Stroke In Hypertensive Patients Research Articles

PP.LB01.08] PREDICTORS OF STROKE IN HYPERTENSIVE PATIENTS ACCORDING TO THE FIVE-YEAR OBSERVATION

Objective: Investigate the possible predictors of stroke, according to a five-year follow-up in hypertensive patients. Design and method: Eighty essential hypertensive patients aged between 30–59 years were observed within 5 years. General clinical investigation, 24-h ABPM and brain MRI were performed in all patients at the onset of the study and after 5 years observation. Presence of increased subarachnoidal spaces (SS) and lateral ventricles (LV) of a brain, periventricular leucoaraiosis (PL), lacuna infarcts (LI) and focal white matter lesions (FWML) were evaluated in all patients. Results: 13,7% of patients during 5 years experienced stroke. This patients (I group - 13,7 %) were compared to group of hypertensive patients without stroke (II group – 86,3 %) with regard to baseline data. At patients with insults on initial brain tomograms authentically were more often registered FWML (75% vs 42%; chi square = 4,49, p = 0,046), LA (75% vs 44%; chi square = 5,04, p = 0,024) and LI (50% vs 6%;chi square = 17,04, p = 0,000). At baseline, 24-h systolic (170.7 ± 18.09 vs 149.8 ± 15.02, p = 0,000), diastolic (106.8 ± 9,70 vs 97.9 ± 10,73, p = 0.003) blood pressure and the number of night-pikkers (45.5% vs 15.9%; chi square = 5,14, p = 0,025) were higher at patients of I group. In multiple regression model including clinical data, baseline MRI signs and BP parameters, daytime systolic blood pressure (R = 0,38, p = 0,002), daytime systolic BP load (R = 0,41; p = 0.002), LA (R = 0,42; p = 0,025) and FWML (R = 0,39; p = 0,012) were best predictors of stroke. Significance of Multiple linear regression model: R = 0,53; R2 = 0,28; p = 0,0007. Conclusions: Our study demonstrates that systolic BP, focal white matter lesions and leucoaraiosis are independent predictors of stroke in hypertensive patients. Thus, ABPM and brain MRI early may significantly improve risk stratification in hypertensive patients.

OS 32-04 ACUTE BLOOD PRESSURE CONTROL BY RENAL DENERVATION IMPROVED PROGNOSIS AFTER CEREBRAL INFARCTION THROUGH REDUCTION OF OXIDATIVE STRESS IN SHRSP RATS

Although hypertensive patients show significant elevation of blood pressure (BP) in acute phase after cerebral infarction, it is still unknown how it should be managed to carry the best prognosis. To address this issue, we investigated the effect of acute control of elevated BP by bilateral renal denervation (RD) against ischemic stroke in SHRSP rats with 90 minutes transient middle cerebral arterial occlusion (MCAO). Seventy-five male SHRSP rats of 15 weeks of age were assigned to sham-operated (control, n = 15) and MCAO + sham (sham, n = 30), and MCAO + RD (RD, n = 30). Bilateral RD was done approximately 30 minutes after ischemia induction. In experiment 1, we evaluated the acute effects of RD by measurement of continuous BP, cerebral blood flow (CBF), cerebral vascular resistance (CVR), vasoreactivity by acetazolamide, neurological function, and infarct volume. In addition, phosphorylated Akt and e-NOS, and oxidative stress using gp91phox and dihydroethidium in ischemic brain were also evaluated at 24 hours after ischemia induction. In experiment 2, temporal changes of body weight of the rats were measured in every week and also rotarod test were assessed around 4 weeks after ischemia induction. Although the ischemic rats in sham group showed severe hypertension, RD significantly reduced BP through 24 hours after ischemia induction. The value of CBF after reprefusion was significantly lower in RD group compared to sham group, while CVR and vasoreactivity was not changed by RD. RD significantly ameliorated neurological deficit and infarct volume. Moreover, RD reduced not only the level of phosphorylated Akt and e-NOS but also oxidative stress. In experiment 2, body weight and rotarod test showed significant increasing in RD group compared to sham group. Our results suggest that acute blood pressure control by RD is promising therapeutic strategy to improve prognosis after ischemic stroke in hypertensive patients.

Plasma growth differentiation factor 15 predicts first-ever stroke in hypertensive patients.

