Stroke In Hypertensive Patients Research Articles

C-reactive protein-triglyceride glucose index predicts stroke incidence in a hypertensive population: a national cohort study

BackgroundBoth the triglyceride-glucose (TyG) index, a predictor of insulin resistance (IR), and inflammation are risk factors for stroke in hypertensive patients. However, only a handful of studies have coupled the TyG index and inflammation indices to predict stroke risk in hypertensive patients. The C-reactive protein-triglyceride-glucose index (CTI) is a novel marker that comprehensively assesses the severity of IR and inflammation. The present study explored the association between CTI and the risk of stroke in patients with hypertension.MethodsA total of 3,834 hypertensive patients without a history of stroke at baseline were recruited from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate Cox regression and restricted cubic spline (RCS) analyses were employed to assess the relationship between CTI and stroke risk in hypertensive patients. Furthermore, the Boruta algorithm was applied to evaluate the importance of CTI and construct prediction models to forecast the incidence of stroke in the study cohort.ResultsAfter 7 years of follow-up, the incidence of stroke in hypertensive patients was 9.6% (368 cases). Multivariate Cox regression analysis revealed a 21% increase in stroke risk with an increase in each CTI unit (hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.08–1.37). The top quartile group was 66% more likely to have a stroke than the bottom quartile group (HR = 1.66, 95% CI = 1.23–2.25). RCS analysis confirmed a linear relationship between CTI and stroke risk. The Boruta algorithm validated CTI as a crucial indicator of stroke risk. The Support Vector Machine (SVM) survival model exhibited the best predictive performance for stroke risk in hypertensive patients, with an area under the curve (AUC) of 0.956.ConclusionsAn increase in CTI levels is associated with a higher risk of stroke in hypertensive patients. This study suggests that CTI may emerge as a unique predictive marker for stroke risk.

Impact of Undiagnosed Hypertension In Patients Presenting With Stroke: Comparison With Patients Having Diagnosed Hypertension

Objectives: To compare morbidity and mortality among stroke patients with undiagnosed hypertension vs those with pre-existing, diagnosed hypertension. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan from December 2022 to May 2023. Methodology: A total of 86 patients fulfilling the inclusion criteria were included in the study. Detailed history was obtained to assess for hypertension i.e., undiagnosed hypertension (group A) or pre-existing, diagnosed hypertension (group B). Stroke outcomes including type of stroke, in-hospital mortality and 30-day disability were compared between groups using Chi-square and Mann-Whittney U-test. Results: Mean age of patients was 55.18±11.31 years. There were 57(66.28%) male and 29(33.72%) female patients. Frequency of “undiagnosed hypertension (HTN)” was 26(30.23%) while of “pre-existing hypertension (HTN)” it was 60(69.77%). Patients with “undiagnosed hypertension” were found to have significantly higher frequency of hemorrhagic stroke (p<0.001), in-hospital mortality (p = 0.001) and 30-days disability score (p<0.001). Conclusion: Frequency of undiagnosed hypertension in stroke patients was 30.23% and is associated with poor outcomes in term of morbidity and mortality in stroke patients as compared to those having pre-existing, diagnosed hypertension.

Impact of Non-Compliance with Antihypertensive Medication on Stroke Incidence

Background: Hypertension is a major risk factor for stroke. Effective management of hypertension through medication adherence is crucial in preventing stroke events. However, non-compliance with antihypertensive medication remains a significant challenge, leading to adverse health consequences. Aim of the study: The aim of this study was to evaluate the impact of non-compliance with antihypertensive medication on stroke incidence. Methods: This descriptive cross-sectional study was conducted in Department of Medicine and Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh from March 2010 to August 2010. Total 120 patients who were diagnosed with stroke were selected for the study. Result: The majority of participants were aged 51-60 (35.8%) and the mean age was 54.6 years (SD 4.3). Males (57.5%) outnumbered females (42.5%), with a male-to-female ratio of 1.38:1. Age and sex distributions were significantly different (p < .001). Cerebral infarction was the most common stroke type (62.5%). Most participants (65.0%) were known hypertensive, with 11.7% newly diagnosed and 23.3% normotensive. Among hypertensive patients, non-compliance was high (71.8%). In hypertensive stroke patients, non-compliance was associated with higher rates of cerebral infarction (37.2% vs. 20.5%) and cerebral hemorrhage (33.3% vs. 6.4%). Subarachnoid hemorrhage and hemorrhagic transformation were rare. The overall Chi-square test was significant (p < .001). Recurrent stroke was more common in non-compliant patients (68.8% vs. 31.3%). The Chi-square test was significant (p < .001). Conclusion: Non-compliance was strongly associated with increased risk of both cerebral infarction and cerebral hemorrhage, underscoring the importance of consistent medication adherence.

