Hypertension Stroke Research Articles

INCREASED IONIZED CALCIUM-MAGNESIUM RATIO IN ELDERLY HYPERTENSIVES

Objective: Alterations in the metabolism of calcium and the biofactor magnesium can be involved in the pathogenesis of essential hypertension. Serum magnesium concentrations only insufficiently reflect disorders in magnesium handling in humans, as only about 1% of total body magnesium stores are in blood. The calcium and magnesium flux across the external membrane is regulated by a calcium pump (calcium-magnesium-ATPase), calcium and magnesium (TRPM 6 and 7) channels and a sodium magnesium antiport. An increased calcium-magnesium ratio is known to be involved in the development of atherosclerosis. Early onset of this disorders are known in hypertension. Design and method: We present a study in 18 hypertensive elderly concerning ionized magnesium concentrations and ionized calcium-magnesium ratio in blood measured by a Prime Plus apparatus by NOVA Medical, Andover, USA. Results: In 18 elderly hypertensives (9 male/9 female with normal renal function) ionized magnesium was measured 0.55 +/- 0.04 mmol/l (normal range: 0.54 - 0.80 mmol/l). The ionized calcium-magnesium ratio was 2.33 +/- 0.18 (normal range below 2.40)(p< 0.05). Data are means +/- SD. ANOVA was used for statistical evaluation. About 40% of elderly hypertensives showed an significantly increased ratio of ionized calcium and magnesium, which is well known to be a marker for the development of arteriosclerosis. Conclusions: As described earlier, a deficiency in the biofactor magnesium can be involved in the pathogenesis of essential hypertension. Ionized magnesium data, as presented here, are rare, but ionized magnesium is the active magnesium in the body regulating about 600 enzymatic reactions. The significantly increased ratio of ionized calcium and magnesium is important in the development of arteriosclerosis often resulting in stroke or heart insufficiency in hypertension.

Effect of the number of unhealthy lifestyles in middle-aged and elderly people on hypertension and the first occurrence of ischemic stroke after the disease.

To determine the relationship between the number of controllable unhealthy lifestyles on the risk of the first occurrence of ischemic stroke after the disease in middle-aged and elderly people in the community, and to provide data support and basis for community physicians to guide hypertensive patients to control modifiable risk factors to prevent the first occurrence of ischemic stroke. The relationship between the number of unhealthy lifestyles and the risk of hypertension was analyzed by binary logistic regression in 584 subjects using a medical record control study. A retrospective cohort study of 629 hypertensive patients was used to analyze the relationship between the number of unhealthy lifestyles and the risk of the first occurrence of ischemic stroke within 5 years of developing hypertensive disease using Cox proportional risk regression models. Logistic regression model analysis showed that taking an unhealthy lifestyle as a reference, the OR (95% CI) values of, 2, 3, 4 and 5 unhealthy lifestyle were 4.050 (2.595-6.324), 4 (2.251-7.108), 9.297 (3.81-22.686), and 16.806 (4.388-64.365), respectively. Cox Proportional risk regression model analysis showed that the risk of ischemic stroke within 5 years after developing hypertension was referenced to 5 unhealthy lifestyles, and the HR (95% CI) for 3, 2, and 1 unhealthy lifestyle were 0.134 (0.023-0.793), 0.118 (0.025-0.564), and 0.046 (0.008-0.256), respectively. The number of controllable unhealthy lifestyles in middle-aged and elderly people was positively associated with the risk of hypertension and first ischemic stroke after hypertension, and there was a dose-effect relationship between them. The risk of hypertension and first ischemic stroke within 5 years after hypertension onset increased with the number of unhealthy lifestyles.

Electrocardiographic markers of subclinical atrial fibrillation detected by implantable loop recorder

