From the University of Texas School of Public Health, Houston (B.R.D.);
Cancer Research Center of Hawaii, Honolulu (T.V.); University of California,
San Francisco (P.H.F.); University of California, Davis (A.B.); St Louis
University School of Medicine (Mo) (J.C.); Robert Wood Johnson Medical School,
New Brunswick, NJ (A.W.); Yale University School of Medicine, New Haven, Conn
(L.M.B.); Albert Einstein School of Medicine, Bronx, NY (W.F.); University of
Maryland School of Medicine, Baltimore (T.P.); and Northwestern University
Medical School, Chicago, Ill (J.S.).
Correspondence to Barry R. Davis, MD, PhD, University of Texas School of Public Health, 1200 Herman Pressler St, Houston, TX 77030. E-mail davis{at}utsph.sph.uth.tmc.edu
Background and Purpose—We sought to
determine risk factors for stroke and stroke type in persons with
isolated systolic hypertension (ISH).
Methods—We performed proportional hazards analyses of
data from the Systolic Hypertension in the Elderly Program, a
double-blind, randomized, placebo-controlled trial of 4736 persons aged
Results—During an average follow-up of 4.5 years, 384 strokes or
TIAs and 262 strokes (including 217 ischemic, 66 lacunar, 26
atherosclerotic, and 25 embolic strokes) were documented. In
multivariate analyses, placebo treatment, older
age, smoking, history of diabetes, higher systolic blood
pressure, lower HDL cholesterol, and ECG abnormality were
significantly associated (P<0.05) with increased
incidence of stroke or TIA, stroke, or ischemic stroke. Greater
lacunar stroke risk was significantly related to placebo treatment,
older age, history of diabetes (relative risk [RR]=3.03; 95%
confidence interval [CI], 1.70 to 5.40), and smoking (RR=3.04; 95%
CI, 1.73 to 5.37). Greater atherosclerotic and embolic stroke risk were
significantly related to presence of carotid bruit (RR=5.75; 95% CI,
2.50 to 13.24) and older age (RR=1.65 per 5 years; 95% CI, 1.25 to
2.18), respectively.
Conclusions—In older persons with ISH, history of diabetes and
smoking are important risk factors for lacunar stroke, whereas carotid
bruit and age are important risk factors for atherosclerotic and
embolic stroke, respectively.
© 1998 American Heart Association, Inc.
Original Contributions
Risk Factors for Stroke and Type of Stroke in Persons With Isolated Systolic Hypertension
60 years with ISH (systolic blood pressure, 160 to 219
mm Hg; diastolic blood pressure, <90 mm Hg). One
treatment group received chlorthalidone (12.5 to 25 mg/d) with step-up
to atenolol (25.0 to 50.0 mg/d) or reserpine (0.05 to 0.10 mg/d), if
needed. The other treatment group received matching placebo. The main
outcome measures were stroke, stroke or transient ischemic
attack [TIA], and stroke types: ischemic (including lacunar,
atherosclerotic, and embolic) and hemorrhagic.
Key Words: clinical trials • hypertension • lacunar infarction • stroke, ischemic
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