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Age-related changes in stroke risk in men with hypertension and normal blood pressure
J D Curb1, R D Abbott, C J MacLean
1John A. Burns School of Medicine, University of Hawaii at Manoa, USA. curb@hhs.cba.hawaii.edu.
Insights
Hypertension is a significant stroke risk factor, but its impact on stroke incidence increases with age, particularly in previously normotensive men. Unidentified factors also contribute to stroke risk in older adults.
Area of Science:
- Gerontology
- Cardiovascular Epidemiology
- Neurology
Background:
- Stroke is a leading cause of death and disability in older adults.
- Hypertension is a well-established risk factor for stroke.
- Limited data exist on how the hypertension-stroke relationship evolves with age.
Purpose of the Study:
- To investigate age-related changes in the association between hypertension and stroke risk.
- To analyze stroke incidence in relation to hypertension across different age groups.
Main Methods:
- Examined 6-year stroke incidence in Japanese-American men aged 45-81.
- Utilized updated blood pressure data from the Honolulu Heart Program.
- Analyzed data considering hypertension status (blood pressure or medication use).
Main Results:
- Both hypertension prevalence and stroke incidence significantly increased with age.
- The rise in thromboembolic stroke incidence with age was more pronounced in normotensive individuals compared to hypertensive ones.
- The proportion of strokes attributable to hypertension decreased with age, suggesting other factors become more important.
Conclusions:
- Aggressive screening and treatment of hypertension remain valuable in the elderly due to its high prevalence and treatment efficacy.
- Unidentified factors appear to play an increasingly significant role in stroke causation in older age.
Background And Purpose:
Stroke is a major contributor to total morbidity and mortality in older individuals, and hypertension is an important risk factor for stroke. Relatively few data exist on whether this relationship changes with age.
Methods:
To examine age-related changes in the relationships between risk of stroke and hypertension, we examined the 6-year incidence of stroke among men aged 45 to 81 years using updated blood pressure data from three examinations of Japanese-American men from the Honolulu Heart Program.
Results:
Both the prevalence of hypertension (systolic blood pressure > or = 160 mm Hg or diastolic blood pressure > or = 95 mm Hg or the use of antihypertensive medication) and the 6-year incidence of stroke increased significantly with increasing age (P < .01). The increase in thromboembolic stroke incidence with age was more marked in those who were normotensive at baseline (2.7/1000 in those aged 45 to 54 years to 23.9/1000 in those > or = 65 years; P < .001) than in hypertensive men (20.6/1000 in those aged 45 to 54 years to 33.5/1000 in those > or = 65 years; P < .01). The age-related increase in risk of thromboembolic stroke among normotensive men resulted in a decrease in the percentage of strokes attributable to hypertension (50% in those aged 45 to 54 years to 18% in those > or = 65 years; P < .05). Similar trends were seen for hemorrhagic stroke. There were no age-related changes in the relationships of other major atherosclerotic risk factors with stroke. The hypertension/stroke relationships were present after multivariate adjustment for age, smoking, cholesterol, and other factors.
Conclusions:
In view of the greater prevalence of hypertension and the proven efficacy of treatment in the elderly, these findings do not negate the value of aggressive screening and treatment of hypertension in this age group. However, it appears that other unidentified factors have an increasing role in the causation of stroke with advancing age.