Incidence Of Stroke In Men Research Articles

IMPACT OF SEX AND GENDER IN STROKE IN SOUTH-AND-SOUTHEAST ASIA: A RAPID SCOPING REVIEW.

South Asia and Southeast Asia account for more than 40% of the global stroke burden, with differences in stroke risk factors, mortality, and outcomes compared to high-income countries. Socio-cultural norms compound the pre-existing biological risk differences, resulting in a disproportionate burden of stroke in women in this region. This review summarizes the sex and gender differences across the stroke care continuum in South Asia and Southeast Asia over the past 20 years. Despite a higher incidence of stroke in men than women in South-and-Southeast Asia, women have greater stroke severity and poorer outcomes after stroke. Higher levels of pre-morbid disability and poor physical health at baseline may be contributory. There is a high prevalence of vascular risk factors such as hypertension, dyslipidemia, cardiac sources of embolism, as well as metabolic syndrome and insulin resistance, among the women in this region. Smoking is uncommon among women, however other forms of smokeless tobacco (SLT), such as tobacco leaf and betel nut chewing are more prevalent, especially in the rural areas in these countries. Women are more likely to have delayed presentations to the hospital due to untimely recognition of stroke symptoms, however, with regards to door-to-needle times or intravenous thrombolysis (IVT) rates, we found equivocal data. Wide gaps exist in stroke awareness and healthcare-seeking behaviors, with women more commonly opting for public hospitals and low-cost wards, more likely to discontinue treatment, and less likely to adhere to post-stroke rehabilitation. This review exposes the gender lacunae in stroke service provision across South Asia and Southeast Asia while acknowledging the many knowledge gaps in our understanding. Although the biological risk differences are non-modifiable, educational, policy, and economic measures to mitigate socio-cultural barriers are much needed in the region. Sound epidemiological data is needed from more countries to better understand these differences and bridge this gap. It is imperative to advocate and implement policies and programs for stroke care viable for women, cognizant of the gender and cost bias, as well as the interplay of social and cultural structures specific to the regions.

Association of Body Mass Index with Ischemic and Hemorrhagic Stroke.

Data on the association between body mass index (BMI) and stroke are scarce. We aimed to examine the association between BMI and incident stroke (ischemic or hemorrhagic) and to clarify the relationship between underweight, overweight, and obesity and stroke risk stratified by sex. We analyzed the JMDC Claims Database between January 2005 and April 2020 including 2,740,778 healthy individuals (Median (interquartile) age, 45 (38–53) years; 56.2% men; median (interquartile) BMI, 22.3 (20.2–24.8) kg/m2). None of the participants had a history of cardiovascular disease. Each participant was categorized as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2), or obese (BMI ≥ 30 kg/m2). We investigated the association of BMI with incidence stroke in men and women using the Cox regression model. We used restricted cubic spline (RCS) functions to identify the association of BMI as a continuous parameter with incident stroke. The incidence (95% confidence interval) of total stroke, ischemic stroke, and hemorrhagic stroke was 32.5 (32.0–32.9), 28.1 (27.6–28.5), and 5.5 (5.3–5.7) per 10,000 person-years in men, whereas 25.7 (25.1–26.2), 22.5 (22.0–23.0), and 4.0 (3.8–4.2) per 10,000 person-years in women, respectively. Multivariable Cox regression analysis showed that overweight and obesity were associated with a higher incidence of total and ischemic stroke in both men and women. Underweight, overweight, and obesity were associated with a higher hemorrhagic stroke incidence in men, but not in women. Restricted cubic spline showed that the risk of ischemic stroke increased in a BMI dose-dependent manner in both men and women, whereas there was a U-shaped relationship between BMI and the hemorrhagic stroke risk in men. In conclusion, overweight and obesity were associated with a greater incidence of stroke and ischemic stroke in both men and women. Furthermore, underweight, overweight, and obesity were associated with a higher hemorrhagic stroke risk in men. Our results would help in the risk stratification of future stroke based on BMI.

