Time course of blood pressure control prior to lacunar TIA and stroke

ObjectiveTo determine the age-specific temporal trends in blood pressure (BP) before acute lacunar vs nonlacunar TIA and stroke.MethodsIn a population-based study of TIA/ischemic stroke (Oxford Vascular Study), we studied 15-year premorbid BP readings from primary care records in patients with lacunar vs nonlacunar events (Trial of Org 10172 in Acute Stroke Treatment [TOAST]) stratified by age (<65, ≥65 years).ResultsOf 2,085 patients (1,250 with stroke, 835 with TIA), 309 had lacunar events. In 493 patients <65 years of age, the prevalence of diagnosed hypertension did not differ between lacunar and nonlacunar events (46 [48.4%] vs 164 [41.2%], p = 0.20), but mean/SD premorbid BP (44,496 BP readings) was higher in patients with lacunar events (15-year records: systolic BP [SBP] 138.5/17.7 vs 133.3/15.0 mm Hg, p = 0.004; diastolic BP [DBP] 84.1/9.6 vs 80.9/8.4 mm Hg, p = 0.001), mainly because of higher mean BP during the 5 years before the event (SBP 142.6/18.8 vs 134.6/16.6 mm Hg, p = 0.0001; DBP 85.2/9.7 vs 80.6/9.0 mm Hg, p < 0.0001), with a rising trend (ptrend = 0.006) toward higher BP leading up to the event (<30-day pre-event SBP: 152.7/16.1 vs 135.3/23.1 mm Hg, p = 0.009; DBP 87.9/9.4 vs 80.8/12.8 mm Hg, p = 0.05; mean BP ≤1 year before the event 145.8/22.0 vs 134.7/16.1 mm Hg, p = 0.001; 86.1/10.7 vs 80.4/9.8 mm Hg, p = 0.0001). Maximum BP in the 5 years before the event was also higher in patients with lacunar events (SBP 173.7/26.6 vs 158.6/23.2 mm Hg, p = 0.0001; DBP 102.3/12.9 vs 94.2/11.2 mm Hg, p < 0.0001), as was persistently elevated BP (≥50% SBP >160 mm Hg, odd ratio 4.95, 95% confidence interval 1.99–12.31, p = 0.0002). However, no similar differences in BP were observed in patients ≥65 years of age.ConclusionRecent premorbid BP control is strongly temporarily related to acute lacunar events at younger ages, suggesting a direct role of BP in accelerating causal pathology and highlighting the need to control hypertension quickly.

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Access to and use of high blood pressure medications in Brazil

Revista de Saúde Pública ◽

10.1590/s1518-8787.2016050006154 ◽

2016 ◽

Vol 50 (suppl 2) ◽

Cited By ~ 7

Author(s):

Sotero Serrate Mengue ◽

Andréa Dâmaso Bertoldi ◽

Luiz Roberto Ramos ◽

Mareni Rocha Farias ◽

Maria Auxiliadora Oliveira ◽

...

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Pressure Control ◽

Access To Medicines ◽

Population Based ◽

First Line ◽

Cross Sectional ◽

Population Based Study ◽

Unified Health System ◽

Number Of Patients

ABSTRACT OBJECTIVE To analyze the access to and use of medicines for high blood pressure among the Brazilian population according to social and demographic conditions. METHODS Analysis of data from Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide cross-sectional, population-based study, with probability sampling, carried out between September 2013 and February 2014 in urban households in the five Brazilian regions. The study evaluated the access and use of medicines to treat people with high blood pressure. The independent variables were gender, age, socioeconomic status and Brazilian region. The study also described the most commonly used drugs and the percentage of people treated with one, two, three or more drugs. Point estimations and confidence intervals were calculated considering the sample weights and sample complex plan. RESULTS Prevalence of high blood pressure was 23.7% (95%CI 22.8–24.6). Regarding people with this condition, 93.8% (95%CI 92.8–94.8) had indication for drug therapy and, of those, 94.6% (95%CI 93.5–95.5) were using the medication at the time of interview. Full access to medicines was 97.9% (95%CI 97.3–98.4); partial access, 1.9% (95%CI 1.4–2.4); and no access, 0.2% (95%CI 0.1–0.4). The medication used to treat high blood pressure, 56.0% (95%CI 52.6–59.2) were obtained from SUS (Brazilian Unified Health System), 16.0% (95%CI 14.3–17.9) from Popular Pharmacy Program, 25.7% (95%CI 23.4–28.2) were paid for by the patients themselves and 2.3% (95%CI 1.8–2.9) were obtained from other locations. The five most commonly used drugs were, in descending order, hydrochlorothiazide, losartan, captopril, enalapril and atenolol. Of the total number of patients on treatment, 36.1% (95%CI 34.1–37.1) were using two medicines and 13.5% (95%CI 12.3–14.9) used three or more. CONCLUSIONS Access to medicines for the treatment of high blood pressure may be considered high and many of them are available free of charge. The most commonly used drugs are among those recommended as first-line treatment for high blood pressure control. The percentage of people using more than one drug seems to follow the behavior observed in other countries.

