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Impact of Hypertension on Stroke

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Abstract

Hypertension is the single most important risk factor for all types of stroke: ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage. Epidemiologic studies over the past 30 years have demonstrated a dramatic reduction in the incidence and mortality of all stroke types with good control of hypertension, and it appears that all effective antihypertensive agents have similar efficacy in their ability to reduce stroke risk. In addition, it appears that acute treatment of hypertension in the setting of intracerebral hemorrhage and subarachnoid hemorrhage is beneficial, but it is still uncertain in the setting of ischemic stroke what level of blood pressure will result in the best possible outcome.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  PubMed  CAS  Google Scholar 

  2. •• Gillepsie C, Kuklina EV, Briss PA et al. Vital signs: prevalence, treatment, and control of hypertension—United States, 1999–2002 and 2005–2008. Morbidity and Mortality Weekly Report. 2011;60(4):102–8. This report contains the most recent population-based data regarding the prevalence and treatment of hypertension in the United States. It demonstrates how treatment has improved over the past several decades.

    Google Scholar 

  3. Rosamund W, Flegal K, Furie K, et al. Heart disease and stroke statistics – 2008 update: a report from the American Heart Association Statistics Subcommittee. Circulation. 2008;117(4):e25–146.

    Article  Google Scholar 

  4. Carandang R, Seshadri S, Beuser A, et al. Trends in incidence, lifetime risk severity and 30-day mortality of stroke over the last 50 years. JAMA. 2006;296(24):2939–46.

    Article  PubMed  CAS  Google Scholar 

  5. Kannel WB, Wolf PA, Verter J, et al. Epidemiologic assessment of the role of blood pressure in stroke. The Framingham study. JAMA. 1970;214:301–10.

    Article  PubMed  CAS  Google Scholar 

  6. Kannel WB, Wolf PA, McGee DL, et al. Systolic blood pressure, arterial rigidity, and risk of stroke. The Framingham study. JAMA. 1981;245:1225–9.

    Article  PubMed  CAS  Google Scholar 

  7. Johansson BB. Hypertension mechanisms causing stroke. Clin Exp Pharmacol Physiol. 1999;7:563–5.

    Article  Google Scholar 

  8. Fisher C. Pathological observations in hypertensive cerebral hemorrhage. J Neuropath Exp Neurol. 1971;30:536–50.

    Article  PubMed  CAS  Google Scholar 

  9. Heistad DD, Mayhan WG, Baumbach GL. Impaired dilation of cerebral arterioles in chronic hypertension. Blood Vessels. 1990;27:258–62.

    PubMed  CAS  Google Scholar 

  10. Baumbach GL, Heistad DD. Cerebral circulation in chronic arterial hypertension. Hypertension. 12:89–95.

  11. •• Rost NS, Rahman RM, Biffi A et al. White matter hyperintensity volume is increased in small vessel stroke subtypes. Neurology. 2010;75:1670–77. White matter hyperintensities, or leukoaraiosis, as diagnosed on MRI, have been noted as a risk factor for subsequent small vessel strokes as well as intracerebral hemorrhage, and have also been linked to chronic hypertension.

    Article  PubMed  CAS  Google Scholar 

  12. O’Sullivan M. Leukoaraiosis. Pract Neurol. 2008;8:26–38.

    Article  PubMed  Google Scholar 

  13. Berenstein A, Lasjaunias P, Ter Brugge KG. Aneurysmal vasculopathy: segmental vulnerability. In: Surgical neuroangiography. Berlin: Spring-Verlag; 2004. 375–80.

  14. Ruland SD. Lifestyle modification, antihypertensives, and cholesterol-lowering medication for primary and secondary stroke prevention. Continuum. 11;4:47–60.

  15. MacMahon S. Blood pressure and the prevention of stroke. J Hypertens. 1996;14 Suppl 6:S39–46.

    CAS  Google Scholar 

  16. PROGRESS Collaborative Group. Randomized trial of a perindopril-based blood pressure-lowering regimen amont 6105 individuals with previous stroke or transient ischemic attack. Lancet. 2001;358:1033–41.

    Article  Google Scholar 

  17. The Heart Outcome Prevention Evaluation Study Investigators. Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145–53.

    Article  Google Scholar 

  18. Dahlof B, Devereuz RB, for the LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan intervention for endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet. 2002;359:995–1003.

