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Cerebrovascular disease and risk of stroke
Submitted by Dr. Yasser
Mokhtar, MD. Dept. of internal medicine. School of
medicine, University of South Dakota.
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Stroke is a loss of cerebral
function with symptoms lasting >24 hrs or death due to vascular
disease |
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Modifiable risk factors
1. Hypertension
After age, hypertension is the most powerful stroke risk factor. It is
strongly related not only to atherothrombotic brain, but also to intracerebral
and subarachnoid hemorrhage (Shimizu et al., 1984). Although most of the
information comes from consideration of the diastolic blood pressure, the
relationship with systolic blood pressure is similar and possibly stronger
(Shaper et al., 1991), even isolated systolic hypertension is associated with
increased risk (Rowe 1983). Systolic hypertension, which is increasingly
prevalent with age, has also been shown to be a risk factor for stroke in the
Framingham studies (Kannel et al., 1981 and Wolf 1985).
The percentage difference in stroke risk associated with a given difference
in blood pressure is similar, in males and females, at all levels of blood
pressure. Stroke risk about doubles with each 7.5 mmHg increase in the usual
diastolic blood pressure (MacMahon et al., 1990).
Hypertension increases stroke risk, probably by increasing the extent and
severity of atheroma and the prevalence of microvascular disease in the small
penetrating arteries within the brain (Reed et al., 1988 and Hower et al.,
1991). Because the strength of blood pressure / stroke association is so strong
and consistent and the fact that it is biologically plausible and because
treatment of hypertension reduces stroke risk, one can conclude that
hypertension is a causal risk factor (Collins et al., 1990). Furthermore,
several studies have shown that effective treatment of hypertension will reduce
stroke incidence and mortality (Medical Research Council Working Party 1985).
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