Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients

Olaf H. Klungel, Robert C. Kaplan, Susan R. Heckbert, Nicholas L. Smith, Rozenn N. Lemaitre, W. T. Longstreth, Hubert G M Leufkens, Anthonius De Boer, Bruce M. Psaty

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background and Purpose - Despite improved control of blood pressure during the last decades in the United States, a considerable proportion of treated hypertensives have not achieved target blood pressure levels. We estimated the proportion of strokes occurring among treated hypertensive patients that may be attributable to uncontrolled blood pressure. Methods - A population-based case-control study was conducted among treated hypertensive members of Group Health Cooperative of Puget Sound. Cases were treated hypertensive patients who sustained a first fatal or nonfatal ischemic (n=460) or hemorrhagic (n=95) stroke during 1989-1996. Controls were a random sample of stroke-free, treated hypertensive Group Health Cooperative enrollees (n=2966), similar in age to the stroke cases. Multiple measurements of blood pressure and other cardiovascular risk factors were collected from medical records. Logistic regression was used to estimate the risk of ischemic stroke and hemorrhagic stroke associated with uncontrolled blood pressure, defined as diastolic blood pressure >90 mm Hg or systolic blood pressure >140 mm Hg. The fraction of strokes attributable to uncontrolled blood pressure among treated hypertensives was calculated. Results - Blood pressure was uncontrolled in 78% of ischemic stroke cases, 85% of hemorrhagic stroke cases, and 65% of controls. After adjustment for potential confounders, uncontrolled blood pressure among treated hypertensive patients was moderately associated with ischemic stroke (risk ratio = 1.5 [95% CI, 1.2 to 1.9]) and strongly related to hemorrhagic stroke (risk ratio=3.0 [95% CI, 1.7 to 5.4]). We estimated that 27% (95% CI, 11% to 39%) of the ischemic strokes and 57% (95% CI, 26% to 75%) of the hemorrhagic strokes among treated hypertensive patients were attributable to uncontrolled blood pressure. Overall, 32% (95% CI, 14% to 45%) of all strokes were attributable to uncontrolled blood pressure. Conclusions - A considerable proportion of incident strokes among treated hypertensive patients may be prevented by achieving control of blood pressure.

Original languageEnglish (US)
Pages (from-to)420-424
Number of pages5
JournalStroke
Volume31
Issue number2
StatePublished - Feb 2000
Externally publishedYes

Fingerprint

Stroke
Blood Pressure
Odds Ratio
Health
Medical Records
Case-Control Studies
Logistic Models

Keywords

  • Hypertension
  • Pharmacology
  • Risk
  • Stroke, hemorrhagic
  • Stroke, ischemic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Klungel, O. H., Kaplan, R. C., Heckbert, S. R., Smith, N. L., Lemaitre, R. N., Longstreth, W. T., ... Psaty, B. M. (2000). Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients. Stroke, 31(2), 420-424.

Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients. / Klungel, Olaf H.; Kaplan, Robert C.; Heckbert, Susan R.; Smith, Nicholas L.; Lemaitre, Rozenn N.; Longstreth, W. T.; Leufkens, Hubert G M; De Boer, Anthonius; Psaty, Bruce M.

In: Stroke, Vol. 31, No. 2, 02.2000, p. 420-424.

Research output: Contribution to journalArticle

Klungel, OH, Kaplan, RC, Heckbert, SR, Smith, NL, Lemaitre, RN, Longstreth, WT, Leufkens, HGM, De Boer, A & Psaty, BM 2000, 'Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients', Stroke, vol. 31, no. 2, pp. 420-424.
Klungel OH, Kaplan RC, Heckbert SR, Smith NL, Lemaitre RN, Longstreth WT et al. Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients. Stroke. 2000 Feb;31(2):420-424.
Klungel, Olaf H. ; Kaplan, Robert C. ; Heckbert, Susan R. ; Smith, Nicholas L. ; Lemaitre, Rozenn N. ; Longstreth, W. T. ; Leufkens, Hubert G M ; De Boer, Anthonius ; Psaty, Bruce M. / Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients. In: Stroke. 2000 ; Vol. 31, No. 2. pp. 420-424.
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AU - Klungel, Olaf H.