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The LOOP Study was funded by Innovation Fund Denmark [grant number 12-1352259], The Research Foundation for the Capital Region of Denmark, The Danish Heart Foundation [grant number 11-04-R83-A3363-22625], Aalborg University Talent Management Program, Arvid Nilssons Fond, Skibsreder Per Henriksen, R og Hustrus Fond, the European Union’s Horizon 2020 program [grant number 847770], Læge Sophus Carl Emil Friis og hustru Olga Doris Friis’ Legat, and an unrestricted grant from Medtronic. Background Atrial fibrillation (AF) is a well-known and treatable risk factor for stroke, which has sparked a substantial interest in AF screening. However, further insights into subclinical AF development are warranted to inform strategies of screening and subsequent clinical management upon AF detection. Purpose This study sought to identify 12-lead electrocardiogram (ECG) parameters associated with the onset, burden and progression of subclinical AF detected by long-term continuous monitoring. Methods We included AF-naïve individuals aged 70-90 years with ≥1 additional stroke risk factors (hypertension, diabetes, heart failure, or prior stroke) who underwent implantable loop recorder (ILR) monitoring in the LOOP Study. Using data from daily ILR recordings and computerized analysis of baseline ECG, we studied empirically selected ECG parameters for AF detection (≥6 minutes), cumulative AF burden, long-lasting AF (≥24 hours), and AF progression. Results Of 1370 individuals included, 419 (30.6%) developed AF during follow-up, with a mean cumulative AF burden of 1.5% [95% confidence interval (CI): 1.2-1.8%]. Several P-wave-related and ventricular ECG parameters were associated with new-onset AF as well as with cumulative AF burden in AF patients. P-wave duration (PWD), P-wave terminal force in lead V1, and interatrial block (IAB) further demonstrated significant associations with the risk of AF episode ≥24 hours. Among AF patients, we observed an overall reduction in cumulative AF burden over time (incidence rate ratio 0.70 [95% CI: 0.51-0.96]), whereas IAB was related to an increased risk of progression to AF episodes ≥24 hours (hazard ratio 1.86 [95% CI: 1.02-3.39]). Further spline analysis revealed longer PWD to also be associated with this progression in AF duration. Conclusions We identified several ECG parameters associated with new-onset AF detected by ILR. Especially PWD and IAB were robustly related to the onset and the burden of subclinical AF as well as progression over time.

Associations between environmental noise and myocardial infarction and stroke: Investigating the potential mediating effects of hypertension

BackgroundWe investigated whether hypertension may be a mediator in the pathway linking environmental noise exposure to incident MI and stroke. MethodsSeparately for MI and stroke, we built two population-based cohorts from linked health administrative data. Participants were residents of Montreal (Canada) between 2000 and 2014, aged 45 years and older who were free of hypertension and MI or stroke at time of entry. MI, stroke and hypertension were ascertained from validated case definitions. Residential long-term environmental noise exposure, expressed as the annual mean level acoustic equivalent 24 h (LAeq24h), was estimated from a land use regression model. We performed mediation analysis based on the potential outcomes framework. We used a Cox proportional hazards model for the exposure-outcome model and a logistic regression for the exposure-mediator model. In sensitivity analysis we applied a marginal structural approach to estimate the natural direct and indirect effects. ResultsEach cohort included approximately 900 000 individuals, with 26 647 incident cases of MI and 16 656 incident cases of stroke. 36% of incident MI and 40% of incident stokes had previously developed hypertension. The estimated total effect per interquartile range increase (from 55.0 to 60.5 dB A) in the annual mean LAeq24h was 1.073 (95% confidence interval (CI): 1.070–1.077) for both MI for stroke. We found no evidence of exposure-mediator interaction for both outcomes. The relationships between environmental noise and MI and stroke was not mediated by hypertension. ConclusionsThis population-based cohort study suggests that the main route by which environmental noise exposure may cause MI or stroke is not through hypertension.

Meta-Analysis of the Association Between Atrial Fibrillation, Hypertension, Sleep-Disordered Breathing, and Wake-Up Stroke.

The occurrence of atrial fibrillation, circadian fluctuation in blood pressure, and oxygen desaturation at night is likely associated with the pathophysiology of wake-up stroke. Whether patients who experience wake-up strokes are candidates for thrombolysis treatment is a serious dilemma. The aim is to investigate the association between risk factors and wake-up stroke and to determine variations that are associated with the pathophysiology of wake-up stroke. Five major electronic databases were searched using a fitted search strategy to identify relevant studies. Odds ratios with 95% CIs were used to calculate estimates, and the Quality Assessment for Diagnostic Accuracy Studies-2 tool was used to conduct the assessment quality. A total of 29 studies were included in this meta-analysis. Hypertension is not associated with wake-up stroke (odds ratio, 1.14 [95% CI, 0.94-1.37]; P = .18). Atrial fibrillation is an independent risk factor to wake-up stroke, with a statistically significant difference (odds ratio, 1.28 [95% CI, 1.06-1.55]; P = .01). Subgroup analysis showed a different result in patients with sleep-disordered breathing, although no significant difference was assessed. This study revealed that atrial fibrillation is an independent risk factor for wake-up stroke and that patients with atrial fibrillation who also experience sleep-disordered breathing tend to have fewer wake-up strokes.

