Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Li, Linxin, Welch, Sarah J.V., Gutnikov, Sergei A., Mehta, Ziyah, Rothwell, Peter M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2018
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
_version_ 1783324035043557376
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
work_keys_str_mv AT lilinxin timecourseofbloodpressurecontrolpriortolacunartiaandstrokepopulationbasedstudy
AT welchsarahjv timecourseofbloodpressurecontrolpriortolacunartiaandstrokepopulationbasedstudy
AT gutnikovsergeia timecourseofbloodpressurecontrolpriortolacunartiaandstrokepopulationbasedstudy
AT mehtaziyah timecourseofbloodpressurecontrolpriortolacunartiaandstrokepopulationbasedstudy
AT rothwellpeterm timecourseofbloodpressurecontrolpriortolacunartiaandstrokepopulationbasedstudy
AT timecourseofbloodpressurecontrolpriortolacunartiaandstrokepopulationbasedstudy