Residual risk for acute stroke in patients with type 2 diabetes and hypertension in primary care: Skaraborg Hypertension and Diabetes Project.
OBJECTIVE
The aim of this study was to investigate the risk of acute stroke in subgroups of patients treated for hypertension and type 2 diabetes in primary care.


METHODS
Patients with hypertension only (n = 695), type 2 diabetes only (n = 181) or both (n = 240), who consecutively attended an annual control in primary care in Skara, Sweden during 1992-1993, were evaluated for cardiovascular disease risk factors and enrolled in this study. Subjects with neither hypertension nor type 2 diabetes (n = 824) who participated in a population survey in the same community served as controls. Possible events of acute stroke through 2002 were validated using hospital records and death certificates.


RESULTS
During a mean follow-up time of 8.4 years, 190 first events of acute stroke, fatal or non-fatal, were ascertained. Risk factor levels were generally higher in all patient categories than in controls. Stroke risk was significantly increased in all male patients: hazard ratio 4.2 (95% CI 2.1-8.4) in patients with both conditions, 3.3 (1.5-7.0) in those with type 2 diabetes alone and 2.8 (1.5-5.3) in those with hypertension alone (adjusted for age, total cholesterol, current smoking, BMI and physical activity). Corresponding findings in women were 2.9 (1.5-5.8) in patients with type 2 diabetes only and 2.4 (1.2-4.7) in those with both conditions. However, in women with hypertension only, a significant risk was seen first when subjects were truncated at 85 years of age. There were too few fatal stroke events for conclusive results on stroke mortality.


CONCLUSIONS
A considerable risk of acute stroke remains in patients with type 2 diabetes and hypertension. Strategies for stricter multiple risk factor interventions should be implemented in primary care.
Junga
K
K
Department of Clinical Sciences, Malmo, Community Medicine, Lund University, Malmo University Hospital, Malmo, Sweden.
Merlo
J
J
Gullberg
B
B
Bog-Hansen
E
E
Rastam
L
L
Lindblad
U
U
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013548:Sweden / Q000453:epidemiology