Growth differentiation factor 15 (GDF-15) is a relatively new biomarker that predicts adverse stroke outcomes. However, the association of GDF-15 with first-ever stroke in hypertensive patients has not yet been evaluated. The objective of this study was to evaluate the clinical implications of plasma GDF-15 on the development of first-ever stroke in patients with hypertension.In total, 254 patients with hypertension without a history of stroke were included from March 2010 to August 2010 and followed up until June 2013. The baseline circulating GDF-15 was determined by enzyme-linked immunosorbent assays.During a follow-up of 3.0 ± 0.6 years, 22 (8.7%) first-ever strokes were identified, including 12 ischemic strokes and 10 intracerebral hemorrhages (ICH). According to tertiles of GDF-15, survival free of first-ever stroke was lower in the highest tertile of GDF-15 (log-rank P = 0.001). By backward stepwise Cox-regression analysis, adjusted for age, gender, diabetes mellitus, hyperlipidemia, hypertension stage, body mass index, cigarette smoking, anti-hypertensive drugs, and uric acid, every 100 pg/mL-increase in plasma of GDF-15 predicted an 11% greater risk of first-ever stroke (hazard ratios [HR]: 1.11, 95% confidence interval [CI]: 1.03-1.20, P = 0.010) and an 18% increase in ischemic stroke risk (HR: 1.18, 95% CI: 1.07-1.30, P = 0.001). Receiver operating characteristic analysis indicated that GDF-15 had reasonable accuracy to predict first-ever stroke (area under curve = 0.73, 95% CI: 0.62-0.83, P < 0.001).This study identifies that GDF-15 is an independent predictor of first-ever stroke, especially for ischemic stroke in the patients with hypertension.

Prospective Association of Fasting Blood Glucose Levels with Risk of Incident Stroke among Hypertensive Patients in China: Impact of Folic‐acid Intervention

BackgroundDiabetes has been shown to independently increase the risk of ischemic stroke. Aside from conventional clinical intervention (blood pressure control and cholesterol lowering), uncertainty remains on the role of folic acid supplementation in preventing stroke among individuals with elevated glucose, in particular, in low folate regions such as China.ObjectivesThis study sought to address two questions: (1) what is the prospective relationship between baseline blood glucose levels (ranging from normal, prediabetes to diabetes) and incident stroke risk? (2) can folic acid supplementation reduce the risk of stroke in hypertensive patients with elevated blood glucose levels?MethodsThis analysis included 20,313 hypertensive adults without history of stroke or myocardial infarction (MI) in the China Stroke Primary Prevention Trial (CSPPT), who were randomly assigned to a double‐blind daily treatment with 10mg enalapril and 0.8mg folic acid (n=10,348) or 10mg enalapril alone (n=10,354). Kaplan‐Meier survival analysis and Cox proportionate hazard models were used to estimate the effect of fasting blood glucose levels and folic acid therapy on first stroke risk, adjusting for pertinent covariates.ResultsDuring a median treatment duration of 4.5 years, 615 participants developed first stroke. High fasting blood glucose level (≥7.0 mmol/L) or diabetes, compared to low level (&lt;5.6 mmol/L), was associated with increased risk of first stroke (5.1% versus 2.7%, HR, 1.6; 95%CI, 1.3–2.0; p‐value &lt;0.001). Importantly, an inverse association between glucose and stroke was observed even at glucose levels far below current clinical cutoff for diabetes. Folic acid supplementation can significantly reduce the risk of stroke across a wide range of elevated glucose levels. The risk reduction was the greatest among those with fasting blood glucose level ≥7.0 mmol/L or diabetes (35%, HR, 0.65, 95%CI, 0.45–0.95, P&lt;0.001). These findings were mainly observed in ischemic stroke.ConclusionAmong adults with hypertension but without history of stroke and MI in China, higher fasting blood glucose levels (even still within the normal range) were associated with increased risk of ischemic stroke. Folic acid therapy can significantly reduce the risk of ischemic stroke among hypertensive patients with elevated blood glucose levels. Our findings warrant additional investigation and suggest that folic acid may offer a simple, safe, and effective strategy to further reduce the risk of first stroke among hypertensive patients with elevated blood glucose levels.