Characteristic of 24-Hour Blood Pressure Dipping Patterns in Hypertensive Stroke Patients.

We conducted a study titled for Investigation on the characteristics of 24-hour blood pressure (BP) dipping patterns in hypertensive stroke patients. Descriptive research, analysis, and comparison, the research was conducted from July 2019 to September 2020 at the Vietnam Heart Institute - Bach Mai Hospital. There are 100 patients diagnosed with idiopathic hypertension who were divided into two groups (without stroke complications and another group with chronic stroke complications > 6weeks), both groups were similar in age (45-64 years old). The daytime systolic BP (SBP) indices, 24-hour BP including SBP, diastolic BP (DBP), and mean arterial pressure (MAP), and particularly night-time BP indices were elevated in the stroke group compared with those without stroke complications (p < 0.05); there were no significant differences observed in daytime DBP and MAP between the two groups. SBP indices were higher in those with hemorrhage stroke compared with those with ischemic stroke, albeit without statistical significance. The prevalence of non-dipper was significantly higher in the stroke group compared with the non-stroke group (p < 0.001). The daytime SBP indices, 24-hour BP (SBP, DBP, MAP), and particularly night-time BP indices were elevated in the stroke group compared with those without stroke complications. The prevalence of non-dipper was significantly higher in the stroke group compared with the non-stroke group.

Joint Modifiable Risk Factor Control and Incident Stroke in Hypertensive Patients.

Recent guidelines have recognized several factors, including blood pressure (BP), body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), smoking, and physical activity, as key contributors to stroke risk. However, the impact of simultaneous management of these risk factors on stroke susceptibility in individuals with hypertension remains ambiguous. This study involved 238 388 participants from the UK Biobank, followed up from their recruitment date until April 1, 2023. Cox proportional hazard models with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to illustrate the correlation between the joint modifiable risk factor control and the stroke risk. As the degree of risk factor control increased, a gradual reduction in stroke risk was observed. Hypertensive patients who had the optimal risk factor control (≥5 risk factor controls) had a 14.6% lower stroke risk than those who controlled 2 or fewer (HR: 0.854; 95% CI: 804-0.908; p < 0.001). The excess risk of stroke linked to hypertension slowly diminished as the number of controlled risk factors increased. However, the risk was still 25.1% higher for hypertensive patients with optimal risk factor control as compared to the non-hypertensive population (HR: 1.251; 95% CI: 1.100-1.422; p < 0.001). The protective effect of joint risk factor control against the stroke risk due to hypertension was stronger in medicated hypertensive patients than in those not medicated. This finding leads to the conclusion that joint risk factor control combined with pharmacological treatment could potentially eliminate the excess risk of stroke associated with hypertension.

FIBROSIS AS AN ADDITIONAL RISK FACTOR FOR STROKE DEVELOPMENT IN HYPERTENSIVE PATIENTS WITH ATRIAL FIBRILLATION (RETROSPECTIVE STUDY)

