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(Hypertension. 2007;49:799.)
© 2007 American Heart Association, Inc.

Original Articles

Differences in Blood Pressure Control and Stroke Mortality Across Spain

The Prevención de Riesgo de Ictus (PREV-ICTUS) Study

Josep Redón; Luis Cea-Calvo; José V. Lozano; Juan C. Martí-Canales; José L. Llisterri; Jose Aznar; Jorge González-Esteban on behalf of the investigators of the PREV-ICTUS Study

From the Hypertension Clinic (J.R.), Hospital Clínico Universitario, Universidad de Valencia, Spain; the Clinical Research Department (L.C.-C., J.G.-E.), Merck, Sharp, and Dohme de España, Madrid, Spain; Serrería 2 Health Center (J.V.L.), Valencia, Spain; the Orcera Health Center (J.C.M.-C.), Jaen, Spain; Ingeniero Joaquín Benlloch Health Center (J.L.L.), Valencia, Spain; and the Research Unit (J.A.), Hospital Marina Alta, Denia, Spain.

Correspondence to Josep Redon, Hypertension Clinic, Internal Medicine, Hospital Clinico, University of Valencia, 46010 Valencia, Spain. E-mail: josep.redon{at}uv.es

The objective was to assess the stroke risk and prevalence of the cardiovascular risk factors and to analyze their relationship with the specific stroke rates of mortality in each of the autonomic communities of Spain. We conducted a multicenter, cross-sectional study of population >60 years old in Spanish primary care centers. In all of the subjects, clinical, biochemical, and electrocardiographic data were obtained, and the 10-year stroke risk was calculated using the Framingham score. Mortality rates of stroke, age and sex adjusted, were obtained for each of the autonomic communities from the Ministry of Health. A total of 7343 subjects (mean age: 71.6 years, 53.4% women, 34.4% obese, and 27.1% diabetic subjects) were analyzed. A total of 73% were already diagnosed with hypertension. Among hypertensive subjects, 29.1% had blood pressure on therapeutic objective, and, of the total population, 35.7% had blood pressure under control. ECG–left ventricular hypertrophy was present in 12.9% of the subjects. The estimated stroke risk was 19.6%. Stroke mortality rates were significantly related to the estimated 10-year stroke risk (r=0.41; P<0.05) in each autonomic community. Poor hypertension control (P=–0.42; P<0.05) and prevalence of ECG–left ventricular hypertrophy (P=0.52; P<0.05) were the main factors related to the stroke mortality rates after controlling by age, sex, obesity, diabetes, and urban setting. Differences in stroke mortality throughout the autonomic communities of Spain were associated with indexes of worse blood pressure handling, low control rates, and high left-ventricular hypertrophy.

Key Words: hypertension • blood pressure • stroke • elderly • risk factors • stroke mortality • autonomic communities of Spain

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