Published online before print February 19, 2004, doi: 10.1161/01.STR.0000116869.64771.5A
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2004;35:776.)
© 2004 American Heart Association, Inc.
Comments, Opinions, and Reviews |
Blood Pressure and Stroke
An Overview of Published Reviews
From the Clinical Trials Research Unit, Department of Medicine, University of Auckland, Auckland, New Zealand.
Correspondence to Carlene Lawes, Clinical Trials Research Unit, Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail c.lawes{at}ctru.auckland.ac.nz
| A CORRECTED VERSION OF THIS ARTICLE HAS BEEN PUBLISHED
|
Background— The last few years have seen a considerable increase in the amount of information available concerning blood pressure (BP) and stroke associations. This article provides an overview of published reviews of the effects on stroke seen in trials of BP-lowering drugs and compares these with the results available from cohort studies.
Summary of Review— We present a review of major overviews of prospective cohort studies and an updated meta-analysis of >40 randomized controlled trials of BP lowering, which included >188 000 participants and approximately 6800 stroke events. Cohort studies now indicate that in the Asia Pacific region as well as in North America and Western Europe, each 10 mm Hg lower systolic BP is associated with a decrease in risk of approximately one third in subjects aged 60 to 79 years. The association is continuous down to levels of at least 115/75 mm Hg and is consistent across sexes, regions, and stroke subtypes and for fatal and nonfatal events. The proportional association is age dependent but is still a strong and positive association in those aged 80 years. Data from randomized controlled trials, in which mean age at event was approximately 70 years, indicate that a 10 mm Hg reduction in systolic BP is associated with a reduction in risk of stroke of approximately one third. Per mm Hg systolic BP reduction, the benefits for stroke appear similar between agents, by baseline BP levels, and whether or not individuals have a past history of cardiovascular disease. There is, however, evidence of greater benefit with a larger BP reduction.
Conclusions— The epidemiologically expected benefits of BP lowering for stroke risk reduction are broadly consistent across a range of different population subgroups. There are greater benefits from larger BP reductions, and initiating and maintaining BP reduction for stroke prevention is a more important issue than choice of initial agent.
Key Words: blood pressure • cohort studies • epidemiology • meta-analysis • randomized controlled trials • stroke
This article has been cited by other articles:
 |
|
 |
|
  K. Tu Hypertension management by family physicians: Is it time to pat ourselves on the back? Can Fam Physician, July 1, 2009; 55(7): 684 - 685. [Full Text] [PDF]
|
|
|
|
|
|
K. Tu Prise en charge de l'hypertension par les medecins de famille: Est-ce le temps de nous feliciter? Can Fam Physician, July 1, 2009; 55(7): 686 - 687. [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Behringer, C. K. Vanterpool, W. J. Pearce, S. M. Wilson, and J. N. Buchholz Advancing Age Alters the Contribution of Calcium Release From Smooth Endoplasmic Reticulum Stores in Superior Cervical Ganglion Cells J Gerontol A Biol Sci Med Sci, February 4, 2009; (2009) gln053v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Rautio, M. Eliasson, and B. Stegmayr Favorable Trends in the Incidence and Outcome in Stroke in Nondiabetic and Diabetic Subjects: Findings From the Northern Sweden MONICA Stroke Registry in 1985 to 2003 Stroke, December 1, 2008; 39(12): 3137 - 3144. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Talelli and R. J. Greenwood Review: Recurrent stroke: where do we stand with the secondary prevention of noncardioembolic ischaemic strokes? Therapeutic Advances in Cardiovascular Disease, October 1, 2008; 2(5): 387 - 405. [Abstract] [PDF]
|
|
|
|
 |
|
 E. I. Levy, J. Mocco, R. M. Samuelson, R. D. Ecker, B. S. Jahromi, and L. N. Hopkins Optimal treatment of carotid artery disease. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 979 - 985. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. C. Marschner, R. J. Simes, and A. Keech Biases in the Identification of Risk Factor Thresholds and J-Curves Am. J. Epidemiol., October 1, 2007; 166(7): 824 - 831. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. N. Turan, G. Cotsonis, M. J. Lynn, S. Chaturvedi, M. Chimowitz, and for the Warfarin-Aspirin Symptomatic Intracranial Relationship Between Blood Pressure and Stroke Recurrence in Patients With Intracranial Arterial Stenosis Circulation, June 12, 2007; 115(23): 2969 - 2975. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. K. Vanterpool, E. A. Vanterpool, W. J. Pearce, and J. N. Buchholz Advancing age alters the expression of the ryanodine receptor 3 isoform in adult rat superior cervical ganglia J Appl Physiol, August 1, 2006; 101(2): 392 - 400. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. El-Saed, L. H. Kuller, A. B. Newman, O. Lopez, J. Costantino, K. McTigue, M. Cushman, and R. Kronmal Factors Associated With Geographic Variations in Stroke Incidence Among Older Populations in Four US Communities Stroke, August 1, 2006; 37(8): 1980 - 1985. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Hankey Potential New Risk Factors for Ischemic Stroke: What Is Their Potential? Stroke, August 1, 2006; 37(8): 2181 - 2188. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F El Fakiri, M A Bruijnzeels, and A W Hoes Prevention of cardiovascular diseases: focus on modifiable cardiovascular risk Heart, June 1, 2006; 92(6): 741 - 745. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Salvetti and L. Ghiadoni Thiazide Diuretics in the Treatment of Hypertension: An Update J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S25 - S29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Circulation, March 14, 2006; 113(10): e409 - e449. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Senior, C. S. Anderson, M.-h. Chen, R. Haydon, D. Walker, D. Fourie, S. Lillis, and J. Gommans Management of hypertension in the oldest old: a study in primary care in New Zealand Age Ageing, March 1, 2006; 35(2): 178 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke, February 1, 2006; 37(2): 577 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Prepared by: British Cardiac Society, British Hype JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice Heart, December 1, 2005; 91(suppl_5): v1 - v52. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Terzolo, S. Bovio, A. Pia, P. A. Conton, G. Reimondo, C. Dall'Asta, D. Bemporad, A. Angeli, G. Opocher, M. Mannelli, et al. Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma Eur. J. Endocrinol., August 1, 2005; 153(2): 307 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Williams Recent hypertension trials: Implications and controversies J. Am. Coll. Cardiol., March 15, 2005; 45(6): 813 - 827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. H. Messerli and A. Fournier Re: Lawes et al: Blood Pressure and Stroke Stroke, October 1, 2004; 35(10): 2238 - 2238. [Full Text] [PDF]
|
|
|
|
 |
|
 Other articles noted: 06 Feb 2004 to 16 Apr 2004 Evid. Based Nurs., July 1, 2004; 7(3): e3 - e3. [Full Text] [PDF]
|
|