Longitudinal Study on Independent and Joint Effect of Brachial‐Ankle Pulse Wave Velocity and Blood Pressure Control on Incident Stroke in Hypertensive Patients

BackgroundPulse wave velocity (PWV) has been shown to affect the effects of anti‐hypertensive treatment in prevention of cardiovascular diseases. Data are very limited regarding whether PWV is an independent predictor of stroke above and beyond hypertension control. In their current guidelines for the management of arterial hypertension, the European Society of Hypertension included PWV as a potential consideration in managing middle‐aged hypertensive patients with increased aortic stiffness. However, none of the current stroke prevention guidelines have considered PWV due to limited data.ObjectiveThis longitudinal analysis examined the independent and joint effect of brachial‐ankle PWV (baPWV) with hypertension control on the risk of first stroke.MethodsThis report included 3,310 hypertensive adults (age: 59.6 ± 7.5 years), a subset of the China Stroke Primary Prevention Trial (CSPPT) with baseline measurement for baPWV. All the participants had no prior history of stroke or myocardial infarction (MI).ResultsMean baseline baPWV was 18.76 (SD: 3.82) m/sec. During a median follow‐up of 4.5 years, 111 participants developed first stroke. The risk of stroke was higher among participants with baPWV in the highest quartile than that in the lower range (6.3% vs. 2.4%). Similarly, the participants with inadequate hypertension control had a higher risk of stroke than those with adequate control (5.1% vs. 1.8%). When baPWV and hypertension control were examined jointly, participants in the highest baPWV quartile and with inadequate control had the highest risk of stroke compared to their counterparts as demonstrated by Kaplan‐Meier curves (log rank test p&lt;0.0001) and Cox proportional hazard modeling (hazard ratio (HR): 3.6; 95% confidence interval (CI): 1.9–6.8, p&lt;0.001), after adjusting for demographic and cardiovascular risk factors. Furthermore, there was a significant and independent effect of high baPWV on stroke as shown among participants with adequate hypertension control (HR=2.3, 95%CI: 1.1–4.8, p=0.029).ConclusionAmong hypertensive patients, baPWV and hypertension control were demonstrated to independently and jointly affect the risk of first stroke. Participants with high baPWV and inadequate hypertension control had the highest risk of stroke compared to other groups. Our findings warrant additional investigation and raise a possibility that baPWV may serve as a simple noninvasive screening tool in clinical or community settings to identify hypertensive adults at high‐risk of stroke. It may also offer a novel therapeutic target to further reduce stroke risk beyond conventional management.

Poor drug adherence and lack of awareness of hypertension among hypertensive stroke patients in Kampala, Uganda: a cross sectional study.

BackgroundRaised blood pressure (BP) remains an important risk factor for cardiovascular diseases such as stroke. Adherence to therapeutic recommendations especially antihypertensive drugs is important in BP control. The aim of the study was to assess the stroke risk factors and levels of adherence among hypertensive patients with stroke in Kampala Uganda.MethodsIn a cross-sectional study we describe 112 hypertensive subjects with stroke from two Kampala city hospitals. A standardized pre-tested questionnaire was used to collect medical history, clinical details, radiological findings and laboratory data.ResultsA total of 112 hypertensive subjects with stroke were enrolled between May 2013 and April 2014. The median ages were 63.5 years (52.5–75.0) for the cases. Seventy percent (78/112) of the study participants had ischemic strokes. Only 17 % were adherent to anti-hypertensive medications. The main cause of non-adherence appears to be lack of knowledge.ConclusionsPoor adherence of anti-hypertensive medications among hypertensive patients remains a big challenge in our setting. This has been attributed to lack of adequate knowledge and cost of the prescribed drugs. There is therefore an urgent need to promptly diagnose and educate hypertensive patients with emphasis on adherence to anti hypertensive drugs.

