Postural Changes in Blood Pressure and Incidence of Ischemic Stroke Subtypes
Key result
Orthostatic systolic BP decrease ≥20 mm Hg increased the risk of nonlacunar thrombotic (HR 2.02; 95% CI 1.43-2.84) and cardioembolic strokes, while lacunar stroke showed a U-shaped association.
Why the study?
Does orthostatic blood pressure change predict the incidence of ischemic stroke subtypes in individuals without a history of stroke?
Population
12,817 black and white individuals without a history of stroke at baseline from the Atherosclerosis Risk in…
Design
Cohort
Follow-up
median 18.7 years
Authors
Discussion
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Implication
Orthostatic hypotension is an independent risk factor for nonlacunar thrombotic and cardioembolic strokes, while both orthostatic increases and decreases in systolic blood pressure are associated with lacunar strokes.
Key Points
- This research aims to explore the relationship between orthostatic blood pressure changes and the incidence of ischemic stroke subtypes.
- Analyzed data from the Atherosclerosis Risk in Communities Study (1987-1989) involving 12,817 individuals without history of stroke.
- Followed participants for median 18.7 years to assess the incidence of ischemic strokes and their subtypes.
- Utilized hazard ratios to determine associations with orthostatic changes in systolic and diastolic blood pressure.
- Found a U-shaped association between orthostatic systolic blood pressure change and lacunar stroke incidence (quadratic P=0.004).
- Orthostatic systolic blood pressure decrease of 20 mm Hg or more was linked to increased risks of nonlacunar thrombotic (HR 2.02; 95% CI 1.43-2.84) and cardioembolic strokes (HR 1.85; 95% CI 1.01-3.39).
- Each 10 mm Hg decrease in diastolic blood pressure increased the risk of nonlacunar thrombotic (HR 1.26; 95% CI 1.06-1.50) and cardioembolic strokes (HR 1.41; 95% CI 1.06-1.88).
Study Design
Type
Cohort (n=12,817)
Multicenter
Yes
Structured PICO
Does orthostatic blood pressure change predict the incidence of ischemic stroke subtypes in individuals without a history of stroke?
P
Population
12,817 black and white individuals without a history of stroke at baseline, followed for a median of 18.7 years.
E
Exposure
Orthostatic blood pressure change (within 2 minutes after supine to standing)
O
Outcome
Incidence of ischemic stroke subtypes (lacunar, nonlacunar thrombotic, and cardioembolic strokes)hard clinical
Main Result
Hazard Ratio: 2.02 (95% CI 1.43–2.84)
Orthostatic hypotension is an independent risk factor for nonlacunar thrombotic and cardioembolic strokes, while both orthostatic increases and decreases in systolic blood pressure are associated with lacunar strokes.
Cite This Study
Yatsuya et al. (2011) conducted a cohort in Ischemic stroke (n=12,817). Orthostatic systolic blood pressure decrease of ≥20 mm Hg vs. Reference group (no orthostatic decrease) was evaluated on Nonlacunar thrombotic stroke (HR 2.02, 95% CI 1.43 to 2.84). Orthostatic systolic BP decrease ≥20 mm Hg increased the risk of nonlacunar thrombotic (HR 2.02; 95% CI 1.43-2.84) and cardioembolic strokes, while lacunar stroke showed a U-shaped association.