Skip to main content
SpringerLink
Log in

Stroke Risk Screening of Adults with Hypertension

Prospective Cross-Sectional Study in Primary Care

  • Original Research Article
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Abstract

Objectives:

There is a lack of current epidemiological data on the risk of cerebrovascular disease associated with arterial hypertension. We therefore aimed to assess the risk factor profile of hypertensive patients in primary care in various age groups, and to calculate their corresponding risk of stroke.

Methods:

A total of 2482 primary-care practices throughout Germany included 47 394 consecutive unselected patients with diagnosed hypertension in a cross-sectional prospective observational study. In addition to demographic characteristics, participating primary-care physicians documented known risk factors for stroke using standardized questionnaires. The 10-year prospective risk of first stroke was then calculated according to the Framingham Stroke Risk Score.

Main outcome measures:

Patients were evenly balanced for sex (females 51%), and the mean age was 66.5 years. Mean systolic (SBP)/diastolic (DBP) blood pressure was 147/86 mmHg. Only 29.1% of patients had an SBP <140 mmHg, and 60.2% had a DBP <90 mmHg. The most prevalent risk factors were a positive family history of cardiovascular disease (46.1%), diabetes mellitus (36.1%), coronary artery disease (34.4%), and left ventricular hypertrophy (33.3%). Drug treatment was given as combination therapy in 73.5% of the total cohort of patients. The mean 10-year risk of stroke was 26% in the total cohort (0–19% in 50.6% of patients, 20–49% in 32.7%, and ≥50% in 16.7%).

Conclusion:

Co-morbidities relevant for total stroke risk are very prevalent among typical primary-care patients, confirming a substantial burden of disease in this setting. The resulting risk of stroke is substantial. The need for more aggressive BP control and treatment of modifiable risk factors is confirmed by our results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council. Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline [published erratum appears in Stroke 2007; 38 (1): 207]. Stroke 2006; 37: 1583–633

    PubMed  Google Scholar 

  2. Sacco RL, Adams R, Albers G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke 2006; 37: 577–617

    Article  PubMed  Google Scholar 

  3. Adams RJ, Albers G, Alberts MJ, et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. Epub 2008 Mar 5

  4. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–13

    Article  PubMed  Google Scholar 

  5. Kjeldsen SE, Julius S, Hedner T, et al. Stroke is more common than myocardial infarction in hypertension: analysis based on 11 major randomized intervention trials. Blood Press 2001; 10: 190–2

    Article  PubMed  CAS  Google Scholar 

  6. D’Agostino RB, Wolf PA, Belanger AJ, et al. Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke 1994; 25: 40–3

    Article  PubMed  Google Scholar 

  7. Wolf PA, D’Agostino RB, Belanger AJ, et al. Probability of stroke: a risk profile from the Framingham Study. Stroke 1991; 22: 312–8

    Article  PubMed  CAS  Google Scholar 

  8. Krone W, Böhm M, Wöhrmann A, et al. Erhebung und Verbesserung der Behandlungssituation von Patienten mit Diabetes mellitus. Das DUTY-Register. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47: 540–6

    PubMed  CAS  Google Scholar 

  9. Sharma A, Wittchen H, Kirch W, et al. High prevalence and poor control of hypertension in primary care: cross sectional study. J Hypertens 2004; 22: 479–86

    Article  PubMed  CAS  Google Scholar 

  10. Bronner LL, Kanter DS, Manson JE. Primary prevention of stroke. N Engl J Med 1995; 333: 1392–400

    Article  PubMed  CAS  Google Scholar 

  11. Pittrow D, Kirch W, Bramlage P, et al. Patterns of antihypertensive drug utilization in primary care. Eur J Clin Pharmacol 2004; 60: 135–42

    Article  PubMed  CAS  Google Scholar 

  12. Anderson KM, Wilson PW, Odell PM, et al. An updated coronary risk profile: a statement for health professionals. Circulation 1991; 83: 356–62

    Article  PubMed  CAS  Google Scholar 

  13. Anderson KM, Odell PM, Wilson PW, et al. Cardiovascular disease risk profiles. Am Heart J 1991; 121: 293–8

    Article  PubMed  CAS  Google Scholar 

  14. Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987–1003

    Article  PubMed  CAS  Google Scholar 

  15. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the Prospective Cardiovascular Munster (PROCAM) Study. Circulation 2002; 105: 310–5

