Jingwei Li1,2,3, Sook Ching Yang4, Tom J Moullaali5, Ruiqi Chen6, Mark Woodward3,7, Cheryl Carcel3, Candice Delcourt3,8, Else Charlotte Sandset9, Craig Anderson3,10, Guofang Chen11, Xia Wang3. 1. Department of Cardiology, People's Liberation Army General Hospital, Beijing. 2. Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, China. 3. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, New South Wales, Australia. 4. The Royal Infirmary of Edinburgh. 5. Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. 6. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China. 7. The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 8. Department of Neurology, Royal Prince Alfred Hospital, the University of Sydney, New South Wales, Australia. 9. Department of Neurology, Oslo University Hospital, Oslo, Norway. 10. The George Institute China at Peking University Health Science Centre, Beijing. 11. Neurology Department, The Affiliated Xuzhou Center Hospital of Nanjing University of Chinese Medicine, Xuzhou, China.
Abstract
OBJECTIVES: Evidence about sex differences in blood pressure (BP) at the time of acute stroke presentation is scarce. We aimed to summarize available data on sex differences in BP at the time of acute stroke presentation, including stratification by prior history of hypertension and stroke subtype. METHODS: We performed a systematic literature search across MEDLINE and Embase, from inception to 21 December 2018, to identify all population-based observational studies that reported BP at the time of acute stroke presentation. We extracted data on patient demographics, stroke-type (ischaemic or haemorrhagic), stroke severity, vascular risk factors, and SBP and DBP at the time of stroke presentation. Wherever possible, data were pooled for meta-analysis with weighted mean difference (WMD) and corresponding 95% confidence intervals (CI) using random effects meta-analysis. RESULTS: We included 128 138 stroke patients from 43 studies. Women had higher SBP at presentation than men (WMD, 1.46; 95% CI, 0.65-2.26); this difference was significant in ischaemic stroke (1.49; 0.25-2.72 mmHg), but not in intracerebral haemorrhage (0.19; -4.21 to 4.59 mmHg). Meta regression show that sex differences in SBP were consistent with increasing age, stroke severity, other comorbidities and medication history. CONCLUSION: This systematic review and meta-analysis indicates that women have higher SBP at the time of presentation with acute stroke. These differences are consistent with sex differences in hypertension patterns in older age, and may be explained by the fact that women are more likely to have a premorbid hypertension. This highlights the need for effective sex-specific blood pressure control in patients at high risk for stroke.
OBJECTIVES: Evidence about sex differences in blood pressure (BP) at the time of acute stroke presentation is scarce. We aimed to summarize available data on sex differences in BP at the time of acute stroke presentation, including stratification by prior history of hypertension and stroke subtype. METHODS: We performed a systematic literature search across MEDLINE and Embase, from inception to 21 December 2018, to identify all population-based observational studies that reported BP at the time of acute stroke presentation. We extracted data on patient demographics, stroke-type (ischaemic or haemorrhagic), stroke severity, vascular risk factors, and SBP and DBP at the time of stroke presentation. Wherever possible, data were pooled for meta-analysis with weighted mean difference (WMD) and corresponding 95% confidence intervals (CI) using random effects meta-analysis. RESULTS: We included 128 138 strokepatients from 43 studies. Women had higher SBP at presentation than men (WMD, 1.46; 95% CI, 0.65-2.26); this difference was significant in ischaemic stroke (1.49; 0.25-2.72 mmHg), but not in intracerebral haemorrhage (0.19; -4.21 to 4.59 mmHg). Meta regression show that sex differences in SBP were consistent with increasing age, stroke severity, other comorbidities and medication history. CONCLUSION: This systematic review and meta-analysis indicates that women have higher SBP at the time of presentation with acute stroke. These differences are consistent with sex differences in hypertension patterns in older age, and may be explained by the fact that women are more likely to have a premorbid hypertension. This highlights the need for effective sex-specific blood pressure control in patients at high risk for stroke.