scholarly journals Blood Pressure Control and Recurrent Stroke After Intracerebral Hemorrhage in 2002 to 2018 Versus 1981 to 1986: Population-Based Study

Stroke ◽  
2021 ◽  
Author(s):  
Linxin Li ◽  
Susanna M. Zuurbier ◽  
Wilhelm Kuker ◽  
Charles P. Warlow ◽  
Peter M. Rothwell
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Recurrent Stroke ◽  
Pressure Control ◽  
Population Based ◽  
Stroke Study ◽  
Before And After ◽  
Oxfordshire Community Stroke Project ◽  
The Impact

Background and Purpose: The PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study) conducted in the early 1990s showed that blood pressure (BP) lowering therapy reduced the risks of recurrent stroke by about 50% after spontaneous intracerebral hemorrhage (ICH). However, the ICH subgroup was a minority, and trial cohorts are invariably selective. Therefore, it is unclear whether the impact of BP control on risk of recurrent stroke in ICH observed in PROGRESS would be as great in real-world practice. Methods: We compared BP control (mean BP during study follow-up) and risks of recurrent stroke after first-ever primary ICH in 2 colocated population-based studies before and after the PROGRESS trial (1995–2001) in Oxfordshire: Oxfordshire Community Stroke Project (OCSP; 1981–1986) and OXVASC (Oxford Vascular Study; 2002–2018). Results: Two hundred seventy-seven patients (753 patient-years of follow-up) with first-ever primary ICH were ascertained in OXVASC and OCSP. Baseline systolic BP was comparable between the 2 studies (mean/SD=183.8/36.5 in OXVASC versus 178.1/38.2 in OCSP, P =0.30) but among one hundred thirty-seven 90-day survivors, mean BP during follow-up was substantially lower in OXVASC versus OCSP (135.2/16.4 versus 157.3/17.8, P <0.0001). Risks of recurrent stroke (per 100 patient-years) decreased from 10.3 (95% CI, 4.7–19.5) in OCSP to 3.1 (1.8–4.8) in OXVASC ( P =0.006), predominantly driven by a reduction at younger ages (5-year risk at age <75 years: 35.4% versus 6.9%, P =0.001; hazard ratio, 0.14 [0.04–0.54]). Conclusions: Risks of recurrent stroke after primary ICH have fallen significantly in Oxfordshire over the past 4 decades, coinciding with substantial improvements in BP control during follow-up.

scholarly journals Impact of Patient Beliefs on Blood Pressure Control in the General Population: Findings from the Population-Based STAAB Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Theresa Tiffe ◽  
Caroline Morbach ◽  
Viktoria Rücker ◽  
Götz Gelbrich ◽  
Martin Wagner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Blood Pressure Control ◽  
Antihypertensive Medication ◽  
Pressure Control ◽  
Population Based ◽  
Blood Pressure Target ◽  
Successful Implementation ◽  
Inverse Association ◽  
The Impact

Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences.

scholarly journals Office, Central, and Ambulatory Blood Pressure for Predicting First Stroke in Older Adults: A Community-Based Cohort Study

Hypertension ◽  
2021 ◽  
Author(s):  
Kenji Matsumoto ◽  
Zhezhen Jin ◽  
Shunichi Homma ◽  
Mitchell S.V. Elkind ◽  
Joseph E. Schwartz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Model ◽  
Population Based ◽  
Applanation Tonometry ◽  
Competing Risk ◽  
Community Based ◽  
Older Population ◽  
Competing Risk Model ◽  
The Impact

