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(Stroke. 2005;36:234.)
© 2005 American Heart Association, Inc.

Original Contributions

Risk Factors for Stroke in Subjects With Normal Blood Pressure

A Prospective Cohort Study

Cairu Li, MD, PhD; Gunnar Engström, MD, PhD; Bo Hedblad, MD, PhD; Göran Berglund, MD, PhD Lars Janzon, MD, PhD

From the Departments of Community Medicine (C.L., G.E., B.H., L.J.), and Medicine, Surgery, and Orthopedics (G.B.), Malmö University Hospital, Sweden.

Correspondence to Dr Cairu Li, Department of Community Medicine, Malmö University Hospital, Malmö, Sweden, 205-02. E-mail cairu.li{at}smi.mas.lu.se

Background and Purpose— Although stroke is strongly associated with hypertension, some individuals with normal blood pressure (BP) experience a stroke. This prospective study explored risk factors for stroke in subjects with normal BP.

Methods— A total of 11 228 men and 17 174 women, 45 to 73 years old, were examined in a population-based cohort study. Normal BP was defined as BP <140/90 mm Hg and no treatment for hypertension. The incidence of stroke was followed over a mean period of 6 years.

Results— In the cohort, 10 938 (38%) had normal BP. Of them, 56 patients experienced a first-ever stroke (12% of all stroke). Compared with subjects without stroke during follow-up, these stroke subjects were older, had lower education, were often smokers and alcohol nondrinkers, and had a history of coronary heart disease (CHD), gastric ulcer, or renal calculus. Subjects with stroke had a higher body mass index (BMI) and a high-normal BP (130 to 139/85 to 89 mm Hg) more often. In a backward stepwise Cox-regression analysis, age (per 1 year; relative risk [RR], 1.12), current smoking (RR, 3.21), BMI (per SD; RR, 1.39), high-normal diastolic BP (RR, 2.35), history of CHD (RR, 4.92), and gastric ulcer (RR, 2.21) remained significantly associated with incidence of stroke.

Conclusion— In subjects with normal BP, there are a number of potentially modifiable risk factors associated with an increased incidence of stroke.

Key Words: blood pressure • risk factors • stroke

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