(Stroke. 2000;31:420.)
© 2000 American Heart Association, Inc.
Original Contributions |
Control of Blood Pressure and Risk of Stroke Among Pharmacologically Treated Hypertensive Patients
From the Departments of Epidemiology (O.H.K., R.C.K., B.M.P., S.R.H., W.T.L.), Medicine (B.M.P., N.L.S., R.N.L., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), Cardiovascular Health Research Unit, University of Washington, Seattle; and the Department of Pharmacoepidemiology and Pharmacotherapy (O.H.K., H.G.M.L., A. de B.), Utrecht Institute of Pharmaceutical Sciences, Utrecht University (Netherlands).
Correspondence to Olaf H. Klungel, Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, Netherlands. E-mail o.h.klungel{at}pharm.uu.nl
Background and Purpose—Despite improved control of blood pressure during the last decades in the United States, a considerable proportion of treated hypertensives have not achieved target blood pressure levels. We estimated the proportion of strokes occurring among treated hypertensive patients that may be attributable to uncontrolled blood pressure.
Methods—A population-based case-control study was conducted among treated hypertensive members of Group Health Cooperative of Puget Sound. Cases were treated hypertensive patients who sustained a first fatal or nonfatal, ischemic (n=460) or hemorrhagic (n=95) stroke during 1989–1996. Controls were a random sample of stroke-free, treated hypertensive Group Health Cooperative enrollees (n=2966), similar in age to the stroke cases. Multiple measurements of blood pressure and other cardiovascular risk factors were collected from medical records. Logistic regression was used to estimate the risk of ischemic stroke and hemorrhagic stroke associated with uncontrolled blood pressure, defined as diastolic blood pressure >90 mm Hg or systolic blood pressure >140 mm Hg. The fraction of strokes attributable to uncontrolled blood pressure among treated hypertensives was calculated.
Results—Blood pressure was uncontrolled in 78% of ischemic stroke cases, 85% of hemorrhagic stroke cases, and 65% of controls. After adjustment for potential confounders, uncontrolled blood pressure among treated hypertensive patients was moderately associated with ischemic stroke (risk ratio=1.5 [95% CI, 1.2 to 1.9]) and strongly related to hemorrhagic stroke (risk ratio=3.0 [95% CI, 1.7 to 5.4]). We estimated that 27% (95% CI, 11% to 39%) of the ischemic strokes and 57% (95% CI, 26% to 75%) of the hemorrhagic strokes among treated hypertensive patients were attributable to uncontrolled blood pressure. Overall, 32% (95% CI, 14% to 45%) of all strokes were attributable to uncontrolled blood pressure.
Conclusions—A considerable proportion of incident strokes among treated hypertensive patients may be prevented by achieving control of blood pressure.
Key Words: hypertension • pharmacology • risk • stroke, hemorrhagic • stroke, ischemic
This article has been cited by other articles:
 |
|
 |
|
  D. Samal, S. Greisenegger, E. Auff, W. Lang, and W. Lalouschek The Relation Between Knowledge About Hypertension and Education in Hospitalized Patients With Stroke in Vienna Stroke, April 1, 2007; 38(4): 1304 - 1308. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Rienstra, D. J. Van Veldhuisen, H. J.G.M. Crijns, I. C. Van Gelder, and for the RACE investigators Enhanced cardiovascular morbidity and mortality during rhythm control treatment in persistent atrial fibrillation in hypertensives: data of the RACE study Eur. Heart J., March 2, 2007; 28(6): 741 - 751. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Li, G. Engstrom, B. Hedblad, G. Berglund, and L. Janzon Blood Pressure Control and Risk of Stroke: A Population-Based Prospective Cohort Study Stroke, April 1, 2005; 36(4): 725 - 730. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Sookaneknun, R. M. Richards, J. Sanguansermsri, and C. Teerasut Pharmacist Involvement in Primary Care Improves Hypertensive Patient Clinical Outcomes Ann. Pharmacother., December 1, 2004; 38(12): 2023 - 2028. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. M. Psaty, T. A. Manolio, N. L. Smith, S. R. Heckbert, J. S. Gottdiener, G. L. Burke, J. Weissfeld, P. Enright, T. Lumley, N. Powe, et al. Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults: The Cardiovascular Health Study Arch Intern Med, November 11, 2002; 162(20): 2325 - 2332. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Friday, M. Alter, and S.-M. Lai Control of Hypertension and Risk of Stroke Recurrence Stroke, November 1, 2002; 33(11): 2652 - 2657. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kivipelto, E.-L. Helkala, M. P. Laakso, T. Hanninen, M. Hallikainen, K. Alhainen, S. Iivonen, A. Mannermaa, J. Tuomilehto, A. Nissinen, et al. Apolipoprotein E {epsilon}4 Allele, Elevated Midlife Total Cholesterol Level, and High Midlife Systolic Blood Pressure Are Independent Risk Factors for Late-Life Alzheimer Disease Ann Intern Med, August 6, 2002; 137(3): 149 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kivipelto, E.-L. Helkala, M. P Laakso, T. Hanninen, M. Hallikainen, K. Alhainen, H. Soininen, J. Tuomilehto, and A. Nissinen Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study BMJ, June 16, 2001; 322(7300): 1447 - 1451. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Eigenbrodt, K. M. Rose, D. J. Couper, D. K. Arnett, R. Smith, and D. Jones Orthostatic Hypotension as a Risk Factor for Stroke : The Atherosclerosis Risk in Communities (ARIC) Study, 1987-1996 Stroke, October 1, 2000; 31(10): 2307 - 2313. [Abstract] [Full Text] [PDF]
|
|