Among hypertensive patients with chronic coronary artery disease, an increased risk of stroke is predicted by black race, US residency, and conditions associated with worse vascular disease severity and arrhythmia, according to findings published in the February issue of
Stroke. "The propensity for increased blood pressure (BP) and coronary artery disease (CAD) to increase stroke risk has been known for more than two decades, yet our understanding of factors associated with stroke risk in patients with these conditions is incomplete," Dr. Carl J. Pepine, of the University of Florida College of Medicine, Gainesville, and colleagues write.
The researchers used data from the INternational VErapamil SR-trandolapril STudy (INVEST) to examine factors associated with the risk of stroke among hypertensive patients with CAD. They assessed the effect of baseline characteristics and on-treatment BP to determine the risk of fatal or non-fatal stroke among the 22,576 patients enrolled.
A total of 377 patients had an incident stroke during 61,835 patient-years of follow-up (6.1 strokes/1000 patient-years), and 104 patients had a fatal stroke.
An association was observed between an increased risk of stroke and older age, black race, US residency, and a history of arrhythmia, coronary artery bypass surgery, diabetes, smoking, and prior myocardial infarction.
More than 70 per cent of subjects achieved BP control (<140/90 mm Hg), and this was associated with a decreased risk of stroke. There was no significant difference in stroke risk between the verapamil SR-based treatment and the atenolol-based treatment.
"Our results strongly support the importance of reducing BP to <140/90 mm Hg for stroke prevention in CAD patients," Dr. Pepine's team concludes. They note that the effect of BP control in reducing stroke risk was apparent in patients with any of the high-risk characteristics identified.