A study of prevalence of migraine in stroke patients and its association with ischemic versus hemorrhagic stroke: a cross sectional study

Background: Migraine is characterized by recurrent attacks of disabling headache and autonomic nervous system dysfunction. Up to one third of patients also have neurological aura symptoms. It has been suggested that migraine can be a risk factor for stroke. Migraine affects three times the number of women than men. The incidence of stroke in men is two times that of women. It is shown in several studies that women aged 35 to 45 years old are at increased risk of ischemic stroke who had migraine with or without aura.Methods: The present cross sectional study was conducted in 350 consecutive patients of stroke who were attended OPD and admitted in wards of the Department of Medicine, M.G.M. Medical College and MY Hospital, Indore, MP, India, during period from December 2017 to December 2018.Results: The highest percentage of respondents i.e. 68% belonged to male group followed by 32% of respondents who were females. The highest percentage of respondents i.e. 66.6% had ischemic stroke while, 33.4% had hemorrhagic stroke. The highest percentage of respondents i.e. 90.9% had no Migraine while, 9.1% had Migraine. The highest percentage of respondents i.e. 31.2% had weekly reoccurrence, followed by forth nightly (25%) and lowest was 3.1% of daily recurrence. The association of type of stroke with sex group of patient’s history of headache which found to be significant (p ˂0.05). The association of type of stroke with sex group of patient’s history of various cerebro-vascular risk factors which found to be significant (p&lt;0.05). Patients having hemorrhagic and ischemic stroke also had HTN in 47% and 12.4% patients respectively.Conclusions: In this study it is concluded that migraine can be established as a risk factor for ischemic stroke. Early diagnosis and treatment with available medication can be helpful in prevention or decreasing risk for developing stroke.

Association of lipid markers with coronary heart disease and stroke mortality: A 15-year follow-up study.

Objective(s):It has been proposed that lipid markers may predict cardiovascular events; however, their effect may vary depending on the type of cardiovascular disease. The purpose of this study was to investigate the effects of lipid markers on death from coronary heart disease (CHD) and stroke in competing risks setting.Materials and Methods:Participants included 2502 women and 2020 men, age 40 years or older from Tehran Lipid and Glucose Study. The association between total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) with hazard and cumulative incidence of CHD and stroke was investigated using cause-specific hazard and sub-distribution hazard models. Statistical analyses were performed using “risk regression” and “cmprsk” package in R 3.3.2.Results:One standard deviation (SD) increase in TC and LDL-C increased the hazard of CHD death by 1.42 (CI=1.07,1.89) and 1.41 (CI=1.04,1.93), respectively. 1-SD increase in TG increased the cumulative incidence of CHD death increased by 1.94 (CI=1.02,3.75) in women. Other risk factors were not associated with the hazard and cumulative incidence of CHD in women, men and the total sample. In addition, none of lipids had a significant effect on the hazard and cumulative incidence of stroke in men, women and the total sample.Conclusion:The associations of lipid components on CHD death were modified by gender. TC, LDL-C and TG were independent predictors of CHD mortality in women. Furthermore, death due to stroke changes the association of lipid markers with CHD mortality.

Heme Iron Intake and Risk of Stroke

Intake of iron, especially heme iron, has been associated with several diseases. However, epidemiological studies of heme iron and nonheme iron intake in relation to risk of stroke are lacking. The aim of this study was to examine the associations between heme iron and nonheme iron intake and stroke incidence in men. The population-based prospective Cohort of Swedish Men included 38 859 men, aged 45 to 79 years, who had no history of stroke, coronary heart disease, or cancer at baseline. Hazard ratios and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards regression models. During an 11.7 years follow-up, 3097 incident cases of stroke, including 2482 cerebral infarctions and 450 intracerebral hemorrhages, were registered. The hazard ratios of total stroke and cerebral infarction for the highest compared with the lowest quintiles of heme iron intake were 1.16 (95% CI, 1.03-1.31; P trend=0.037) and 1.15 (95% CI, 1.00-1.31; P trend=0.089), respectively. The incidence rates of total stroke per 10 000 person-years were 72.6 in the lowest quintile and 84.4 in the highest. The association was confined to men with body mass index <25 kg/m(2), the hazard ratios were 1.40 (95% CI, 1.17-1.68; P trend<0.001) for total stroke and 1.38 (95% CI, 1.13-1.70; P trend=0.001) for cerebral infarction; no association was observed among overweight and obese men. There was no association between nonheme iron intake and risk of total stroke and stroke types. Findings from this prospective study indicate that a high heme iron intake, particularly in normal weight individuals, may increase the risk of stroke.

