Abstract
ObjectiveTo determine the age-specific temporal trends in blood pressure (BP) before acute lacunar vs nonlacunar TIA and stroke.MethodsIn a population-based study of TIA/ischemic stroke (Oxford Vascular Study), we studied 15-year premorbid BP readings from primary care records in patients with lacunar vs nonlacunar events (Trial of Org 10172 in Acute Stroke Treatment [TOAST]) stratified by age (<65, ≥65 years).ResultsOf 2,085 patients (1,250 with stroke, 835 with TIA), 309 had lacunar events. In 493 patients <65 years of age, the prevalence of diagnosed hypertension did not differ between lacunar and nonlacunar events (46 [48.4%] vs 164 [41.2%], p = 0.20), but mean/SD premorbid BP (44,496 BP readings) was higher in patients with lacunar events (15-year records: systolic BP [SBP] 138.5/17.7 vs 133.3/15.0 mm Hg, p = 0.004; diastolic BP [DBP] 84.1/9.6 vs 80.9/8.4 mm Hg, p = 0.001), mainly because of higher mean BP during the 5 years before the event (SBP 142.6/18.8 vs 134.6/16.6 mm Hg, p = 0.0001; DBP 85.2/9.7 vs 80.6/9.0 mm Hg, p < 0.0001), with a rising trend (ptrend = 0.006) toward higher BP leading up to the event (<30-day pre-event SBP: 152.7/16.1 vs 135.3/23.1 mm Hg, p = 0.009; DBP 87.9/9.4 vs 80.8/12.8 mm Hg, p = 0.05; mean BP ≤1 year before the event 145.8/22.0 vs 134.7/16.1 mm Hg, p = 0.001; 86.1/10.7 vs 80.4/9.8 mm Hg, p = 0.0001). Maximum BP in the 5 years before the event was also higher in patients with lacunar events (SBP 173.7/26.6 vs 158.6/23.2 mm Hg, p = 0.0001; DBP 102.3/12.9 vs 94.2/11.2 mm Hg, p < 0.0001), as was persistently elevated BP (≥50% SBP >160 mm Hg, odd ratio 4.95, 95% confidence interval 1.99–12.31, p = 0.0002). However, no similar differences in BP were observed in patients ≥65 years of age.ConclusionRecent premorbid BP control is strongly temporarily related to acute lacunar events at younger ages, suggesting a direct role of BP in accelerating causal pathology and highlighting the need to control hypertension quickly.
Highlights
From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience University of Oxford, UK
Trend of long-term blood pressure (BP) change over time (i.e., >10, 5–10, 1–5, and ≤1 year and ≤30 days) in patients with lacunar vs nonlacunar events was assessed with the mixed regression model, and we identified any evidence of a systematic rise in BP during the year before the event using regression analysis of the most recent premorbid BP vs the log of the time from the BP measurement to the index event, stratified by event type
For patients
Summary
From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience University of Oxford, UK. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. The Article Processing charge was funded by Wellcome Trust.
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