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Stroke hospitalization in the southern united states, 1979–1997
AJH
2000;13:233A–236A
D001 RELATION OF RENAL BLOOD FLOW AND CEREBRAL BLOOD FLOW AT PERFORATING ARTERY REGION IN ESSENTIAL HYPERTENSION K. Takatsugi, M. Mukai, H. Mawatari, K. Goya, K. Matsuzaki, and E. Murakami*. Hypertension Center, Kinki Central Hospital, Itami, Hyogo, Japan Arteriolosclerosis is an important vascular change induced by hypertension. Blood flow of kidney and perforating artery area in the brain in essential hypertensive patients are determined by the severity of arteriolosclerosis in each region. The aim of the study was to evaluate relation of effective renal plasma flow (ERPF) and regional cerebral blood flow (rCBF) including basal ganglia as perforating artery region in essential hypertension using renography and brain SPECT imaging. The study subjects were 28 essential hypertensive patients (56.2 ⫾ 10.5 years, M/F ⫽ 16/12). ERPF was determined by dynamic renal scintigraphy by clearance method using 99mTc-mercapto acetyl triglycine. The rCBF was quantitatively measured by N-isopropyl-p-[123I]iodoamphetamine autoradiography method. Regions of interest on rCBF images were set in the frontal, temporal, parietal, occipital cortex, the basal ganglia and the cerebellum. The rCBF in the frontal, temporal, parietal, occipital cortexes and the cerebellum were not correlated to ERPE However, the rCBF in the basal ganglia is significantly correlated to ERPF (r ⫽ 0.38, p ⬍ 0.05). We conclude that hypertensive arteriolosclerosis at the kidney and at perforating artery region in the brain develops in parallel. Key Words: Hypertension; cerebral blood flow; renal blood flow D002 24-HOUR NONINVASIVE CONTINUOUS FINGER BLOOD PRESSURE VARIABILITY AND CEREBRAL WHITE MATTER LESIONS. PRELIMINARY RESULTS E. Go´mez-Angelats, C. Sierra, A. de la Sierra*, M.T. Aguilera, E. Bragulat, M.T. Antonio, J.M. Mercader, A. Coca*. Hypertension Unit and Magnetic Resonance Unit. Hospital Clinic. Barcelona. Spain The aim of the present study was to assess the relationship of 24-hour noninvasive continuous finger blood pressure variability to the presence of cerebral white matter lesions (WML) in asymptomatic middle-aged untreated hypertensive patients. Seventeen mild to moderate never treated essential hypertensive patients (11 men, 6 women), aged 50 – 60 years, without clinical evidence of target organ damage were studied. All patients underwent a brain-magnetic resonance imaging and a 24-hour noninvasive beat-to-beat finger blood pressure monitoring by means of a Portapres device. Systolic (SBP), diastolic (DBP) and mean (MBP) blood pressures were obtained from each single pulse wave by the FAST software. We calculated 24-hour SBP, DBP, MBP, pulse pressure (PP) as well as short-term variability (average of the standard deviations obtained for each halfhour MBP) and long-term variability (standard deviation of © 2000 by the American Journal of Hypertension, Ltd. Published by Elsevier Science, Inc.
POSTERS: Cerebrovascular Disease/Stroke
the average of the half-hour MBP values). Preliminary results show that middle-aged hypertensives with silent cerebral WML have a tendency towards higher values of SBP, DBP, MBP, PP, and longterm variability than hypertensives without WML.
Portapres 24-h SBP Portapres 24-h DBP Portapres 24-h MBP Pulse pressure Short-term variability Long-term variability
Without WML (n ⴝ 9)
With WML (n ⴝ 8)
135.79 (13.05) 77.00 (10.02) 95.71 (9.67) 56.93 (13.03) 9.59 (1.41) 9.63 (2.87)
138.54 (11.21) 79.84 (6.97) 99.84 (6.27) 58.69 (10.82) 9.15 (1.26) 10.49 (1.80)
Data are mean (standard deviation). Values are expressed in mmHg.
