Morphogenesis of plasmatic arterionecrosis as the cause of hypertensive intracerebral hemorrhage

Ooneda, Genju; Yoshida, Yasuhiko; Suzuki, Keiji; Sekiguchi, Takemi

doi:10.1007/bf00543548

Cited by 68 publications

(20 citation statements)

References 24 publications

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“…Hypertension is the major factor for arterionecrosis. 36 According to our autopsy study in a hospital of Akita Prefecture in 1966-1972, 49% of the 37 cerebral hemorrhage cases ages 30-59 years showed no significant atherosclerosis in basal arteries in the Circle of Willis or in intracerebral small arteries.…”

Section: Determination Of Risk Factors For Strokementioning

confidence: 88%

Trends for coronary heart disease and stroke and their risk factors in Japan.

et al. 1989

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Disease surveillance and population surveys of risk characteristics in a northeast rural community of Japan (1965 census population, 7,030) are combined in an attempt to relate morbidity and risk factor trends for coronary heart disease and stroke during the last 2 decades. Between 1964 and 1983, the incidence of coronary heart disease (i.e., combined myocardial infarction, angina pectoris, and sudden death) did not change significantly among men and women ages 40-69, and was lower than that for stroke. The incidence of all stroke declined about 60% for both men and women, ages 40-69, with a significant decrease in cerebral hemorrhage for both sexes and in cerebral infarction for men. Between 1963Between -1966Between and 1980Between -1983 upward shifts occurred in the means and distributions of serum total cholesterol and serum total protein in every age and sex group, primarily during the 1st decade. Age-adjusted mean cholesterol levels rose 22 mg/dl to the 1980-1983 mean of 179 mg/dl in men ages 40-69. In women ages 40-69, the mean rose 29 mg/dl to 192 mg/dl. Among nutrients, animal fat intake doubled in men ages 40-59 from 4.5% of daily calories in 1969 to 9.6% in 1980-1983. Animal protein intake also increased, from 5.8% to 7.1%. Most of this increase occurred between 1969 and 1972-1975 and may be attributable to an increased intake of meat, eggs and dairy products. From 1963From -1966From to 1980From -1983 relative weight index rose significantly for all age-sex groups except men ages 50-69. Mean systolic and diastolic blood pressure levels declined for every age-sex group, with a 15-mm Hg age-adjusted decrease in systolic, 4-mm Hg decrease in diastolic pressure among men ages 40-69, and a 11-mm Hg systolic and 4-mm Hg diastolic decrease for women. Two cohorts of men and women ages 40-69 at baseline were followed for disease incidence: an early cohort (2,257 persons) followed from 1963-1966 to 1973 and a later cohort (2,711 persons) followed from 1972-1975 to 1983. In these cohorts, significant risk prediction for cerebral hemorrhage and infarction was obtained with blood pressure level and end organ effects in the electrocardiogram and fundus photographs. Serum cholesterol was inversely associated with cerebral hemorrhage in the early cohort but not in the later. The reduced association of serum cholesterol in the later cohort may be due in part to the marked upward shift in means and distributions of serum cholesterol between these two periods and the lower power of the later analysis. (Circulation 1989;79:503-515) The frequency of coronary heart disease (CHD) and stroke in populations is strongly related to the prevalence of hypertension and atherosclerosis, which are greatly influenced, in turn, by risk characteristics, related behaviors, and associated environmental factors.' Japan has recently experienced rapid change in living and eating patterns.2 This provides a unique opportunity to observe a natural experiment in which population risk may change.In an attempt to relate morbidity t...

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Section: Determination Of Risk Factors For Strokementioning

confidence: 88%

Trends for coronary heart disease and stroke and their risk factors in Japan.

et al. 1989

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“…Micro-aneurysms, fibrinoid arteritis, and plasmatic arterionecrosis have been described. 27 " 30 More recent pathologic studies have documented the increasing incidence of cerebral amylojd angiopathy with age 31 and its etiologic importance within the framework of an aging population and better long term management of hypertension. 3233 In one large pathologic series where 54 specimens were adequate for analysis, the etiology was more often amyloid angiopathy (n = 6) than hypertensive vasculopathy (n = 4); however, a specific anatomic etiology could be found in only 26 per cent of the specimens.…”

Section: Discussionmentioning

confidence: 99%

Hypertension as a risk factor for spontaneous intracerebral hemorrhage.

