The Epidemiological Association between Blood Pressure and Stroke: Implications for Primary and Secondary Prevention

MacMahon, Stephen; Rodgers, Anthony

doi:10.1291/hypres.17.supplementi_s23

Cited by 57 publications

(20 citation statements)

References 23 publications

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“…Maximum patients were in age group 61-70 years. This result is consistent with the result of Sagui et al 19 In this study, 52.8% patients had hypertension. Hypertension was common in ischaemic and haemorrhagic stroke.…”

Section: Discussionsupporting

confidence: 94%

Evaluation of High Density Lipoprotein Cholesterol Concentrations among Elderly Ischaemic Stroke Patients

Ara

Masum²,

Saleheen

et al. 2018

Univ. Heart J.

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Introduction:Stroke is the second most common cause of death throughout the world and is the most common cause of severe adult physical disability 1 and third leading cause of death in Bangladesh. 2 The World Health Organization (WHO) ranks mortality due to stroke in Bangladesh as number 84 in the world. The reported prevalence of stroke in Bangladesh is 0.3%. The high number of disability-adjusted life years lost due to stroke (485 per 10,000 people) shows that stroke severely impacts Bangladesh's economy. 2 Recognized risk factors are hypertension, diabetes, smoking, heart disease, dyslipidaemia. So for primary prevention of stroke, risk factors identification is essential. 3 Hyperlipidaemia is manifested by elevation of the plasma concentrations of the various lipid and lipoprotein fractions (total cholesterol, LDL cholesterol, VLDL, triglycerides etc). Elevation of total and LDL cholesterol is associated particularly with atherosclerotic disease (like CHD, stroke etc) risk, but it is increasingly clear that moderately raised triglycerides or VLDL in the presence of low HDL-cholesterol may also be atherogenic. 4 There is a well-established inverse relation between serum concentrations of HDL cholesterol and the risk of coronary heart disease, 5 but it is not a welldocumented risk factor for stroke. Several case-control studies have noted an inverse relation between HDL cholesterol and risk of stroke or transient ischemic attack. 6,7,8 The Framingham Study, the Copenhagen Study and the Israeli Heart Disease Study have all demonstrated a trend toward higher risk of thromboembolic stroke with lower HDL cholesterol levels in men. 9,10,11 These data add to the evidence relating lipids to stroke and support HDL-C as an important modifiable stroke risk factor. 12 In conjunction with other risk factors, measurement of HDL cholesterol (commonly available from routine lipid screening) could become an increasingly useful tool for identifying elderly persons at high risk of stroke. Abstract:Stroke is an alarming health hazard all over the world as well as in Bangladesh and one of the leading causes of mortality and morbidity. There is a well-established inverse relation between serum concentrations of high density lipoprotein cholesterol (HDL-c) and the risk of coronary heart diseases but it is not a welldocumented risk factor for stroke. This study was done to evaluate of the HLD-c concentration among elderly ischaemic stroke patients. This cross sectional study was conducted

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Section: Discussionsupporting

confidence: 94%

Evaluation of High Density Lipoprotein Cholesterol Concentrations among Elderly Ischaemic Stroke Patients

Ara

Masum²,

Saleheen

et al. 2018

Univ. Heart J.

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“…However, because of limitations in the existing evidence, this systematic review was not able to conclusively determine the degree to which depression is associated with poor adherence to antihypertensive medications. Given this limitation, and considering the high prevalence of hypertension and its disabling complications [43], additional studies that are designed to specifically address the role of depression in antihypertensive medication nonadherence seem warranted. These studies should incorporate prospective designs, include validated and consistent objective measures of adherence to antihypertensive medications, and use validated and consistent methods to assess depression or depressive symptoms.…”

Section: Discussionmentioning

confidence: 99%

The association of depression with adherence to antihypertensive medications: a systematic review

