Published Online
on December 23, 2004

A more recent version of this article appeared on February 1, 2005

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Submitted on July 1, 2004
Revised on October 14, 2004
Accepted on November 3, 2004

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; and 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.

^* To whom correspondence should be addressed. 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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