Hypertension is the most prevalent modifiable risk factor for stroke. Office blood pressure (BP) measurements may have limitations in defining the impact of hypertension on stroke. Our aim was to compare the stroke risk for office, central, and ambulatory BP measurements in a predominantly older population-based prospective cohort. Participants in the CABL study (Cardiovascular Abnormalities and Brain Lesions; n=816; mean age, 70.8±9.0 years; 39.8% men) underwent applanation tonometry of the radial artery for central BP and 24-hour ambulatory BP monitoring. During a follow-up of 9.6±3.1 years, stroke occurred in 76 participants (9.3%). Among office BP variables, only diastolic BP was associated with stroke in multivariable competing risk model ( P =0.016). None of the central BP variables showed a significant association with stroke. Conversely, all ambulatory systolic and diastolic BP variables were significantly associated with stroke after adjustment for clinical confounders (all P <0.005). In an additional multivariable competing risk model including both ambulatory systolic and diastolic BP values obtained at the same time of the day, diastolic BP was more strongly associated with stroke than systolic BP in 24-hour, daytime, and nighttime periods (all P <0.05). Therefore, in a predominantly older population-based cohort, office diastolic BP was weakly associated with incident stroke; no central BP variable was prognostic of stroke. However, all ambulatory systolic and diastolic BP values were significantly associated with stroke in multivariable competing risk analyses. Moreover, ambulatory diastolic BP was a stronger predictor of stroke than ambulatory systolic BP.

The impact of routine follow-up with health care teams on blood pressure control among patients with hypertension

2019 ◽  
Vol 33 (6) ◽  
pp. 466-474
Author(s):  
Hui-Juan Zuo ◽  
Ji-Xiang Ma ◽  
Jin-Wen Wang ◽  
Xiao-Rong Chen ◽  
Lei Hou
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Health Care Teams ◽  
The Impact

scholarly journals The 10-year incidence of hypertension across blood pressure categories in a population-based cohort in southwestern Sweden

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ulf Lindblad ◽  
Klara Lundholm ◽  
Jenny Eckner ◽  
Ying Li ◽  
Lennart Råstam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Lifestyle Modification ◽  
Population Based ◽  
Baseline Blood Pressure ◽  
Swedish Population ◽  
Incident Hypertension ◽  
Pressure Lowering ◽  
Optimal Blood Pressure ◽  
The Impact

Abstract Background To explore the determinants of incident hypertension, and especially the impact of baseline blood pressure categories, in a representative Swedish population. Methods A 10-year longitudinal study of residents aged 30–74. Blood pressures were measured and categorized according to ESH guidelines with optimal blood pressure < 120/80 mmHg, normal 120–129/80–84 mmHg, and high normal 130–139/85–89 mmHg. Incident hypertension was defined as ongoing treatment or three consecutive blood pressure readings ≥ 140/ ≥ 90 mmHg (one or both) at follow-up, while those with ≥ 140 and/or ≥ 90 mmHg at only one or two visits were labelled as unstable. After excluding subjects with hypertension, ongoing blood pressure lowering medication or a previous CVD event at baseline, 1099 remained for further analyses. Results Sixteen (2.6%) subjects with optimal baseline blood pressure had hypertension at follow up. Corresponding numbers for subjects with normal, high normal and unstable blood pressure were 55 (19.4%), 50 (39.1%) and 46 (74.2%), respectively. Compared with subjects in optimal group those in normal, high normal and unstable blood pressure categories had significantly higher risk to develop manifest hypertension with odds ratios OR and (95% CI) of 7.04 (3.89–12.7), 17.1 (8.88–33.0) and 84.2 (37.4–190), respectively, with adjustment for age, BMI and family history for hypertension. The progression to hypertension was also independently predicted by BMI (p < 0.001), however, not by age. Conclusions Subjects with high normal or unstable blood pressure should be identified in clinical practice, evaluated for global hypertension risk and offered personalized advice on lifestyle modification for early prevention of manifest hypertension and cardiovascular disease.

scholarly journals Impact of Uncontrolled Hypertension at 3 Months After Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Alessandro Biffi ◽  
Kay‐Cheong Teo ◽  
Juan Pablo Castello ◽  
Jessica R. Abramson ◽  
Ian Y. H. Leung ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Blood Pressure Control ◽  
Massachusetts General Hospital ◽  
Recurrent Stroke ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Stroke Recurrence ◽  
Prognostic Impact ◽  
Treatment Resistant

