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Elevated Midlife Blood Pressure Increases Stroke Risk in Elderly Persons
The Framingham Study
Sudha Seshadri, MD;
Philip A. Wolf, MD;
Alexa Beiser, PhD;
Ramachandran S. Vasan, MD;
Peter W. F. Wilson, MD;
Carlos S. Kase, MD;
Margaret Kelly-Hayes, EdD, RN;
William B. Kannel, MD, MPH;
Ralph B. D'Agostino, PhD
Arch Intern Med. 2001;161:2343-2350.
Background Stroke risk predictions are traditionally based on current blood pressure
(BP). The potential impact of a subject's past BP experience (antecedent BP)
is unknown. We assessed the incremental impact of antecedent BP on the risk
of ischemic stroke.
Methods A total of 5197 stroke-free subjects (2330 men) in the community-based
Framingham Study cohort were enrolled from September 29, 1948, to April 25,
1953, and followed up to December 31, 1998. We determined the 10-year risk
of completed initial ischemic stroke for 60-, 70-, and 80-year-old subjects
as a function of their current BP (at baseline), recent antecedent BP (average
of readings at biennial examinations 1-9 years before baseline), and remote
antecedent BP (average at biennial examinations 10-19 years earlier), with
adjustment for smoking and diabetes mellitus. Models incorporating antecedent
BP were also adjusted for baseline BP. The effect of each BP component (systolic
BP, diastolic BP, and pulse pressure) was assessed separately.
Results Four hundred ninety-one ischemic strokes (209 in men) were observed
in eligible subjects. The antecedent BP influenced the 10-year stroke risk
at the age of 60 years (relative risk per SD increment of recent antecedent
systolic BP: women, 1.68 [95% confidence interval, 1.25-2.25]; and men, 1.92
[95% confidence interval, 1.39-2.66]) and at the age of 70 years (relative
risk per SD increment of recent antecedent systolic BP: women, 1.66 [95% confidence
interval, 1.28-2.14]; and men, 1.30 [95% confidence interval, 0.97-1.75]).
This effect was evident for recent and remote antecedent BP, consistent in
hypertensive and nonhypertensive subjects, and demonstrable for all BP components.
Conclusions Antecedent BP contributes to the future risk of ischemic stroke. Optimal
prevention of late-life stroke will likely require control of midlife BP.
From the National Heart, Lung, and Blood Institute's Framingham Study,
Framingham, Mass (Drs Seshadri, Vasan, and Kannel); the Departments of Neurology
(Drs Seshadri, Wolf, Kase, and Kelly-Hayes), Preventive Medicine and Epidemiology
(Drs Vasan and Kannel), and Medicine (Dr Wilson), Boston University School
of Medicine; Department of Epidemiology and Biostatistics, Boston University
School of Public Health (Dr Beiser), and Department of Mathematics, Boston
University (Dr D'Agostino), Boston, Mass.
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