High blood pressure and stroke
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High Blood Pressure and Stroke: A Comprehensive Overview
Introduction to High Blood Pressure and Stroke
High blood pressure (BP) is a significant modifiable risk factor for stroke, which is the second leading cause of death and a major cause of disability worldwide. Elevated BP can lead to both ischemic and hemorrhagic strokes, and managing BP is crucial for both the prevention and treatment of stroke.
High Blood Pressure in Acute Stroke
Association with Poor Outcomes
High BP is commonly observed in patients with acute stroke and is associated with poor outcomes. A systematic review of 32 studies involving 10,892 patients found that elevated mean arterial BP (MABP) and high diastolic BP (DBP) were significantly associated with increased mortality. Specifically, high systolic BP (SBP) and DBP were linked to combined death or dependency in primary intracerebral hemorrhage (PICH) and ischemic stroke. Another study from the International Stroke Trial (IST) confirmed a U-shaped relationship between baseline SBP and both early death and late death or dependency, indicating that both high and low BP are independent prognostic factors for poor outcomes.
Prevalence and Characteristics
In a study of 388 acute stroke patients, those with very high BP (SBP ≥ 200 mmHg and DBP ≥ 115 mmHg) were younger and had a higher prevalence of previous hypertension and alcohol abuse. Mortality was significantly higher in this group compared to those with lower BP. Additionally, a large dataset from the National Hospital Ambulatory Medical Care Survey revealed that over 60% of stroke patients presented with elevated BP, highlighting the prevalence of this condition in acute stroke scenarios.
Blood Pressure Control for Stroke Prevention
Primary Prevention
High BP is the most important modifiable risk factor for stroke, associated with 54% of stroke episodes globally. Clinical trials have shown that antihypertensive therapy significantly reduces the risk of stroke, stroke-related death, and disability. Features such as nocturnal hypertension and morning BP surge are also predictors of increased stroke risk, although effective modalities for correcting these disturbances are still under investigation.
Secondary Prevention
Lowering BP is also crucial for preventing recurrent vascular events in patients with a history of stroke or transient ischemic attack (TIA). A systematic review of randomized controlled trials demonstrated that antihypertensive agents reduce the risk of recurrent stroke, nonfatal stroke, myocardial infarction, and total vascular events. The effectiveness of BP reduction was positively correlated with the magnitude of BP decrease.
Sex- and Ethnic/Racial-Specific Considerations
Differences in BP and Stroke Risk
BP increases with age in both sexes, but the prevalence of high BP is higher in males during early adulthood and in females during middle age. Regional differences also exist, with females overtaking males in BP levels earlier in low- and middle-income countries compared to high-income countries. Observational evidence suggests that females might benefit from lower BP thresholds to reduce stroke risk. Additionally, high BP has a more significant impact on stroke burden among Black and Asian individuals compared to Whites, likely due to differences in lifestyle, socioeconomic status, and healthcare resources.
Conclusion
High BP is a critical factor in both the occurrence and outcome of stroke. Effective management of BP through lifestyle modifications and antihypertensive therapy is essential for both primary and secondary stroke prevention. Further research is needed to optimize BP management strategies, taking into account sex, ethnicity, and individual patient characteristics to improve stroke outcomes globally.
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