These preliminary results suggest that, in addition to the severity of BP values, long-term Bp variability may be associated with the development of cerebral white matter lesions. Key Words: Continuous finger blood pressure; blood pressure variability; cerebral white matter lesions D003 STROKE HOSPITALIZATION IN THE SOUTHERN UNITED STATES, 1979 –1997 J. Fang, S. Madhavan, H. Cohen, M.H. Alderman*. Albert Einstein College of Medicine, Bronx, New York It is well known that stroke mortality is highest in the southern part of the United States. Less is known about stroke morbidity. We have analyzed the National Hospital Discharge Survey data 1979 –1997 to compare stroke hospitalization in the south to that of the rest of the country. From 1979 to 1997, total hospitalizations declined by 8% in the south and by 20% in the rest of the country. At the same time, stroke hospitalization increased by 76% in the south, thus increasing the percentage of all hospitalization related to stroke from 2.1–3.7%, and 55% (2.0% to 3.1%) in the rest of the country. Death among those hospitalized for stroke decreased by 48% (11.1% to 5.8%) in the south, and 53% (13.6% to 6.4%) in the rest of the country. In the south, during this time, stroke hospitalization increased more among nonblacks (81%,) thus increasing the percentage of all hospitalization due to stroke among non-blacks (2.1% to 3.8%), compared to blacks (55%) (2.0% to 3.1%). In the south, mortality among those hospitalized for stroke declined for blacks and non-blacks, although not smoothly, with average (1979 –1997) stroke mortality of 8.5% and 8.2% for blacks and non-blacks respectively. Hemorrhagic stroke was more common and increased more in blacks (11.2%–18.3%) than in non-blacks (6.3%–9.1%), while ischemic stroke was initially similar and increased slightly more among non-blacks (26.5%–51.9%) than blacks (25.3%– 47.6%). Of note, nonblacks had higher mortality than blacks for hemorrhagic stroke (32.4% vs 29.4%) and ischemic stroke (6.4% vs 6.1%). In summary, hospitalization for stroke in the south increased more, and mortality decreased less, than in the rest 0895-7061/00/$20.00
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ASH XV ABSTRACTS
of the country. Thus, in the southern United States, stroke morbidity remains a public health challenge for blacks and non-blacks that has yet to respond to ongoing preventive efforts. Key Words: Stroke; hospitalization; south; blacks D004 STROKE HOSPITALIZATION AND MORTALITY TREND (1979 –1997), UNITED STATES J. Fang, S. Madhavan, H. Cohen, M.H. Alderman*. Albert Einstein College of Medicine, New York Age-adjusted stroke mortality in the United States has declined in recent decades. However, there is little information about changes in morbidity. We have examined the National Hospital Discharge Survey data from 1979 to 1997 to determine stroke hospitalization. From 1979 to 1997, total noninstitutional hospitalization in the United States decreased from 36,746,563 to 30,914,167 (16%). At the same time, stroke (ICD-9 430 – 438) hospitalization increased by 36% (746,520 to 1,017,667). Thus, the percentage of stroke hospitalization increased by 65%, from 2.0% to 3.3%. The percentage of hospitalization accounted for by stroke defined as hemorrhagic and ischemic increased symmetrically from 6.5% to 11.2% and 26.6% to 49.5% respectively. Mortality among hospitalized stroke patients decreased from 13.5% to 6.3% (53%), but the percentage reduction was greater for ischemic (70.5%) than hemorrhagic (40.5%) stroke. Thus, over the past 20 pears, in the face of decreased overall hospitalization, the number of stroke hospitalization has increased by more than 1/3. Precision of diagnosis has sharply increased, but the proportion of hemorrhagic vs ischemic remains unchanged, as does the increased risk of death associated with hemorrhagic stroke. Thus, it appears that decreased case fatality, and not reduced incidence, account for declining stroke mortality in the US.
