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
This article has been cited by other articles:
 |
|
 |
|
  J. Z. Willey, Q. Xu, B. Boden-Albala, M. C. Paik, Y. P. Moon, R. L. Sacco, and M. S. V. Elkind Lipid Profile Components and Risk of Ischemic Stroke: The Northern Manhattan Study (NOMAS) Arch Neurol, November 1, 2009; 66(11): 1400 - 1406. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Zhang, J. M. Galloway, T. K. Welty, D. O. Wiebers, J. P. Whisnant, R. B. Devereux, J. R. Kizer, B. V. Howard, L. D. Cowan, J. Yeh, et al. Incidence and Risk Factors for Stroke in American Indians: The Strong Heart Study Circulation, October 7, 2008; 118(15): 1577 - 1584. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Sacchetti, G. Trifiro, A. Caputi, C. Turrina, E. Spina, C. Cricelli, O. Brignoli, E. Sessa, and G. Mazzaglia Risk of stroke with typical and atypical anti-psychotics: a retrospective cohort study including unexposed subjects J Psychopharmacol, January 1, 2008; 22(1): 39 - 46. [Abstract] [PDF]
|
|
|
|
 |
|
 E. L. Air and B. M. Kissela Diabetes, the Metabolic Syndrome, and Ischemic Stroke: Epidemiology and possible mechanisms Diabetes Care, December 1, 2007; 30(12): 3131 - 3140. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Woodward, F. Barzi, V. Feigin, D. Gu, R. Huxley, K. Nakamura, A. Patel, S. Ho, K. Jamrozik, and for the Asia Pacific Cohort Studies Collaboration Associations between high-density lipoprotein cholesterol and both stroke and coronary heart disease in the Asia Pacific region Eur. Heart J., November 1, 2007; 28(21): 2653 - 2660. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Ohira, E. Shahar, L. E. Chambless, W. D. Rosamond, T. H. Mosley Jr, and A. R. Folsom Risk Factors for Ischemic Stroke Subtypes: The Atherosclerosis Risk in Communities Study Stroke, October 1, 2006; 37(10): 2493 - 2498. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kubo, Y. Kiyohara, T. Ninomiya, Y. Tanizaki, K. Yonemoto, Y. Doi, J. Hata, Y. Oishi, K. Shikata, and M. Iida Decreasing incidence of lacunar vs other types of cerebral infarction in a Japanese population Neurology, May 23, 2006; 66(10): 1539 - 1544. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Curb, R. D. Abbott, B. L. Rodriguez, K. H. Masaki, R. Chen, J. S. Popper, H. Petrovitch, G. W. Ross, I. J. Schatz, G. C. Belleau, et al. High Density Lipoprotein Cholesterol and the Risk of Stroke in Elderly Men: The Honolulu Heart Program Am. J. Epidemiol., July 15, 2004; 160(2): 150 - 157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. F. McGruder, A. M. Malarcher, T. L. Antoine, K. J. Greenlund, and J. B. Croft Racial and Ethnic Disparities in Cardiovascular Risk Factors Among Stroke Survivors: United States 1999 to 2001 Stroke, July 1, 2004; 35(7): 1557 - 1561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Arauz, L. Murillo, C. Cantu, F. Barinagarrementeria, and J. Higuera Prospective Study of Single and Multiple Lacunar Infarcts Using Magnetic Resonance Imaging: Risk Factors, Recurrence, and Outcome in 175 Consecutive Cases Stroke, October 1, 2003; 34(10): 2453 - 2458. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. M Buckley Review: Lipids and stroke The British Journal of Diabetes & Vascular Disease, May 1, 2003; 3(3): 170 - 176. [Abstract] [PDF]
|
|
|
|
 |
|
 J. Bucerius, J. F. Gummert, M. A. Borger, T. Walther, N. Doll, J. F. Onnasch, S. Metz, V. Falk, and F. W. Mohr Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients Ann. Thorac. Surg., February 1, 2003; 75(2): 472 - 478. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Qureshi, M. F. K. Suri, Y. Mohammad, L. R. Guterman, and L. N. Hopkins Isolated and Borderline Isolated Systolic Hypertension Relative to Long-Term Risk and Type of Stroke: A 20-Year Follow-Up of the National Health and Nutrition Survey Stroke, December 1, 2002; 33(12): 2781 - 2788. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Nasreen, T. Nabika, H. Shibata, H. Moriyama, K. Yamashita, J. Masuda, and S. Kobayashi T-786C Polymorphism in Endothelial NO Synthase Gene Affects Cerebral Circulation in Smokers: Possible Gene-Environmental Interaction Arterioscler Thromb Vasc Biol, April 1, 2002; 22(4): 605 - 610. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Jin and F. Chung Minimizing perioperative adverse events in the elderly{dagger} Br. J. Anaesth., October 1, 2001; 87(4): 608 - 624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Tanizaki, Y. Kiyohara, I. Kato, H. Iwamoto, K. Nakayama, N. Shinohara, H. Arima, K. Tanaka, S. Ibayashi, and M. Fujishima Incidence and Risk Factors for Subtypes of Cerebral Infarction in a General Population : The Hisayama Study Stroke, November 1, 2000; 31(11): 2616 - 2622. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. J. M. Barnett, R. W. Gunton, M. Eliasziw, L. Fleming, B. Sharpe, P. Gates, and H. Meldrum Causes and Severity of Ischemic Stroke in Patients With Internal Carotid Artery Stenosis JAMA, March 15, 2000; 283(11): 1429 - 1436. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Makino, Y. Kawano, J. Minami, T. Yamaguchi, and S. Takishita Risk of Stroke in Relation to Level of Blood Pressure and Other Risk Factors in Treated Hypertensive Patients Stroke, January 1, 2000; 31(1): 48 - 52. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. H. Almassi, T. Sommers, T. E. Moritz, A. L. W. Shroyer, M. J. London, W. G. Henderson, G. K. Sethi, F. L. Grover, and K. E. Hammermeister Stroke in cardiac surgical patients: determinants and outcome Ann. Thorac. Surg., August 1, 1999; 68(2): 391 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Nasreen, T. Nabika, H. Shibata, H. Moriyama, K. Yamashita, J. Masuda, and S. Kobayashi T-786C Polymorphism in Endothelial NO Synthase Gene Affects Cerebral Circulation in Smokers: Possible Gene-Environmental Interaction Arterioscler Thromb Vasc Biol, April 1, 2002; 22(4): 605 - 610. [Abstract] [Full Text] [PDF]
|
|