Document Detail


Postural changes in blood pressure and incidence of ischemic stroke subtypes: the ARIC study.
MedLine Citation:
PMID:  21199999     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The relation of orthostatic blood pressure decrease, or increase, with occurrence of ischemic stroke subtypes has not been examined. We investigated the association of orthostatic blood pressure change (within 2 minutes after supine to standing) obtained at baseline (1987 to 1989) in the Atherosclerosis Risk in Communities Study with incidence of ischemic stroke subtypes through 2007. Among 12 817 black and white individuals without a history of stroke at baseline, 680 ischemic strokes (153 lacunar, 383 nonlacunar thrombotic, and 144 cardioembolic strokes) occurred during a median follow-up of 18.7 years. There was a U-shaped association between orthostatic systolic blood pressure change and lacunar stroke incidence (quadratic P=0.004). In contrast, orthostatic systolic blood pressure decrease of 20 mm Hg or more was associated with increased occurrence of nonlacunar thrombotic and cardioembolic strokes independent of sitting systolic blood pressure, antihypertensive medication use, diabetes, and other lifestyle, physiological, biochemical, and medical conditions at baseline (for nonlacunar thrombotic: hazard ratio, 2.02; 95% CI, 1.43 to 2.84; for cardioembolic: hazard ratio, 1.85, 95% CI, 1.01 to 3.39). Orthostatic diastolic blood pressure decrease was associated with increased risk of nonlacunar thrombotic and cardioembolic strokes; the hazard ratios (95% CI) associated with 10 mm Hg lower orthostatic diastolic blood pressure (continuous) were 1.26 (1.06 to 1.50) and 1.41 (1.06 to 1.88), respectively, in fully adjusted models. In conclusion, the present study found that nonlacunar ischemic stroke incidence was positively associated with an orthostatic decrease of systolic and diastolic blood pressure, whereas greater lacunar stroke incidence was associated with both orthostatic increases and decreases in systolic blood pressure.
Authors:
Hiroshi Yatsuya; Aaron R Folsom; Alvaro Alonso; Rebecca F Gottesman; Kathryn M Rose;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-01-03
Journal Detail:
Title:  Hypertension     Volume:  57     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-20     Completed Date:  2011-04-22     Revised Date:  2013-12-11    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  167-73     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
African Americans / statistics & numerical data
Atherosclerosis / physiopathology
Blood Pressure / physiology*
Brain Ischemia / complications,  physiopathology*
Cohort Studies
European Continental Ancestry Group / statistics & numerical data
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Posture / physiology*
Risk Factors
Stroke / ethnology,  etiology,  physiopathology*
United States / epidemiology
Grant Support
ID/Acronym/Agency:
N01 HC055019/HC/NHLBI NIH HHS; N01-HC-55015/HC/NHLBI NIH HHS; N01-HC-55016/HC/NHLBI NIH HHS; N01-HC-55018/HC/NHLBI NIH HHS; N01-HC-55019/HC/NHLBI NIH HHS; N01-HC-55020/HC/NHLBI NIH HHS; N01-HC-55021/HC/NHLBI NIH HHS; N01-HC-55022/HC/NHLBI NIH HHS
Comments/Corrections
Comment In:
Hypertension. 2011 Feb;57(2):158-9   [PMID:  21199993 ]

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