Death risk highest for people with hypertension who had a stroke

People who have chronic conditions such as high blood pressure and diabetes are more likely to die prematurely, regardless of whether they have had a stroke or a blood clot, according to a new study by the Harvard T.H. Chan School of Public Health.

The finding, published July 13 in JAMA Internal Medicine, suggests that the treatment of cardiovascular disease (CVD) may be an effective way to reduce premature death, since it can reduce the likelihood of patients developing other disorders.

The researchers found that people who had a stroke were at risk for premature mortality only if they had hypertension and diabetes. Overall, 3 in every 1,000 stroke survivors had chronic blood disorders, such as hypertension and diabetes. These disorders increased the likelihood of premature death by 7 percent.

“The effect of more severe treatments such as stroke and heart attack on premature mortality has received less attention,” said co-author Richard Kurr, associate professor of community health sciences at Harvard Chan School.

CVD accounts for roughly 8% of all male deaths and results in approximately 35 percent of all stroke survivors surviving at least 20 years after a stroke.

High blood pressure controls 1 in 3 strokes patients with hypertension and 2 in 3 strokes patients with diabetes have a heart attack, while diabetes controls 1 in 5 strokes patients with high blood pressure and 1 in 4 strokes patients with diabetes have a heart attack or diabetes.

The researchers found that in people with consistent CVD or hypertension:

Over 6 years of follow-up, mortality rates on the compared patient group were elevated for both hypertension and diabetes.

Cardiovascular disease relative risks, which account for other medical conditions, were approximately 1.3 and 0.9 times higher, respectively, in stroke survivors with baseline CVD risk.

“These findings suggest that complications due to CVD in stroke survivors may be due to another pathophysiological process, especially hypertension and diabetes, causing premature death in most cases,” Kurr said.

The study did not investigate how to prevent CVD-related premature mortality and death in stroke survivors. Kurr said it is not possible to prevent stroke and CVD-related premature death in individuals at high risk for CVD, he noted. “This is especially true in those who were already predisposed to having such predisposition,” Kurr said.