O' Donnell Martin, Hankey Graeme J, Rangarajan Sumathy, Chin Siu Lim, Rao-Melacini Purnima, Ferguson John, Xavier Denis, Lisheng Liu, Zhang Hongye, Pais Prem, Lopez-Jaramillo Patricio, Damasceno Albertino, Langhorne Peter, Rosengren Annika, Dans Antonio L, Elsayed Ahmed, Avezum Alvaro, Mondo Charles, Smyth Andrew, Judge Conor, Diener Hans-Christoph, Ryglewicz Danuta, Czlonkowska Anna, Pogosova Nana, Weimar Christian, Iqbal Romana, Diaz Rafael, Yusoff Khalid, Yusufali Afzalhussein, Oguz Aytekin, Wang Xingyu, Penaherrera Ernesto, Lanas Fernando, Ogah Okechukwu Samuel, Ogunniyi Adensola, Iversen Helle K, Malaga German, Rumboldt Zvonko, Oveisgharan Shahram, AlHussain Fawaz, Daliwonga Magazi, Nilanont Yongchai, Yusuf Salim
HRB-Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
Heart. 2020 Dec 14. doi: 10.1136/heartjnl-2019-316515.
Hypertension is the most important modifiable risk factor for stroke globally. We hypothesised that country-income level variations in knowledge, detection and treatment of hypertension may contribute to variations in the association of blood pressure with stroke.
We undertook a standardised case-control study in 32 countries (INTERSTROKE). Cases were patients with acute first stroke (n=13 462) who were matched by age, sex and site to controls (n=13 483). We evaluated the associations of knowledge, awareness and treatment of hypertension with risk of stroke and its subtypes and whether this varied by gross national income (GNI) of country. We estimated OR and population attributable risk (PAR) associated with treated and untreated hypertension.
Hypertension was associated with a graded increase in OR by reducing GNI, ranging from OR 1.92 (99% CI 1.48 to 2.49) to OR 3.27 (2.72 to 3.93) for highest to lowest country-level GNI (p-heterogeneity<0.0001). Untreated hypertension was associated with a higher OR for stroke (OR 5.25; 4.53 to 6.10) than treated hypertension (OR 2.60; 2.32 to 2.91) and younger age of first stroke (61.4 vs 65.4 years; p<0.01). Untreated hypertension was associated with a greater risk of intracerebral haemorrhage (OR 6.95; 5.61 to 8.60) than ischaemic stroke (OR 4.76; 3.99 to 5.68). The PAR associated with untreated hypertension was higher in lower-income regions, PAR 36.3%, 26.3%, 19.8% to 10.4% by increasing GNI of countries. Lifetime non-measurement of blood pressure was associated with stroke (OR 1.80; 1.32 to 2.46).
Deficits in knowledge, detection and treatment of hypertension contribute to higher risk of stroke, younger age of onset and larger proportion of intracerebral haemorrhage in lower-income countries.
高血压是全球范围内导致中风最重要的可改变风险因素。我们推测，不同国家收入水平在高血压知识、检测和治疗方面的差异，可能导致血压与中风之间关联的差异。
我们在32个国家开展了一项标准化病例对照研究（INTERSTROKE）。病例为急性首次中风患者（n = 13462），按年龄、性别和发病部位与对照（n = 13483）进行匹配。我们评估了高血压知识、知晓率和治疗与中风及其亚型风险之间的关联，以及这种关联是否因国家国民总收入（GNI）不同而有所差异。我们估计了与治疗和未治疗高血压相关的比值比（OR）和人群归因风险（PAR）。
随着国民总收入降低，高血压与OR分级增加相关，从国家层面最高国民总收入时的OR 1.92（99%可信区间1.48至2.49）到最低国民总收入时的OR 3.27（2.72至3.93）（p异质性<0.0001）。未治疗的高血压与中风的OR（OR 5.25；4.53至6.10）高于治疗的高血压（OR 2.60；2.32至2.91），且首次中风年龄更小（61.4岁对65.4岁；p<0.01）。未治疗的高血压与脑出血风险（OR 6.95；5.61至8.60）高于缺血性中风（OR 4.76；3.99至5.68）。低收入地区与未治疗高血压相关的PAR更高，随着国家国民总收入增加，PAR分别为36.3%、26.3%、19.8%至10.4%。终生未测量血压与中风相关（OR 1.80；1.32至2.46）。
低收入国家在高血压知识、检测和治疗方面的不足导致中风风险更高、发病年龄更小以及脑出血比例更大。