Abstract 9903: Baseline Left Atrial Abnormality by Electrocardiogram Predicts Incident Stroke in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy

Background: Recent findings in population-based studies suggest that abnormal P-wave terminal force in lead V 1 (PTFV 1 ), a marker of left atrial (LA) abnormalities such as fibrosis, dilatation and elevated filling pressures, is associated with incident ischemic stroke, even in the absence of atrial fibrillation (AF). However, whether PTFV 1 predicts incident stroke in hypertensive patients during aggressive blood pressure (BP) lowering has not been examined. Methods: Risk of incident stroke was examined in relation to abnormal PTFV 1 on a baseline ECG in 1879 hypertensive patients aged 60 or younger with ECG left ventricular hypertrophy (LVH), no history of AF, in sinus rhythm on their baseline ECG with no incident AF during follow-up, who were randomly assigned to losartan- or atenolol-based treatment. Patients &gt;60 years old were not included because of a highly significant interaction between PTFV 1 and age in Cox analyses. Abnormal PTFV 1 was defined by the presence of a negative terminal P wave in lead V 1 with amplitude x duration ≥4000 V*ms. Results: During mean follow-up of 4.8±0.9 years, 45 patients (2.4%) experienced a definite stroke. A higher incidence of stroke occurred in those with abnormal than normal baseline PTFV 1 : incidence rate per 1000 person-years, 7.8, 95% CI, 5.2-11.4 vs 3.4; 95% CI, 2.2-5.2; p=0.004. In univariate Cox models, abnormal PTFV 1 was associated with a &gt; 2-fold increased risk of incident stroke (HR 2.31, 95% CI 1.28-4.16, p=0.005). In multivariable Cox regression models that adjusted for other significant predictors of incident stroke in this population (gender, history of stroke or transient ischemic attack, ischemic heart disease or diabetes, baseline creatinine and in-treatment systolic BP), abnormal PTFV 1 remained associated with a &gt; 2-fold increased risk of incident stroke (HR, 2.06; 95% CI, 1.14-3.74, p=0.017). Conclusions: Abnormal PTFV 1, a marker of LA abnormality, was strongly associated with incident stroke in hypertensive patients, independent of in-treatment systolic BP and other predictors of incident stroke. This association, in the absence of detectable AF, suggests that an underlying atrial cardiopathy may cause LA thromboembolism and a subsequent stroke without necessarily manifesting with AF.

Autonomic symptoms in hypertensive patients with post-acute minor ischemic stroke

BackgroundMost studies regarding autonomic dysfunction in ischemic stroke are limited to heart rate and blood pressure changes during the acute phase. However, there are few data on quantitative assessment of autonomic symptoms. We sought to assess autonomic symptoms in hypertensive ischemic stroke patients. MethodsIn 100 hypertensive patients (45 with symptomatic ischemic stroke (6 months after stroke onset) and 55 without stroke), we assessed autonomic symptoms using the Scale for Outcomes in Parkinson disease-Autonomic (SCOPA-AUT). ResultsThe age (mean±standard deviation) for the stroke group was 66±12 and 63±15 for the without stroke group (P=0.8). Orthostatic hypotension occurred in 3.6% of the stroke group and 4.4% in the group without stroke. The total SCOPA-AUT score was higher in the stroke group compared with the group without stroke (P=0.001). Domain scores for gastrointestinal (P=0.001), urinary (P=0.005) and cardiovascular (P=0.001) were higher in the stroke group. No differences were found when comparing the total SCOPA-AUT scores for stroke subtypes (P=0.168) and for lateralization (P=0.6). SCOPA AUT scores were correlated with depression scores (P=0.001) but not with stroke severity (P=0.2). ConclusionAutonomic symptoms, especially, gastrointestinal, urinary and cardiovascular function, were significantly increased in hypertensive patients with minor ischemic stroke. Symptoms were associated with depression but not with the characteristic of the stroke.

Prevalence and radiological peculiarities of metabolic syndrome and hypertension in stroke patients

Prevalence and radiological peculiarities of metabolic syndrome and hypertension in stroke patients

Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients.