    Article  PubMed  CAS  Google Scholar 

  19. ALHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic. The antihypertensive and lipid-lowering treatment to prevent heart attack trial. JAMA. 2002;288:2981–97.

    Article  Google Scholar 

  20. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the systolic hypertension in the elderly program (SHEP). JAMA. 1991;265:3255–64.

    Article  Google Scholar 

  21. Yusuf S, Diener H-C, Sacco RL, for the Prevention Regimen for Effictively avoiding Second Strokes (PRoFESS) study group, et al. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med. 2008;359(12):1225–37.

    Article  PubMed  CAS  Google Scholar 

  22. Poulter NR, Wedel H, Dahlof B, for the ASCOT Investigators, et al. Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outomces Trial-Blod pressure lowering Arm (ASCOT-BPLA). Lancet. 2005;366:907–13.

    Article  PubMed  CAS  Google Scholar 

  23. Staussen JA, Thijs L, Gasowski J, et al. Dihydropyridine calcium channel blockers for antihypertensive treatment in older patients—evidence from the Systolic Hypertension in Europe Trial. S Afr Med J. 2001;12:1060–8.

    Google Scholar 

  24. Black HR, Elliot WJ, Grandits G, et al. Results of the controlled Onset Verapamil Investigation of Cardiovascular Endpoints by geographic region (CONVINCE). J Hypertens. 2005;23(5):1099–106.

    Article  PubMed  CAS  Google Scholar 

  25. Lindolm LH, Carlberg B, Samuelsson O. Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet. 2005;366:1545–53.

    Article  Google Scholar 

  26. Psaty BM, Lumley T, Furberg CD, et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA. 2003;289:2534–44.

    Article  PubMed  CAS  Google Scholar 

  27. Wright JM, Musini VM. First line agents for hypertension. Cochrane Database Syst Rev. 2009:CD001841.

  28. Adams H, Del Zoppo G, Alberts M, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular and Interventional Radiology and Intervention Council and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–711.

    Article  PubMed  Google Scholar 

  29. International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomized trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischemic stroke. Lancet. 1997;349:1569–81.

    Article  Google Scholar 

  30. Leonardi-Bee J, Bath PM, Phillips SJ, FRCP for the IST Collaborative Group, et al. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke. 2002;33:1315–20.

    Article  PubMed  Google Scholar 

  31. The National Institute of Neurological Disorders and Stroke rt-PA Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.

    Article  Google Scholar 

  32. •• Geeganage C, Tracy M, England T, et al. for TIAST Investigators. Relationship between baseline blood pressure parameters (including mean pressure, pulse pressure, and variability) and early outcome after stroke. Stroke. 2011;42:491–93. The TIAST trial showed that early death and neurologic deterioration, as well as recurrent stroke, were independently associated with baseline high systolic BP, mean arterial BP, pulse pressure, and blood pressure variability.

    Article  PubMed  CAS  Google Scholar 

  33. Ahmed J, Nassman P, Wahlgren NG. Effect of intravenous nimodipine on blood pressure and outcome after acute ischemic stroke. Stroke. 2000;31:1250.

    Article  PubMed  CAS  Google Scholar 

  34. Schrader J, Luders S, Kulschewski A, on behlaf of the ACCESS Study Group, et al. The ACCESS study: evaluation of acute candesartan cilexetil therapy in stroke survivors. Stroke. 2003;34:1699–703.

    Article  PubMed  Google Scholar 

  35. •• Sandset EC, Bath PW, Boysen G, et al. on behalf of the SCAST Study Group. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomized, placebo-controlled, double-blind trial. Lancet. 2011;371:741–50. In this trial, candesartan, compared with placebo, resulted in a lower BP in the acute setting of ischemic stroke, but this did not result in reduced mortality, or recurrent stroke risk.

    Article  Google Scholar 

  36. Shin HK, Nishimura M, Jones PB, et al. Mild induced hypertension improves blood flow and oxygen metabolism in transient focal cerebral ischemia.

  37. Wise G, Sutter R, Burhkolder J. The treatment of brain ischemia with vasopressor drugs. Stroke. 1972;3:135–40.

    Article  PubMed  CAS  Google Scholar 

  38. Hillis AE, Ulatowski JA, Barker PB, et al. A pilot randomized trial of induced blod pressure elevation: effects of function and focal perfusion in acute and subacute stroke. Cerebrovasc Dis. 2003;16:236–46.

