High blood pressure stroke risk
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High Blood Pressure and Stroke Risk: A Comprehensive Overview
Introduction to High Blood Pressure and Stroke Risk
High blood pressure (BP) is a significant modifiable risk factor for stroke, which is one of the leading causes of death and disability worldwide. Elevated BP can damage the arteries, making them more susceptible to plaque buildup, which can lead to heart disease and stroke. This article synthesizes findings from multiple studies to provide a comprehensive understanding of the relationship between high blood pressure and stroke risk.
Blood Pressure Levels and Stroke Risk
General Population Insights
Research indicates that the risk of stroke increases significantly at BP levels above 115/75 mm Hg. High BP is associated with 54% of stroke episodes globally. Studies have shown that antihypertensive therapy can substantially reduce the risk of stroke, stroke-related death, and disability.
Young Adults
A systematic review and meta-analysis involving approximately 4.5 million young adults found that those with raised BP had a slightly increased risk of cardiovascular events, including stroke, later in life. The study highlighted a graded, progressive association between BP categories and increased risk of cardiovascular events.
Elderly Population
In very old individuals (aged 85 and above), high systolic BP (SBP ≥ 160 mm Hg) and diastolic BP (DBP ≥ 90 mm Hg) were identified as significant risk factors for incident stroke. The study also noted that atrial fibrillation was a contributing factor.
Blood Pressure Variability and Stroke Risk
Diurnal and Long-Term Variability
Certain features of BP, such as nocturnal hypertension, morning surge, and increased variability, have been found to predict an increased stroke risk. However, there is no universally accepted effective modality for correcting these disturbances .
Trajectories of Blood Pressure
A study from the Rotterdam cohort identified four distinct BP trajectories over a lifespan. It found that high BP and rapidly increasing BP patterns were associated with a high risk of stroke and death. In contrast, moderately high BP was primarily related to an increased risk of stroke but not death.
Acute Stroke and Blood Pressure
Immediate Outcomes
High BP is common in acute stroke and is associated with poor outcomes, including death, dependency, and deterioration. A systematic review of 32 studies involving 10,892 patients found that elevated mean arterial BP (MABP) and high diastolic BP were significantly associated with increased mortality in acute stroke cases.
Blood Pressure Control in Acute Stroke
Moderate lowering of BP in acute stroke patients might improve outcomes, but this needs to be tested in large, randomized trials. The ARISTOTLE trial also emphasized that high BP at any point during the trial was independently associated with a substantially higher risk of stroke or systemic embolism in patients with atrial fibrillation.
Blood Pressure Control for Stroke Prevention
Clinical Guidelines and Treatment
Clinical trials have demonstrated the beneficial effects of BP reduction on stroke risk. However, there are still unanswered questions regarding the optimal personalized management of BP in stroke patients, including the thresholds to be achieved and the drug classes to be prescribed. Current guidelines recommend the use of diuretics and calcium channel blockers, especially in the elderly, to lower BP to standard levels.
Population-Based Strategies
Preventing age-related increases in BP and intensive treatment of established hypertension could significantly reduce the population burden of BP-related cardiovascular diseases, including stroke.
Conclusion
High blood pressure is a critical risk factor for stroke across different age groups and populations. Effective management of BP through lifestyle changes and antihypertensive therapy can substantially reduce the risk of stroke and improve outcomes in acute stroke cases. Future research should focus on personalized BP management strategies and the potential pathogenic significance of BP variability and trajectories.
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