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Changing clinical characteristics of infants treated for hypoxic-ischaemic encephalopathy in England, Wales and Scotland: a population-based study using the National Neonatal Research Database

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-319685 ◽

2021 ◽

pp. fetalneonatal-2020-319685

Author(s):

Lory Hage ◽

Dusha Jeyakumaran ◽

Jon Dorling ◽

Shalini Ojha ◽

Don Sharkey ◽

...

Keyword(s):

Therapeutic Hypothermia ◽

Clinical Characteristics ◽

Temporal Trends ◽

Standard Of Care ◽

Population Based ◽

Research Database ◽

Clinical Markers ◽

Population Based Study ◽

Using Data

BackgroundTherapeutic hypothermia is standard of care for babies with moderate/severe hypoxic-ischaemic encephalopathy and is increasingly used for mild encephalopathy.ObjectiveDescribe temporal trends in the clinical condition of babies diagnosed with hypoxic-ischaemic encephalopathy who received therapeutic hypothermia.DesignRetrospective cohort study using data held in the National Neonatal Research Database.SettingNational Health Service neonatal units in England, Wales and Scotland.PatientsInfants born from 1 January 2010 to 31 December 2017 with a recorded diagnosis of hypoxic-ischaemic encephalopathy who received therapeutic hypothermia for at least 3 days or died in this period.Main outcomesPrimary outcomes: recorded clinical characteristics including umbilical cord pH; Apgar score; newborn resuscitation; seizures and treatment on day 1. Secondary outcomes: recorded hypoxic-ischaemic encephalopathy grade.Results5201 babies with a diagnosis of hypoxic-ischaemic encephalopathy received therapeutic hypothermia or died; annual numbers increased over the study period. A decreasing proportion had clinical characteristics of severe hypoxia ischaemia or a diagnosis of moderate or severe hypoxic-ischaemic encephalopathy, trends were statistically significant and consistent across multiple clinical characteristics used as markers of severity.ConclusionsTreatment with therapeutic hypothermia for hypoxic-ischaemic encephalopathy has increased in England, Scotland and Wales. An increasing proportion of treated infants have a diagnosis of mild hypoxic-ischaemic encephalopathy or have less severe clinical markers of hypoxia. This highlights the importance of determining the role of hypothermia in mild hypoxic-ischaemic encephalopathy. Receipt of therapeutic hypothermia is unlikely to be a useful marker for assessing changes in the incidence of brain injury over time.

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Sex differences in the impact of acute stroke treatment in a population-based study: a sex-specific propensity score approach

Annals of Epidemiology ◽

10.1016/j.annepidem.2017.07.006 ◽

2017 ◽

Vol 27 (8) ◽

pp. 493-498.e2 ◽

Cited By ~ 2

Author(s):

Lynda D. Lisabeth ◽

Jonggyu Baek ◽

Lewis B. Morgenstern ◽

Mathew J. Reeves ◽

Devin L. Brown ◽

...

Keyword(s):

Sex Differences ◽

Propensity Score ◽

Acute Stroke ◽

Population Based ◽

Population Based Study ◽

Stroke Treatment ◽

Acute Stroke Treatment ◽

The Impact

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Hypertension, blood pressure control and diabetic retinopathy in a large population-based study

PLoS ONE ◽

10.1371/journal.pone.0229665 ◽

2020 ◽

Vol 15 (3) ◽

pp. e0229665 ◽

Cited By ~ 4

Author(s):

Lei Liu ◽

Nguyen Duc Quang ◽

Riswana Banu ◽

Himeesh Kumar ◽

Yih-Chung Tham ◽

...

