Key result
Acute hypertensive response in patients with ischemic stroke or TIA was associated with a higher incidence of MACCE compared to no AHR (15.5% vs 4.8%; HR 4.60, 95% CI 1.31-16.15).
Why the study?
The underlying pathophysiology linking acute hypertensive response to adverse outcomes and its prognostic impact in ischemic stroke remain unclear.
Does acute hypertensive response predict major adverse cardiovascular and cerebrovascular events and relate to myocardial dysfunction in patients with acute ischemic stroke or TIA?
Cohort (n=244)
Does acute hypertensive response predict major adverse cardiovascular and cerebrovascular events and relate to myocardial dysfunction in patients with acute ischemic stroke or TIA?
Effect estimate: HR 4.60 (95% CI 1.31-16.15)
Absolute Event Rate: 15.5% vs 4.8%
p-value: p=0.014
Acute hypertensive response in patients with ischemic stroke or TIA is a strong predictor of adverse cardiovascular and cerebrovascular events and is associated with left ventricular myocardial dysfunction.
May inform risk stratification after ischemic stroke or TIA; leaves open whether treating AHR improves outcomes.
OBJECTIVES: Acute hypertensive response (AHR) in acute stroke is associated with adverse outcomes; however, the underlying pathophysiology of the association is poorly understood and its prognostic impact in ischemic stroke remains unclear. We aimed to investigate the prognostic significance of AHR in patients with ischemic stroke or transient ischemic attack (TIA), and further examined the relationship between AHR and myocardial function, using two-dimensional speckle-tracking echocardiography (2D-STE). METHODS: A total of 244 consecutive patients with acute ischemic stroke (AIS) (n = 192) or TIA (n = 52), who were evaluated with 2D-STE within 7 days from admission, were retrospectively analysed. The primary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infraction or recurrent ischemic stroke. RESULTS: Among the study population, AHR was observed in 161 (66%) patients. During a mean follow-up of 21.0 ± 12.5 months, 29 patients (11.9%) [25 (15.5%) AHR vs. 4 (4.8%) No AHR, P = 0.014] reached the primary endpoint. A Kaplan-Meier curve revealed that patients with AHR had a significantly higher incidence of MACCE than those without AHR (log-rank P = 0.013). Multivariate Cox regression analysis demonstrated that AHR [adjusted hazard ratio 4.60, 95% confidence interval (95% CI) 1.31-16.15] was a strong predictor of MACCE. In multivariate logistic regression analysis, left ventricular global longitudinal strain (per 1% decrease) showed a significant relationship with AHR (adjusted odds ratio 1.17, 95% CI 1.02-1.35). CONCLUSION: AHR in patients with AIS or TIA may be an important poor prognostic marker related to myocardial dysfunction.
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Yi et al. (2019) conducted a cohort in Acute ischemic stroke or transient ischemic attack (n=244). Acute hypertensive response vs. No acute hypertensive response was evaluated on Composite of major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infraction or recurrent ischemic stroke (HR 4.60, 95% CI 1.31-16.15, p=0.014). Acute hypertensive response in patients with ischemic stroke or TIA was associated with a higher incidence of MACCE compared to no AHR (15.5% vs 4.8%; HR 4.60, 95% CI 1.31-16.15).
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