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Recurrent vertigo is a predictor of stroke in a large cohort of hypertensive patients

Courand, Pierre-Yvesa,b; Serraille, Michaela; Grandjean, Adriena; Tilikete, Carolinec,d; Milon, Huguesa; Harbaoui, Brahima,b; Lantelme, Pierrea,b

doi: 10.1097/HJH.0000000000001978

Objective: Dizziness is associated with hypertension but there are numerous other causes. The aims of the present study were to describe the characteristics and the clinical correlates of dizziness in a large cohort of hypertensive patients, and to test its prognostic value for all-cause, cardiovascular, and stroke mortality.

Methods: A total of 1716 individuals from the OLD-HTA Lyon's cohort of hypertensive patients recruited in the 1970s were categorized according to the absence or the presence of dizziness. The dizziness group was subdivided into vertigo and other dizziness excluding vertigo.

Results: Multiple regression analysis demonstrated that presence of dizziness was predicted by age, female sex, coronary artery disease, and the absence of microalbuminuria. During 30 years of follow-up, we observed 956 deaths, 508 of which with a cardiovascular cause, and 114 fatal acute strokes. In the multivariate Cox regression model, the presence of dizziness had no impact on the risk for all-cause mortality [hazard ratio 0.91; 95% CI (0.78–1.06)], cardiovascular mortality [hazard ratio 0.86; 95% CI (0.70–1.05)], or stroke mortality [hazard ratio 1.27; 95% CI (0.85–1.90)]. In an analysis of the different subgroups of dizziness, only vertigo had a prognostic impact. The increased risk was particularly marked on stroke death with a hazard ratio of 2.43 (95% CI 1.33–4.46) vs. patients without dizziness and 2.22 (95% CI 1.21–4.06) vs. patients with dizziness excluding vertigo.

Conclusion: Hypertensive patients with dizziness did not have a high-risk profile at baseline, but those with vertigo must be carefully followed over years because of the higher stroke mortality.

aCardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon

bUniversité de Lyon, CREATIS; CNRS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1

cNeuro-Ophthalmology and Neurocognition, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon

dImpAct Team, CNRL INSERM U1028 CNRS UMR5292, Université Claude Bernard Lyon 1, Bron, France

Correspondence to Pierre-Yves Courand, MD, PhD, Cardiology Department, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, F-69004, Lyon, France. Tel: +33 472 071 667; fax: +33 472 071 674; e-mail:

Abbreviations: BP, blood pressure; CVD, cardiovascular disease; LVH, left ventricular hypertrophy; MDRD, Modification in Diet in Renal Disease; PP, pulse pressure

Received 6 June, 2018

Accepted 25 September, 2018

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