Clinical outcome in patients with acute hypertensive hemorrhagic stroke with intravenous fluid versus no intravenous fluid: a randomized controlled study (P7-5.005)

<h3>Objective:</h3> This study was done to compare the outcome(mRS) of patients with acute hypertensive hemorrhagic stroke receiving intravenous fluid vs. no iv fluids in the acute period <h3>Background:</h3> Intracerebral hemorrhage (ICH) accounts for 10% of all strokes. Dehydration has a poor prognosis for both AIS and ICH patients. No randomized controlled trials have been done on hemorrhagic stroke patients. Studies are needed to see if intravenous fluids given to such individuals can help prevent early or late neurological impairment. <h3>Design/Methods:</h3> This was a prospective, single-center, open-label, randomized controlled trial. The outcome assessment was blinded. The patient’s relatives were informed that they would have full authority to enroll or withdraw from the study. All the patients with clinical features of acute hypertensive hemorrhagic stroke and were diagnosed with imaging findings between February 2021 and February 2022 were screened for eligibility. <h3>Results:</h3> A total of 80 patients were included. All baseline characters, including age, sex, GCS at admission, NIHSS score at admission, ICH volume, ICH score at admission, and mRS at admission, were all comparable between the groups. Out of the total 82 patients included in the analysis, 38 were females (46.3%), and 44 were males (53.7%). The primary outcome was a good functional outcome defined as a mRS of 0–3 at three months of follow-up. We found that those in the IVF group had better and statistically significant good functional outcomes at three months of follow-up than those in the no-IVF group. The mean duration of hospital stay in the IVF group was 7.51±2.81 days and in the no-IVF group, it was 10.49±5.98 days(p&lt;0.001). <h3>Conclusions:</h3> Our findings imply that in patients with acute hypertensive intracerebral hemorrhage, normal saline administered at 100ml per hour in the early period is associated with a better functional outcome at three months, as well as a lower risk of dehydration. <b>Disclosure:</b> Dr. Pathak has nothing to disclose.

Spontaneous Paradoxical Improvement of Motor Function after a Second Stroke (P2-5.009)

<h3>Objective:</h3> Describe paradoxical improvement of the motor function after a second stroke located in the area of the first stroke. <h3>Background:</h3> Animal studies have shown that humoral factors induced by acute stroke facilitate recovery more if rehabilitation is commenced earlier than later. Moreover, a second stroke may improve recovery from the first stroke. It is unknown if this phenomenon occurs in humans. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> 53-year-old right-handed woman with a history of hypertension and ischemic stroke 2 years before, with residual left hemiplegia, and post-stroke epilepsy presented with acute onset of mild weakness and numbness of the right arm and leg. Neurological examination revealed mild weakness and numbness of the left face, power of 4/5 and 5/5 in the right arm and leg respectively, and 0/5 in the left arm and leg. Sensation to light touch and pin was decreased in the left arm and leg. Vibration was decreased on left and proprioception was impaired distally bilaterally. Reflexes were 1+ at right triceps and biceps, 2+ at right patella, 3+ at left triceps, biceps, patella, and 0 at ankle bilaterally. Next day, she developed dysarthria and the power of right limbs decreased to 2/5. By the third day, dysarthria and right hemiparesis resolved. Additionally, the patient noted spontaneous increased power of the proximal left side to 3/5 in both arm and leg. However, distally, power remained 0/5 in both left arm and leg. MRI demonstrated acute infarction located in the center of a chronic infarct corresponding to the territory of right anterior cerebral artery. CT angiogram showed right anterior cerebral artery occlusion. <h3>Conclusions:</h3> The patient had spontaneous paradoxical improvement of the motor deficit after a second stroke. There is no similar case report in humans. This may confirm the limited window of improved recovery triggered by another stroke. <b>Disclosure:</b> Mr. Li has nothing to disclose. Dr. Bloch has nothing to disclose. Dr. Baek has nothing to disclose. Dr. Sivakumar has nothing to disclose. Dr. Hiana has nothing to disclose. Dr. Marchidann has stock in Eli Lilly. Dr. Marchidann has stock in Pfizer. Dr. Marchidann has stock in Merck. Dr. Marchidann has stock in Illumina. Dr. Marchidann has stock in Aeterna Zentaris. Dr. Marchidann has stock in Abbot. Dr. Marchidann has received publishing royalties from a publication relating to health care. Dr. Marchidann has received publishing royalties from a publication relating to health care.