    Article  PubMed  CAS  Google Scholar 

  39. Marzan AS, Hungerbuhler JH, Studer A, et al. Feasibility and safety of norepinephrine induced arterial hypertension in acute ischemic stroke. Neurology. 2004;62:1193–5.

    PubMed  CAS  Google Scholar 

  40. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352:1305–16.

    Article  PubMed  CAS  Google Scholar 

  41. Brott T, Thalinger K, Hertzberg V. Hypertension as a risk factor for spontenous intracerebral hemorrhage. Stroke. 1986;17:1078–83.

    Article  PubMed  CAS  Google Scholar 

  42. Brott T, Broderick J, Korthari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28:1–5.

    Article  PubMed  CAS  Google Scholar 

  43. Olson JD. Mechanisms of hemeostasis: effect of intracerebral hemorrhage. Stroke. 1993;24:1109–14.

    Google Scholar 

  44. Anderson CS, Huang Y, Wang JG, et al. Intensive blood pressure reduction in acute cerebral hemorrhage trial (INTERACT): a randomized pilot trial. Lancet Neurol. 2008;7:391–9.

    Article  PubMed  Google Scholar 

  45. •• ATACH Investigators. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH). Crit Care Med. 2010;38:637–48. This trial compared BP targets in acute intracerebral hemorrhage but did not demonstrate any clinical differences in outcomes between the groups.

    Article  Google Scholar 

  46. Zhang Y, Reilly KH, Tong W, et al. Blood pressure and clinical outcomes among patients with acute stroke in Inner Mongolia, China. J Hypertens. 2008;26:1446–52.

    Article  PubMed  CAS  Google Scholar 

  47. Wilmot M, Leonardi-Bee J, Bath PM. High blood pressure in acute stroke and subsequent outcome: a systemic review. Hypertension. 2004;43:18–24.

    Article  Google Scholar 

  48. Morgenstern LB, Hemphill JC, Anderson C, on behalf of the American Heart Association Stroke Council and Council on Cardiovascular Nursing, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41:2108–29.

    Article  PubMed  Google Scholar 

  49. Teunissen LL, Rinkel GJ, Algra A, et al. Risk factors for subarachnoid hemorrhage—a systemic review. Stroke. 1996;27:544–59.

    Article  PubMed  CAS  Google Scholar 

  50. Ingall TJ, Whisnant JP, Wiebers DO, et al. Has there been a decline in subarachnoid hemorrhage mortality? Stroke. 1989;20:718–24.

    Article  PubMed  CAS  Google Scholar 

  51. Manno EM. Subarachnoid hemorrhage. Neurol Clin N Am. 2004;22:347–66.

    Google Scholar 

  52. Ohkuma H, Tsuratani H, Suzuki S. Incidence and significance of early aneursysmal rebleeding before neurosurgical or neurological management. Stroke. 2001;32:1176–80.

    Article  PubMed  CAS  Google Scholar 

  53. Wijdicks EF, Vermeulen M, Murray GD, et al. The effects of treating hypertension following aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg. 1990;92:111–7.

    Article  PubMed  CAS  Google Scholar 

  54. •• Bederson JB, Sander-Connolly ES, Batjer HH, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage a statement for healthcare professionals from a special Writing Group of the Stroke Council, American Heart Association. Stroke. 2009;40:994–1025. This is the most recent guideline from the AHA regarding the treatment of patients with aneurysmal subarachnoid hemorrhage and should be mandatory reading for all who care for such patients.

    Article  PubMed  Google Scholar 

  55. Matsuda M, Watanabe K, Saito A, et al. Circumstances, activities and events precipitating aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2007;16:25–9.

    Article  PubMed  Google Scholar 

  56. Anda T, Yonekura M, Baba H, et al. Factors affecting rapid growth of unruptured cerebral aneurysms during the acute stage of subarachnoid hemorrhage. Neurol Res. 2006;28:165–71.

    Article  PubMed  Google Scholar 

  57. Juvela S. Prehemorrhage risk factors for fatal intracranial aneurysm rupture. Stroke. 2003;34:1852–7.

    Article  PubMed  Google Scholar 

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  1. New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, F-610, New York, NY, 10065, USA

    Jordan Dubow & Matthew E. Fink

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Correspondence to Matthew E. Fink.

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Dubow, J., Fink, M.E. Impact of Hypertension on Stroke. Curr Atheroscler Rep 13, 298–305 (2011). https://doi.org/10.1007/s11883-011-0187-y

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