Blood Pressure as a Risk Factor for Stroke and the Impact of Antihypertensive Treatment

Gil‐Núñez, A.; Vivancos-Mora, J

doi:10.1159/000089356

Cited by 24 publications

(18 citation statements)

References 190 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Influence of medication and well-treated blood pressure on the one hand and undiagnosed and untreated elevated blood pressure on the other hand may have contributed to the nonsignificant final result. Blood pressure is an important risk factor for stroke and cardiovascular disease [25]. …”

Section: Discussionmentioning

confidence: 99%

Arterial Events after Ischemic Stroke at a Young Age: A Cross-Sectional Long-Term Follow-Up of Patients and Controls in Western Norway

Waje‐Andreassen

Næss²,

Thomassen³

et al. 2007

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: There is little information in the literature on the risk of vascular events among patients after ischemic stroke at a young age. Methods: We examined 144 (77%) of 187 long-term survivors of ischemic stroke and compared them with 167 controls. Mean age of the 187 survivors at inclusion was 41.0 years and mean age of the participating patients was 40.8 years. Results: After a mean duration of observation of 11.8 years, we registered arterial events among 54 patients and 14 controls. Ninety patients with index stroke only had no significant risk factors compared with controls without arterial events. Compared with 54 patients with several arterial events, age, incidence of diabetes mellitus, smoking and family history of coronary disease were significantly lower. Conclusions: The results from index-stroke-only patients suggest that a subgroup of patients has a benign course, probably without chronic vascular disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Arterial Events after Ischemic Stroke at a Young Age: A Cross-Sectional Long-Term Follow-Up of Patients and Controls in Western Norway

Waje‐Andreassen

Næss²,

Thomassen³

et al. 2007

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…35 Many studies have looked at overall prescription drug utilization as an indicator of comorbidity, but this study focused on antihypertensive medication use because this may better reflect comorbidity in the hypertensive population. 36 The antihypertensive MU measure indicates the number of unique antihypertensive medication classes for which prescriptions were filled in the period.…”

Section: Antihypertensive Medication Utilizationmentioning

confidence: 99%

Performance of Comorbidity Measures to Predict Stroke and Death in a Community-Dwelling, Hypertensive Medicaid Population

Tang

Wan

Bailey

2008

Stroke

View full text Add to dashboard Cite

Background and Purpose-The Charlson and Elixhauser comorbidities are widely used to control for differences in comorbidity in epidemiological studies but have not been validated for outpatient studies of hypertension. This study sought that validation using death and stroke outcomes. Methods-Using Cox models in a retrospective cohort study of 49 479 hypertensive patients, Modified Charlson Index was compared with 6 alternative approaches to assessing comorbidity: individual Charlson comorbidities, Elixhauser comorbidities, prior major cardiovascular disease event, traditional risk factors for cerebrovascular accident, healthcare utilization, and antihypertensive medication utilization. Comorbidity measures were calculated at baseline and for a period before occurrence of the study outcome of interest or study conclusion. Results-The Charlson comorbidities had the smallest Akaike information criterion value for both the stroke and death outcomes when baseline data were used. The Elixhauser comorbidities had the smallest Akaike information criterion value for both the stroke and death outcomes when follow-up data were used. Modified Charlson Index also predicted stroke and death, but alternative models were more robust. Conclusion-This study indicates that both the Charlson and Elixhauser comorbidities are valid prediction tools that could enable clinicians and health systems to better assess risk for stroke and death in patients with hypertension. However, the Charlson comorbidities perform better when comorbidities are assessed using baseline data, whereas the Elixhauser comorbidities perform better for short follow-up periods when comorbidities are assessed proximal to events of interest.

show abstract

“…1,3,4 Considerably less attention has been focused on the more direct associations between hypertension and disability. In 1985, hypertension was related to disability in the Framingham Heart Study.…”

mentioning

confidence: 99%

“…One may be inclined to postulate the former, because many antihypertensive medications have been associated with preclinical functional disability as adverse effects. 4,8 The benefits of treatment may outweigh its adverse effects.…”

mentioning

confidence: 99%

“…4,8 For example, in persons with heart failure, angiotensin-converting enzyme inhibitors have been shown to be associated with a decreased rate of decline in physical function for persons with heart failure. 8 After this study, Onder et al 9 investigated the association between angiotensin-converting enzyme inhibitors and physical performance and muscle strength in women free of heart failure and compared 4 groups: patients on angiotensin-converting enzyme inhibitors, patients treated with other antihypertensive medications continuously, patients treated with other antihypertensive medications irregularly, and patients with normal BP.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Blood Pressure and Disability

Elias

2007

Hypertension

View full text Add to dashboard Cite

D isability has been defined as an inability to perform an action in a way that is consistent with the purpose of an organ or an organ system. 1 Preclinical disability, often detected by self-report instruments, is the term for functional limitations that are not clinically diagnosed but nonetheless represent a transition between impairment and disability. 1 Disability is a major public health problem, 1,2 yet there is little information currently available with respect to the role of blood pressure (BP) in its development.It is clear that hypertension-associated diseases and events, eg, stroke, myocardial infarction, angina pectoris, heart failure, and peripheral vascular disease, are risk factors for disability. 1,3,4 Considerably less attention has been focused on the more direct associations between hypertension and disability. In 1985, hypertension was related to disability in the Framingham Heart Study. 3 Nine years later, Hubert and Fries 5 reported an association between the diagnosis of hypertension and disability in a university runners club.Thirteen years later, in this issue of Hypertension, Hajjar et al 2 report a statistically significant association between hypertension and disability and concurrent and prospective associations between systolic BP and disability among 999 stroke-free men and women participating in the Charleston Heart Study, 39% of whom were African American. Concurrently and prospectively measured systolic BP values were positively related to increasing disability as assessed by 3 functional measures: (1) Nagi's Congruency in Medical and Self-Assessment of Disability Scale; (2) the Rosow-Breslaw Scale; and (3) the Katz Activities of Daily Living Scale. Thus, demonstration of a "dose-response" relationship between BP and multiple functional disability measures may be expected to stimulate a timely succession of studies, especially because many unanswered and important questions are raised about possible mechanisms. Hajjar et al 2 suggest the following candidate mechanisms for the positive association between systolic BP and increments in disability over time: white matter hyperintensities in the brain, cerebrovascular function, overall lean muscle mass, inflammation or changes in the renin angiotensin system, and cognitive function. The complexity of understanding these mechanisms may be illustrated by considering cognition as just 1 example of a variable intervening between BP and disability.With respect to cognition, the emphasis on executive functioning (planning, organizing, and properly sequencing activities) and fluid intellect (problem solving) is well placed, because adequate performance in these domains is necessary to meet the heavy demands of managing one's work and personal affairs, as well as everyday life demands, such as shopping, cooking, house management, and dressing. Thus, although each of the proposed mechanisms deserves comment, we will focus on cognitive functioning for 2 reasons: we can illustrate the complexity involved in identifying mechanisms intervening...

show abstract

Blood Pressure as a Risk Factor for Stroke and the Impact of Antihypertensive Treatment

Cited by 24 publications

References 190 publications

Arterial Events after Ischemic Stroke at a Young Age: A Cross-Sectional Long-Term Follow-Up of Patients and Controls in Western Norway

Arterial Events after Ischemic Stroke at a Young Age: A Cross-Sectional Long-Term Follow-Up of Patients and Controls in Western Norway

Performance of Comorbidity Measures to Predict Stroke and Death in a Community-Dwelling, Hypertensive Medicaid Population

Blood Pressure and Disability

Contact Info

Product

Resources

About