Background Survivors of intracerebral hemorrhage (ICH) are at high risk for recurrent stroke, which is associated with blood pressure control. Because most recurrent stroke events occur within 12 to 18 months of the index ICH, rapid blood pressure control is likely to be crucial. We investigated the frequency and prognostic impact of uncontrolled short‐term hypertension after ICH. Methods and Results We analyzed data from Massachusetts General Hospital (n=1305) and the University of Hong Kong (n=523). We classified hypertension as controlled, undertreated, or treatment resistant at 3 months after ICH and determined the following: (1) the risk factors for uncontrolled hypertension and (2) whether hypertension control at 3 months is associated with stroke recurrence and mortality. We followed 1828 survivors of ICH for a median of 46.2 months. Only 9 of 234 (4%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled hypertension, 755 (41%) had undertreated hypertension, and 360 (20%) had treatment‐resistant hypertension. Black, Hispanic, and Asian race/ethnicity and higher blood pressure at time of ICH increased the risk of uncontrolled hypertension at 3 months (all P <0.05). Uncontrolled hypertension at 3 months was associated with recurrent stroke and mortality during long‐term follow‐up (all P <0.05). Conclusions Among survivors of ICH, >60% had uncontrolled hypertension at 3 months, with undertreatment accounting for the majority of cases. The 3‐month blood pressure measurements were associated with higher recurrent stroke risk and mortality. Black, Hispanic, and Asian survivors of ICH and those presenting with severe acute hypertensive response were at highest risk for uncontrolled hypertension.

scholarly journals Association between attendance at outpatient follow-up appointments and blood pressure control among patients with hypertension

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sajid Mahmood ◽  
Zahraa Jalal ◽  
Muhammad Abdul Hadi ◽  
Kifayat Ullah Shah
Keyword(s):  
Blood Pressure ◽  
Treatment Outcomes ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Healthcare Settings ◽  
Co Morbidity ◽  
The Impact

Abstract Objective The aim of this study was to assess the impact of regularity in treatment follow-up appointments on treatment outcomes among hypertensive patients attending different healthcare settings in Islamabad, Pakistan. Additionally, factors associated with regularity in treatment follow-up were also identified. Methods A cross-sectional study was undertaken in selected primary, secondary and tertiary healthcare settings between September, 2017 and December, 2018 in Islamabad, Pakistan. A structured data collection form was used to gather sociodemographic and clinical data of recruited patients. Binary logistic regression analyses were undertaken to determine association between regularity in treatment follow-up appointments and blood pressure control and to determine covariates significantly associated with regularity in treatment follow-up appointments. Results A total of 662 patients with hypertension participated in the study. More than half 346 (52%) of the patients were females. The mean age of participants was 54 ± 12 years. Only 274 (41%) patients regularly attended treatment follow-up appointments. Regression analysis found that regular treatment follow-up was an independent predictor of controlled blood pressure (OR 1.561 [95% CI 1.102–2.211; P = 0.024]). Gender (OR 1.720 [95% CI 1.259–2.350; P = 0.001]), age (OR 1.462 [CI 95%:1.059–2.020; P = 0.021]), higher education (OR 1.7 [95% CI 1.041–2.778; P = 0.034]), entitlement to free medical care (OR 3.166 [95% CI 2.284–4.388; P = 0.0001]), treatment duration (OR 1.788 [95% CI 1.288–2.483; P = 0.001]), number of medications (OR 1.585 [95% CI 1.259–1.996; P = 0.0001]), presence of co-morbidity (OR 3.214 [95% CI 2.248–4.593; P = 0.0001]) and medication adherence (OR 6.231 [95% CI 4.264–9.106; P = 0.0001]) were significantly associated with regularity in treatment follow-up appointments. Conclusion Attendance at follow-up visits was alarmingly low among patients with hypertension in Pakistan which may explain poor treatment outcomes in patients. Evidence-based targeted interventions should be developed and implemented, considering local needs, to improve attendance at treatment follow-up appointments.