Hypertensive patients with electrocardiographic left ventricular hypertrophy are at increased risk of all-cause and cardiovascular death. Lowering blood pressure (BP) after stroke reduces the risk of recurrent stroke, but recent data suggest that lower systolic BP (SBP) measured 5 years after stroke is associated with increased mortality. Whether lower SBP is associated with increased short-term mortality after stroke in hypertensive patients is unclear. All-cause and cardiovascular mortality were examined in relation to average on-treatment SBP after stroke in 541 hypertensive patients with electrocardiographic left ventricular hypertrophy randomly assigned to losartan- or atenolol-based treatment who had new strokes during follow-up. Patients with on-treatment SBP<144 mm Hg (lowest tertile) and SBP>157 (highest tertile) were compared with patients with average SBP between 144 and 157. During 2.02±1.65 years mean follow-up after incident stroke, 170 patients (31.4%) died, 135 (25.0%) from cardiovascular causes. In multivariate Cox analyses, adjusting for significant univariate predictors of mortality, compared with average SBP between 144 and 157, an average SBP<144 was a significant predictor of all-cause (hazard ratio, 1.81; 95% confidence interval, 1.20-2.73) and cardiovascular mortality (hazard ratio, 1.60; 95% confidence interval, 1.02-2.54), whereas patients who had an average SBP>157 had no significant increased risk of death. Lower achieved SBP (<144 mm Hg) is associated with a significantly increased risk of cardiovascular and all-cause mortality after initial stroke in hypertensive patients during short-term follow-up. Further study is required to determine ideal SBP goals after stroke. URL: http://clinicaltrials.gov/. Unique identifier: NCT00338260.

Abstract T P309: Early Initiation of Blood Pressure Lowering Medication and the Outcomes of Hypertensive Acute Ischemic Stroke Patients

Background: Elevated blood pressure (BP) in acute stage of ischemic stroke is common but the management of hyperacute hypertension in stroke patients was only vaguely described in the current clinical guidelines. The aim of our study was to determine the effect of expedited initiation of BP-lowering medication on the functional recovery and vascular events after acute ischemic stroke. Methods: The authors constructed a prospective multicenter registry containing in-hospital BP profiles and BP-lowering medications from 3997 acute ischemic stroke cases. From the data, we selected 841 acute stroke patients who arrived less than 24 hours from onset and who had ≥140 mm Hg of mean systolic BP from ≥3 BP measurement within 24 hours from onset. Initiation of any BP-lowering medications at the day or the next day of stroke onset was defined as “early initiation.” Clinical outcomes of stroke patients have been collected prospectively as quality improvement activity of stroke care and included early neurological deterioration until 3 weeks, mRS score and vascular events at 3 months and 1 year. Adjustment for relevant confounders was performed using ordinal logistic models for mRS scores and using binary logistic models for clinical event outcomes. Results: Of the 841 stroke cases with mean systolic BP ≥140 during the first 24 hours, early initiation of any BP-lowering medication was documented in 36%. Early initiation group, compared with delayed or none, had more frequent atrial fibrillation (34% vs. 17%) and thrombolytic treatment (23% vs. 17%); other baseline characteristics were well balanced. Multivariable regression analyses showed that early initiation was significantly associated with increasing scores of mRS at 3 months (adjusted OR [95% CI]; 1.33; 1.02 _ 1.73) and at 1 year (1.34; 1.01 _ 1.78). However, early initiation was not linked to any vascular events or mortality after stroke. Conclusions: Our study documented that early initiation of BP-lowering medication hindered functional recovery after stroke without increasing adverse clinical events.

Abstract W MP78: Intravascular Volume Delpetion in Hypertensive ED Stroke Patients

Objective: The hypertensive response in acute stroke may mask patients who could be volume depleted. Our objective was to determine the incidence of stroke patients that are volume depleted despite hypertension. This is a pilot study using sonographic markers of volume status as compared to common clinical indicators of volume status. Methods: This was a prospective cohort study of suspected ischemic stroke patients with a NIHSS ≥ 4 and symptoms onset &lt; 24 hours. Exclusion criteria were pregnancy, age &lt; 18, or ICH. Trained investigators performed a sonographic assessment of volume status. An IVC collapsibility index (IVC-CI) &gt; 50% was used to define volume depletion. Investigators collected demographic and clinical information, and laboratory markers of dehydration (elevated blood urea nitrogen to creatinine ratio, hemoconcentration or high serum osmolality). A standardized questionnaire was given to treating clinicians who were blinded to the IVC-CI. They indicated their assessment of the patient's volume status. The analysis excluded subjects ultimately diagnosed with a stroke mimic. Analysis incorporated descriptive and regression statistics using SAS 9.3. The local IRB approved the study. Results: 23 subjects were enrolled, 4 had stroke mimics and were excluded from analysis. Mimics consisted of psychogenic disorders and myelopathy. The mean age was 64 years, 89% were Black, 68% female, and 95% had preexisting HTN. The mean NIHSS was 9.2, the mean time from symptom onset 309 minutes and the mean presenting SBP 170 ± 31 mmHg. 68% of subjects had a cortical infarct on MRI and the remaining had lacunar infarcts. The mean IVC-CI was 70 ± 21% and 84% (95% CI 68 - 100%) of subjects had IVC-CI &gt; 50%. Laboratory markers of dehydration were present in 5% of subjects. Treating physicians classified 29% as subjects as hypovolemic. There was no correlation between IVC-CI and SBP, NIHSS, infarct location or laboratory markers of dehydration (r = 0.04 - 0.29, p &gt; 0.23). Conclusions: This pilot study suggests that despite being hypertensive, the majority of ED stroke patients have US indications of volume depletion and may be able to tolerate volume expansion. Future studies may identify which patients have improvement in cerebral perfusion with volume expansion.

