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Articles
September 28, 2011

Presence of baseline prehypertension and risk of incident stroke
A meta-analysis

October 4, 2011 issue
77 (14) 1330-1337

Abstract

Objective:

To qualitatively and quantitatively assess the association of prehypertension with incident stroke through a meta-analysis of prospective cohort studies.

Methods:

We searched Medline, Embase, the Cochrane Library, and bibliographies of retrieved articles. Prospective cohort studies were included if they reported multivariate-adjusted relative risks (RRs) and corresponding 95%confidence intervals (CI) of stroke with respect to baseline prehypertension.

Results:

Twelve studies with 518,520 participants were included. Prehypertension was associated with risk of stroke (RR 1.55, 95% CI 1.35–1.79; p < 0.001). Seven studies further distinguished a low prehypertensive population (systolic blood pressure [SBP] 120–129 mm Hg or diastolic blood pressure [DBP] 80–84 mm Hg) and a high prehypertensive population (SBP 130–139 mm Hg or DBP 85–89 mm Hg). Among persons with lower-range prehypertension, stroke risk was not significantly increased (RR 1.22, 0.95–1.57). However, for persons with higher values within the prehypertensive range, stroke risk was substantially increased (RR 1.79, 95% CI 1.49–2.16).

Conclusions:

Prehypertension is associated with a higher risk of incident stroke. This risk is largely driven by higher values within the prehypertensive range and is especially relevant in nonelderly persons. Randomized trials to evaluate the efficacy of blood pressure reduction in persons with this designation are warranted.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 77Number 14October 4, 2011
Pages: 1330-1337
PubMed: 21956722

Publication History

Received: January 15, 2011
Accepted: March 31, 2011
Published online: September 28, 2011
Published in print: October 4, 2011

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Disclosure

Dr. Lee has received research support from Chang Gung Memorial Hospital, Taiwan (CMRPG 660311, Taiwan). Dr. Saver has served/serves on scientific advisory boards for CoAxia, Inc., Concentric Medical, Talecris Biotherapeutics, Grupo Ferrer Internacional SA, AGA Medical Corporation, BrainsGate, PhotoThera, ev3 Inc., and SYGNIS; serves on the editorial boards of Stroke, Reviews in Neurologic Disease, the Journal of Neuroimaging, and the Journal of Stroke and Cerebrovascular Diseases; has received speaker honoraria from Grupo Ferrer Internacional SA; and receives research support from the NIH/NINDS and the American Heart Association. B. Chang, Dr. Chang, and Dr. Hao report no disclosures. Dr. Ovbiagele serves as an Assistant Editor of Stroke, as an Associate Editor of BMC Public Health, and on the editorial boards of the Journal of Stroke and Cerebrovascular Diseases and Stroke Research and Treatment.

Authors

Affiliations & Disclosures

M. Lee, MD
From Stroke Center (M.L., J.L.S., Q.H.), Geffen School of Medicine, University of California, Los Angeles; Chang Gung Memorial Hospital at Chiayi (M.L.) and Linkou (K.-H.C.), Chang Gung University College of Medicine, Taiwan; School of Medicine (B.C.) and Stroke Center and Department of Neuroscience (B.O.), University of California, San Diego.
J.L. Saver, MD
From Stroke Center (M.L., J.L.S., Q.H.), Geffen School of Medicine, University of California, Los Angeles; Chang Gung Memorial Hospital at Chiayi (M.L.) and Linkou (K.-H.C.), Chang Gung University College of Medicine, Taiwan; School of Medicine (B.C.) and Stroke Center and Department of Neuroscience (B.O.), University of California, San Diego.
B. Chang, BS
From Stroke Center (M.L., J.L.S., Q.H.), Geffen School of Medicine, University of California, Los Angeles; Chang Gung Memorial Hospital at Chiayi (M.L.) and Linkou (K.-H.C.), Chang Gung University College of Medicine, Taiwan; School of Medicine (B.C.) and Stroke Center and Department of Neuroscience (B.O.), University of California, San Diego.
K.-H. Chang, MD, PhD
From Stroke Center (M.L., J.L.S., Q.H.), Geffen School of Medicine, University of California, Los Angeles; Chang Gung Memorial Hospital at Chiayi (M.L.) and Linkou (K.-H.C.), Chang Gung University College of Medicine, Taiwan; School of Medicine (B.C.) and Stroke Center and Department of Neuroscience (B.O.), University of California, San Diego.
Q. Hao, MD, PhD
From Stroke Center (M.L., J.L.S., Q.H.), Geffen School of Medicine, University of California, Los Angeles; Chang Gung Memorial Hospital at Chiayi (M.L.) and Linkou (K.-H.C.), Chang Gung University College of Medicine, Taiwan; School of Medicine (B.C.) and Stroke Center and Department of Neuroscience (B.O.), University of California, San Diego.
B. Ovbiagele, MD, MSc
From Stroke Center (M.L., J.L.S., Q.H.), Geffen School of Medicine, University of California, Los Angeles; Chang Gung Memorial Hospital at Chiayi (M.L.) and Linkou (K.-H.C.), Chang Gung University College of Medicine, Taiwan; School of Medicine (B.C.) and Stroke Center and Department of Neuroscience (B.O.), University of California, San Diego.

Notes

Address correspondence and reprint requests to Dr. Bruce Ovbiagele, Stroke Center and Department of Neuroscience, University of California, San Diego, 9500 Gilman Drive, #9127, La Jolla, CA 92093-9127 [email protected]

Author Contributions

M.L., J.L.S., and B.O. conceived the study. M.L. and B.O. designed the inclusion and exclusion criteria. M.L., B.C., and K.-H.C. participated in the study search and data collection and extraction. M.L. did the statistical analysis with guidance from J.L.S. and B.O., M.L. wrote the first draft of the report, and J.L.S., Q.H., and B.O. did the major revision and made comments. All other authors commented on the draft and approved the final version. M.L. and B.O. had full access to all the data and had the final decision to submit for publication.

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