Key Words: Stroke; hospitalization; mortality D005 CLINICAL CHARACTERISTICS OF STROKE AMONG CHINESE PATIENTS S.H. Foo, J. Fang, J.S. Jeng, P.K. Yip, M.H. Alderman*. New York University Downtown Hospital, New York, NY, and Albert Einstein College of Medicine, Bronx, NY To compare the characteristics and experience of Chinese patients experiencing stroke with others in New York City, we have reviewed the medical records of stroke patients hospitalized at New York University Downtown hospital from January 1995 to July 1998. During three and half years, there were 843 stroke patients admitted (Chinese 499, whites
AJH–APRIL 2000 –VOL. 13, NO. 4, PART 2
153, blacks 88, Hispanics 99 and other Asia 4). Compared to other race/ethnic groups, Chinese stroke patients were older 71.5 vs 69.7 (whites), 62.6 (blacks), and 64.9 (Hispanics) p ⬍ 0.01); had lower body mass index (22.8 vs 26.1, 26.2 and 25.2 respectively) (p ⬍ 0.01), were less likely to smoke (11.8% vs 22.2%, 22.7 and 32.3%, p ⬍ 0.01), to regularly drink alcohol (7.8% vs 28.1%, 34.1% and 29.3%, p ⬍ 0.01). Chinese and blacks were more likely, and whites least likely, to have history of hypertension, untreated hypertension, and left ventricular hypertrophy. Compared with other race/ethnic groups, Chinese had the highest risk of hemorrhagic stroke (19.2% vs 12.4%, 12.5% and 11.1%). Overall hospital mortality was 12% with no significant difference between groups. Hemorrhagic stroke was more likely to be fatal than ischemic stroke (35.3% vs 7.0%, p ⬍ 0.001). However, Chinese patients had the lowest hospital death rates for both hemorrhagic and ischemic stroke, compared to whites, blacks and Hispanics (6.1% vs 9.5%, 8.1% and 7.6% for ischemic stroke, 31.3% vs 31.6%, 54.5% and 54.5% for hemorrhagic stroke, p ⬍ 0.05). Controlling for age and gender, the variables significantly predictive of hospital deaths for stroke (odds ratios and 95% confidence interval) are SBP (1.02, 1.01–1.03), blood sugar (1.01, 1.005–1.016), and hemorrhagic stroke (5.53, 1.96 –15.61). These associations were similar for all groups. Although Chinese stroke patients different in important ways from others, mortality rate did not, despite the fact that Chinese were more likely to experience the more lethal hemorrhagic than ischemic form of stroke. Key Words: Stroke; Chinese patients; clinical characteristics D006 LIPIDS AND FIBRINOGEN PLASMA LEVELS IN ISCHEMIC AND HEMORRHAGIC STROKE. OUR EXPERIENCE IN 2538 PATIENTS G.N. Ziakas, A.I. Hatzitolios, C.G. Savopoulos, A.D. Kounanis, J.P. Christoforidis, A.G. Ziakas. 1st Medical Prop. DeptAHEPA Hospital, Aristotelian University, Thessaloniki, Greece Purpose: Lipids and fibrinogen plasma levels have already been considered as independent risk factors for stroke. In this study we compared these factors in patients with ischemic and hemorrhagic stroke. Design and method: we studied 2538 patients in a period of 6 years (1993–1999). 2380 with ischemic stroke (1131 male and 1249 female patients with mean age 73,16 ⫾ 8,86 years ) and 156 with hemorrhagic stroke (72 male and 84 female patients with mean age 71,12 ⫾ 7,33 years). Plasma levels of cholesterol, triglycerides, HDL and fibrinogen were determined and the analysis was made using t-test for means. The results (mean ⫾ SD ) were as follows: Conclusions: a: the statistical analysis indicated significant relation between plasma cholesterol levels and ischemic stroke, while these levels seem to be lower in patients with hemorrhagic stroke. b: there was also significant relation between plasma triglycerides levels and ischemic stroke. c: no significant difference was observed in HDL and fibrinogen levels among patients with ischemic or hemorrhagic stroke.