Emerging Trends in Stroke Epidemiology in Indian Women Over the Last Decade (P1-5.025)

<h3>Objective:</h3> <b>Temporal trends in clinico-epidemiological parameters of stroke among Indian women have not been studied. We aimed to study the changes in these parameters over the last decade</b> <h3>Background:</h3> Scant literature is available from India regarding the clinico-epidemiologic parameters of stroke among women.. Sociocultural issues might lead to a delay in seeking health care and thrombolysis, leading to poorer stroke outcomes among Indian women. Hence, this study was conducted to understand whether there is any paradigm shift in demographic parameters and other risk factors contributing to both ischemic and hemorrhagic stroke in Indian women over a 12-year period. <h3>Design/Methods:</h3> 417 strokes (ischemic/hemorrhagic) were prospectively recruited in two timelines. In total, 267 strokes were recruited in 2005 while 150 strokes were recruited in 2016–17. Patients underwent stepwise evaluation via a structured proforma. Demographic factors, stroke subtypes, and risk factors were analyzed. <h3>Results:</h3> Female strokes had a higher mean age in 2017 compared to 2005 (60.90 ± 16.9 vs. 53.21 ± 16.75 years, <i>P</i> = 0.002). Hemorrhagic strokes among females increased over the last decade. Female strokes with dyslipidemia were significantly lower in 2017 compared to 2005 (<i>P</i> = 0.002). Proportion of hypertensive and diabetic strokes were not significantly different between these two periods. <h3>Conclusions:</h3> Our study showed that acute stroke (ischemic/hemorrhagic) among Indian women is occurring at a later age. Hemorrhagic stroke among women has increased over the last decade. Furthermore, dyslipidemia among stroke patients has decreased over the past decade. However, hypertension and diabetes prevalence among stroke patients has not decreased significantly and requires urgent strengthening of public health measures. <b>Disclosure:</b> Prof. Dhamija has nothing to disclose. ABHISHEK AGGARWAL has nothing to disclose. Dr. Saluja has nothing to disclose. Dr. Parihar has nothing to disclose.

Association of Circulating Metabolites With Racial Disparities in Hypertension and Stroke in the REGARDS Study.

In the United States, the risk of stroke is greater among Black compared with that among White individuals. However, the reasons for the difference in stroke incidence are not fully elucidated. We aimed to identify metabolites that account for higher prevalent hypertension and incident ischemic stroke among Black adults. We used a stroke case cohort nested within the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Targeted metabolomic profiling of 162 plasma metabolites was performed by liquid chromatography-tandem mass spectrometry. We identified metabolites that were associated with prevalent hypertension and incident ischemic stroke and mediated the relationship between hypertension and ischemic stroke by weighted logistic regression, Cox proportional hazard model, and inverse odds ratio weighting mediation analysis. Incident ischemic stroke cases adjudicated through April 1, 2019 (n = 1,075) were included in the study. The random cohort sample was derived from the full cohort using stratified sampling (n = 968). Among 162 metabolites, gluconic acid was associated with prevalent hypertension in Black adults (odds ratio [OR] 1.86, 95% CI 1.39-2.47, p = 2.58 × 10-5) but not in White adults (OR 1.00, 95% CI 0.80-1.24, p = 0.97; p for interaction = 4.57 × 10-4). Gluconic acid also demonstrated an association with incident ischemic stroke among Black participants (hazard ratio [HR] 1.53, 95% CI 1.28-1.81, p = 1.76 × 10-6) but not White participants (HR 1.16, 95% CI 1.00-1.34, p = 0.057; p for interaction = 0.019). In mediation analysis, gluconic acid mediated 25.4% (95% CI 4.1%-46.8%, p = 0.02) of the association between prevalent hypertension and incident ischemic stroke among Black individuals. Specific socioeconomic factors were linked to elevated gluconic acid level among Black adults in multivariable analysis, including a Southern dietary pattern (β = 0.18, 95% CI 0.08-0.28, p < 0.001), lower educational attainment (β = 0.45, 95% CI 0.19-0.72, p = 0.001), and a lack of exercise (β = 0.26, 95% CI 0.01-0.51, p = 0.045). Gluconic acid is associated with prevalent hypertension and incident ischemic stroke and mediates the relationship between hypertension and ischemic stroke in Black but not White adults. Gluconic acid is a biomarker that is associated with social determinants of health including a Southern diet, low educational attainment, and low physical activity.