Objective: Atrial fibrillation (AF) is a common issue that is increasingly prevalent, particularly in hypertensive patients and leads to severe complications, notably stroke. Several prothrombotic factors are elevated in AF, contributing to an increased risk of stroke. Tissue factor (TF) is the main initiator of the blood coagulation cascade, also involved in inflammation and fibrogenesis. Atrial fibrosis plays a central role in creating the substrate for AF, with the Transforming Growth Factor (TGF-B1) identified as a key cytokine involved in the pathogenesis of atrial fibrosis. The aim of this study is to investigate the relationship between atrial fibrosis and the risk of developing transient ischemic attack (TIA) or stroke in hypertensive patients with AF (retrospective study). Design and method: We observed 445 hypertensive patients with nonvalvular AF over three years (2017-2019). Clinical examination included a study of complaints, physical, laboratory, and instrumental examination, along with additional biochemical blood tests, such as TF, hsCRP, IL-6, and TGF-B1. Blood tests were determined using the ELISA method. Treatment regimens for all patients included standard therapy (anticoagulants, antiarrhythmic, and symptomatic medication). Studies were conducted based on open-label protocols, using the universal statistical packages SPSS 13.0. Results: The obtained results have shown that among the 445 hypertensive patients with AF within three years, TIA or stroke was detected in 128 patients (28.8%). We found that in these patients, the level of TF is statistically elevated compared to other patients with AF (1350±65 vs. 850±33 pg/ml). Hypertensive patients undergoing TIA or stroke exhibited a significant increase in levels of inflammatory and fibrosis markers compared with other hypertensive patients with AF. Significant differences between hsCRP levels were observed (8.6±1.4 vs. 4.2±1.6, p=0.002); IL-6 levels (6.4±0.8 vs. 3.6±1.2 pg/ml, p=0.043); and TGF-B1 levels (1240±75 vs. 900±43 pg/ml, p=0.02). Moreover, plasma levels of hs-CRP were higher among AF patients at high risk of stroke (3 or more) according to CHA2DS2-VASc (p=0.002). Conclusions: We have demonstrated that fibrosis and inflammation markers, along with coagulation cascade markers, are additional prognostic criteria contributing to the development of TIA or stroke in hypertensive patients with AF.

Evaluation of Burden of Carotid Artery Disease In Ischemic Stroke Patients With And Without Hypertension

Evaluation of Burden of Carotid Artery Disease In Ischemic Stroke Patients With And Without Hypertension

A Study Evaluating the Aspects of Stroke-specific Quality of Life and Severity in Hypertensive Stroke Patients

ABSTRACT Background: A wide range of cognitive and physical effects occur depending on the location and extent of brain damage caused by the stroke. These effects vary widely in terms of severity. There is a strong correlation between quality of life (QoL) scores and the traditional functional outcome measures. The objective is to evaluate stroke patients’ QoL and severity. A total of 196 hypertensive stroke patients across all age groups are included in this prospective observational study. Methods: Stroke-specific QoL Scale (SS-QoL) questionnaires were self-administered, to assess health-related QoL among stroke patients. The severity level was determined using the modified Barthel index (MBI) and Modified Ranking Scales (mRS). Suitable Statistical methods (Pearson Chi-square and Pearson correlation) were applied to analyze the outcomes. Results: A total of 156 hypertensive stroke patients were assessed for SS-Qol and MBI. We observed that patients with hemorrhagic stroke (5.8%) showed excellent QoL (200–249 range) in comparison with that of ischemic stroke patients (4.4%) and correlation between the domains was significant at P &lt; 0.05 level. Majority of 61 (39.1%) patients showed severe dependence and 1% of patients were independent. mRS was assessed on 196 hypertensive stroke patients, our results showed that the majority of 51 (27%) had severe disability followed by 49 (25%) patients who were completely bedridden, and about 40 (20.4%) deaths were encountered. Conclusion: From our study, we conclude that on using SS-QoL scales assessing SS-QoL the results showed that patients who suffered from a stroke were severely affected physically and mentally decreasing the normal lifespan of a patient and causing death.

Analysis of Health-Related Quality of Life in Elderly Patients with Stroke Complicated by Hypertension in China Using the EQ-5D-3L Scale.

