Medline search strategy in Database: Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process &
Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R) <1946 to
June 3rd 2013>
1. exp hypertension/
2. (hypertens$ or hyper tens$).ab. /freq=2
3. (hypertens$ or hyper tens$).ti.
4. 2 or 3
5. ((high or elevat$) adj3 blood pressure).ab. /freq=2
6. ((high or elevat$) adj3 blood pressure).ti.
7. 5 or 6
8. 1 or 4 or 7
9. exp stroke/
10. cerebrovascular disorders/
11. exp brain ischemia/
12. ischemia/
13. exp "intracranial embolism and thrombosis"/
14. brain/
15. blood supply.fs.
16. 14 and 15
17. stroke$.ti.
18. stroke$.ab. /freq=2
19. 17 or 18
20. ((cerebrovascular or cerebr$ vascular or brain) adj2 (infarct$ or ischemi$)).tw.
21. (brain adj2 vascular adj2 (disease$ or disorder$ or accident$ or event$)).tw.
22. ((cerebrovascular or cerebr$ vascular) adj2 (disease$ or disorder$ or accident$
or event$)).tw.
23. apoplex$.tw.
24. (CVA or CVAS).tw.
25. (ischemi$ adj2 (encephalopath$ or attack$ or brain$ or cerebr$)).tw.
26. (tia or tias).tw.
27. 9 or 10 or 11 or 12 or 13 or 16 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26
28. 8 and 27
29. epidemiology.fs.
30. exp causality/
31. exp sex factors/
32. (epidemiolog$ or risk$).tw.
33. 29 or 30 or 31 or 32
34. 28 and 33
35. women's health/
36. wom?n$.ti.
37. wom?n$.ab. /freq=2
38. 36 or 37
39. exp women/
40. 35 or 38 or 39
41. 34 and 40
42. wom?n$.tw.
43. 35 or 39 or 42
44. 34 and 43
Supplemental Figure S1 Medline search strategy.
Ab, abstract; adj, adjacent; exp, exploded ;freq, frequency; f.s., floating subheader; ti, title; tw,
text word
Embase search strategy in Embase Classic+Embase <1947 to June 3rd 2013>
1. exp *hypertension/
2. (hypertens$ or hyper tens$).ti.
3. (hypertens$ or hyper tens$).ab. /freq=2
4. 2 or 3
5. ((high or elevat$) adj3 blood pressure).ti.
6. ((high or elevat$) adj3 blood pressure).ab. /freq=2
7. 5 or 6
8. 1 or 4 or 7
9. exp cerebrovascular accident/
10. exp brain infarction/
11. exp brain ischemia/
12. vertebrobasilar insufficiency/
13. exp occlusive cerebrovascular disease/
14. brain embolism/
15. stroke$.ab. /freq=2
16. stroke$.ti.
17. 15 or 16
18. ((cerebrovascular or cerebr$ vascular or brain) adj2 (infarct$ or ischemi$)).tw.
19. (brain adj2 vascular adj2 (disease$ or disorder$ or accident$ or event$)).tw.
20. apoplex$.tw.
21. (cva or cvas).tw.
22. (ischemi$ adj2 (encephalopath$ or attack$ or brain$ or cerebr$)).tw.
23. (tia or tias).tw.
24. 9 or 10 or 11 or 12 or 13 or 14 or 17 or 18 or 19 or 20 or 21 or 22 or 23
25. 8 and 24
26. ep.fs.
27. exp causality/
28. exp sex factors/
29. (epidemiolog$ or risk$).tw.
30. 26 or 27 or 28 or 29
31. 25 and 30
32. women's health/
33. wom?n$.tw.
34. 32 or 33
35. 31 and 34
Supplemental Figure S2 Embase search strategy.
Ab, abstract; adj, adjacent; exp, exploded ;freq, frequency; ti, title; tw., text word
Supplemental Figure S3 Flowchart of screening strategy.
Supplemental Table S1 Definition of hypertension and stroke per study.