Keyword(s):

Blood Pressure ◽

Diabetic Retinopathy ◽

Blood Pressure Control ◽

Large Population ◽

Pressure Control ◽

Population Based ◽

Population Based Study

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Blood Pressure Management in Stroke

Hypertension ◽

10.1161/hypertensionaha.120.14653 ◽

2020 ◽

Vol 76 (6) ◽

pp. 1688-1695

Author(s):

Philip B. Gorelick ◽

Paul K. Whelton ◽

Farzaneh Sorond ◽

Robert M. Carey

Keyword(s):

Blood Pressure ◽

Recurrent Stroke ◽

Pressure Control ◽

Disability Adjusted Life Years ◽

Pressure Management ◽

Stroke Treatment ◽

Blood Pressure Management ◽

Disability Adjusted Life ◽

Life Years ◽

Acute Stroke Treatment

Hypertension is a well-established and modifiable risk factor for stroke and other cardiovascular diseases. Notably, stroke is the second leading cause of death worldwide and the second most common cause of disability-adjusted life-years. As such, we provide a viewpoint on blood pressure management in stroke and emphasize blood pressure control or management for first and recurrent stroke prevention, acute stroke treatment, and for prevention of cognitive impairment or dementia.

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Seasonal Variations in the Achievement of Guideline Targets for HbA1c, Blood Pressure, and Cholesterol Among Type 2 Diabetic Patients: A Nationwide Population-Based Study

SSRN Electronic Journal ◽

10.2139/ssrn.3244932 ◽

2018 ◽

Author(s):

Masaya Sakamoto ◽

Daisuke Matsutani ◽

Yuki Tsujimoto ◽

Souichirou Minato ◽

Yosuke Kayama ◽

...

Keyword(s):

Blood Pressure ◽

Seasonal Variations ◽

Population Based ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Population Based Study ◽

Type 2 Diabetic

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Association between Blood Pressure and Serum Thyroid-Stimulating Hormone Concentration within the Reference Range: A Population-Based Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-2208 ◽

2007 ◽

Vol 92 (3) ◽

pp. 841-845 ◽

Cited By ~ 119

Author(s):

Bjørn O. Åsvold ◽

Trine Bjøro ◽

Tom I. L. Nilsen ◽

Lars J. Vatten

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Outcome Measures ◽

Odds Ratio ◽

Reference Range ◽

Positive Association ◽

Population Based ◽

Thyroid Stimulating Hormone ◽

Cross Sectional ◽

Population Based Study

Abstract Context: The association between thyroid function and blood pressure is insufficiently studied. Objective: The objective of the investigation was to study the association between TSH within the reference range and blood pressure. Design and Setting: This was a cross-sectional, population-based study. Subjects: A total of 30,728 individuals without previously known thyroid disease were studied. Main Outcome Measures: The main outcome measures were mean systolic and diastolic blood pressure and pulse pressure and odds ratio for hypertension (>140/90 mm Hg or current or previous use of antihypertensive medication), according to categories of TSH. Results: Within the reference range of TSH (0.50–3.5 mU/liter), there was a linear increase in blood pressure with increasing TSH. The average increase in systolic blood pressure was 2.0 mm Hg [95% confidence interval (CI) 1.4–2.6 mm Hg] per milliunit per liter increase in TSH among men, and 1.8 mm Hg (95% CI 1.4–2.3 mm Hg) in women. The corresponding increase in diastolic blood pressure was 1.6 mm Hg (95% CI 1.2–2.0 mm Hg) in men and 1.1 mm Hg (95% CI 0.8–1.3 mm Hg) in women. Comparing TSH of 3.0–3.5 mU/liter (upper part of the reference) with TSH of 0.50–0.99 mU/liter (lower part of the reference), the odds ratio for hypertension was 1.98 (95% CI 1.56–2.53) in men and 1.23 (95% CI 1.04–1.46) in women. Conclusion: Within the reference range of TSH, we found a linear positive association between TSH and systolic and diastolic blood pressure that may have long-term implications for cardiovascular health.

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