    Article  PubMed  Google Scholar 

  16. Rothwell PM, Giles MF, Flossmann E, et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 2005; 366: 29–36

    Article  PubMed  CAS  Google Scholar 

  17. Diener HC. Modified-release dipyridamole combined with aspirin for secondary stroke prevention. Aging Health 2005; 1: 19–26

    Article  CAS  Google Scholar 

  18. Johnston SC, Gress DR, Browner WS, et al. Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000; 284: 2901–6

    Article  PubMed  CAS  Google Scholar 

  19. Truelsen T, Lindenstrom E, Boysen G. Comparison of probability of stroke between the Copenhagen City Heart Study and the Framingham Study. Stroke 1994; 25: 802–7

    Article  PubMed  CAS  Google Scholar 

  20. Rodgers H, Greenaway J, Davies T, et al. Risk factors for first-ever stroke in older people in the north east of England: a population-based study. Stroke 2004; 35: 7–11

    Article  PubMed  Google Scholar 

  21. Lumley T, Kronmal RA, Cushman M, et al. A stroke prediction score in the elderly: validation and Web-based application. J Clin Epidemiol 2002; 55: 129–36

    Article  PubMed  Google Scholar 

  22. Grundy SM, D’Agostino RB, Mosca L, et al. Cardiovascular risk assessment based on US cohort studies: findings from a National Heart, Lung, and Blood Institute workshop. Circulation 2001; 104: 491–6

    Article  PubMed  CAS  Google Scholar 

  23. Wilson SL, Poulter NR. Cardiovascular risk: its assessment in clinical practice. Br J Biomed Sci 2001; 58: 248–51

    PubMed  CAS  Google Scholar 

  24. Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 2000; 356: 1955–64

    Article  PubMed  CAS  Google Scholar 

  25. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–71

    Article  PubMed  CAS  Google Scholar 

  26. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28: 1462–536

    PubMed  Google Scholar 

  27. Brindle P, Emberson J, Lampe F, et al. Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study. BMJ 2003; 327: 1267–70

    Article  PubMed  Google Scholar 

  28. D’Agostino Sr RB, Grundy S, Sullivan LM, et al. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA 2001; 286: 180–7

    Article  PubMed  Google Scholar 

  29. Hippisley-Cox J, Coupland C, Vinogradova Y, et al. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ 2007; 335(7611): 136

    Article  PubMed  Google Scholar 

  30. Sharma AM, Wittchen HU, Kirch W, et al. High prevalence and poor control of hypertension in primary care: cross-sectional study. J Hypertens 2004; 22: 479–86

    Article  PubMed  CAS  Google Scholar 

  31. Wolf-Maier K, Cooper RS, Banegas JR, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003; 289: 2363–9

    Article  PubMed  Google Scholar 

  32. Staessen JA, Wang JG, Thijs L. Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003. J Hypertens 2003; 21: 1055–76

    Article  PubMed  CAS  Google Scholar 

  33. Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For End-point reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The study was supported by an unrestricted educational grant from MSD Sharp & Dohme GmbH, Haar/Munich, Germany. We acknowledge the input of D. Pittrow, MD, PhD, Institute for Clinical Pharmacology, Dresden, into the interpretation of the study. Dr Bestehorn is an employee of MSD Sharp & Dohme GmbH. The other authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

  1. Institute for Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany

    Kurt Bestehorn & W. Kirch

  2. MSD Sharp & Dohme GmbH, Haar, Germany

    Kurt Bestehorn

  3. Institute for Practice Research, German Primary-Care Physician’s Association (Deutscher Hausärzteverband e.V., BDA), Cologne, Germany

    Klaus Wahle

Authors
  1. Kurt Bestehorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus Wahle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Kirch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kurt Bestehorn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bestehorn, K., Wahle, K. & Kirch, W. Stroke Risk Screening of Adults with Hypertension. Clin. Drug Investig. 28, 281–289 (2008). https://doi.org/10.2165/00044011-200828050-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00044011-200828050-00002

Keywords

Search

Navigation