Study
Arima25
Hypertension definition
Stroke definition
Optimal: <120/<80 mmHg
Normal: 120-129/80-84mmHg)
High normal: 130-139/85-89 mmHg
Grade 1: 140-159/90-99 mmHg)
Grade 2: 160-179/100-109 mmHg)
Grade 3: ≥180/≥110 mmHg
A sudden onset of non-convulsive and focal neurological deficits
persisting for more than 24h.Classified as cerebral infarction, hemorrhage,
subarachnoid, or undetermined.
Chambless26
HTN: ≥140/≥90 mmHg or use of antihypertensive
medication
Based on combinations of symptom (type, duration, severity), results of
neuroimaging and other diagnostic procedures, and autopsy evidence
when available.
Ikeda27
Optimal: <120/<80 mmHg
Normal: 120-129/80-84 mmHg
High normal: 130-139/85-89 mmHg
Mild HTN: 140-159/90-99 mmHg
Moderate HTN:160-179/100-109 mmHg
Severe HTN: ≥180/ ≥110 mmHg
Presence of focal neurological deficits of sudden or rapid onset lasting
≥24h or until death.
Stroke further classified as subarachnoid hemorrhage, intraparenchymal
hemorrhage or ischemic stroke (thrombotic or embolic).
Ishikawa28
Normotensives: <140/<90 mmHg
Treated hypertensives: receiving antihypertensive
treatment irrespective of current BP levels
Non-treated hypertensives: ≥140/≥90 mmHg
Controlled treated hypertensives: >140/>90 mmHg
with anti-hypertensive treatment
Uncontrolled treated hypertensives: ≥140/≥90 mmHg
without antihypertensive treatment
Presence of a focal and non-convulsive neurological deficit for ≥24h with
a clear onset.
Stroke subtype determined by the National Institute of Neurological
Disorder and Stroke.
Cerebral infarction further divided as lacunar, atherothrombotic,
cardioembolic, or undetermined.
Kikumura29
WHO criteria of HTN diagnosis
Evidence of focal neurological deficit with relatively rapid onset, and
progression during observation.
Lokkengaard30
Self-reported HTN status
Ischemic stroke: ICD-8 codes 432-434 or 436, ICD-10 codes 163 to 165
Mannisto31
Normotensive: <145/<95 mmHg throughout
pregnancy. No proteinuria.
Chronic HTN: HTN before 20th gestational week,
continuing throughout pregnancy and/or up to 6
weeks after pregnancy, or using antihypertensive
treatment. No proteinuria.
Gestational HTN: normotensitve before the 20th
gestational week but hypertensive after the 20th
gestational week. No proteinuria.
Preeclampsia/eclampsia: normotensive before 20th
gestational week, but HTN after the 20th gestational
week with proteinuria
Not defined
Not defined
Martin-Merino32
Not defined
Ness33
Diagnosis according to the JNC 6 report on the
detection, evaluation, and treatment of hypertension.
Not defined
Pfeffer34
HTN
- Past history of HTN
- Current diagnosis of HTN, or HTN therapy
- Two or more elevated BP
WHO categories used for diagnosis
- Normotensive: <140/<90 mmHg
- Borderline: 140-160/90-95 mmHg
- HTN: >160/>95 mmHg
Stroke type determined using standard clinical criteria, laboratory data,
and necropsy findings.
Rohr35
Self-reported history of hypertension diagnosis prior to
the current admission for stroke.
Stroke was defined according to the criteria of WHO.
Cerebral infarction was defined according to the criteria of the National
Institute of Neurological and Communicative Disorders and Stroke Data
Bank.
Excluded:
- Stroke ICD-9 431.00 to 438.0, 671.5 to 671.54, 674.00 to 674.04
- Stroke as an immediate consequence of trauma
Cerebral infarction associated with subarachnoid hemorrhage.
Salonen36
Not defined
Cerebral strokes and transient ischemic attacks: ICD-8 430-437
Cerebral infarction:ICD-8 433-434
Seshadri37
Not defined
Stroke subtypes categorized according to pre-established diagnostic
criteria [clinical features, imaging, non-invasive vascular studies,
cardiac evaluations (embolus), and autopsy studies, when available].
