(Stroke. 1999;30:1312-1318.)
© 1999 American Heart Association, Inc.
Original Contributions |
Excess Stroke Among Hypertensive Men and Women Attributable to Undertreatment of Hypertension
From the Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Pharmacy, University of Utrecht (O.H.K., A.H.P.P., A.B., A. de B.); Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and Environmental Protection, Bilthoven (O.H.K., J.C.S.); and Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam (O.H.K., B.H.C.S., Z.V., M.M.B.B.), Netherlands.
Correspondence to Olaf H. Klungel, PhD, Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Pharmacy, University of Utrecht, Sorbonnelaan 16, PO Box 80082, 3508 TB Utrecht, Netherlands. E-mail o.h.klungel{at}pharm.uu.nl
Background and Purpose—Most population-based studies indicate that a considerable proportion of hypertensive subjects are undertreated and that undertreatment is more prevalent among hypertensive men than among hypertensive women. The aim of our study was to investigate the consequences of undertreatment of hypertension for women and men in terms of stroke occurrence.
Methods—Approximately 45 000 men and women aged 
20 years were
examined in 2 population-based studies in the Netherlands. A cohort of
2616 hypertensive subjects (pharmacologically treated hypertensives and
untreated hypertensives who needed pharmacological treatment according
to the severity of their hypertension and the coexistence of additional
cardiovascular risk factors) was selected for a
follow-up study. Follow-up (mean duration, 4.6 years) was complete for
2369 (91%) of the enrolled hypertensive subjects.
Results—Compared with treated and controlled hypertensives, the
relative risks of stroke for treated and uncontrolled hypertensives and
for untreated hypertensives who needed treatment were 1.30 (95% CI,
0.70 to 2.44) and 1.76 (95% CI, 1.05 to 2.94), respectively. These
relative risks and the prevalence of (undertreated) hypertension in the
total population of 45 000 subjects were used to estimate the number
of strokes in the Netherlands attributable to undertreatment. Among
hypertensive men and women aged 20 years in the Netherlands, the
proportions of strokes attributable to treated but uncontrolled blood
pressure were 3.1% (95% CI, -5.2% to 18.7%) and 4.1% (95% CI,
-7.2% to 20.7%), respectively. For untreated hypertensive men and
women who should have been treated, these proportions were 22.8% (95%
CI, 0.8% to 38.4%) and 25.4% (95% CI, 0.5% to 42.5%),
respectively.
Conclusions—Increasing the detection of hypertension and improving adherence to current guidelines might prevent a considerable proportion of the incident strokes among hypertensives. The potential impact of achieving control of blood pressure in patients already being treated on the reduction of strokes requires further investigation.
Key Words: hypertension • population-based studies • stroke • treatment
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