Blood Pressure and Estimated Risk of Stroke in the Elderly Population of Spain

Abstract

on behalf of the investigators of the PREV-ICTUS study Background and Purpose-The objective of this study was to estimate the high blood pressure values and the 10-year risk of stroke in the Spanish general population aged 60 years or older using the Framingham scale. Methods-This was a multicenter, population-based, cross-sectional study performed in Spanish primary care centers. A randomized selection of centers and recruitment population was used. We collected clinical, biochemical, and electrocardiographic data. Results-We analyzed 7343 subjects (mean age, 71.6 years; standard deviation, 7.0; 53.4% females, 34.4% obese subjects, and 27.1% diabetic subjects). Electrocardiographic-left ventricle hypertrophy was present in 12.9% of the subjects, atrial fibrillation in 8.4%, and established cardiovascular disease in 28.9%; 73.0% already had hypertension diagnosed, and 12.8% showed high blood pressure without a prior diagnosis of hypertension. Among hypertensive subjects, 29.1% had high blood pressure on therapeutic objective, and of the total population 35.7% had high blood pressure under control. Those with hypertension already diagnosed showed a higher prevalence of other stroke risk factors (left ventricle hypertrophy, atrial fibrillation, diabetes, or established cardiovascular disease). The estimated 10-year stroke risk was 19.6% (standard deviation, 17.3%), and was greater in hypertensive patients (23.7%; standard deviation, 18.5) than in patients with high blood pressure without known hypertension (12.4%; standard deviation, 9.2), or in normotensive subjects (5.3%; standard deviation, 0.2; PϽ0.001). Conclusion-The 10-year estimated stroke risk was 19.6%, and it was greater in hypertensive patients as compared with the remainder people at any blood pressure range. The concomitant stroke risk factors are more prevalent in patients with hypertension already diagnosed, which implies an important additional estimated risk of stroke.

Factors Explaining Excess Stroke Prevalence: The Spanish Stroke Belt

“…4 Thus, for instance, in Andalusia, among the population Ն60 years of age, the prevalence of diagnosed hypertension and the prevalence of ECG-left ventricular hypertrophy are 79.4% and 19.6%, respectively, the highest values in the Spanish population (with a mean of 73% and 12.9%, respectively). 3,5 Furthermore, the control rate of hypertension in this population is 28.5%, which is the lowest in the country. 3 As expected, a direct relationship between stroke mortality rates and the prevalence and control rates of hypertension has been demonstrated.…”

“…3 As expected, a direct relationship between stroke mortality rates and the prevalence and control rates of hypertension has been demonstrated. 3,5 Therefore, the effect of these factors on the total burden of stroke in different countries is similar and substantial. Additional global efforts are needed to understand and reduce these huge disparities and finally eliminate these stroke belts.…”

Differences in Blood Pressure Control and Stroke Mortality Across Spain

“…The primary objective of the study was to estimate the 10-year risk of stroke in the Spanish general population aged Ն60 years, using the Framingham scale. 10,11 …”

“…10 Briefly, BP values were measured using an OMRON model M6 automated device. 12 The subjects were divided according to their current BP and previous diagnosis of HT as normotensive patients (BP not elevated and no previous diagnoses of HT), known hypertensive subjects (subjects with a previous diagnoses of HT, whether their BP was controlled or not), and patients with elevated BP but no previous diagnosis of HT.…”

“…9 The Prevención de Riego de Ictus (PREV-ICTUS) Study is a community-based study designed to assess the risk of stroke in the general population of Spain Ͼ60 years old. 10 The population of the study, which included Ͼ7000 people, was stratified not only according to age, sex, and urban distribution but also according to the population of the CCAAs, allowing us to analyze separately each of the CCAAs. Therefore, the objective of the present study was to assess the stroke risk, as well as the prevalence of the cardiovascular risk factors in each of the CCAAs and to analyze the relationship with the specific stroke rates of mortality.…”