Eze‐Nliam

Thombs

Lima

et al. 2010

Journal of Hypertension

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Objective-To examine the strength and consistency of the evidence on the relationship between depression and adherence to antihypertensive medications.Methods-The MEDLINE, CINAHL, PsycINFO, Embase, SCOPUS, and ISI databases were searched from inception until December 11, 2009 for published studies of original research that assessed adherence to antihypertensive medications and used a standardized interview, validated questionnaire or International Classification of Diseases Ninth Revision (ICD-9) code to assess depression or symptoms of depression in patients with hypertension. Manual searching was conducted on 22 selected journals. Citations of included articles were tracked using Web of Science and Google Scholar. Two investigators independently extracted data from the selected articles and discrepancies were resolved by consensus.Results-Eight studies were identified that included a total of 42,790 patients. 95% of these patients were from one study. Only 4 of the studies had the assessment of this relationship as a primary objective. Adherence rates varied from 29% to 91%. There were widely varying results within and across studies. All 8 studies reported at least one significant bivariate or multivariate negative relationship between depression and adherence to antihypertensive medications. Insignificant findings in bivariate or multivariate analyses were reported in 6 of 8 studies.Conclusions-All studies reported statistically significant relationships between depression and poor adherence to antihypertensive medications, but definitive conclusions cannot be drawn because of substantial heterogeneity between studies with respect to the assessment of depression [6,7], optimal blood pressure control is achieved in less than two-thirds of patients who are prescribed antihypertensive treatment [6]. The major modifiable cause of poor control in patients on therapy is nonadherence to antihypertensive medications [8]. Since hypertension generally does not cause symptoms, cues to take medications are often absent. Indeed, "not remembering" to take antihypertensive medications has been shown to be the most common reason for treatment nonadherence [9]. Factors shown to be associated with adherence to antihypertensive treatment include age [10], medication side effects [11,12], race/ethnicity [13,14], and medication cost [15].Depression is present in approximately 5-10% of patients in primary care [16] and is associated with a 3-fold greater risk of nonadherence to medical treatment [17]. Depression therefore represents a potentially important predictor of treatment nonadherence in patients with hypertension. The importance of understanding the relationship between depression and antihypertensive treatment nonadherence is underlined when one considers that depressed patients are at greater risk than those without depression to develop hypertension [18]. This systematic review of the literature was therefore conducted to assess the strength and consistency of evidence linking depression or depressive symptoms...

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“…Hypertension was considered present in patients with an established history of blood pressure (BP) greater than 160/190 mm Hg or supervised use of antihypertensive medication [16]. The patients who experienced a transient rise of BP on admission were not considered to be hypertensive.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors, Subtypes and Outcome of Ischaemic Stroke in Kuwait – A Hospital-Based Study

Al-Shammri

Shahid²,

Ghali³

et al. 2003

Med Princ Pract

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Objective: To report on stroke subtypes, associated risk factors and outcome in Kuwait. Methods: The records of 62 patients (30 male, 32 female) admitted with diagnosis of stroke to Kuwait Oil Company Hospital, Kuwait, a tertiary care hospital, during a 5-year period (1995–1999), were retrospectively reviewed. Results: Small artery infarction was the most common subtype and occurred in 37 subjects (59.7%); less common were atherosclerotic large artery strokes (19 patients, 30.6%) and strokes of cardio-embolic origin (6 patients, 9.7%). Identifiable risk factors or associated morbidities were hypertension (72.5%), diabetes mellitus (69.4%), ischaemic heart disease (14.5%), history of migraine (8.1%), lone atrial fibrillation (5.0%), and valvular heart disease (1.6%). The most important determinants of a deleterious 30-day outcome, as indicated by severe disability or death, were female gender, lack of use of anti-platelet drugs, presence of a large artery infarction stroke subtype, and cardio-embolic stroke. Conclusion: Prevalence of hypertension and diabetes is high among patients with stroke in Kuwait, with rates higher than those found in any previous reports from the Gulf region. Two unusual observations were that women had a rather high frequency of stroke, and infarction of the small artery was more common than that of the large artery. Outcome, as indicated by severe disability or death, was worse among women, elderly patients, and those with large artery atherosclerotic and cardio-embolic strokes. There is some evidence that such a deleterious outcome might be ameliorated with use of anti-platelet drugs.

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The Epidemiological Association between Blood Pressure and Stroke: Implications for Primary and Secondary Prevention

Cited by 57 publications

References 23 publications

Evaluation of High Density Lipoprotein Cholesterol Concentrations among Elderly Ischaemic Stroke Patients

Evaluation of High Density Lipoprotein Cholesterol Concentrations among Elderly Ischaemic Stroke Patients

The association of depression with adherence to antihypertensive medications: a systematic review

Risk Factors, Subtypes and Outcome of Ischaemic Stroke in Kuwait – A Hospital-Based Study

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