Category of ABI included large-artery infarcts, lacunar infarcts, and
infarcts of unknown origin. Ischemic brain infarct was classified as an
ABI if no cardiac sources of emboli could be found.
Transient ischemic attacks and intracranial (intracerebral or
subarachnoid) haemorrhage were not included.
Shahzad38
Not defined
Not defined
Takahashi39
Normal: <120/<80 mmHg
Pre hypertension: 120-139/80-89 mmHg
Stage 1 HTN: 140-159/90-99mmHg
Stage 2 HTN: ≥160/≥100 mmHg
Non-fatal stroke coded ICD-7 (330-332, 334 352 and 435), ICD-8 (333,
430-434, 436 and 438), ICD-9 (430, 431 and 433-438), and ICD-10
(G45, I60, I61, I63-66 and I69). Cases were further classified by
subtype of stroke.
Tanizaki5
Not defined
Stroke: sudden onset of non-convulsive and focal neurological deficit
persisting >24h. Classified as cerebral infarction, cerebral haemorrhage,
subarachnoid haemorrhage, or undetermined.
Cerebral infarction further divided into lacunar infarction,
atheorthombotic infarction, cardioembolic infarction, and undetermined
(Classification of the Cerebrovascular disease III, National Institute of
the Neurological Disorders and Stroke, and Trial or Org 10172 in Acute
Stroke Treatment (TOAST) study and Cerebral Embolism Task Force
for cerebral infarction subtypes).
Ueshima40
Not defined
Stroke diagnosis criteria developed by the Study Group of the Ministry
of Education.
Woodward13
Not defined
Ischemic stroke classified according to ICD-9 (433.0-434.9)
ABI, atherothrombotic brain infarction; HTN, hypertension; ICD, International Classification of Diseases; JNC, Japanese National Committee; WHO, World
Health Organisation.
Supplemental Table 2 Baseline characteristics by study.
Study
N (women)
Arima25
1 621(914)
Chambless26
14 685 (8 113)
N ischemic stroke
Age (y)
(women/men)
142/128
>40, mean:
Women: 57
Men: 56
185/249
45-64
Ikeda27
33 372 (21 688)
218/295
Ishikawa28
11 103 (6 785)
112/150
Kikumura29
1 181 (690)
27/44
BMI (kg/m2)
Follow-up (y)
Ethnicity
-
Up to 32
Japanese
-
Median: 12.3
Americans
40-69
-
Median: 11.0
Japanese
Mean:
Women: 22.6-24.8
Men: 22.5-23.9
-
10.7
Japanese
9
Japanese
-
5
Danish
Lokkengaard30 13 122 (all women)
99
Mean:
Women: 52.9-62.0
Men: 52.8-63.0
>40, mean of:
Women: 66.3
Men: 64.1
>45
Mannisto31
585
Mean: 62.6-72.6
Mean: 22.6-25.4
39.4
Finnish
Martin-Merino3212 953 (6 377)
1455/1498
40-84
3.63
English
Ness33
1 911 (1 444)
296/126
ø
American
Pfeffer34
22 818 (13 691)
169
60-102, Mean:
Women: 81
Men: 80
64
Ranging from:
<20-60
-
8
American
Rohr35
1 516 (873)
145/151
18-44
-
ø
American
Salonen36
7 824 (4 074)
21/34
35-59
-
6
Finnish
Seshadri37
8 013 (4 863)
282/209
30-62
50
Framingham cohort
Shahzad38
37 (all women)
29
12-45
Mean:
Women: 26.0-26.5
Men: 25.8-26.5
-
ø
Pakistani
10 314 (all women)
Takahashi39
7 847
Tanizaki5
1621(914)
154/44
Ueshima40
1 814 (1 032)
23/34
Woodward13
214 032 (all women) 272
>55
BMI, body mass index; N, number of participants; y, years.
≥ 40, mean:
Women: 57
Men: 56
40-69
Mean: 46
Mean:
Women: 11.8-42.7
Men: 12.1-38.3
Women: 21.7
Men: 21.5
Median: 16.1
Japanese
32
Japanese
-
4
Japanese
-
ø
Asian-pacific
population

1 Simplified Medical Language