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McGurgan IJ, Clarke R, Lacey B, Kong XL, Chen Z, Chen Y, Guo Y, Bian Z, Li L, Lewington S. Blood Pressure and Risk of Subarachnoid Hemorrhage in China. Stroke 2019; 50:38-44. [PMID: 30580702 PMCID: PMC6314500 DOI: 10.1161/strokeaha.118.022239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/11/2018] [Accepted: 10/31/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Subarachnoid hemorrhage (SAH) has a high case fatality rate and young mean age at onset compared with other types of stroke, but the pathogenesis of SAH is not fully understood. We examined associations of systolic and diastolic blood pressure with incident nontraumatic SAH in a large prospective study in China. Methods- In 2004 to 2008, 512 891 adults (59% women) from the general population were recruited into the CKB study (China Kadoorie Biobank). Participants were interviewed, measured, and followed up for fatal and nonfatal events. After excluding those with prior vascular disease, Cox regression analysis was used to relate blood pressure to incident SAH events. Analyses were adjusted for major confounders and corrected for regression dilution to give associations with long-term average blood pressure. Results- At baseline, mean age was 51 (SD, 11) years, and mean systolic blood pressure/diastolic blood pressure was 130.6/77.6 (SD, 21.0/11.1) mm Hg. During 3.5 million person-years of follow-up, there were 553 incident SAH cases (mean age at event, 61 [SD, 11] years), yielding an overall annual incidence rate of 12.9 per 100 000. Higher average levels of blood pressure were linearly and positively associated with higher risks of incident SAH: a 10 mm Hg higher systolic blood pressure and a 5 mm Hg higher diastolic blood pressure were associated with hazard ratios for SAH of 1.21 (95% CI, 1.13-1.29) and 1.20 (95% CI, 1.12-1.28), respectively. There was no evidence that the hazard ratios varied by age or sex or by levels of other vascular risk factors. Elevated blood pressure (systolic blood pressure, >120 mm Hg) accounted for 23% of all SAH cases. Conclusions- The incidence of SAH in China was comparable with estimates from Western populations. Higher levels of blood pressure were positively associated with higher risks of SAH, and elevated blood pressure accounted for about a quarter of all SAH cases.
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Affiliation(s)
- Iain John McGurgan
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Robert Clarke
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Ben Lacey
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health (B.L., X.L.K., S.L.), University of Oxford, United Kingdom
| | - Xiang Ling Kong
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health (B.L., X.L.K., S.L.), University of Oxford, United Kingdom
| | - Zhengming Chen
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Yiping Chen
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China (Y.G., Z.B., L.L.)
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China (Y.G., Z.B., L.L.)
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, China (Y.G., Z.B., L.L.)
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China (L.L.)
| | - Sarah Lewington
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health (B.L., X.L.K., S.L.), University of Oxford, United Kingdom
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McGurgan IJ, Lonergan R, Killeen R, McGuigan C. Cervical spine arteriovenous fistula associated with hereditary haemorrhagic telangiectasia. BMJ Case Rep 2017; 2017:bcr2016218172. [PMID: 28174188 PMCID: PMC5307285 DOI: 10.1136/bcr-2016-218172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 11/03/2022] Open
Abstract
Reported is a case of a man aged 55 years who presented with progressive spastic paraparesis. Examination demonstrated multiple cutaneous telangiectases. Subsequent development of upper limb weakness, acute urinary retention and eventual respiratory compromise resulted in the requirement for intensive care unit admission and mechanical ventilation. MRI spine revealed diffuse T2 hyperintensity in the cervical cord with enhancement and cord expansion. Immunomodulatory therapy for a presumed diagnosis of transverse myelitis yielded no response, so a vascular aetiology was suspected. Spinal angiography demonstrated an arteriovenous fistula involving the upper cervical cord. Endovascular embolisation was successfully performed and a marked clinical improvement was achieved. Cervical arteriovenous fistulas can cause progressive myelopathy, subarachnoid haemorrhage and brainstem dysfunction. Management typically comprises endovascular embolisation or surgical interruption. A clinical diagnosis of hereditary haemorrhagic telangiectasia was also made in this case, and spinal arteriovenous fistula formation has been associated with this condition.
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Affiliation(s)
- Iain John McGurgan
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Roisin Lonergan
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Ronan Killeen
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
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