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April 01, 2014; 82 (13) Article

Prehypertension and the risk of stroke

A meta-analysis

Yuli Huang, Xiaoyan Cai, Yingying Li, Liang Su, Weiyi Mai, Sheng Wang, Yunzhao Hu, Yanxian Wu, Dingli Xu
First published March 12, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000268
Yuli Huang
From the Department of Cardiology (Y.H., Y.L., L.S., S.W., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Clinical Medicine Research Institute (X.C., Y.H., Y.W.), The First People's Hospital of Shunde, Foshan; and Department of Cardiology (W.M.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Xiaoyan Cai
From the Department of Cardiology (Y.H., Y.L., L.S., S.W., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Clinical Medicine Research Institute (X.C., Y.H., Y.W.), The First People's Hospital of Shunde, Foshan; and Department of Cardiology (W.M.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Yingying Li
From the Department of Cardiology (Y.H., Y.L., L.S., S.W., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Clinical Medicine Research Institute (X.C., Y.H., Y.W.), The First People's Hospital of Shunde, Foshan; and Department of Cardiology (W.M.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Liang Su
From the Department of Cardiology (Y.H., Y.L., L.S., S.W., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Clinical Medicine Research Institute (X.C., Y.H., Y.W.), The First People's Hospital of Shunde, Foshan; and Department of Cardiology (W.M.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Weiyi Mai
From the Department of Cardiology (Y.H., Y.L., L.S., S.W., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Clinical Medicine Research Institute (X.C., Y.H., Y.W.), The First People's Hospital of Shunde, Foshan; and Department of Cardiology (W.M.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Sheng Wang
From the Department of Cardiology (Y.H., Y.L., L.S., S.W., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Clinical Medicine Research Institute (X.C., Y.H., Y.W.), The First People's Hospital of Shunde, Foshan; and Department of Cardiology (W.M.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Yunzhao Hu
From the Department of Cardiology (Y.H., Y.L., L.S., S.W., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Clinical Medicine Research Institute (X.C., Y.H., Y.W.), The First People's Hospital of Shunde, Foshan; and Department of Cardiology (W.M.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Yanxian Wu
From the Department of Cardiology (Y.H., Y.L., L.S., S.W., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Clinical Medicine Research Institute (X.C., Y.H., Y.W.), The First People's Hospital of Shunde, Foshan; and Department of Cardiology (W.M.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Dingli Xu
From the Department of Cardiology (Y.H., Y.L., L.S., S.W., D.X.), Nanfang Hospital, Southern Medical University, Guangzhou; Clinical Medicine Research Institute (X.C., Y.H., Y.W.), The First People's Hospital of Shunde, Foshan; and Department of Cardiology (W.M.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Citation
Prehypertension and the risk of stroke
A meta-analysis
Yuli Huang, Xiaoyan Cai, Yingying Li, Liang Su, Weiyi Mai, Sheng Wang, Yunzhao Hu, Yanxian Wu, Dingli Xu
Neurology Apr 2014, 82 (13) 1153-1161; DOI: 10.1212/WNL.0000000000000268

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Abstract

Objective: In this meta-analysis, we sought to evaluate the association between prehypertension and the risk of stroke.

Methods: We searched PubMed and EMBASE databases for studies with data on prehypertension and stroke. Two independent reviewers assessed the reports and extracted data. Prospective studies were included if they reported multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) for the associations between stroke and prehypertension or its 2 subranges (low-range prehypertension: 120–129/80–84 mm Hg; high-range prehypertension: 130–139/85–89 mm Hg). We conducted subgroup analyses according to blood pressure ranges, stroke type, endpoint, age, sex, ethnicity, and study characteristics.

Results: Pooled data included the results of 762,393 participants from 19 prospective cohort studies. Prehypertension increased the risk of stroke (RR 1.66; 95% CI 1.51–1.81) compared with optimal blood pressure (<120/80 mm Hg). In the secondary outcome analyses, even low-range prehypertension increased the risk of stroke (RR 1.44; 95% CI 1.27–1.63), and the risk was greater for high-range prehypertension (RR 1.95; 95% CI 1.73–2.21). The RR was higher with high-range than with low-range prehypertension (p < 0.001). There were no significant differences in any of the subgroup analyses (all p > 0.05).

Conclusions: After adjusting for multiple cardiovascular risk factors, prehypertension is associated with stroke morbidity. Although the increased risk is largely driven by high-range prehypertension, the risk is also increased in people with low-range prehypertension.

GLOSSARY

BP=
blood pressure;
CI=
confidence interval;
CVD=
cardiovascular disease;
JNC 7=
seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure;
PAR=
population-attributable risk;
RR=
relative risk;
SE=
standard error

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received August 30, 2013.
  • Accepted in final form December 26, 2013.
  • © 2014 American Academy of Neurology
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