Abstract 2267: Poor Long-Term Blood Pressure Control after Intracerebral Hemorrhage in a Predominantly African American Hypertensive Population

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Darin B Zahuranec ◽  
Jeffrey J Wing ◽  
Dorothy F Edwards ◽  
Ravi S Menon ◽  
Stephen J Fernandez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Socioeconomic Status ◽  
African American ◽  
Health Insurance ◽  
Linear Regression ◽  
Intracerebral Hemorrhage ◽  
Blood Pressure Control ◽  
Private Health Insurance ◽  
Pressure Control

Objective: Hypertension is the most important risk factor for both primary and secondary prevention of intracerebral hemorrhage (ICH). We sought to determine the frequency of blood pressure control after ICH and explored predictors of higher blood pressure (BP) at presentation, 30 days, and 1 year in a prospective cohort study. Methods: Individuals with spontaneous non-traumatic ICH were prospectively enrolled in the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. BP was measured at 30 days and 1 year during in-person visits, and BP at presentation was abstracted from the medical record. Linear regression was used to determine factors associated with mean arterial pressure (MAP) at presentation, and longitudinal linear regression was used to determine baseline predictors of MAP at 30 days at 1 year. Results: A total of 143 patients had blood pressure data available at either 30 days (125 patients) or 1 year (85 patients). Mean age was 59, 57% were men, and 80% were African American (AA) and the rest were White (other race/ethnic groups excluded due to low numbers). AAs were younger (57 vs. 65, p=0.002), less likely to be married (37% vs. 61%, p=0.02), more likely to have a history of hypertension (90% vs. 71%, p=0.03), and more likely to be smokers (30% vs. 11%, p=0.03) than Whites. Average BP at presentation was 178±35/99±24mmHg. Multivariable linear regression revealed that AAs had a presenting MAP that was on average 14mmHg higher than Whites despite adjustment for age, gender, socioeconomic status, body mass index, private health insurance, marital status, smoking, cocaine, and ICH volume. Blood pressure control at follow-up was poor, with fewer than 20% of patients having a normal blood pressure (<120/80) at 30 days and 1 year after ICH (no difference by race). The only factor significantly associated with lower MAP at follow up was being married at baseline (β=-5.2, p=0.047) despite adjustment for age, race, gender, socioeconomic status, private health insurance, smoking, cocaine use, National Institutes of Health Stroke Scale, time point of one year (reference: day 30), and living in a personal residence (reference: living in a facility). Other covariates in the model including race were not associated with MAP at follow up, though there was a trend toward living in a personal residence being associated with a higher MAP (β=4.4, p=0.10) Conclusions: AAs had a higher MAP than Whites at the time of presentation with ICH. Optimal blood pressure control at 1 year occurred in less than 20% of the cohort. The only factor predictive of lower MAP at follow up was being married at baseline. Additional efforts are urgently needed to improve blood pressure control in both AA and White ICH survivors.

scholarly journals Characteristics Associated With Antihypertensive Treatment and Blood Pressure Control: A Population-Based Follow-Up Study in Peru

Global Heart ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 109 ◽  
Author(s):  
J. Alfredo Zavala-Loayza ◽  
Catherine Pastorius Benziger ◽  
María Kathia Cárdenas ◽  
Rodrigo M. Carrillo-Larco ◽  
Antonio Bernabé-Ortiz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Antihypertensive Treatment ◽  
Pressure Control ◽  
Population Based ◽  
Follow Up Study

scholarly journals BMI gain and insulin resistance among school-aged children: a population-based longitudinal study in the Brazilian Amazon

