Hypertension control tied to decline in stroke mortality

Antihypertensive therapy is likely the main reason for the dramatic drop in stroke fatalities in the past 50 years, a study has shown.

The “accelerated decline in stroke mortality that began in the 1970s is consistent with the aggressive hypertension treatment and control strategies implemented in that period. The decrease in blood pressure with drug therapy appears to be the major determinant of reduction in the risk of stroke and stroke deaths,” wrote a professor of epidemiology at the Medical University of South Carolina, Charleston.

Statins, diabetes drugs, public health efforts, increased research, improved imaging, and quicker and better stroke treatment, also has helped. People have lost weight, cut salt from their diets, and quit smoking. But the evidence is strongest for hypertension control in accounting for the stroke mortality rate reduction from 88/100,000 in 1950 to 23/100,000 in 2010 – a reduction that holds across racial, age, and gender lines, the authors said.

The decline began at  the start of the 20th century, decades before hypertension treatment, but “the slope of the decline accelerated significantly after the introduction of tolerable antihypertensive drug therapy in the 1960s,” they wrote. Stroke is now the fourth leading cause of death in this country, instead of the third. Recurrent and first-time strokes are down.

Great racial disparities still exist in stroke mortality, particularly for blacks, but ‘the decline in stroke mortality for all racial/ethnic groups has reduced the magnitude of the racial/ethnic gap in stroke mortality risks and likewise that variation in stroke mortality by geographic area, with particular emphasis in the Stroke Belt,” the researchers noted.

“The decline is real, not a statistical fluke or the result of more people dying of lung disease, the third leading cause of death.

It’s also not due to changes in billing codes, diagnostic improvements, death certificates cause of death, or other factors. It is “one of the major public health successes of the past 50 years.”

They looked at literature reviews, morbidity and mortality reports, clinical and public health guidelines, and expert opinion.

They noted that advanced neuro-imaging “might improve the diagnosis of milder, less-fatal strokes over time. This would result in an apparent decline in the stroke case-fatality rate, solely as a result of improved detection. [But] this should not result in a change in stroke mortality over time unless technological advances improve the diagnosis of more severe, fatal strokes also, which seems unlikely.”