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Alloubani A, Saleh A, Abdelhafiz I. Hypertension and diabetes mellitus as a predictive risk factors for stroke. Diabetes Metab Syndr 2018; 12:577-584. [PMID: 29571978 DOI: 10.1016/j.dsx.2018.03.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/15/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Stroke is becoming a major challenge in healthcare systems, and this has necessitated the study of the various risk factors. As the number of people with hypertension, diabetes mellitus and obesity increases, the problem is expected to worsen. This review paper evaluates what can be done to eliminate or reduce the risk of stroke. OBJECTIVE The aim of the research is to evaluate the risk factors for stroke. The paper also aims to understand how these risks can be handled to avoid incidences of stroke. METHOD Published clinical trials of stroke risk factors studies were recognised by a search of EMBASE and MEDLINE databases with keywords hypertension, blood pressure, diabetes mellitus, stroke or cardiovascular disease, or prospective study, and meta-analysis. RESULTS The findings of this review are that the prevention of stroke starts with identifying risk factors for stroke, most of the patients diagnosed with stroke have various risk factors. Consequently, it is a very significant to identify all the risk factors for stroke as well as to teach the patient how to dominate them. CONCLUSION after summarising all the studies mentioned in the paper, it can be established that hypertension and diabetes mellitus are a stroke risk factors and correlated in patients with atherosclerosis.
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Affiliation(s)
- Aladeen Alloubani
- King Hussein Cancer Center, Nursing Supervisor for Research & Evidence Based Practice, Amman, Jordan.
| | - Abdulmoneam Saleh
- University of Tabuk, Family Medicine, Faculty of Medicine, Tabuk, Saudi Arabia
| | - Ibrahim Abdelhafiz
- Al-Ghad International Health Sciences Colleges, Health Management, Najran, Saudi Arabia
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Ryan PB, Schuemie MJ, Ramcharran D, Stang PE. Atypical Antipsychotics and the Risks of Acute Kidney Injury and Related Outcomes Among Older Adults: A Replication Analysis and an Evaluation of Adapted Confounding Control Strategies. Drugs Aging 2017; 34:211-219. [PMID: 28124262 DOI: 10.1007/s40266-016-0430-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A recently published analysis of population-based claims data from Ontario, Canada reported higher risks of acute kidney injury (AKI) and related outcomes among older adults who were new users of atypical antipsychotics (AAPs) compared with unexposed patients. In light of these findings, the objective of the current study was to further investigate the risks of AKI and related outcomes among older adults receiving AAPs. METHODS A replication of the previously published analysis was performed using the US Truven MarketScan Medicare Supplemental database (MDCR) among patients aged 65 years and older. Compared with non-users of AAPs, the study compared the risk of AKI and related outcomes with users of AAPs (quetiapine, risperidone, olanzapine, aripiprazole, or paliperidone) using a 1-to-1 propensity score matched analysis. In addition, we performed adapted analyses that: (1) included all covariates used to fit propensity score models in outcome models; and (2) required patients to have a diagnosis of schizophrenia, bipolar disorder, or major depression and a healthcare visit within 90 days prior to the index date. RESULTS AKI effect estimates [as odds ratios (ORs) with 95% confidence intervals (CIs)] were significantly elevated in our MDCR replication analyses (OR 1.45, 95% CI 1.32-1.60); however, in adapted analyses, associations were not significant (OR 0.91, 95% CI 0.78-1.07)). In analyses of AKI and related outcomes, results were mostly consistent between the previously published and the MDCR replication analyses. The primary change that attenuated associations in adapted analyses was the requirement for patients to have a mental health condition and a healthcare visit prior to the index date. CONCLUSIONS The MDCR analysis yielded similar results when the methodology of the previously published analysis was replicated, but, in adapted analyses, we did not find significantly higher risks of AKI and related outcomes. The contrast of results between our replication and adapted analyses may be due to the analytic approach used to compare patients (and potential confounding by indication). Further research is warranted to evaluate these associations, while also examining methods to account for differences in older adults who do and do not use these medications.