Brott¹,

Thalinger

Hertzberg

1986

Stroke

333

134

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SUMMARY To better define the etiologic importance of hypertension for spontaneous intracerebral hemorrhage, hospital records were studied for all patients sustaining intracerebral hemorrhage during 1982 in the Cincinnati metropolitan area. Hypertension pre-dating the hemorrhage was present in 45% (69 of 154), as determined by history. A more inclusive definition of hypertension, combining those with a positive history with those found to have left ventricular hypertrophy by electrocardiogram or cardiomegaly by chest radiography, applied in 56% (87 of 154). The cases were compared to controls with and without hypertension derived from the NHANESII study of blood pressure (n = 16,204) to determine relative risk. For the presence of hypertension by history, the relative risk of intracerebral hemorrhage was 3.9 (95% confidence interval, 2.7 to 5.7). For the inclusive definition of hypertension, the relative risk was 5.4 (3.7 to 7.9). Relative risk was also determined for hypertension in blacks ( = 4.4), age > 70 ( = 7), prior cerebral infarction ( = 22), and diabetes ( = 3).We conclude that the term "hypertensive hemorrhage" should be used very selectively, particularly in whites, and propose that hypertension be viewed as one of several important risk factors for spontaneous intracerebral hemorrhage. Stroke Vol 17, No 6, 1986 THE TERM HYPERTENSIVE INTRACEREBRAL HEMORRHAGE is firmly imbedded in the medical literature.'" 3 When the characteristic high density lesion is seen in the computed tomographic scan (CT) critical differential diagnosis in the setting of acute stroke is too often truncated. Hypertension is quickly assumed to be causal, if present on the admission exam or if detected by history.We have been impressed at the bedside that an adequate history of hypertension is often lacking in patients with spontaneous intracerebral hemorrhage. When an adequate history for hypertension is established, other disorders of potential etiologic importance may be identified but are seldom given serious consideration. In prior studies of intracerebral hemorrhage, the blood pressure measurements (BP) were often those obtained during the acute event, 4 ' 5 or they were not provided. 6 Potential risk factors such as prior cerebral infarction or diabetes mellitus, were infrequently documented. 7 In 2 large studies of intracerebral hemorrhage in which criteria for the definition of hypertension were carefully specified, the results differed sharply regarding the importance of hypertension in pathogenesis. 89 A prospective epidemiologic study of intracerebral hemorrhage and potential risk factors is impractical. A ten-year study would require follow-up of approximately one million subjects to obtain 100 or more index cases. A longer study would require fewer subFrom the

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“…2 This type of stroke is caused primarily by hypertension and possibly by low concentrations of low-density lipoprotein (LDL) cholesterol. 3,4 …”

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confidence: 99%

Low-Density Lipoprotein Cholesterol Concentrations and Death Due to Intraparenchymal Hemorrhage

et al. 2009

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Background-Few studies have examined the association between low levels of low-density lipoprotein (LDL) cholesterol and risk of intraparenchymal hemorrhage. Methods and Results-A total of 30 802 men and 60 417 women, 40 to 79 years of age with no history of stroke or coronary heart disease, completed a baseline risk factor survey in 1993 under the auspices of the Ibaraki Prefectural Health Study. Systematic mortality surveillance was performed through 2003, and 264 intraparenchymal hemorrhage deaths were identified. LDL cholesterol levels were calculated with the Friedewald formula. Persons with LDL cholesterol Ն140 mg/dL had half the sex-and age-adjusted risk of death due to intraparenchymal hemorrhage of those with LDL cholesterol Ͻ80 mg/dL. After adjustment for cardiovascular risk factors, the multivariable hazard ratio compared with persons with LDL cholesterol Ͻ80 mg/dL was 0.65 (95% CI 0.44 to 0.96) for those with LDL cholesterol 80 to 99 mg/dL, 0.48 (0.32 to 0.71) for 100 to 119 mg/dL, 0.50 (0.33 to 0.75) for 120 to 139 mg/dL, and 0.45 (0.30 to 0.69) for Ն140 mg/dL. These inverse associations were not altered substantially after the exclusion of persons with hypertriglyceridemia, after analysis with a Cox proportional hazard model with time-dependent covariates, or in sensitivity analysis for the potential effect of competing risks. Conclusions-Low LDL cholesterol levels are associated with elevated risk of death due to intraparenchymal hemorrhage.

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Morphogenesis of plasmatic arterionecrosis as the cause of hypertensive intracerebral hemorrhage

Cited by 68 publications

References 24 publications

Trends for coronary heart disease and stroke and their risk factors in Japan.

Trends for coronary heart disease and stroke and their risk factors in Japan.

Hypertension as a risk factor for spontaneous intracerebral hemorrhage.

Low-Density Lipoprotein Cholesterol Concentrations and Death Due to Intraparenchymal Hemorrhage

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