Imperial College London


Faculty of MedicineSchool of Public Health

Chair in Epidemiology and Public Health Medicine



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BibTex format

author = {Georgakis, MK and Gill, D and Webb, AJS and Evangelou, E and Elliott, P and Sudlow, CLM and Dehghan, A and Malik, R and Tzoulaki, I and Dichgans, M},
doi = {10.1212/WNL.0000000000009814},
journal = {Neurology},
pages = {e353--361},
title = {Genetically determined blood pressure, antihypertensive drug classes and risk of stroke subtypes},
url = {},
volume = {95},
year = {2020}

RIS format (EndNote, RefMan)

AB - Objective: We employed Mendelian Randomization to explore whether the effects of blood pressure (BP) and BP lowering through different antihypertensive drug classes on stroke risk vary by stroke etiology. Methods: We selected genetic variants associated with systolic and diastolic BP and BP-lowering variants in genes encoding antihypertensive drug targets from a GWAS on 757,601 individuals. Applying two-sample Mendelian randomization, we examined associations with any stroke (67,162 cases; 454,450 controls), ischemic stroke and its subtypes (large artery, cardioembolic, small vessel stroke), intracerebral hemorrhage (ICH, deep and lobar), and the related small vessel disease phenotype of WMH.Results: Genetic predisposition to higher systolic and diastolic BP was associated with higher risk of any stroke, ischemic stroke, and ICH. We found associations between genetically determined BP and all ischemic stroke subtypes with a higher risk of large artery and small vessel stroke compared to cardioembolic stroke, as well as associations with deep, but not lobar ICH. Genetic proxies for calcium channel blockers, but not beta blockers, were associated with lower risk of any stroke and ischemic stroke. Proxies for CCBs showed particularly strong associations with small vessel stroke and the related radiological phenotype of WMH.Conclusions: This study supports a causal role of hypertension in all major stroke subtypes except lobar ICH. We find differences in the effects of BP and BP lowering through antihypertensive drug classes between stroke subtypes and identify calcium channel blockade as a promising strategy for preventing manifestations of cerebral small vessel disease.
AU - Georgakis,MK
AU - Gill,D
AU - Webb,AJS
AU - Evangelou,E
AU - Elliott,P
AU - Sudlow,CLM
AU - Dehghan,A
AU - Malik,R
AU - Tzoulaki,I
AU - Dichgans,M
DO - 10.1212/WNL.0000000000009814
EP - 361
PY - 2020///
SN - 0028-3878
SP - 353
TI - Genetically determined blood pressure, antihypertensive drug classes and risk of stroke subtypes
T2 - Neurology
UR -
UR -
VL - 95
ER -