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Social and Economic Implications of Stroke Prevention

Epidemiologists demonstrated in the 1950S and '6os that the risk of stroke increases rapidly with a rise in both systolic and diastolic blood pressures; risk is greater if diastolic pressures are 100 compared to go mm Hg; risk of stroke is greater if the systolic pressure is 16o compared to 140 mm Hg (1). Although the incidence of strokes in men at a given diastolic pressure is higher than in women, the number of strokes is higher in women because more of them survive to ages above 75 years. Risk of stroke is clearly related to the aging process, with the majority of strokes occurring in patients 65 years of age and over. In fact, over 6o percent of strokes occur in individuals over 65 years of age and over 75 percent occur in patients 55 years of age and over (Fig. 1). The Chicago Stroke Study (2) also demonstrated that stroke risk is increased with isolated systolic elevations above 18o mm Hg; stroke death rate is more than doubled when compared to persons with systolic pressures between 135 and 16o mm Hg. It is clear, therefore, that the older the patient and the higher the blood pressure, the greater the risk of stroke. High blood pressure is a common condition, affecting over 30 million people in the United States. Incidence of hypertension increases with age; over the age of so more than 20 percent, and over the age of 6o more than 30 percent of the population have elevated blood pressure. Over 6o percent of strokes and over 70 percent of intracerebral hemorrhages occur