Influence of different Movements on Blood Pressure in Hypertensive Subacute Stroke Patients

Blood pressure is the pressure exerted by the blood against the walls of the blood vessels, especially the arteries, and is one of the vital signs. Acute stroke patients with hypertension require rehabilitation, but exercise seems to be linked to transient increase in blood pressure. Thus, it is necessary to examine the effects of different types of active movements on blood pressure in hypertensive stroke patients.

Impact of renin–angiotensin system inhibitors on mortality and major cardiovascular endpoints in hypertension: A number-needed-to-treat analysis

ObjectiveTo assess the effectiveness of renin–angiotensin aldosterone system (RAAS) inhibitors to prevent all-cause and cardiovascular death, myocardial infarction and stroke in hypertensive patients considering the number needed to treat (NNT). MethodsData from a meta-analysis of 18 prospective, randomized, controlled morbidity–mortality trials (68 343 RAAS inhibitor; 84 543 control) were used to calculate NNTs for the prevention of all-cause and cardiovascular mortality, myocardial infarction, and stroke. ResultsAngiotensin-converting enzyme (ACE) inhibitors were used in 7 trials and angiotensin receptor blockers (ARBs) in 11 trials. Mean follow-up was 4.3years. The annual incidence rate of all-cause mortality was 0.0233 in patients randomized to RAAS inhibitors versus 0.0252 in controls (hazard ratio 0.95, 95% confidence interval 0.91 to 0.99). The corresponding median NNT to prevent one death was 113 (2.5–97.5th percentile, 85 to 168) in favor of RAAS inhibitors, which was driven by ACE inhibitors (NNT 67, 2.5–97.5th percentile, 53 to 92) rather than ARBs (NNT 335, 2.5–97.5th percentile, −4341 to 5076). Results for cardiovascular mortality (NNT 116 for ACE inhibitors and 409 for ARBs, respectively) and myocardial infarction (NNT 80 and 338, respectively) also appeared to be driven by ACE inhibitors. We found a lower NNT for stroke in favor of ARB (NNT 337 and 131, respectively) although this difference was statistically non-significant. ConclusionAmong hypertensive patients, ACE inhibitors but not ARBs, substantially reduce all-cause and cardiovascular mortality and myocardial infarction.

The prognostic value of long-term visit-to-visit blood pressure variability on stroke in real-world practice: A dynamic cohort study in a large representative sample of Chinese hypertensive population

BackgroundThe prognostic significance of long-term visit-to-visit blood pressure variability (BPV) has not yet been validated in “real world” hypertensive patients. The aim of the current study is to explore the prognostic value of BPV on stroke in hypertensive patients. MethodsThis was a dynamic prospective cohort study based on electronic medical records in Shanghai, China. Hypertensive patients (N=122,636) without history of stroke at baseline, were followed up from 2005 to 2011. The cohort comprised of 4522 stroke patients and 118,114 non-stroke patients during a mean follow-up duration of 48months. BPV was measured by standard deviation (SD) and the coefficient of variation (CV) of blood pressure. ResultsThe visit-to-visit variability of both systolic blood pressure (SBP) and diastolic blood pressure (DBP) was independently associated with the occurrence of stroke [SD: the hazard ratios (95% confidence intervals) of SBP and DBP were 1.042 (1.021 to 1.064) and 1.052 (1.040 to 1.065); CV: the hazard ratios (95% confidence intervals) of SBP and DBP were 1.183 (1.010 to 1.356) and 1.151 (1.005 to 1.317), respectively]. The hazard ratio values increased along with an increase of the BPV levels of SBP and DBP. The increment effect remained significant after controlling the blood pressure control status of subjects. ConclusionsIncreased BPV of both SBP and DBP, independent of the average blood pressure, is a predictor of stroke among community hypertensive patients in real-world clinical practice. The risk of stroke increased along with increased BPV. Stabilizing BPV might be a therapeutic target in hypertension.