Red meat consumption and risk of stroke in Swedish men

Red and processed meat consumption has been implicated in several diseases. However, data on meat consumption in relation to stroke incidence are sparse. Our objective was to examine the associations of red meat and processed meat consumption with stroke incidence in men. We prospectively followed 40,291 men aged 45-79 y who had no history of cardiovascular disease or cancer at baseline. Meat consumption was assessed with a self-administered questionnaire in 1997. During a mean follow-up of 10.1 y, 2409 incident casesof stroke (1849 cerebral infarctions, 350 hemorrhagic strokes, and 210 unspecified strokes) were identified from the Swedish Hospital Discharge Registry. Consumption of processed meat, but not of fresh red meat, was positively associated with risk of stroke. The multivariable relative risks (RRs) of total stroke for the highest compared with the lowest quintiles of consumption were 1.23 (95% CI: 1.07, 1.40; P for trend = 0.004) for processed meat and 1.07 (95% CI: 0.93, 1.24; P for trend = 0.77) for fresh red meat. Processed meat consumption was also positively associated with risk of cerebral infarction in a comparison of the highest with the lowest quintile (RR: 1.18; 95% CI: 1.01, 1.38; P for trend = 0.03). The findings from this prospective cohort of men indicate that processed meat consumption is positively associated with risk of stroke. The Cohort of Swedish Men is registered at clinicaltrials.gov as NCT01127711.

Heart rate recovery after treadmill exercise testing is an independent predictor of stroke incidence in men with metabolic syndrome

Heart rate recovery (HRR), a measure of the heart rate which decreases after a graded exercise test, has been associated with mortality and cardiovascular diseases. However, the association between HRR and risk of stroke has not been fully determined in men with metabolic syndrome (MetS). Participants were 3886 men with MetS, aged 40-79 years, who completed a maximal exercise test during 1979-2004. We calculated 5-min HRR as the primary predictor and identified HRR tertiles; tertile 1 (<59 bpm), tertile 2 (59-71 bpm), and tertile 3 (>71 bpm). Stroke incidence was ascertained from responses to mail-back surveys during 1982-2004. Differences in baseline characteristics across HRR tertiles were examined using general linear model. Hazard ratios (HRs) and 95% confidence intervals (95% CIs), were estimated using Cox regression model after adjusted for potential confounders. We identified 90 incident stroke cases during an average follow-up of 15.2 years. After adjusting for age-, examination year-, and survey response indicator, a significant inverse association between HRR and incident stroke was observed in men with MetS (p < 0.001). Compared with the lowest tertile of HRR, adjusted HRs in the second and third tertiles were 0.96 (0.53-1.74) and 0.41 (0.20-0.87), respectively. We also found a significant linear trend (p < 0.03) across increments of HRR. Delayed HRR was independently associated the higher risk of incident stroke in men with MetS. This suggests that HRR have prognostic value of stroke risk for men with MetS.

Heart Rate Recovery as a Predictor of Stroke Incidence in Men with Metabolic Syndrome

Heart Rate Recovery as a Predictor of Stroke Incidence in Men with Metabolic Syndrome

Effects of gemfibrozil on outcome after permanent middle cerebral artery occlusion in mice

Fibrates are lipid lowering drugs and found as ligands for peroxisome proliferator-activated receptors (PPARs). A clinical study has shown that one type of fibrate gemfibrozil reduces stroke incidence in men. However, it remains unknown whether gemfibrozil improves outcome after stroke. We hypothesized that prophylactic administration of gemfibrozil improves outcome after ischemic stroke. In this study, we measured the impact of gemfibrozil in two permanent middle cerebral artery occlusion (MCAO) models in young adult male mice on normal diet. First, we tested gemfibrozil in a filamentous MCAO model. Pretreatment with gemfibrozil (30 mg/kg) for 7 days moderately but significantly reduced infarct size at 24 h after MCAO. A higher dose (120 mg/kg) did not attenuate infarct size. Rather, it tended to increase brain swelling. Second, we tested in a distal MCAO model. Gemfibrozil (30 mg/kg) for 7 days before and after stroke significantly attenuated cortical lesion size at 7 days after MCAO. Cortical blood flow measured by laser speckle imaging was improved by gemfibrozil in the ischemic hemisphere. In non-stroke animals gemfibrozil also altered gene expression levels of PPARs in both the aorta and brain in organ specific manners; however, endothelial nitric oxide synthase (eNOS) was not significantly affected. These findings suggested the possibility that the observed infarct reductions and cortical blood flow improvements in ischemic brains were not through eNOS-mediated mechanisms. Further investigations may be meritorious to examine whether prophylactic usage of gemfibrozil against stroke is beneficial.