To evaluate the health-related quality of life(HRQoL)status of elderly patients with hypertensive stroke, to understand the factors influencing it, and to provide a basis for the development of health intervention policies. This study used the EQ-5D-3L scale to assess the HRQoL among elderly patients who experienced a stroke related to high blood pressure. Various analytical methods were employed to examine the factors that influenced the patient's quality of life. Univariate analysis, Tobit regression, random forest, and XGBoost models were applied to analyze the HRQoL of the patients. Furthermore, to interpret the machine learning results, the SHAP method was utilized. This method involved assessing the importance of each feature, examining the effect of each feature on the prediction result of a single sample, and determining the impact of individual features on the overall prediction. The study found that the median health utility value for elderly patients with hypertensive stroke was 0.427, with an interquartile range of 0.186 to 0.745. The results of the Tobit regression model, Random Forest, and XGBoost model were compared. The results of the model evaluation show that the performance of the machine learning model and the Tobit regression model are not very different. The XGBoost model performs slightly better relative to the random forest model. The factors that strongly influenced the health utility value of patients included BMI, social activities, smoking, education level, alcohol consumption, urban/rural residence, annual income, physical activity level, and hours of sleep at night. Health-related quality of life in hypertensive stroke patients is influenced by a variety of factors. Health-related quality of life can be positively influenced by modifying these factors and making lifestyle adjustments. Maintaining a healthy weight, being socially active, quitting smoking, improving living conditions, increasing physical activity levels and getting enough sleep are recommended. Lifestyle changes need to be developed for each individual on a case-by-case basis and by medical advice.

Evaluation of the management of hypertension among stroke patients in a neurology department of Côte d'Ivoire

Reducing blood pressure after stroke is important to prevent recurrent stroke, but we have no data about the control of blood pressure in our context. The purpose of this study was to assess management of hypertension among post-stroke patients in a neurology department. It was a retrospective study involving hypertensive stroke patients. They were followed up at 1, 3, 6 and 12 months after discharge. 141 patients fulfilled the inclusion criteria. The mean age was 61 years. Almost all patients (94.3%) received a dual antihypertensive therapy combining mainly an ACE inhibitor and a diuretic (70.2%). During follow-up, only 76 patients were assessed at M1, 50 at M3, 44 at M6 and 42 at M12. The average monthly cost of antihypertensive treatment was 13,771 CFA francs (21 euros). Non-adherence to antihypertensive medication were mostly noted in widows, patients without occupation, those with low education and no health insurance. At one year, blood pressure was controlled in 80% of the 42 patients still present. Non-control of blood pressure was related to poor therapeutic compliance (p<0.05). This study highlights follow-up issues in hypertensive post-stroke patients with a high number of lost to follow-up. Blood pressure was controlled in patients who were regularly followed and adherent to antihypertensive treatment.

Effects of calcium channel blockers on perioperative ischemic events in hypertensive patients with intracranial aneurysms undergoing neurointervention

BackgroundAlthough calcium channel blockers (CCBs) are useful in stroke prevention, their specific role in preventing stroke in hypertensive patients with intracranial aneurysms undergoing endovascular stent placement remains unclear.MethodsWe retrospectively examined...

The association between circulating fatty acids and stroke in hypertensive patients

BackgroundStroke is prevalent in hypertensive population. It has been suggested that unsaturated fatty acids (USFA) have protective effect on stroke. The effect of saturated fatty acids (SFAs) on stroke is still unclear. Therefore, we studied the relationship between circulating fatty acids and acute ischemic stroke (AIS) in hypertensive patients. MethodsEighty-nine pairs including 100 men and 78 women matched by sex and age were recruited. Each pair included a hypertensive patient within 48h of AIS onset and a hypertensive patient without stroke. Six circulating fatty acids were methylated before concentration determination which was repeated twice with percent recovery estimated. ResultsThere were differences in educational level (P = 0.002) and occupation (P < 0.001) between stroke and non-stroke participants. All the 6 fatty acid levels were higher in non-stroke participants (P = 0.017 for palmitoleic acid, 0.001 for palmitic acid, <0.001 for linoleic acid, <0.001 for behenic acid, <0.001 for nervonic acid and 0.002 for lignoceric acid). In logistic regression analysis, AIS was inversely associated with fatty acid levels except for lignoceric acid. After adjustment for education and occupation, the palmitoleic acid and palmitic acid levels were no longer inversely associated with AIS. After further adjustment for systolic blood pressure, smoking, drinking, total cholesterol and triglyceride, the inverse associations of linoleic acid (OR = 0.965, 95%CI = 0.942-0.990, P = 0.005), behenic acid (OR = 0.778, 95%CI = 0.664-0.939, P = 0.009), nervonic acid (OR = 0.323, 95%CI = 0.121-0.860, P = 0.024) with AIS remained significant. ConclusionsCirculating fatty acids except lignoceric acid were inversely associated with AIS. Both USFAs and SFAs may have beneficial effect on stroke prevention in hypertensive population.

