Community surveillance of stroke in persons under 70 years old: contribution of uncontrolled hypertension.

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Abstract
In 1979, a community-wide hospital surveillance system was established in Monroe County, New York [USA] (population 702,000), to investigate the continuing contribution of uncontrolled high blood pressure (HBP) to the occurrence of stroke. This paper reports findings among 200 consecutive strokes in persons under 71 yr of age. Average age was 58 yr. There was a prestroke history of HBP in 129 (65%) cases. Two-thirds of the 129 had other predisposing conditions (heart disease, diabetes, previous cerebrovascular accident) and 95% had one or more other cardiovascular risk factors (smoking, elevated cholesterol, obesity). Over 90% had visited a physician during the year prior to stroke (average of 4 visits). Elevated pressures (DBP .gtoreq. 95 or SBP .gtoreq. 160) were recorded at half or more of the visits for 45% of the patients; these cases were classified as uncontrolled. Reduction of unnecessary strokes in persons under age 71 should be achievable by giving increased attention to those already under medical care for hypertension who have co-existing stroke risk conditions and cardiovascular risk factors.