Social Class, Risk Factors, and Stroke Incidence in Men and Women

The purpose of this study was to investigate the association between occupational social class and stroke incidence and the extent to which classical, lifestyle, and psychosocial risk factors may explain such relationships. A prospective population study was conducted of 22488 men and women aged 39 to 79 years living in the general community in Norfolk, UK, recruited in 1993 to 1997 and followed up for stroke incidence to 2007. An inverse relationship was observed between social class and stroke incidence with an age- and sex-adjusted hazard ratio for social Class V compared with I of 2.62 (95% CI, 1.63 to 4.22; P=0.001). Adjusting for classical (systolic blood pressure, total blood cholesterol, smoking, history of diabetes, and body mass index), lifestyle (plasma vitamin C levels, alcohol intake, and physical activity), and psychosocial (5-item version of the Mental Health Inventory) risk factors had little effect, and a socioeconomic differential was still apparent: hazard ratio for social Class V compared with I of 2.55 (95% CI, 1.34 to 4.85, P=0.004 for comparison of V to I). Stroke incidence increased with lower social class in both men and women. Adjustment for a comprehensive range of classical, lifestyle, and psychosocial risk factors did not explain the socioeconomic differential in stroke incidence. If we are to reduce inequalities in health, further understanding of the mechanisms underlying the association is needed.

Blood Pressure and the Risk of Stroke, Cardiovascular Disease, and All-Cause Mortality Among Japanese: The JPHC Study

Little is known about the influence of blood pressure (BP) on cardiovascular disease (CVD) outcomes among Asian populations. We examined population attributable fractions (PAFs) and hazard ratios (HRs) associated with BP in relation to stroke and coronary heart disease (CHD) incident and mortality within a cohort of 33,372 Japanese men and women aged 40-69 years, free of prior diagnosis of cancer and CVD. The BP was classified based on modified criteria of the 2003 European Society of Hypertension-European Society of Cardiology guidelines. A total of 943 stroke events, 182 CHD events, 262 stroke deaths, and 120 CHD deaths occurred between the baseline questionnaire (1990-1994) and the end of follow-up in 31 December 2003. BP levels were linearly associated with incidence and mortality of CVD in men and women. According to the PAF estimation, the elimination of normal to severe hypertension would prevent 64% of stroke incidence in men and 50% in women; 67% of stroke mortality in men and 29% in women; and 38% of total CVD mortality in men and 36% in women. The PAF estimate for total stroke incidence was the highest for mild hypertension, and lower for moderate to severe hypertension in both sexes. The contributions of normal BP, high normal BP, and mild hypertension to the occurrence of stroke events were greater than those made by moderate and severe hypertension, highlighting the importance of primary prevention and of treatment for low-to-moderate degrees of hypertension.

Combined effect of health behaviours and risk of first ever stroke in 20 040 men and women over 11 years’ follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study

Objective To quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community.Design Population based prospective study (EPIC-Norfolk).Setting Norfolk,...

The APOE polymorphism and 1-year outcome in ischemic stroke: genotype–gender interaction

In human genetic studies an effect of the apolipoprotein E gene (APOE) polymorphism on the risk, course and prognosis in chronic and acute nervous system disorders was established. We aimed to evaluate whether the APOE genotype is related to acute neurological impairments due to ischemic stroke (IS), and to outcomes (up to 1 year) indicated by severe functional disability, dependence in daily living or death. A total of 657 patients (326 men, 331 women), divided into the three groups: E2 (APOEepsilon2/epsilon3 subjects), E3 (APOEepsilon3/epsilon3 subjects), and E4 (APOEepsilon3/epsilon4 and epsilon4/epsilon4 subjects), were analyzed. There was no association between the APOE genotype and baseline clinical characteristics, severity of neurological impairments during acute stroke, and 1-year outcome, when analyzing whole patient population. APOE gene interacted with gender in predicting severity of acute neurological deficit and post-stroke mortality within the period up to 1 year after the IS. Gender-stratified analysis indicated the E4 genotype as a significant independent positive predictor of death within 1 year after stroke incidence in men patients. Ischemic stroke severity and outcome may be affected by complex interactions between gender and genetic factors that warrant further exploration.