Hypertensive and Non-hypertensive Hospital Admission Blood Pressure Association with Cognitive Function in Stroke Patients

Highlight: A comparative study of hypertension and non-hypertension on cognitive function. Hospital admission blood pressure and cognitive function in acute-phase stroke patients. Blood pressure is not associated with cognitive function. ABSTRACT Introduction: Cognitive impairment is one of the many stroke effects. White matter damage, microinfarcts, microbleeding, atrophy, and amyloid buildup in the brain due to stroke are all potential causes of this condition. Cognitive impairment studies have yet to provide a definitive explanation for how this condition develops following a stroke. Blood pressure is one of several risk factors for stroke. Meanwhile, few studies have been conducted on the association between blood pressure and cognitive function in stroke patients, and no definitive results have been established. Objective: This research was designed to examine and evaluate the difference in the measured cognitive function category between hypertensive and non-hypertensive hospital admission blood pressure stroke patients. Methods: This research used a cross-sectional design with a consecutive sampling method on acute stroke patients at Dr. Soetomo General Academic Hospital. The MMSE (Mini Mental State Examination) was carried out to assess the degree of cognitive function. The blood pressure measured is the hospital admission blood pressure. Results: There were 40 patients included in this study. A total of 36 patients (90%) were in the hypertension group (blood pressure ≥ 130/80 mmHg), and 4 patients (10%) were in the non-hypertension group (blood pressure &lt; 130/80 mmHg). The MMSE results showed that 10 patients performed with no cognitive impairment, 12 patients performed with mild cognitive impairment, and 18 patients performed with severe cognitive impairment. Statistical analysis of the Mann-Whitney U test showed that p = 0.561. Conclusion: There was no difference in the measured cognitive function category between hypertensive and non-hypertensive hospital admission blood pressure stroke patients.

Association of Antihypertensive Drug-Related Gene Polymorphisms with Stroke in the Chinese Hypertensive Population.

Antihypertensive therapy is crucial for preventing stroke in hypertensive patients. However, the efficacy of antihypertensive therapy varies across individuals, partially due to therapy-related genetic variations among individuals. We investigated the association of antihypertensive drug-related gene polymorphism with stroke in patients with hypertension. Demographic information, medication, and outcome data were obtained from a hypertensive patient management system, and a PCR fluorescence probe technique was used to detect 7 gene polymorphic loci (CYP2D6∗10, ADRB1, CYP2C9∗3, AGTR1, ACE, CYP3A5∗3, and NPPA), and these loci were compared between patients with and without stroke. Logistic regression was performed to analyze the association of these genetic variations with stroke risk in hypertensive patients while controlling for potential factors. The prevalence of stroke in the hypertensive population in Changsha County of Hunan Province was 2.75%. The mutation frequencies of ADRB1 (1165G > C), CYP2D6∗10, CYP2C9∗3, AGTR1 (1166A > C), ACE (I/D), NPPA (2238T > C), and CYP3A5∗3 were 74.43%, 57.23%, 4.26%, 5.71%, 31.62%, 1.17%, and 69.58%, respectively. Univariate analysis revealed that ADRB1 polymorphism was associated with stroke (χ2 = 8.659, P < 0.05), with a higher stroke risk in the CC group than in the GC and GG groups (GC + GG). Multivariate unconditional logistic regression analysis showed that the CC genotype in ADRB1 (vs. the GC + GG genotype) was associated with an increased risk of stroke [odds ratio (OR) = 1.184, P<0.05] in hypertensive patients. No association was observed between CYP2D6∗10, CYP2C9∗3, AGTR1 (1166A > C), ACE (I/D), CYP3A5∗3, and NPPA (2238T > C) polymorphisms and stroke. ADRB1 (1165G > C) gene polymorphism is associated with the risk of stroke in Chinese hypertensive patients. The CC genotype is correlated with a higher risk of stroke than the GC + GG genotype.

