This study explored the association between enalapril-folic acid treatment and the likelihood of developing cardiovascular disease (CVD) in patients with hemorrhagic stroke combined with H-type hypertension. This prospective study involved 799 patients diagnosed with hemorrhagic stroke and H-type hypertension (defined as total homocysteine levels ≥ 10 μmol/L). Patients were instructed to take a daily regimen of enalapril (10 mg) and folic acid (0.8 mg) and were monitored for a median duration of 9.6 months. Adherence to the treatment was classified as either high (≥ 70%) or low (< 70%). The study’s primary endpoint comprised a combination of CVD events, such as cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke. The relationship between adherence to treatment and clinical outcomes was analyzed using Cox proportional hazards models, controlling for confounding factors. Subgroup analyses investigated interactions within stratifications of sex, age (< 65 vs ≥ 65 years), body mass index (< 24 vs ≥ 24 kg/m 2 ), seated blood pressure (< 160 vs ≥ 160 mm Hg), total cholesterol (< 4.6 vs ≥ 4.6 mmol/L), and total homocysteine (< 13.7 vs ≥ 13.7 μmol/L). During the follow-up, 40 participants (5.0%) developed CVD, and 21 participants (2.6%) experienced recurrent hemorrhagic stroke. Patients with high adherence to enalapril-folic acid therapy exhibited significantly reduced risks of CVD (hazard ratio HR: 0.16; 95% confidence interval CI: 0.06–0.45), recurrent hemorrhagic stroke (HR: 0.21; 95% CI: 0.07–0.67), and all-cause mortality (HR: 0.14; 95% CI: 0.05–0.41) when compared to those with low adherence. Greater compliance with enalapril-folic acid therapy was associated with decreased CVD and recurrent hemorrhagic stroke incidence in hypertensive individuals with elevated homocysteine levels. The results indicated that folic acid supplementation may be a promising strategy for secondary stroke prevention. Nonetheless, further randomized controlled trials are required to confirm its efficacy.
Dai et al. (Fri,) studied this question.