Risk of Stroke in Relation to Level of Blood Pressure and Other Risk Factors in Treated Hypertensive Patients

Abstract

Background and Purpose-Treatment of hypertension effectively reduces the risk of stroke. However, many treated patients still have high blood pressure (BP), other cardiovascular risk factors, and complications. The risk of stroke in treated hypertensive patients is not well understood. Methods-We analyzed the level of BP over 1 year before the onset of stroke and other cardiovascular risk factors in treated hypertensive patients in a case-control study. The study population included 126 hypertensive patients (74 men; mean age, 70.9 years) with first strokes during 1988 -1993 who had been treated for Ͼ1 year before stroke onset (stroke group). As a control group, we selected 126 sex-and age-matched hypertensive patients who were treated during the same period and were free from stroke. Results-Mean 12-month BP was not significantly different between stroke and control groups, although systolic BP was 2. Mean pulse pressure was also significantly higher in the stroke group than the control group in patients aged Ͻ70 years but not in older patients. In the stroke group, the level of BP within 1 month before stroke onset did not differ from the mean value over the 12-month period. Patients with brain hemorrhage had higher diastolic BP than those with other subtypes. The stroke group had higher plasma glucose, lower HDL cholesterol, and higher frequencies of diabetes mellitus, proteinuria, atrial fibrillation (29.4% versus 4.0%), and use of antiplatelet (31.0% versus 11.1%) and anticoagulant (10.3% versus 1.6%) agents than the control group. Conclusions-The onset of stroke in treated hypertensive patients was related to a higher level of BP in subjects Ͻ70 years old, although this relationship was not obvious in older patients. The risk of stroke in these patients was associated with the presence of metabolic risk factors and cardiovascular complications. Office BP did not change significantly 1 month before the onset of stroke. (Stroke. 2000;31:48-52.)

Mean Arterial Pressure: A Better Marker of Stroke in Patients with Uncontrolled Hypertension in Rural Areas of China

“…Physiologically speaking, F i g u r e 2 . Ag e -s p e c i f i c ORs a n d 9 5 % CI s o f c e r e b r a l h e mo r r h a g e f o r s t a n d a r d P u l s e P r e s s u r e a n d Me a n Ar t e r i a l P r e s s u r e wh e n c o r r e c t i n g f o r a g e , s e x , b o d y ma s s i n d (22). In our study, drinking alcohol was negatively associated with ischemic stroke and cerebral hemorrhage, which was not found in other studies (23).…”

Association between renin-angiotensin-aldosterone system genotypes and haplotypes and risk of ischemic stroke of atherosclerotic etiology

“…In addition to hypertension, a well-established risk factor for ischemic stroke (14,21), and given the key role RAAS plays in blood pressure Objective -The association of renin C-4063T and angiotensinogen (AGT) T174M, AGT M235T and AGT A-6G polymorphisms with ischemic stroke of atherosclerotic etiology was investigated in 329 Tunisian patients with stroke and 444 controls. Materials and methods -Genotyping was performed using PCR-RFLP and the contributions of polymorphisms to the risk of stroke were analyzed using haplotype and multivariate regression analysis.…”

Twenty-Four-Hour Blood Pressure Changes in the Course of Lacunar Disease

“…Numerous investigations on the relationship between blood pressure (BP) and cerebrovascular disease (CVD) have been reported in both primary and secondary prevention, demonstrating that BP represents the most serious risk factor for CVD [1, 2, 3, 4]. BP readings examined in such studies, however, were either discrete readings taken at one instant or mean values for limited periods.…”