Abstract 11734: 'Whispering Stroke' May Be Very Common in Southeastern African Americans With Uncontrolled High Blood Pressure

Abstract

Introduction: High blood pressure (BP) increases risk for stroke, but individuals experiencing stroke symptoms don’t always seek medical attention. Such ‘whispering stroke’ symptoms are reportedly common but have not been examined in African Americans with persistently uncontrolled hypertension. Hypothesis: Stroke symptoms without a stroke diagnosis are more common in African Americans with uncontrolled hypertension and are associated with stroke risk factors. Methods: We used data from the Southeastern Collaboration to Improve Blood Pressure Control, a randomized controlled trial that enrolled 1596 African Americans from rural AL and NC with persistently uncontrolled hypertension (mean clinic systolic BP >140 mm Hg in the year prior to enrollment, and research-grade BP > 140/90 mm Hg at enrollment). Stroke symptoms were detected using the Questionnaire to Verify Stroke-Free Status (QVSS) that detects 6 symptoms that could represent stroke. Stroke risk factors included age, blood pressure, diabetes, and cigarette smoking. Multivariable Poisson regression models estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the association between stroke risk factors and report of any stroke symptom without stroke diagnosis. Results: The 1239 individuals who reported never having had a stroke or transient ischemic attack (TIA) diagnosis had mean age 57.0 + 12.0 years, 37.4% were men, and 36.1% reported having experienced a stroke symptom. In adjusted models, report of stroke symptoms without a stroke diagnosis were associated with age (PR 0.99, 95% CI 0.99-1.00), systolic blood pressure (PR 1.03, 95% CI 1.00-1.05), diabetes (PR 1.33, 95% CI 1.15-1.55), and current smoking (PR 1.29, 95% CI 1.08-1.55). Conclusions: Over one third of this relatively young sample reported stroke symptoms without a stroke diagnosis. Stroke risk factors were associated with stroke symptoms without a stroke diagnosis. Screening for stroke symptoms in individuals with persistently uncontrolled hypertension may be warranted.