A survey on stroke prevention knowledge among primary hypertension stroke patients and its influencing factors

Objective To investigate stroke prevention knowledge among primary hypertension stroke patients.Methods The survey was conducted among 100 primary hypertensive stroke patients older than 35 years old for sociodemographic information,and stroke prevention knowledge.Results The stroke prevention knowledge score of 100 patients was (63.22 ± 20.68) points,diet dimension got the best score,came in first,to master the knowledge of the incidence of stroke signs was the worst,came in last.Blood pressure medication,coronary heart disease were stroke-related knowledge influencing factors.Conclusions The level of stroke prevention knowledge among primary hypertension stroke patients is low.In order to help hypertensive stroke patients improve their stroke prevention knowledge,health education should be promoted. Key words: Primary hypertension; Stroke prevention knowledge; Stroke

Left ventricular hypertrophy, abnormal ventricular geometry and relative wall thickness are associated with increased risk of stroke in hypertensive patients among the Han Chinese

Our study aimed to explore whether left ventricular hypertrophy (LVH), abnormal LV geometry and relative wall thickness (RWT) are associated with an increased risk of stroke in a hypertensive Chinese population. This study included 462 stroke patients and 3808 non-stroke hypertensive patients. LVH was diagnosed using the criteria of LV mass ⩾49.2 g m(-2.7) for men and 46.7 g m(-2.7) for women. A partition value of 0.43 was used for RWT. LV geometric patterns (normal, concentric remodeling, concentric or eccentric hypertrophy) were calculated according to LVH and RWT. Logistic regression analyses were used to determine the odds ratio (OR) and 95% confidence intervals (CI) of LVH, LV geometry abnormality and RWT for stroke. Our study suggested that LVH was associated with increased stroke risk (adjusted OR, 1.52; 95% CI, 1.25-1.85; multivariate-adjusted OR, 1.43; 95% CI, 1.16-1.75) and that concentric hypertrophy carried the highest risk of stroke (adjusted OR, 1.62; 95% CI, 1.21-2.17), followed by eccentric hypertrophy (adjusted OR, 1.51; 95% CI, 1.12-2.03), with concentric remodeling ranked third (adjusted OR, 1.34; 95% CI, 1.01-1.80). RWT was associated with an increased risk of stroke and was independent of LVMI and other risk factors for stroke (adjusted OR, 3.97; 95% CI, 1.10-14.34). Our observations in Chinese patients with hypertension indicated that LVH was an important risk factor for stroke, LV geometry abnormality was related to the presence of stroke, concentric hypertrophy carried the highest risk of stroke in cases of abnormal LV geometry and that RWT was also a risk factor for stroke and was independent of LVMI and other stroke risk factors.

Stroke Prevention Knowledge and Prestroke Health Behaviors Among Hypertensive Stroke Patients in Mainland China

Individuals with hypertension are at risk of stroke, and patients with stroke histories are at risk of experiencing another stroke. At this time, however, only a few studies have reported on stroke prevention knowledge and health behaviors among hypertensive patients who have had an initial stroke. The purpose of this study was to determine stroke prevention knowledge and health behaviors and to analyze the association between these 2 variables among hypertensive stroke patients who have had an initial stroke. With the use of a descriptive correlational design, a sample of 112 hypertensive stroke patients was recruited from the departments of neurology of 3 hospitals in Guangzhou, China. Each patient completed 2 reliable, validated questionnaires, the Stroke Prevention Knowledge Questionnaire and the Health Promoting Lifestyle Profile II. Data were collected during patients' hospital admission for stroke, within 2 days of stroke onset, and before they received stroke education. Pearson correlation coefficient was used to examine the correlations between the study variables. Multiple stepwise regression analysis was used to predict both the level of knowledge relating to stroke prevention and health behaviors. The participants showed a relatively low level of stroke prevention knowledge and a moderate level of engagement in healthy behaviors. Pearson correlation coefficient between these 2 variables was 0.423 (P < .001). The results of multiple regression analysis showed that stroke prevention knowledge was positively influenced by education level; health behaviors were positively influenced by both gender and stroke prevention knowledge. Findings suggest that male hypertensive patients and those with a lower education level need targeted stroke education. Because knowledge was unrelated to behavior with respect to smoking, alcohol use, and low-salt diet, behavioral interventions should be explored to address these important risk factors among patients at risk for stroke.