Verschillen in preventieve zorg door huisartsen verklaren sociaal-economische verschillen in de incidentie van CVA niet

Objective: To assess socioeconomic disparities in stroke incidence and in the quality of preventive care in general practice for stroke in the Netherlands. Study design and setting A total of 190,664 patients who registered in 96 general practices were followed up for 12 months. Data were collected on diagnoses, referrals, prescriptions, and diagnostic procedures. Hazard ratios (HR) were calculated to assess the association between educational level and stroke incidence. We developed quality indicators based on evidence based guidelines for stroke prevention at general practice, and assessed deviations from these guidelines. Multilevel logistic regression was used to assess socioeconomic disparities in the quality of preventive care for stroke precursors. Results: Lower educational level was associated with higher incidence of stroke in men (HR 1.36, 95% CI 1.06-1.74) but not in women. Among both men and women, there were socioeconomic disparities in the prevalence of hypertension, hypercholesterolemia, diabetes, angina pectoris, heart failure, and peripheral artery disease. Lower educated hypercholesterolemia patients under medication were less likely to be prescribed statins (odds ratio 0.62, 95% CI 0.42-0.91). However, for other precursors of stroke, there were no major disparities in the quality of preventive care. Conclusion: There are socioeconomic disparities in stroke incidence among men but not among women. Socioeconomic differences in factors such as hypertension and diabetes are likely to contribute to stroke disparities. Universal access to general practice and the implementation of general practice guidelines in the Netherlands are likely to have promoted the provision of equal and standardised care for stroke precursors across socioeconomic groups.

Disparities in stroke preventive care in general practice did not explain socioeconomic disparities in stroke

Objective To assess socioeconomic disparities in stroke incidence and in the quality of preventive care for stroke in the Netherlands. Study Design and Settings A total of 190,664 patients who registered in 96 general practices were followed up for 12 months. Data were collected on diagnoses, referrals, prescriptions, and diagnostic procedures. Hazard ratios (HR) were calculated to assess the association between educational level and stroke incidence. Multilevel logistic regression was used to assess socioeconomic disparities in the quality of preventive care for stroke precursors. Results Lower educational level was associated with higher incidence of stroke in men (HR = 1.36, 95% CI = 1.06–1.74) but not in women. Among both men and women, there were socioeconomic disparities in the prevalence of hypertension, hypercholesterolemia, diabetes, angina pectoris, heart failure, and peripheral artery disease. Lower educated hypercholesterolemia patients under medication were less likely to be prescribed statins (odds ratio = 0.62, 95% CI = 0.42–0.91). However, for other precursors of stroke, there were no major disparities in the quality of preventive care. Conclusion There are socioeconomic disparities in stroke incidence among men but not among women. Socioeconomic differences in factors such as hypertension and diabetes are likely to contribute to stroke disparities. However, general practitioners(GPs) provide care of a similar quality to patients from different socioeconomic groups.

Is pulse pressure a predictor for the incidence of stroke in men? The Korea Medical Insurance Corporation Study

Is pulse pressure a predictor for the incidence of stroke in men? The Korea Medical Insurance Corporation Study

Trends in stroke incidence. The Copenhagen City Heart Study.

Stroke incidence has increased in some countries and decreased in others. After 20 years of intensive antihypertensive treatment the latter could be expected, and we have evaluated the sex-specific temporal trends in stroke incidence using 17 years of follow-up in the Copenhagen City Heart Study. Our cohort comprised 19,698 subjects living in Copenhagen, Denmark. They were invited for health examinations in the following time periods: 1976 through 1978, 1981 through 1983, and 1992 through 1994. Trends are presented for all persons who attended at least one of the two first examinations as well as the total cohort including nonresponders. Subjects between 45 and 84 years of age were followed from March 1, 1976 until March 1, 1993. Changes in age-specific stroke incidence were calculated by means of Poisson regression analysis. For subjects aged 45 to 64 years, no significant trends were observed, with an annual incidence rate ratio of 1.00 (95% confidence interval [CI], 0.97 to 1.03) and 1.04 (95% CI, 0.99 to 1.08) for men and women, respectively. In subjects aged 65 to 84 years a significant decrease in stroke incidence was found in men, whose annual rate ratio was 0.97 (95% CI, 0.95 to 0.99), but not in women, whose annual rate ratio was 0.98 (95% CI, 0.95 to 1.00). Throughout four observed periods the stroke incidence among men remained significantly higher than that for women. During the period from 1976 to 1993 there has been a decline in incidence of stroke in men and women aged 65 to 84 years that was significant only in men, whereas no changes were found for persons aged 45 to 64 years.

