Key result
Hypertension linked to ~10-fold higher recurrent ischemic stroke risk in young stroke patients.
Why the study?
The cause of ischemic stroke in young patients is often cryptogenic despite vascular risk factors, and the impact of arterial hypertension and post-discharge blood pressure levels on recurrent ischemic stroke risk remains unclear.
Does arterial hypertension and elevated blood pressure after discharge increase the risk of recurrent ischemic stroke in young patients (<50 years)?
Observational (n=319)
No
Does arterial hypertension and elevated blood pressure after discharge increase the risk of recurrent ischemic stroke in young patients (<50 years)?
Arterial hypertension is highly prevalent in young ischemic stroke patients and is associated with a higher risk of recurrent stroke, though prior antiplatelet use serves as the strongest independent predictor of recurrence.
Answers are grounded in this paper and cite their sources.
Hypertension was associated with higher recurrence in young stroke patients; hypothesis-generating and should not yet change practice.
INTRODUCTION: In young patients, the cause of ischemic stroke (IS) remains often cryptogenic despite presence of traditional vascular risk factors (VRFs). Since arterial hypertension (AH) is considered the most important one, we aimed to evaluate the impact of AH and blood pressure (BP) levels after discharge on risk of recurrent IS (RIS) in young patients. METHODS: The study set consisted of acute IS patients < 50 years of age enrolled in the prospective Heart and Ischemic STrOke Relationship studY registered on ClinicalTrials.gov (NCT01541163). Cause of IS was assessed according to the ASCOD classification. RESULTS: Out of 319 enrolled patients <50 years of age (179 males, mean age 41.1 ± 7.8 years), AH was present in 120 (37.6%) of them. No difference was found in the rates of etiological subtypes of IS between patients with and without AH. Patients with AH were older, had more VRF, used more frequently antiplatelets prior IS, and had more RIS (10 vs. 1%, p = 0.002) during a follow-up (FUP) with median of 25 months. Multivariate logistic regression stepwise model showed the prior use of antiplatelets as only predictor of RIS (p = 0.011, OR: 6.125; 95% CI: 1.510-24.837). Patients with elevated BP levels on BP Holter 1 month after discharge did not have increased rate of RIS during FUP (3.8 vs. 1.7%, p = 1.000). CONCLUSION: AH occurred in 37.6% of young IS patients. Patients with AH had more frequently RIS. Prior use of antiplatelets was found only predictor of RIS in young IS patients with AH.
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Divišová et al. (2020) conducted an observational in Young Ischemic Stroke (n=319). Arterial hypertension vs. No arterial hypertension was evaluated on Recurrent ischemic stroke (RIS) (p=0.002). Arterial hypertension was associated with a significantly higher rate of recurrent ischemic stroke compared to patients without hypertension (10% vs 1%) in young ischemic stroke patients.
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