long-term impact of hypertension and diabetes management, as well as smoking cessation intervention on CVD events, CVD deaths and post-CVD population. Methods The systems modelling methodology of system dynamics was used to develop a simulation model to evaluate the impact of aggressive hypertension, diabetes and smoking cessation management on CVD outcomes at the population level. Result The insights from this research suggest that despite that at the individual level, hypertension management is associated with the highest risk reduction for CVD (50%) compared to diabetes and smoking (20%) and is also the most prevalent risk factor, at the population level, diabetes management interventions are projected to have higher impact on reducing CVD events compared to hypertension management or smoking cessation interventions. However, a combined intervention of diabetes and hypertension management, as well as smoking cessation has the most impact on CVD outcomes. Conclusion Due to aging population and the increasing prevalence of chronic conditions in Singapore, the number of CVD events in Singapore is projected to rise significantly in the near future—hence the need for proactive planning to implement needed interventions. Findings from this research suggest that CVD events and its associated deaths and disabilities could be reduced significantly if diabetes and hypertension patients are aggressively managed. Electronic supplementary material The online version of this article (10.1186/s12889-019-7429-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

An evaluation of the impact of aggressive hypertension, diabetes and smoking cessation management on CVD outcomes at the population level: a dynamic simulation analysis

Ansah¹,

Inn²,

Ahmad³

2019

BMC Public Health

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“…1–4 The decline in stroke mortality over the last decade can be partly attributed to the aggressive treatment of hypertension and dyslipidemia that is common in the stroke population. 3,5 In fact, hypertension is the most important modifiable risk factor for all types of stroke. The incidence of stroke increases proportionally with both systolic and diastolic pressure, increasing the relative risk 3.1-fold for men and 2.9-fold for women.…”

Section: Introductionmentioning

confidence: 99%

The importance of comorbidities in ischemic stroke: Impact of hypertension on the cerebral circulation

Cipolla

Liebeskind

Chan

2018

J Cereb Blood Flow Metab

245

160

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Comorbidities are a hallmark of stroke that both increase the incidence of stroke and worsen outcome. Hypertension is prevalent in the stroke population and the most important modifiable risk factor for stroke. Hypertensive disorders promote stroke through increased shear stress, endothelial dysfunction, and large artery stiffness that transmits pulsatile flow to the cerebral microcirculation. Hypertension also promotes cerebral small vessel disease through several mechanisms, including hypoperfusion, diminished autoregulatory capacity and localized increase in blood-brain barrier permeability. Preeclampsia, a hypertensive disorder of pregnancy, also increases the risk of stroke 4-5-fold compared to normal pregnancy that predisposes women to early-onset cognitive impairment. In this review, we highlight how comorbidities and concomitant disorders are not only risk factors for ischemic stroke, but alter the response to acute ischemia. We focus on hypertension as a comorbidity and its effects on the cerebral circulation that alters the pathophysiology of ischemic stroke and should be considered in guiding future therapeutic strategies.

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“…The implementation of hypertension management protocols and recommendations based on evidence from clinical studies is associated with the risk reduction in stroke, as well as cardiovascular and renal disease. 1 The impact of the structured hypertension guidelines can be seen in the Figure where the risks of elevated blood pressure identified in the 1920s and the benefit of blood pressure reduction from the Veterans Administration studies was associated with declines in population stroke mortality. [2][3][4][5] As evidence in the Table, the decline in stroke mortality coincides with the reduction of population blood pressure pressures which was consistent with the lowered blood pressure thresholds and targets described in the sequential recommendations from the Guidelines.…”

Section: See Related Article Pp E13-e115mentioning

confidence: 99%

Global Implications of Blood Pressure Thresholds and Targets

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Implications of Recent Clinical Trials and Hypertension Guidelines on Stroke and Future Cerebrovascular Research

Cited by 30 publications

References 72 publications

An evaluation of the impact of aggressive hypertension, diabetes and smoking cessation management on CVD outcomes at the population level: a dynamic simulation analysis

An evaluation of the impact of aggressive hypertension, diabetes and smoking cessation management on CVD outcomes at the population level: a dynamic simulation analysis

The importance of comorbidities in ischemic stroke: Impact of hypertension on the cerebral circulation

Global Implications of Blood Pressure Thresholds and Targets

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