2000;13:233A–236A
D001 RELATION OF RENAL BLOOD FLOW AND CEREBRAL BLOOD FLOW AT PERFORATING ARTERY REGION IN ESSENTIAL HYPERTENSION K. Takatsugi, M. Mukai, H. Mawatari, K. Goya, K. Matsuzaki, and E. Murakami*. Hypertension Center, Kinki Central Hospital, Itami, Hyogo, Japan Arteriolosclerosis is an important vascular change induced by hypertension. Blood flow of kidney and perforating artery area in the brain in essential hypertensive patients are determined by the severity of arteriolosclerosis in each region. The aim of the study was to evaluate relation of effective renal plasma flow (ERPF) and regional cerebral blood flow (rCBF) including basal ganglia as perforating artery region in essential hypertension using renography and brain SPECT imaging. The study subjects were 28 essential hypertensive patients (56.2 ⫾ 10.5 years, M/F ⫽ 16/12). ERPF was determined by dynamic renal scintigraphy by clearance method using 99mTc-mercapto acetyl triglycine. The rCBF was quantitatively measured by N-isopropyl-p-[123I]iodoamphetamine autoradiography method. Regions of interest on rCBF images were set in the frontal, temporal, parietal, occipital cortex, the basal ganglia and the cerebellum. The rCBF in the frontal, temporal, parietal, occipital cortexes and the cerebellum were not correlated to ERPE However, the rCBF in the basal ganglia is significantly correlated to ERPF (r ⫽ 0.38, p ⬍ 0.05). We conclude that hypertensive arteriolosclerosis at the kidney and at perforating artery region in the brain develops in parallel. Key Words: Hypertension; cerebral blood flow; renal blood flow D002 24-HOUR NONINVASIVE CONTINUOUS FINGER BLOOD PRESSURE VARIABILITY AND CEREBRAL WHITE MATTER LESIONS. PRELIMINARY RESULTS E. Go´mez-Angelats, C. Sierra, A. de la Sierra*, M.T. Aguilera, E. Bragulat, M.T. Antonio, J.M. Mercader, A. Coca*. Hypertension Unit and Magnetic Resonance Unit. Hospital Clinic. Barcelona. Spain The aim of the present study was to assess the relationship of 24-hour noninvasive continuous finger blood pressure variability to the presence of cerebral white matter lesions (WML) in asymptomatic middle-aged untreated hypertensive patients. Seventeen mild to moderate never treated essential hypertensive patients (11 men, 6 women), aged 50 – 60 years, without clinical evidence of target organ damage were studied. All patients underwent a brain-magnetic resonance imaging and a 24-hour noninvasive beat-to-beat finger blood pressure monitoring by means of a Portapres device. Systolic (SBP), diastolic (DBP) and mean (MBP) blood pressures were obtained from each single pulse wave by the FAST software. We calculated 24-hour SBP, DBP, MBP, pulse pressure (PP) as well as short-term variability (average of the standard deviations obtained for each halfhour MBP) and long-term variability (standard deviation of © 2000 by the American Journal of Hypertension, Ltd. Published by Elsevier Science, Inc.
POSTERS: Cerebrovascular Disease/Stroke
the average of the half-hour MBP values). Preliminary results show that middle-aged hypertensives with silent cerebral WML have a tendency towards higher values of SBP, DBP, MBP, PP, and longterm variability than hypertensives without WML.
Portapres 24-h SBP Portapres 24-h DBP Portapres 24-h MBP Pulse pressure Short-term variability Long-term variability
Without WML (n ⴝ 9)
With WML (n ⴝ 8)
135.79 (13.05) 77.00 (10.02) 95.71 (9.67) 56.93 (13.03) 9.59 (1.41) 9.63 (2.87)
138.54 (11.21) 79.84 (6.97) 99.84 (6.27) 58.69 (10.82) 9.15 (1.26) 10.49 (1.80)
Data are mean (standard deviation). Values are expressed in mmHg.