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Affiliation(s)
- Patrick B Ryan
- Janssen Research & Development, LLC, Global Research and Development Epidemiology, 1125 Trenton Harbourton Road, Rm K30205, Titusville, NJ, 08560, USA
| | - Martijn J Schuemie
- Janssen Research & Development, LLC, Global Research and Development Epidemiology, 1125 Trenton Harbourton Road, Rm K30205, Titusville, NJ, 08560, USA
| | - Darmendra Ramcharran
- Janssen Research & Development, LLC, Global Research and Development Epidemiology, 1125 Trenton Harbourton Road, Rm K30205, Titusville, NJ, 08560, USA.
| | - Paul E Stang
- Janssen Research & Development, LLC, Global Research and Development Epidemiology, 1125 Trenton Harbourton Road, Rm K30205, Titusville, NJ, 08560, USA
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Pergola PE, White CL, Szychowski JM, Talbert R, Brutto OD, Castellanos M, Graves JW, Matamala G, Pretell EJ, Yee J, Rebello R, Zhang Y, Benavente OR. Achieved blood pressures in the secondary prevention of small subcortical strokes (SPS3) study: challenges and lessons learned. Am J Hypertens 2014; 27:1052-60. [PMID: 24610884 DOI: 10.1093/ajh/hpu027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lowering blood pressure (BP) after stroke remains a challenge, even in the context of clinical trials. The Secondary Prevention of Small Subcortical Strokes (SPS3) BP protocol, BP management during the study, and achieved BPs are described here. METHODS Patients with recent symptomatic lacunar stroke were randomized to 1 of 2 levels of systolic BP (SBP) targets: lower: <130mm Hg, or higher: 130-149mm Hg. SBP management over the course of the trial was examined by race/ethnicity and other baseline conditions. RESULTS Mean SBP decreased for both groups from baseline to the last follow-up, from 142.4 to 126.7mm Hg for the lower SBP target group and from 143.6 to 137.4mm Hg for the higher SBP target group. At baseline, participants in both groups used an average of 1.7±1.2 antihypertensive medications, which increased to a mean of 2.4±1.4 (lower group) and 1.8±1.4 (higher group) by the end-study visit. It took an average of 6 months for patients to reach their SBP target, sustained to the last follow-up. Black participants had the highest proportion of SBP ≥150mm Hg at both study entry (40%) and end-study visit (17%), as compared with whites (9%) and Hispanics (11%). CONCLUSIONS These results show that it is possible to safely lower BP even to a SBP goal <130mm Hg in a variety of patients and settings, including private and academic centers in multiple countries. This provides further support for protocol-driven care in lowering BP and consequently reducing the burden of stroke.
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Affiliation(s)
- Pablo E. Pergola
- Department of Medicine, University of Texas Health Sciences Center at San Antonio and Renal Associates PA, San Antonio, Texas
| | - Carole L. White
- School of Nursing, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Jeff M. Szychowski
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert Talbert
- College of Pharmacy, University of Texas at Austin, Austin, Texas
| | - Oscar del Brutto
- Department of Neurological Sciences, Hospital-Clínica Kennedy, and School of Medicine, Universidad Espíritu Santo–Ecuador, Guayaquil, Ecuador
| | - Mar Castellanos
- Department of Neurology, Hospital Universitari Dr. Josep Trueta of Girona, Barcelona, Spain
| | - John W. Graves
- Division of Nephrology and Hypertension College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gonzalo Matamala
- Unidad de Neurologia, Hospital Naval A. Nef, Vina del Mar, Chile
| | | | - Jerry Yee
- Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | - Rosario Rebello
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - Yu Zhang
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Oscar R. Benavente
- Division of Neurology, Department of Medicine, Brain Research Center, University of British Columbia, Vancouver, Canada
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Xu J, Zhao X, Wang Y, Wang C, Liu L, Sun B, Wang A, Wang Y. Impact of a better persistence with antihypertensive agents on ischemic stroke outcomes for secondary prevention. PLoS One 2013; 8:e65233. [PMID: 23776454 PMCID: PMC3679119 DOI: 10.1371/journal.pone.0065233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 04/23/2013] [Indexed: 11/24/2022] Open
Abstract
