Excess Stroke Among Hypertensive Men and Women Attributable to Undertreatment of Hypertension

Abstract

Background and Purpose-Most population-based studies indicate that a considerable proportion of hypertensive subjects are undertreated and that undertreatment is more prevalent among hypertensive men than among hypertensive women. The aim of our study was to investigate the consequences of undertreatment of hypertension for women and men in terms of stroke occurrence. Methods-Approximately 45 000 men and women aged Ն20 years were examined in 2 population-based studies in the Netherlands. A cohort of 2616 hypertensive subjects (pharmacologically treated hypertensives and untreated hypertensives who needed pharmacological treatment according to the severity of their hypertension and the coexistence of additional cardiovascular risk factors) was selected for a follow-up study. Follow-up (mean duration, 4.6 years) was complete for 2369 (91%) of the enrolled hypertensive subjects. Results-Compared with treated and controlled hypertensives, the relative risks of stroke for treated and uncontrolled hypertensives and for untreated hypertensives who needed treatment were 1.30 (95% CI, 0.70 to 2.44) and 1.76 (95% CI, 1.05 to 2.94), respectively. These relative risks and the prevalence of (undertreated) hypertension in the total population of 45 000 subjects were used to estimate the number of strokes in the Netherlands attributable to undertreatment. Among hypertensive men and women aged Ն20 years in the Netherlands, the proportions of strokes attributable to treated but uncontrolled blood pressure were 3.1% (95% CI, Ϫ5.2% to 18.7%) and 4.1% (95% CI, Ϫ7.2% to 20.7%), respectively. For untreated hypertensive men and women who should have been treated, these proportions were 22.8% (95% CI, 0.8% to 38.4%) and 25.4% (95% CI, 0.5% to 42.5%), respectively. Conclusions-Increasing the detection of hypertension and improving adherence to current guidelines might prevent a considerable proportion of the incident strokes among hypertensives. The potential impact of achieving control of blood pressure in patients already being treated on the reduction of strokes requires further investigation. (Stroke. 1999;30:1312-1318.)

Population Group Differences in Trends in Stroke Mortality in Israel

“…[22][23][24][25][26] In 1990-1991, a study of a Jerusalem population aged 70 years reported high rates of awareness and treatment of hypertension (87% and 86%, respectively) but disappointingly low levels of control (43%). 27 Higher levels of control are required to reduce both stroke incidence and mortality.…”

Recruitment of participants through community pharmacies for a pharmacogenetic study of antihypertensive drug treatment

“…Despite the availability of a variety of effective antihypertensive drugs, inadequate control of blood pressure is common in hypertensive patients, and responsible for a large proportion of the burden of stroke and myocardial infarction (MI) in the population [2,3]. Although there are some weak predictors of response to antihypertensive drugs, individualization of treatment is mostly done empirically [4].…”

Control of Blood Pressure and Risk of Stroke Among Pharmacologically Treated Hypertensive Patients

“…4 Studies in the United Kingdom and the Netherlands have demonstrated that the quality of control of hypertension is strongly related to the occurrence of stroke in the population. 5,6 Using data from a population-based case-control study, we estimated the proportion of incident strokes occurring among treated hypertensive patients that may be attributable to uncontrolled BP in the United States.…”