These preliminary results suggest that, in addition to the severity of BP values, long-term Bp variability may be associated with the development of cerebral white matter lesions. Key Words: Continuous finger blood pressure; blood pressure variability; cerebral white matter lesions D003 STROKE HOSPITALIZATION IN THE SOUTHERN UNITED STATES, 1979 –1997 J. Fang, S. Madhavan, H. Cohen, M.H. Alderman*. Albert Einstein College of Medicine, Bronx, New York It is well known that stroke mortality is highest in the southern part of the United States. Less is known about stroke morbidity. We have analyzed the National Hospital Discharge Survey data 1979 –1997 to compare stroke hospitalization in the south to that of the rest of the country. From 1979 to 1997, total hospitalizations declined by 8% in the south and by 20% in the rest of the country. At the same time, stroke hospitalization increased by 76% in the south, thus increasing the percentage of all hospitalization related to stroke from 2.1–3.7%, and 55% (2.0% to 3.1%) in the rest of the country. Death among those hospitalized for stroke decreased by 48% (11.1% to 5.8%) in the south, and 53% (13.6% to 6.4%) in the rest of the country. In the south, during this time, stroke hospitalization increased more among nonblacks (81%,) thus increasing the percentage of all hospitalization due to stroke among non-blacks (2.1% to 3.8%), compared to blacks (55%) (2.0% to 3.1%). In the south, mortality among those hospitalized for stroke declined for blacks and non-blacks, although not smoothly, with average (1979 –1997) stroke mortality of 8.5% and 8.2% for blacks and non-blacks respectively. Hemorrhagic stroke was more common and increased more in blacks (11.2%–18.3%) than in non-blacks (6.3%–9.1%), while ischemic stroke was initially similar and increased slightly more among non-blacks (26.5%–51.9%) than blacks (25.3%– 47.6%). Of note, nonblacks had higher mortality than blacks for hemorrhagic stroke (32.4% vs 29.4%) and ischemic stroke (6.4% vs 6.1%). In summary, hospitalization for stroke in the south increased more, and mortality decreased less, than in the rest 0895-7061/00/$20.00
234A
ASH XV ABSTRACTS
of the country. Thus, in the southern United States, stroke morbidity remains a public health challenge for blacks and non-blacks that has yet to respond to ongoing preventive efforts. Key Words: Stroke; hospitalization; south; blacks D004 STROKE HOSPITALIZATION AND MORTALITY TREND (1979 –1997), UNITED STATES J. Fang, S. Madhavan, H. Cohen, M.H. Alderman*. Albert Einstein College of Medicine, New York Age-adjusted stroke mortality in the United States has declined in recent decades. However, there is little information about changes in morbidity. We have examined the National Hospital Discharge Survey data from 1979 to 1997 to determine stroke hospitalization. From 1979 to 1997, total noninstitutional hospitalization in the United States decreased from 36,746,563 to 30,914,167 (16%). At the same time, stroke (ICD-9 430 – 438) hospitalization increased by 36% (746,520 to 1,017,667). Thus, the percentage of stroke hospitalization increased by 65%, from 2.0% to 3.3%. The percentage of hospitalization accounted for by stroke defined as hemorrhagic and ischemic increased symmetrically from 6.5% to 11.2% and 26.6% to 49.5% respectively. Mortality among hospitalized stroke patients decreased from 13.5% to 6.3% (53%), but the percentage reduction was greater for ischemic (70.5%) than hemorrhagic (40.5%) stroke. Thus, over the past 20 pears, in the face of decreased overall hospitalization, the number of stroke hospitalization has increased by more than 1/3. Precision of diagnosis has sharply increased, but the proportion of hemorrhagic vs ischemic remains unchanged, as does the increased risk of death associated with hemorrhagic stroke. Thus, it appears that decreased case fatality, and not reduced incidence, account for declining stroke mortality in the US.
