Stroke incidence with hypertension and ischemic heart disease in Rochester, Minnesota

doi:10.1016/1047-2797(93)90100-I

Annals of Epidemiology

Volume 3, Issue 5, September 1993, Pages 480-482

https://doi.org/10.1016/1047-2797(93)90100-I Get rights and content

Abstract

The primary contribution to increased incidence rates for ischemic stroke in Rochester, Minnesota, for the 1980 to 1984 time period in the age groups from 55 to 84 years was from those persons in the population with ischemic heart disease. The rate and pattern of the decline in incidence rates of ischemic stroke in hypertensive individuals and in nonhypertensive individuals were quite similar, showing no demonstrable population effect of antihypertensive medication. These observations emphasize that there must be some, as yet unidentified, factor that is important in the decline of stroke incidence.

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Cited by (14)

Trends in blood pressure, hypertension control, and stroke mortality: The Minnesota Heart Survey
2006, American Journal of Medicine
Citation Excerpt :
Some authors speculate that the maximum benefits of hypertension treatment are already attained. In Rochester, Minn, stroke incidence declined steadily from 1950 to 1979 but increased in the early 1980s for both men and women.31 This occurred despite improved blood pressure control in Rochester.31
The study’s objective was to determine population trends in blood pressure, hypertension prevalence, hypertension control, and stroke mortality.
We performed population-based surveys of 2906 to 5630 adults from 1980 to 1982, 1985 to 1987, 1990 to 1992, 1995 to 1997, and 2000 to 2002, and stroke mortality from 1980 to 2002, in the Minneapolis/St Paul, Minn metropolitan area (2.63 million population according to the 2000 census). Randomly selected resident adults aged 25 to 74 years (n = 21 773) were each screened once. The main outcome measures were standardized measures of blood pressure, treatment and control of hypertension, and stroke mortality rates.
The mean systolic blood pressure adjusted for age decreased in men (−1.5 mm Hg [95% confidence interval −0.3 to −2.7], P <.01) and women (−1.8 mm Hg [95% confidence interval −0.5 to −3.0], P <.001) from 1980 to 1982 and 2000 to 2002. The mean diastolic blood pressure was unchanged for men (0 mm Hg) and women (−0.4 mm Hg, not significant). The proportion of the population taking antihypertensive medications decreased in the 1990s but returned to 1980s levels from 2000 to 2002. The use of other methods to decrease blood pressure (diet, exercise, and weight loss) peaked in the 1990 to 1992 survey and then decreased. Proportions of hypertensive patients in the aware, treated, and/or controlled categories leveled in the 1980s and 1990s, but improved substantially from 1995 to 1997 and 2000 to 2002 with blood pressure controlled at the less than 140 and/or 90 mm Hg criteria in 44% of the men and 55% of the women. Population mortality trends for stroke paralleled those for hypertension control.
Population data beginning in 1980 to 1982 from the Minnesota Heart Survey indicate a leveling in the detection and control of hypertension in the 1990s followed by improvement from 2000 to 2002.
The incidence and aetiology of stroke in the Caerphilly and Speedwell Collaborative Studies II: Risk factors for ischaemic stroke
2001, Public Health
Reduction of stroke burden requires preventive interventions targeted at important risk factors. This report presents the analysis of risk factors for ischaemic stroke from a representative cohort of middle aged men from South Wales and south-west England. Data on risk factors were collected through validated questionnaires and physical and clinical measurements. Details of possible cerebrovascular events were retrieved, classified into ischaemic, haemorrhagic and uncertain subtypes, and validated. The ratio of definite ischaemic to definite haemorrhagic strokes was calculated. This showed that the vast majority of strokes of unknown subtype were likely to ischaemic. After exclusion of known haemorrhagic strokes and subarrachnoid haemorrhages the remaining strokes were labelled ischaemic. Hazard ratios for possible risk factors were calculated for all ischaemic, and for fatal and non-fatal strokes. There were 293 ischaemic strokes. Statistically significant age-adjusted hazard ratios were: 1.50 (95% confidence interval 1.16–1.95) for being in a manual social class, 1.82 (1.24–2.67) if smoking >15 cigarettes/d at enrolment, 1.19 (1.13–1.24) and 1.23 (1.14–1.34) per 10 mmHg increase in systolic and diastolic blood pressure, respectively, 0.67 (0.46–0.96) for the top quintile high density lipoprotein-cholesterol:cholesterol ratio compared to the bottom quintile, 2.04 (1.40–2.99) for presence of angina, 3.90 (2.01–7.58) for presence of atrial fibrillation, and 3.35 (1.90–5.80) for presence of diabetes. Risk factors were more strongly associated with fatal than non-fatal strokes. Multivariate analyses revealed that, while there was some attenuation of the effect of social class, angina and elevated BP, the risks from atrial fibrillation and diabetes were increased. Public Health (2001) 115, 12–20.
Update on stroke risk factors
1994, Journal of Stroke and Cerebrovascular Diseases
As medicine moves into the 21st century, with the added pressures of increasing costs and limited resources, successful diminution of the impact of stroke on the population will require shifting our emphasis away from treating end stages of generalized atherosclerosis and other underlying diseases to preventing underlying diseases and stroke. This approach will require more sophisticated and more definitive studies to identify, verify, and explain better the relative importance of known risk factors, the interactions of various risk factors with one another, and the existence of currently unknown or unverified risk factors. In this article, we review the current state of knowledge about certain stroke risk factors in light of new epidemiologic studies conducted in the last decade with emphasis on modifiable risk factors, now and in the future.
Screening Questionnaires to Detect Neurological Disorders in Developing Countries: A Systematic Review
2020, Neuroepidemiology
Temporal trends in stroke admissions in Denmark 1997-2009
2013, BMC Neurology
Do patients with non-arteritic ischemic optic neuritis have increased risk for cardiovascular and cerebrovascular events?
2013, Neuroepidemiology

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^☆: This work was supported in part by Public Health Service grants NSO 6663 and AR 30582 from the National Institutes of Health.

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Stroke incidence with hypertension and ischemic heart disease in Rochester, Minnesota☆

Abstract

Accuracy of death certification of stroke

Stroke

Accuracy of death certificate diagnosis of intracranial hemorrhage and nonhemorrhagic stroke. The Minnesota Heart Survey

Am J Epidemiol