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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.


Stroke is a loss of cerebral function with symptoms lasting >24 hrs or death due to vascular disease


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  Cerebral circulation
The internal Medicine Lounge

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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