2014 ◽  
Vol 112 (11) ◽  
pp. 1905-1910 ◽  
Author(s):  
Barbara H. Lourenço ◽  
Suely G. A. Gimeno ◽  
Marly A. Cardoso ◽  
Keyword(s):  
Insulin Resistance ◽  
Blood Pressure ◽  
Weight Gain ◽  
Diastolic Blood Pressure ◽  
Brazilian Amazon ◽  
Household Wealth ◽  
Population Based ◽  
Model Assessment ◽  
The Impact

Investigation of the determinants of metabolic outcomes associated with non-communicable diseases is increasingly important in developing countries, but such parameters have not been explored extensively during childhood. The present study assessed the impact of weight gain, measured as BMI-for-age Z-scores, on glucose and insulin concentrations, homeostasis model assessment index of insulin resistance (HOMA-IR) values, and systolic and diastolic blood pressure during school years among Amazonian children. A population-based prospective study of 696 children aged >4 to ≤ 10 years with complete anthropometric information at baseline (51 % females and 86 % of mixed race) was carried out; 411 children had data on metabolic parameters after a median follow-up period of 2·0 years (range 1·7–2·6 years). During follow-up, there was a significant increase in the proportion of overweight children (BMI-for-age Z-score >1) from 10·1 to 15·8 % (P= 0·003). In linear regression models adjusted for the child's sex, age, race/ethnicity, baseline household wealth, birth weight and pubertal development stage, for each unit of BMI-for-age Z-score variation during follow-up, an increase of 8·58 (95 % CI 7·68, 9·60) pmol/l in fasting plasma insulin concentrations and 1·47 (95 % CI 1·30, 1·66) in HOMA-IR values was observed. There was no significant impact of weight gain on glucose concentrations and systolic and diastolic blood pressure. In conclusion, we found evidence that an increase in BMI during a 2-year period affected insulin resistance during school years. Considering the significant increase in overweight in this age group, special attention should be paid to monitoring increases in BMI in children from the Brazilian Amazon.

scholarly journals A prospective, observational clinical trial on the impact of COVID-19-related national lockdown on thyroid hormone in young males

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giulia Brigante ◽  
Giorgia Spaggiari ◽  
Barbara Rossi ◽  
Antonio Granata ◽  
Manuela Simoni ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Serum Levels ◽  
Stressful Event ◽  
Italian Population ◽  
Reference Ranges ◽  
Endocrine Regulation ◽  
Before And After ◽  
Hpt Axis ◽  
The Impact

AbstractTrying to manage the dramatic coronavirus disease 2019 (COVID-19) infection spread, many countries imposed national lockdown, radically changing the routinely life of humans worldwide. We hypothesized that both the pandemic per se and the consequent socio-psychological sequelae could constitute stressors for Italian population, potentially affecting the endocrine system. This study was designed to describe the effect of lockdown-related stress on the hypothalamic-pituitary-thyroid (HPT) axis in a cohort of young men. A prospective, observational clinical trial was carried out, including patients attending the male infertility outpatient clinic before and after the national lockdown for COVID-19 pandemic. The study provided a baseline visit performed before and a follow-up visit after the lockdown in 2020. During the follow-up visit, hormonal measurements, lifestyle habits and work management were recorded. Thirty-one male subjects were enrolled (mean age: 31.6 ± 6.0 years). TSH significantly decreased after lockdown (p = 0.015), whereas no significant changes were observed in the testosterone, luteinising hormone, follicle-stimulating hormone, estradiol and prolactin serum levels. No patient showed TSH serum levels above or below reference ranges, neither before nor after lockdown. Interestingly, TSH variation after lockdown was dependent on the working habit change during lockdown (p = 0.042). We described for the first time a TSH reduction after a stressful event in a prospective way, evaluating the HPT axis in the same population, before and after the national lockdown. This result reinforces the possible interconnection between psychological consequences of a stressful event and the endocrine regulation.

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