AU - Kaplan, Robert C.

AU - Heckbert, Susan R.

AU - Smith, Nicholas L.

AU - Lemaitre, Rozenn N.

AU - Longstreth, W. T.

AU - Leufkens, Hubert G M

AU - De Boer, Anthonius

AU - Psaty, Bruce M.

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N2 - Background and Purpose - Despite improved control of blood pressure during the last decades in the United States, a considerable proportion of treated hypertensives have not achieved target blood pressure levels. We estimated the proportion of strokes occurring among treated hypertensive patients that may be attributable to uncontrolled blood pressure. Methods - A population-based case-control study was conducted among treated hypertensive members of Group Health Cooperative of Puget Sound. Cases were treated hypertensive patients who sustained a first fatal or nonfatal ischemic (n=460) or hemorrhagic (n=95) stroke during 1989-1996. Controls were a random sample of stroke-free, treated hypertensive Group Health Cooperative enrollees (n=2966), similar in age to the stroke cases. Multiple measurements of blood pressure and other cardiovascular risk factors were collected from medical records. Logistic regression was used to estimate the risk of ischemic stroke and hemorrhagic stroke associated with uncontrolled blood pressure, defined as diastolic blood pressure >90 mm Hg or systolic blood pressure >140 mm Hg. The fraction of strokes attributable to uncontrolled blood pressure among treated hypertensives was calculated. Results - Blood pressure was uncontrolled in 78% of ischemic stroke cases, 85% of hemorrhagic stroke cases, and 65% of controls. After adjustment for potential confounders, uncontrolled blood pressure among treated hypertensive patients was moderately associated with ischemic stroke (risk ratio = 1.5 [95% CI, 1.2 to 1.9]) and strongly related to hemorrhagic stroke (risk ratio=3.0 [95% CI, 1.7 to 5.4]). We estimated that 27% (95% CI, 11% to 39%) of the ischemic strokes and 57% (95% CI, 26% to 75%) of the hemorrhagic strokes among treated hypertensive patients were attributable to uncontrolled blood pressure. Overall, 32% (95% CI, 14% to 45%) of all strokes were attributable to uncontrolled blood pressure. Conclusions - A considerable proportion of incident strokes among treated hypertensive patients may be prevented by achieving control of blood pressure.

AB - Background and Purpose - Despite improved control of blood pressure during the last decades in the United States, a considerable proportion of treated hypertensives have not achieved target blood pressure levels. We estimated the proportion of strokes occurring among treated hypertensive patients that may be attributable to uncontrolled blood pressure. Methods - A population-based case-control study was conducted among treated hypertensive members of Group Health Cooperative of Puget Sound. Cases were treated hypertensive patients who sustained a first fatal or nonfatal ischemic (n=460) or hemorrhagic (n=95) stroke during 1989-1996. Controls were a random sample of stroke-free, treated hypertensive Group Health Cooperative enrollees (n=2966), similar in age to the stroke cases. Multiple measurements of blood pressure and other cardiovascular risk factors were collected from medical records. Logistic regression was used to estimate the risk of ischemic stroke and hemorrhagic stroke associated with uncontrolled blood pressure, defined as diastolic blood pressure >90 mm Hg or systolic blood pressure >140 mm Hg. The fraction of strokes attributable to uncontrolled blood pressure among treated hypertensives was calculated. Results - Blood pressure was uncontrolled in 78% of ischemic stroke cases, 85% of hemorrhagic stroke cases, and 65% of controls. After adjustment for potential confounders, uncontrolled blood pressure among treated hypertensive patients was moderately associated with ischemic stroke (risk ratio = 1.5 [95% CI, 1.2 to 1.9]) and strongly related to hemorrhagic stroke (risk ratio=3.0 [95% CI, 1.7 to 5.4]). We estimated that 27% (95% CI, 11% to 39%) of the ischemic strokes and 57% (95% CI, 26% to 75%) of the hemorrhagic strokes among treated hypertensive patients were attributable to uncontrolled blood pressure. Overall, 32% (95% CI, 14% to 45%) of all strokes were attributable to uncontrolled blood pressure. Conclusions - A considerable proportion of incident strokes among treated hypertensive patients may be prevented by achieving control of blood pressure.

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