Cerebral microbleeds are associated with nocturnal reverse dipping in hypertensive patients with ischemic stroke

BackgroundAbnormalities in nocturnal blood pressure dipping are well known for its relationship to cardiovascular diseases. Cerebral microbleeds are frequently observed in patients with hypertension and are known to be potent risk factors for stroke. However, there are scanty reports about the relationship between nocturnal dipping and cerebral microbleeds.MethodsWe recruited consecutive patients with both hypertension and ischemic stroke within 7 days after symptom onset, and those with cardioembolism were excluded. We applied 24-hour ambulatory blood pressure monitoring two weeks after stroke onset, and we used brain MRI to detect cerebral microbleeds. Various blood pressure parameters such as mean 24-hour blood pressure, awake/sleep blood pressure, and morning surge were compared between cerebral microbleeds (+) vs. (-) groups. Subjects were further classified according to nocturnal dipping status and were analyzed by logistic regression to determine its association with cerebral microbleeds with adjustment for age, gender, and cardiovascular risk factors.ResultsA total of 162 patients (100 males, age 65.33 ± 10.32 years) were included. Cerebral microbleeds were detected in 65 patients (40.1%). Most ambulatory blood pressure parameters except morning surge were significantly higher in those who had cerebral microbleeds. After adjusting for the confounding factors, the reverse dippers were prone to have cerebral microbleeds (odds ratio, 3.81; 95% confidential interval, 1.36-10.65; p-value = 0.01).ConclusionCerebral microbleeds are independently associated with reverse dipping on ambulatory blood pressure monitoring in hypertensive stroke patients.

Arterial stiffness and functional outcome in acute ischemic stroke.

ObjectiveArterial stiffness is a common change associated with aging and can be evaluated by measuring pulse wave velocity (PWV) between sites in the arterial tree, with the stiffer artery having the higher PWV. Arterial stiffness is associated with the risk of stroke in the general population and of fatal stroke in hypertensive patients. This study is to clarify whether PWV value predicts functional outcome of acute ischemic stroke.MethodsOne hundred patients were enrolled with a diagnosis of acute ischemic stroke and categorized into two groups: large-artery atherosclerosis (LAAS) or small vessel disease (SVD) subtype of Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Each group was divided into two sub-groups based on the functional outcome of acute ischemic stroke, indicated by modified Rankin Scale (mRS) at discharge. Poor functional outcome group was defined as a mRS ≥ 3 at discharge. Student's t-test or Mann-Whitney U-test were used to compare maximal brachial-ankle PWV (baPWV) values.ResultsTwenty-four patients whose state was inadequate to assess baPWV or mRS were excluded. There were 38 patients with good functional outcome (mRS < 3) and 38 patients with poor functional outcome (mRS ≥ 3). The baPWV values were significantly higher in patients with poor outcome (2,070.05 ± 518.37 cm/s) compared with those with good outcome (1,838.63 ± 436.65) (p = 0.039). In patients with SVD subtype, there was a significant difference of baPWV values between groups (2,163.18 ± 412.71 vs. 1,789.80 ± 421.91, p = 0.022), while there was no significant difference of baPWV among patients with LAAS subtype (2,071.76 ± 618.42 vs. 1,878.00 ± 365.35, p = 0.579).ConclusionsArterial stiffness indicated by baPWV is associated with the functional outcome of acute ischemic stroke. This finding suggests that measurement of baPWV predicts functional outcome in patients with stroke especially those whose TOAST classification was confirmed as SVD subtype.