Serum gamma-glutamyl transferase level as a risk factor in acute stroke.

Worldwide stroke is the second major cause of mortality and the fourth prominent cause of disease load after coronary heart disease and all types of malignancy. Greater than 3/4th of these cases are in low-priced and middle-priced nations. Several epidemiological studies have shown that alcohol consumption is a risk factor for stroke. The correlation between alcohol consumption and stroke involves various processes. For excessive alcohol consumption, GGT (gamma glutamyl transferase) is used as a marker. The study aims to see whether serum GGT level is an independent risk factor for stroke in young and elderly patients who do not have a history of alcohol intake. The study is an analytical cross-sectional comparative hospital-based study done in the Department of Medicine, RIMS, Ranchi from November 2019 to April 2021. A total number of 100 cases including both sexes who presented with the first episode of stroke have been compared with 100 age-sex-matched healthy control subjects without any cerebrovascular or cardiovascular disease meeting inclusion and exclusion criteria. Analysis of data is done by SPSS software and R studio software. Serum GGT is lower in the age group of 40-60 years (24-hour GGT mean 50.70 U/L+SD 16.86) than the age group of 60-80 years (24-hour GGT 65.89 U/L+SD59.04) with a P value of 0.005. This is also true in 48-hour GGT (48.02 U/L+SD16.02) in 40-60 years compared to 57.94 U/L+SD42.81 in 60-80 years with a P value of 0.001 and 72-hour GGT (44.80 U/L+SD16.98) in 40-60 years compared to the mean (56.16 U/L+SD43.82) in 60-80 years with a P value of 0.001. This suggests that serum GGT level is significantly lower in the 40-60 years age group with a P value < 0.01. The serum GGT level in the case population is mean 58.30 (U/L) + SD43.87, and that in the control group is mean 17.48 (U/L) + SD4.32 with P value < 0.001. This implies an increased level of serum GGT level in stroke patients. Serum GGT level is independently correlated with stroke even in the presence of other risk factors for stroke such as diabetes mellitus, hypertension, and dyslipidemia. Serum GGT level is more in hypertensive, dyslipidemic, and ischemic stroke patients than in non-hypertensive, non-dyslipidemic, non-ischemic stroke patients, but serum GGT level cannot predict the outcome (survival or death) in stroke patients.

Identification of Serum Biomarkers of Ischemic Stroke in a Hypertensive Population Based on Metabolomics and Lipidomics.

Hypertensive individuals are at a high risk of stroke, and thus, prevention of stroke in hypertensive patients is essential. Metabolomics and lipidomics can be used to identify diagnostic biomarkers and conduct early assessments of stroke risk in hypertensive populations. In this study, serum samples were collected from 30 hypertensive ischemic stroke (IS), 30 matched hypertensive and 30 matched healthy participants. Metabolomics and lipidomics analyses were conducted via liquid chromatography-tandem mass spectrometry, and the data were analyzed using multivariate and univariate statistical methods. A random forest algorithm and binary logistic regression were used to screen the biomarkers and establish diagnostic model. We detected 21 differential metabolites and 38 differential lipids between the hypertensive IS and healthy group. Moreover, we found 18 differential metabolites and 31 differential lipids between the hypertensive IS and hypertension group. In particular, the following seven metabolites or lipids distinguished the hypertensive IS from the healthy group: 4-hydroxyphenylpyruvic acid, cafestol, phosphatidylethanolamine (PE) (18:0p/18:2), PE (16:0e/20:4), (O-acyI)-1-hydroxy fatty acid (36:3), PE (16:0p/20:3) and PE (18:1p/18:2) (rep). The following seven biomarkers distinguished the hypertensive IS from the hypertension group: diglyceride (DG) (20:1/18:2), PE (18:0p/18:2), PE (16:0e/22:5), phosphatidylcholine (40:7), dimethylphosphatidylethanolamine (50:3), DG (18:1/18:2), and 4-hydroxyphenylpyruvic acid. The aforementioned panels had good diagnostic and predictive ability for hypertensive IS. Our study determines the metabolomic and lipidomic profiles of hypertensive IS patients and thereby identifies potential biomarkers of the presence of IS in hypertensive populations.

