PREDICTORS OF STROKE RECURRENCE IN HIGH-RISK, HYPERTENSIVE PATIENTS: 3B.01

Abstract

Background: Risk factors for first stroke are well established, but risk factors for stroke recurrence are not well known. Long-term predictors of stroke recurrence recently investigated in 2 874 patients in London were atrial fibrillation, myocardial infarction and hypertension. We aimed to identify independent predictors of stroke recurrence in VALUE Trial participants. Design and Methods: The VALUE trial was a prospective, multicentre, double-blind, randomised, active-controlled, parallel group trial comparing the effects of an angiotensin receptor blocker (valsartan) and a calcium channel blocker (amlodipine) in patients with hypertension and high cardiovascular risk. Of the 15 245 patients included in the trial, 3 014 had a previous stroke or TIA at baseline. We used Cox regression analysis to investigate the predictors of stroke recurrence in this population. Quadratic terms of the continuous variables were entered in the models to test for linearity. Results: Stroke recurrence occurred in 239 (8.9%) patients during the mean 4.1 years of follow-up. In the multivariate Cox regression model controlling for race, gender, treatment type, baseline diabetes status, baseline fasting glucose level, baseline beta-blocker treatment, baseline diuretic treatment, body mass index, smoking, left ventricular hypertrophy, atrial fibrillation, systolic and diastolic BP, both the linear term and quadratic term for ECG heart rate per 10 beats per minute (HR 2.78; 95% CI 1.18–6.58; p = 0.02, HR 0.94; 95% CI 0.89–0.996; p = 0.035) and diabetes at baseline (HR 1.47; 95% CI 1.03–2.09; p = 0.034) significantly increased the risk of stroke recurrence. A trend was seen for the quadratic term for age (HR 1.14; 95% CI 0.99–1.31; p = 0.07). In the stepwise Cox regression model, both the quadratic and linear term for ECG heart rate and the quadratic term for age remained significant predictors of recurrent stroke (p < 0.05).Conclusion: In a high-risk, hypertensive population with previous stroke, ECG heart rate per 10 beats per minute and age are the strongest predictors of recurrent stroke.