Key Words: Stroke; hospitalization; mortality D005 CLINICAL CHARACTERISTICS OF STROKE AMONG CHINESE PATIENTS S.H. Foo, J. Fang, J.S. Jeng, P.K. Yip, M.H. Alderman*. New York University Downtown Hospital, New York, NY, and Albert Einstein College of Medicine, Bronx, NY To compare the characteristics and experience of Chinese patients experiencing stroke with others in New York City, we have reviewed the medical records of stroke patients hospitalized at New York University Downtown hospital from January 1995 to July 1998. During three and half years, there were 843 stroke patients admitted (Chinese 499, whites
AJH–APRIL 2000 –VOL. 13, NO. 4, PART 2
153, blacks 88, Hispanics 99 and other Asia 4). Compared to other race/ethnic groups, Chinese stroke patients were older 71.5 vs 69.7 (whites), 62.6 (blacks), and 64.9 (Hispanics) p ⬍ 0.01); had lower body mass index (22.8 vs 26.1, 26.2 and 25.2 respectively) (p ⬍ 0.01), were less likely to smoke (11.8% vs 22.2%, 22.7 and 32.3%, p ⬍ 0.01), to regularly drink alcohol (7.8% vs 28.1%, 34.1% and 29.3%, p ⬍ 0.01). Chinese and blacks were more likely, and whites least likely, to have history of hypertension, untreated hypertension, and left ventricular hypertrophy. Compared with other race/ethnic groups, Chinese had the highest risk of hemorrhagic stroke (19.2% vs 12.4%, 12.5% and 11.1%). Overall hospital mortality was 12% with no significant difference between groups. Hemorrhagic stroke was more likely to be fatal than ischemic stroke (35.3% vs 7.0%, p ⬍ 0.001). However, Chinese patients had the lowest hospital death rates for both hemorrhagic and ischemic stroke, compared to whites, blacks and Hispanics (6.1% vs 9.5%, 8.1% and 7.6% for ischemic stroke, 31.3% vs 31.6%, 54.5% and 54.5% for hemorrhagic stroke, p ⬍ 0.05). Controlling for age and gender, the variables significantly predictive of hospital deaths for stroke (odds ratios and 95% confidence interval) are SBP (1.02, 1.01–1.03), blood sugar (1.01, 1.005–1.016), and hemorrhagic stroke (5.53, 1.96 –15.61). These associations were similar for all groups. Although Chinese stroke patients different in important ways from others, mortality rate did not, despite the fact that Chinese were more likely to experience the more lethal hemorrhagic than ischemic form of stroke. Key Words: Stroke; Chinese patients; clinical characteristics D006 LIPIDS AND FIBRINOGEN PLASMA LEVELS IN ISCHEMIC AND HEMORRHAGIC STROKE. OUR EXPERIENCE IN 2538 PATIENTS G.N. Ziakas, A.I. Hatzitolios, C.G. Savopoulos, A.D. Kounanis, J.P. Christoforidis, A.G. Ziakas. 1st Medical Prop. DeptAHEPA Hospital, Aristotelian University, Thessaloniki, Greece Purpose: Lipids and fibrinogen plasma levels have already been considered as independent risk factors for stroke. In this study we compared these factors in patients with ischemic and hemorrhagic stroke. Design and method: we studied 2538 patients in a period of 6 years (1993–1999). 2380 with ischemic stroke (1131 male and 1249 female patients with mean age 73,16 ⫾ 8,86 years ) and 156 with hemorrhagic stroke (72 male and 84 female patients with mean age 71,12 ⫾ 7,33 years). Plasma levels of cholesterol, triglycerides, HDL and fibrinogen were determined and the analysis was made using t-test for means. The results (mean ⫾ SD ) were as follows: Conclusions: a: the statistical analysis indicated significant relation between plasma cholesterol levels and ischemic stroke, while these levels seem to be lower in patients with hemorrhagic stroke. b: there was also significant relation between plasma triglycerides levels and ischemic stroke. c: no significant difference was observed in HDL and fibrinogen levels among patients with ischemic or hemorrhagic stroke.