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Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study
OBJECTIVE: To determine the age-specific temporal trends in blood pressure (BP) before acute lacunar vs nonlacunar TIA and stroke. METHODS: In a population-based study of TIA/ischemic stroke (Oxford Vascular Study), we studied 15-year premorbid BP readings from primary care records in patients with...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Lippincott Williams & Wilkins
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957302/ https://www.ncbi.nlm.nih.gov/pubmed/29669909 http://dx.doi.org/10.1212/WNL.0000000000005526 |
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author | Li, Linxin Welch, Sarah J.V. Gutnikov, Sergei A. Mehta, Ziyah Rothwell, Peter M. |
author_facet | Li, Linxin Welch, Sarah J.V. Gutnikov, Sergei A. Mehta, Ziyah Rothwell, Peter M. |
author_sort | Li, Linxin |
collection | PubMed |
description | OBJECTIVE: To determine the age-specific temporal trends in blood pressure (BP) before acute lacunar vs nonlacunar TIA and stroke. METHODS: In a population-based study of TIA/ischemic stroke (Oxford Vascular Study), we studied 15-year premorbid BP readings from primary care records in patients with lacunar vs nonlacunar events (Trial of Org 10172 in Acute Stroke Treatment [TOAST]) stratified by age (<65, ≥65 years). RESULTS: Of 2,085 patients (1,250 with stroke, 835 with TIA), 309 had lacunar events. In 493 patients <65 years of age, the prevalence of diagnosed hypertension did not differ between lacunar and nonlacunar events (46 [48.4%] vs 164 [41.2%], p = 0.20), but mean/SD premorbid BP (44,496 BP readings) was higher in patients with lacunar events (15-year records: systolic BP [SBP] 138.5/17.7 vs 133.3/15.0 mm Hg, p = 0.004; diastolic BP [DBP] 84.1/9.6 vs 80.9/8.4 mm Hg, p = 0.001), mainly because of higher mean BP during the 5 years before the event (SBP 142.6/18.8 vs 134.6/16.6 mm Hg, p = 0.0001; DBP 85.2/9.7 vs 80.6/9.0 mm Hg, p < 0.0001), with a rising trend (p(trend) = 0.006) toward higher BP leading up to the event (<30-day pre-event SBP: 152.7/16.1 vs 135.3/23.1 mm Hg, p = 0.009; DBP 87.9/9.4 vs 80.8/12.8 mm Hg, p = 0.05; mean BP ≤1 year before the event 145.8/22.0 vs 134.7/16.1 mm Hg, p = 0.001; 86.1/10.7 vs 80.4/9.8 mm Hg, p = 0.0001). Maximum BP in the 5 years before the event was also higher in patients with lacunar events (SBP 173.7/26.6 vs 158.6/23.2 mm Hg, p = 0.0001; DBP 102.3/12.9 vs 94.2/11.2 mm Hg, p < 0.0001), as was persistently elevated BP (≥50% SBP >160 mm Hg, odd ratio 4.95, 95% confidence interval 1.99–12.31, p = 0.0002). However, no similar differences in BP were observed in patients ≥65 years of age. CONCLUSION: Recent premorbid BP control is strongly temporarily related to acute lacunar events at younger ages, suggesting a direct role of BP in accelerating causal pathology and highlighting the need to control hypertension quickly. |
format | Online Article Text |
id | pubmed-5957302 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-59573022018-05-18 Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study Li, Linxin Welch, Sarah J.V. Gutnikov, Sergei A. Mehta, Ziyah Rothwell, Peter M. Neurology Article OBJECTIVE: To determine the age-specific temporal trends in blood pressure (BP) before acute lacunar vs nonlacunar TIA and stroke. METHODS: In a population-based study of TIA/ischemic stroke (Oxford Vascular Study), we studied 15-year premorbid BP readings from primary care records in patients with lacunar vs nonlacunar events (Trial of Org 10172 in Acute Stroke Treatment [TOAST]) stratified by age (<65, ≥65 years). RESULTS: Of 2,085 patients (1,250 with stroke, 835 with TIA), 309 had lacunar events. In 493 patients <65 years of age, the prevalence of diagnosed hypertension did not differ between lacunar and nonlacunar events (46 [48.4%] vs 164 [41.2%], p = 0.20), but mean/SD premorbid BP (44,496 BP readings) was higher in patients with lacunar events (15-year records: systolic BP [SBP] 138.5/17.7 vs 133.3/15.0 mm Hg, p = 0.004; diastolic BP [DBP] 84.1/9.6 vs 80.9/8.4 mm Hg, p = 0.001), mainly because of higher mean BP during the 5 years before the event (SBP 142.6/18.8 vs 134.6/16.6 mm Hg, p = 0.0001; DBP 85.2/9.7 vs 80.6/9.0 mm Hg, p < 0.0001), with a rising trend (p(trend) = 0.006) toward higher BP leading up to the event (<30-day pre-event SBP: 152.7/16.1 vs 135.3/23.1 mm Hg, p = 0.009; DBP 87.9/9.4 vs 80.8/12.8 mm Hg, p = 0.05; mean BP ≤1 year before the event 145.8/22.0 vs 134.7/16.1 mm Hg, p = 0.001; 86.1/10.7 vs 80.4/9.8 mm Hg, p = 0.0001). Maximum BP in the 5 years before the event was also higher in patients with lacunar events (SBP 173.7/26.6 vs 158.6/23.2 mm Hg, p = 0.0001; DBP 102.3/12.9 vs 94.2/11.2 mm Hg, p < 0.0001), as was persistently elevated BP (≥50% SBP >160 mm Hg, odd ratio 4.95, 95% confidence interval 1.99–12.31, p = 0.0002). However, no similar differences in BP were observed in patients ≥65 years of age. CONCLUSION: Recent premorbid BP control is strongly temporarily related to acute lacunar events at younger ages, suggesting a direct role of BP in accelerating causal pathology and highlighting the need to control hypertension quickly. Lippincott Williams & Wilkins 2018-05-15 /pmc/articles/PMC5957302/ /pubmed/29669909 http://dx.doi.org/10.1212/WNL.0000000000005526 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Article Li, Linxin Welch, Sarah J.V. Gutnikov, Sergei A. Mehta, Ziyah Rothwell, Peter M. Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study |
title | Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study |
title_full | Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study |
title_fullStr | Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study |
title_full_unstemmed | Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study |
title_short | Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study |
title_sort | time course of blood pressure control prior to lacunar tia and stroke: population-based study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957302/ https://www.ncbi.nlm.nih.gov/pubmed/29669909 http://dx.doi.org/10.1212/WNL.0000000000005526 |
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