Is blood pressure control for stroke prevention the correct goal? The lost opportunity of preventing hypertension

Affiliations

¹ From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.). ghoward@uab.edu.
² From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.).

PMID: 25953369
PMCID: PMC4924927
DOI: 10.1161/STROKEAHA.115.009128

Clinical Trial

Is blood pressure control for stroke prevention the correct goal? The lost opportunity of preventing hypertension

George Howard et al. Stroke. 2015 Jun.

. 2015 Jun;46(6):1595-600.

doi: 10.1161/STROKEAHA.115.009128. Epub 2015 May 7.

Affiliations

¹ From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.). ghoward@uab.edu.
² From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.).

PMID: 25953369
PMCID: PMC4924927
DOI: 10.1161/STROKEAHA.115.009128

Abstract

Background and purpose: Although pharmacological treatment of hypertension has important health benefits, it does not capture the benefit of maintenance of ideal health through the prevention or delay of hypertension.

Methods: A total of 26 875 black and white participants aged 45+ years were assessed and followed for incident stroke events. The association was assessed between incident stroke and: (1) systolic blood pressure (SBP)categorized as normal (<120 mm Hg), prehypertension (120-139 mm Hg), stage 1 hypertension (140-159 mm Hg), and stage 2 hypertension (160 mm Hg+), and (2) number of classes of antihypertensive medications, classified as none, 1, 2, or 3 or more.

Results: During 6.3 years of follow-up, 823 stroke events occurred. Nearly half (46%) of the population were successfully treated (SBP<140 mm Hg) hypertensives. Within blood pressure strata, the risk of stroke increased with each additional class of required antihypertensive medication, with hazard ratio [HR], 1.33; 95% confidence interval, 1.16 to 1.52 for normotensive, HR, 1.15; 95% confidence interval, 1.05 to 1.26 for prehypertension, and HR, 1.22; 95% confidence interval, 1.06 to 1.39 for stage 1 hypertension. A successfully treated (SBP<120 mm Hg) hypertensive person on 3+ antihypertensive medication classes was at marginally higher stroke risk than a person with untreated stage 1 hypertension (HR, 2.48 versus HR=2.19; relative to those with SBP <120 on no antihypertensive medications).

Conclusions: Maintaining the normotensive status solely through pharmacological treatment has a profound impact, as nearly half of this general population cohort were treated to guideline (SBP<140 mm Hg) but failed to return to risk levels similar to normotensive individuals. Even with successful treatment, there is a substantial potential gain by prevention or delay of hypertension.

Keywords: hypertension; prevention and control; risk factors; stroke.

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Is blood pressure control for stroke prevention the correct goal? The lost opportunity of preventing hypertension

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Is blood pressure control for stroke prevention the correct goal? The lost opportunity of preventing hypertension

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