Risk Factors for Hypertension in Patients with Stroke Presenting to Tertiary Care Hospital

OBJECTIVES To determine the frequency of hypertension in stroke patients presenting to the tertiary care hospital of Peshawar, Pakistan. METHODOLOGY This cross-sectional descriptive study was conducted in the Department of Medicine at Khyber Teaching Hospital, Peshawar. This study spanned months and included 225 patients of either gender who had stroke symptoms within the preceding 72 hours. Detailed information was documented in age (in years), residence, gender, educational qualification, family history of hypertension, smoking, diabetes mellitus, obesity, dyslipidemia, hypertension, and duration. SPSS version 26.0 was used.RESULTSThis study’s age ranged from 41 to 80 years, with a mean age of 61.0046.69. The mean duration of hypertension was 3.052±0.85 years. Hypertension was seen in 42.2% of patients. Factors leading to hypertension in stroke patients were age 40.8%, urban area 42%, illiteracy 36.2%, positive family history 61.9%, diabetes mellitus 65.2%, smoking 33.3%, obesity 85.3%, and dyslipidemia 71.8%. CONCLUSION Significant risk factors for stroke include hypertension, diabetes mellitus, hypercholesterolemia, smoking, obesity, and positive family history.

Interpretable machine learning for predicting 28-day all-cause in-hospital mortality for hypertensive ischemic or hemorrhagic stroke patients in the ICU: a multi-center retrospective cohort study with internal and external cross-validation.

Timely and accurate outcome prediction plays a critical role in guiding clinical decisions for hypertensive ischemic or hemorrhagic stroke patients admitted to the ICU. However, interpreting and translating the predictive models into clinical applications are as important as the prediction itself. This study aimed to develop an interpretable machine learning (IML) model that accurately predicts 28-day all-cause mortality in hypertensive ischemic or hemorrhagic stroke patients. A total of 4,274 hypertensive ischemic or hemorrhagic stroke patients admitted to the ICU in the USA from multicenter cohorts were included in this study to develop and validate the IML model. Five machine learning (ML) models were developed, including artificial neural network (ANN), gradient boosting machine (GBM), eXtreme Gradient Boosting (XGBoost), logistic regression (LR), and support vector machine (SVM), to predict mortality using the MIMIC-IV and eICU-CRD database in the USA. Feature selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm. Model performance was evaluated based on the area under the curve (AUC), accuracy, positive predictive value (PPV), and negative predictive value (NPV). The ML model with the best predictive performance was selected for interpretability analysis. Finally, the SHapley Additive exPlanations (SHAP) method was employed to evaluate the risk of all-cause in-hospital mortality among hypertensive ischemic or hemorrhagic stroke patients admitted to the ICU. The XGBoost model demonstrated the best predictive performance, with the AUC values of 0.822, 0.739, and 0.700 in the training, test, and external cohorts, respectively. The analysis of feature importance revealed that age, ethnicity, white blood cell (WBC), hyperlipidemia, mean corpuscular volume (MCV), glucose, pulse oximeter oxygen saturation (SpO2), serum calcium, red blood cell distribution width (RDW), blood urea nitrogen (BUN), and bicarbonate were the 11 most important features. The SHAP plots were employed to interpret the XGBoost model. The XGBoost model accurately predicted 28-day all-cause in-hospital mortality among hypertensive ischemic or hemorrhagic stroke patients admitted to the ICU. The SHAP method can provide explicit explanations of personalized risk prediction, which can aid physicians in understanding the model.