Background The efficacy of antihypertensive (AH) treatment after stroke has been investigated in several randomized clinical trials. However, non-adherence to AH medication is common for stroke patients in “real world” setting. The purpose of this study was to assess the impact of persistence with AH agents on ischemic stroke (IS) outcomes. Methods and Results Using the China National Stroke Registry, we analyzed data from 8409 IS patients with hypertension. Persistence with AH therapy (high persistence ≥75%, low persistence <75%) was measured by patient self-report at 3, 6, and 12 months after stroke. Multivariate logistic regression model was used to assess the relationship between persistence and IS outcomes (stroke recurrence, combined vascular events and death) at 12 months. Of the 8409 patients in this study, 40.0% were female and the mean age at study entry was 66.7 years. 31.6% of patients had high persistence with AH drugs, and 68.4% had low persistence during 1 year after stroke onset. High persistence with AH drugs significantly decreased the risk of stroke recurrence (odds ratio, 0.78; 95% CI, 0.68 to 0.89), combined vascular events (0.71; 0.63–0.81) and death (0.44; 0.36–0.53) compared with low persistence. Conclusions Our study reinforces the benefits of AH medications in routine clinical practice and highlights the importance of persistence with AH therapy among IS patients known to be hypertensive within the first year of an event.
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Affiliation(s)
- Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoying Sun
- Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail:
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Wang Y, Xu J, Zhao X, Wang D, Wang C, Liu L, Wang A, Meng X, Li H, Wang Y. Association of Hypertension With Stroke Recurrence Depends on Ischemic Stroke Subtype. Stroke 2013; 44:1232-7. [DOI: 10.1161/strokeaha.111.000302] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The association between hypertension (HTN) and stroke recurrence is unclear, but may be influenced by different subtypes of stroke. This study aims to explore whether HTN contributes to the recurrence of certain subtypes of ischemic stroke (IS).
Methods—
Data from the China National Stroke Registry was examined and 1-year follow-up data for stroke recurrence was analyzed. Trial of Org 10172 in Acute Stroke Treatment criteria was used to classify the subtypes of all IS. HTN was defined when resting blood pressure was ≥140/90 mm Hg on repeated measurements during hospitalization or a patient had been on antihypertensive medication. Recurrent stroke was defined as a new neurological deficit compatible to IS or intracerebral hemorrhage. The association between HTN and stroke recurrence in patients with different IS subtypes was analyzed by using univariable and multivariable logistic regression models.
Results—
Of 11 560 patients with IS, 8409 (72.7%) had HTN and 2050 (17.7%) experienced a recurrent stroke within 1 year. Patients with HTN had an insignificantly higher stroke recurrence rate than those without (18.0% versus 17.0%;
P
=0.21). After stratification by Trial of Org 10172 in Acute Stroke Treatment subtypes, multivariable analysis revealed a significant association between HTN and stroke recurrence in small-artery occlusion subtype (odds ratio, 1.52; 95% confidence interval, 1.03–2.31), but not in the other subtypes (large-artery atherosclerosis: odds ratio, 0.99; 95% confidence interval, 0.81–1.21; cardioembolic: odds ratio, 1.14; 95% confidence interval, 0.75–1.73; other: odds ratio, 0.88; 95% confidence interval, 0.71–1.09).
Conclusions—
Our results showed that HTN is specifically related to the recurrent strokes in patients with small-vessel diseases, not other subtypes of IS.
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Affiliation(s)
- Yilong Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
| | - Jie Xu
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
| | - Xingquan Zhao
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
| | - David Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
| | - Chunxue Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
| | - Liping Liu
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
| | - Anxin Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
| | - Xia Meng
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
| | - Hao Li
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., J.X., X.Z., C.W., L.L., A.W., X.M., H.L., Y.W.); and INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria, IL (D.W.)
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