Avoidable factors in stroke: Smoking, drinking, and hypertensionBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6922.201b (Published 15 January 1994) Cite this as: BMJ 1994;308:201
EDITOR, - J N Payne and colleagues identify shortcomings in the care of patients dying of diseases related to hypertension.1 I carried out a survey of modifiable risk factors in 70 consecutive young patients with stroke (aged under 55) admitted to hospital over five years.
The main modifiable risk factors identified (table) were hypertension, current cigarette smoking, and excessive alcohol intake (confirmed by macrocytosis and raised (gamma) glutamyl transferase activity). Ten patients had had hypertension diagnosed previously but were not taking antihypertensive drugs at the time of the stroke. Seven patients in whom hypertension had not been diagnosed had raised blood pressure and electrocardiographic evidence of longstanding hypertension (left ventricular hypertrophy). Of the 37 normotensive patients, 27 were current smokers or had an excessive alcohol intake, or both.
In up to 44 of the 70 patients in this series modifiable risk factors may have been managed inadequately. The reasons for this were not addressed by the study, but there are obvious lessons regarding the reduction of stroke in this age group.