Stroke risk screening of adults with hypertension: prospective cross-sectional study in primary care

Abstract

Objectives: There is a lack of current epidemiological data on the risk of cerebrovascular disease associated with arterial hypertension. We therefore aimed to assess the risk factor profile of hypertensive patients in primary care in various age groups, and to calculate their corresponding risk of stroke.

Methods: A total of 2482 primary-care practices throughout Germany included 47,394 consecutive unselected patients with diagnosed hypertension in a cross-sectional prospective observational study. In addition to demographic characteristics, participating primary-care physicians documented known risk factors for stroke using standardized questionnaires. The 10-year prospective risk of first stroke was then calculated according to the Framingham Stroke Risk Score.

Main outcome measures: Patients were evenly balanced for sex (females 51%), and the mean age was 66.5 years. Mean systolic (SBP)/diastolic (DBP) blood pressure was 147/86 mmHg. Only 29.1% of patients had an SBP <140 mmHg, and 60.2% had a DBP <90 mmHg. The most prevalent risk factors were a positive family history of cardiovascular disease (46.1%), diabetes mellitus (36.1%), coronary artery disease (34.4%), and left ventricular hypertrophy (33.3%). Drug treatment was given as combination therapy in 73.5% of the total cohort of patients. The mean 10-year risk of stroke was 26% in the total cohort (0-19% in 50.6% of patients, 20-49% in 32.7%, and > or =50% in 16.7%).

Conclusions: Co-morbidities relevant for total stroke risk are very prevalent among typical primary-care patients, confirming a substantial burden of disease in this setting. The resulting risk of stroke is substantial. The need for more aggressive BP control and treatment of modifiable risk factors is confirmed by our results.