Stroke around the Baltic Sea: Incidence, Case Fatality and Population Risk Factors in Denmark, Finland, Sweden and Lithuania

Within the WHO MONICA Project, stroke has been recorded in 7 populations in 4 countries around the Baltic Sea (Denmark: Glostrup; Finland: North Karelia, Turku/Loimaa and Kuopio; Sweden: Gothenburg and northern Sweden; Lithuania: Kaunas). In population surveys, risk factors for cardiovascular diseases have been examined in 10,364 persons in the age group 35–64 years. During 1987–1989, acute strokes were registered within the same age range in 2,847 men and 1,610 women. The yearly incidence (first ever stroke) per 100,000 was more than twice as high in Kuopio (men 284 and women 142) compared to Gothenburg (men 123 and women 64). Population mean systolic blood pressure was highest in 2 of the Finnish populations and lowest in the Danish population. The blood pressure levels in the populations correlated with stroke incidence in men (r = 0.87; p = 0.01) and in women (r = 0.70; p = 0.08). The large differences in community levels of blood pressure seem to explain much of the large variations in stroke incidence between populations around the Baltic Sea.

Marked increase of stroke incidence in men between 1972 and 1990 in Frederiksberg, Denmark.

Stroke incidence declined until the end of the 1970s in the United States, and the decline continued into the 1980s in Japan. The purpose of this study was to determine possible temporal changes of stroke incidence in a European community. A prospective stroke registry was established in the community of Frederiksberg (population, approximately 90,000), Denmark, in the two periods 1972-1974 and 1989-1990. All patients suspected of stroke were clinically evaluated by a neurologist. Only patients with first-ever stroke were included. Complete case ascertainment was ensured by registration of both hospitalized and nonhospitalized patients. Death certificates were also scrutinized. A total of 927 patients with first-ever stroke was recorded. The annual stroke incidence rate per 1,000 increased by 18% from 2.6 in 1972-1974 to 3.1 in 1989-1990 (p < 0.01). This increase was due solely to a 42% increase in men, in whom stroke incidence rose from 2.1 to 3.0 (p < 0.0005). Incidence was unchanged in women at 3.0 and 3.1, respectively. The incidence rates from 1972-1974 were age and sex adjusted to the 1990 population. After adjustment to the Danish population, stroke incidence in Denmark was 2.0 for all, 2.3 for men, and 1.9 for women. In the second study period computed tomography or necropsy was performed in 85% of cases; 2.4/1,000 had cerebral infarction; 0.20/1,000 had intracerebral hemorrhage; and 0.02/1,000 had subarachnoid hemorrhage. In a period when decline in stroke incidence has stopped in the United States and has continued in Japan, a marked increase of stroke incidence in Danish men was observed.

The Changing Pattern of Hypertension and the Declining Incidence of Stroke

We studied whether changes in recognition and control of hypertension could be detected in the population of Rochester, Minn, from 1950 to 1979, a period in which a major decrease in the incidence rate of stroke was observed. Prevalence of diastolic blood pressure greater than or equal to 105 mm Hg fell 26% and 70% in men and women, respectively, between 1950 to 1959 and 1970 to 1979. Prevalence of pressures greater than or equal to 95 mm Hg decreased 5% in men and 58% in women. Increasing control of hypertension had an almost inverse linear relationship with the decreasing incidence of stroke in women, but the incidence of stroke in men did not decrease until ten years after improvement in the control of blood pressure began. We conclude that improvements in the detection and control of hypertension contributed to the declining incidence of stroke and that differences in management of hypertension could account for the difference between men and women in the trend of stroke decline.