Comparison of circulating lipid profiles, D-dimer and fibrinogen levels between hypertensive patients with and without stroke

BackgroundStroke is one of the leading causes of global mortality and disability, particularly in hypertensive patients. This study aimed to compare lipid profile, fibrinogen, and D-dimer levels between hypertensive patient with and without stroke. MethodsThis was a facility-based cross-sectional study conducted from November 2022 to January 2023 among 115 hypertensive patients (70 patients without stroke and 45 with stroke) who had follow-up at Yikatit 12 Hospital Medical College, Ethiopia. All data analyses were done using SPSS version 25.0 and comparisons of variables between groups were made using the Chi-square test, independent sample t-test, and Mann-Whitney U test. Multiple logistic regression analysis was done to identify predictors of stroke among hypertensive patients. A p-value <0.05 was assumed to be statistically significant for all statistical tests. ResultsSignificantly elevated levels of TC, LDL-C, D-DI, and fibrinogen were observed in the stroke group than in the non-stroke group (p-value<0.05). The mean values of TC, D-DI, and fibrinogen were significantly higher in patients with ischemic stroke compared to those with hemorrhagic stroke. Duration of hypertension (AOR: 1.21; CI: 1.10, 2.09), TC (AOR:1.07; CI: 1.01, 1.22), D-DI (AOR: 1.15; CI: 1.05, 1.69) and fibrinogen (AOR:1.19; CI: 1.10, 2.89) were identified to be independent predictors of stroke in hypertensive patients. ConclusionThe circulating levels of TC, LDL-C, D-DI and fibrinogen in hypertensive patients with stroke were significantly higher than in those without stroke. But only TC, D-DI, and fibrinogen were found to be predictors of stroke in hypertensives. Considerably higher TC, D-DI, and fibrinogen levels were also seen in patients with ischemic stroke than in those with hemorrhagic stroke. This confirms the key roles of dyslipidemia (hypercholesterolemia) and aberrant hemostatic activation to stroke development, notably ischemic stroke.

THE CIRCADIAN PATTERN OF 24-HOUR AMBULATORY BLOOD PRESSURE AND HEART RATE IN THE CEREBRAL INFRACTION PATIENTS WITH HYPERTENSION AND HYPERTENSIVES PATIENTS

Aims: Evaluation of the circadian rhythm of 24-hour ambulatory blood pressure and pulse rate in the cerebral infraction patients with hypertension and hypertensives patients with purpose prognostic, prevention and treatment in two group.&#x0D; Objects and methods: This study included 140 cerebral infarction patients with hypertension, hospitalized for the first 7 days (mean age 65.5±10.4 years) and 143 primary hypertensive patients (mean age of 64.4±7.5 years). All had 24-h ambulatory recording, with measurement 30 every minutes in the daytime (6.00 am - 10.00 pm) and every 60 minutes at night (10.00 pm - 6.00 am). Results: Blood pressure in patients with cerebral infarction oscillated significantly more than in hypertensive patients; mean standard deviation of systolic blood pressure (25.8 mmHg) and diastolic blood pressure (15.8 mmHg) in patients with cerebral infarction respectively was significantly higher than those with hypertension (20 mmHg and 12.1 mmHg) with p &lt;0.01. The rate of non-dipping blood pressure at night, the overload of systolic and diastolic blood pressure, morning surge blood pressure in patients with cerebral infarction was significantly higher than that of hypertensive patients (92.1; 75.5; 60.2; 57.8 versus 64.3; 60.1; 49.1; 36.3 respectively; p &lt;0.01). Conclusion: It is necessary to monitor 24-hours ambulatory blood pressure in hypertensive patients and patients with cerebral infarction in the first week of admission to identify some phenomena such as nocturnal non-dipping blood pressure, the overload of blood pressure, especially morning surge blood pressure early to plan for prevention of target organ damage, particularly cerebral stroke in hypertensive patients.