Effect of blood pressure on recovery outcomes in inpatients with atherothrombotic infarction: A retrospective cross-sectional study

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Abstract

Stroke is one of the leading causes of death worldwide, and the relationship between blood pressure (BP) and outcomes after atherothrombotic infarction has been studied from various perspectives. However, the relationship of BP with rehabilitation outcomes and activities of daily living after atherothrombotic infarction has not been studied extensively. This study aims to investigate the effect of BP on rehabilitation outcomes and activities of daily living after atherothrombotic infarction. In this retrospective cross-sectional study, we analyzed data obtained from the Japan Association of Rehabilitation Database for inpatients undergoing rehabilitation using Wilcoxon’s test, Pearson’s chi-squared test, or Fisher’s exact test. The patients were initially categorized into hypertensive and non-hypertensive groups and were assessed using the 10-item Barthel index (BI) activities and total BI at hospital discharge. The patients were further dichotomized into dependent (patients with scores of 0 for each activity) and nondependent groups based on the BI activities. Compared with hypertensive conditions (n = 108), non-hypertensive conditions (n = 213) were associated with higher dependence (feeding, transfers, toilet use, dressing, and bowel and bladder control). The proportion of non-hypertensive patients with a severely low BI (0–15) was higher than that of hypertensive patients. The hypertensive group had a greater increase in the BI (25 vs 15, P = .006) and daily BI (1.2 vs 0.74, P = .014) than the non-hypertensive group. During in-hospital rehabilitation, hypertensive patients recovered more efficiently than their non-hypertensive counterparts, emphasizing the need for personalized rehabilitation plans based on their individual BP profiles. Our results underscore the impact of BP on inpatients after atherothrombotic infarction, indicating that more non-hypertensive inpatients are affected by BP while receiving treatment than are hypertensive inpatients during rehabilitation.

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Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Fakher Rahim, Yasir Waheed, Yanzhong Wang (2022)

Summary Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.

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FUNCTIONAL EVALUATION: THE BARTHEL INDEX.

F I MAHONEY, D BARTHEL (1965)

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Stroke Risk Factors, Genetics, and Prevention.

Amelia K. Boehme, Charles Esenwa, Mitchell S. V. Elkind (2017)

Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention.

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Author and article information

Contributors

Tetsuo Nishikawa:

ORCID: https://orcid.org/0000-0002-8271-7368

Tetsuo Ota:

ORCID: https://orcid.org/0000-0001-5739-9153

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MD

Title: Medicine

Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: 14 March 2025

Publication date (Electronic): 14 March 2025

Volume: 104

Issue: 11

Electronic Location Identifier: e41796

Affiliations

[a ] Department of Physical Medicine and Rehabilitation, Sunagawa City Medical Center, Sunagawa, Hokkaido, Japan

[b ] Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan

[c ] Department of Physical Medicine and Rehabilitation, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan.

Author notes

[* ]Correspondence: Naohito Saito, Department of Physical Medicine and Rehabilitation, Sunagawa City Medical Center, W4N3-1-1, Sunagawa, Hokkaido 073-0196, Japan (e-mail: 10q711246@ 123456gmail.com ).

Author information

Naohito Saito https://orcid.org/0000-0003-2820-8500

Tetsuo Nishikawa https://orcid.org/0000-0002-8271-7368

Tetsuo Ota https://orcid.org/0000-0001-5739-9153

Article

Publisher ID: MD-D-24-00794 Accession ID: 00006

DOI: 10.1097/MD.0000000000041796

PMC ID: 11922399

PubMed ID: 40101026

SO-VID: 1a5b5ba8-49ef-497a-b210-16ca97ed694b

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 25 January 2024

Date received : 10 February 2025

Date accepted : 20 February 2025

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Keywords: activities of daily living,atherothrombotic infarction,barthel index,blood pressure,rehabilitation

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Keywords: activities of daily living, atherothrombotic infarction, barthel index, blood pressure, rehabilitation

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Effect of blood pressure on recovery outcomes in inpatients with atherothrombotic infarction: A retrospective cross-sectional study

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Most cited references 31

Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

FUNCTIONAL EVALUATION: THE BARTHEL INDEX.

Stroke Risk Factors, Genetics, and Prevention.

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