Intensive Blood Pressure Control After Mechanical Thrombectomy for Acute Ischemic Stroke

Optimal blood pressure targets following successful mechanical thrombectomy remain uncertain. While some observational studies suggest that the relationship between blood pressure and outcomes follows a U-shaped curve, others suggest a linear relationship where lower is better. The recent BP-TARGET study (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy) did not find a benefit to intensive blood pressure lowering regarding the risk of symptomatic intracranial hemorrhage, but it was not sufficiently powered to detect differences in functional outcomes. On its heels arrived the ENCHANTED2 (Enhanced Control of Hypertension and Thrombectomy Stroke Study)/mechanical thrombectomy trial, the first trial of intensive blood pressure lowering in patients with hypertension following successful mechanical thrombectomy powered to detect a difference in functional outcomes. The trial randomized patients to either a systolic blood pressure less than 120 or 140 to 180 mm Hg. The trial was terminated early due to safety concerns in the more intensive blood pressure-lowering group. In this emerging therapy critique, we explore concerns regarding the generalizability of ENCHANTED2/mechanical thrombectomy, including the high prevalence of intracranial atherosclerosis in the studied population. We survey mechanisms for poor outcomes in patients who receive overly aggressive blood pressure reduction following successful thrombectomy, such as poststroke autoregulatory compromise and persistent microcirculatory hypoperfusion. Finally, we advocate for a more moderate approach, pending further research.

Risk of early recurrence and mortality in high-risk myocardial infarction patients: A population-based linked data study

BackgroundSurvival during the early period following myocardial infarction (MI) has significantly improved although there are limited data on cardiovascular recurrence during this period. MethodsWe identified all emergency hospitalisations for MI from November 1, 2011 to October 31, 2016 in Western Australia from a linked hospitalisation/mortality dataset. Patients were included if they survived >3 days, had no acute kidney injury, and had ≥1 of: ≥65 years, prior MI, diabetes or peripheral arterial disease. Outcomes were major adverse cardiovascular events (MACE, a composite of CVD death, recurrent MI or stroke), cardiovascular disease (CVD) death, all-cause mortality, recurrent MI and stroke. Cumulative risks at 90-days and 1-year were estimated from Kaplan-Meier analyses and predictors of each outcome from multivariable Cox regression models. ResultsThere were 8024 high-risk MI patients identified (males 61.8%). Median age was 73.7 years (IQR 66.3–82.2). Half of the risk of MACE occurred in the first 90-days post-MI (6.6% vs 12.6% at 1-year) and was underpinned by risk of recurrent MI. Risk was generally higher in women than men (MACE: 6.0% males, 7.7% females, p = 0.0025; CVD mortality: 1.7% males, 3.7% females; all-cause mortality: 2.8% males, 5.6% females, p < 0.0001). Independent predictors of 90-day MACE were increasing age, heart failure history, hypertension and prior stroke. Female sex was not associated with a higher rate of any of the outcomes after multivariable adjustment. ConclusionHalf of cardiovascular events in the year following an MI occur within 90-days, demonstrating that reductions in MI burden could be achieved by further targeted intervention in the early period following an MI.

Prevalence of Microalbuminuria and its Association with Left Ventricular Hypertrophy (LVH), Ischemic Heart Disease (IHD), Retinopathy, and Stroke in Hypertension

Background: Hypertension is a growing issue of public health problem of the adult population in both developed as well as developing world, is a serious medical condition that significantly increases the risks of heart, brain, kidney, and other diseases. There is a strong association between Microalbuminuria (MA) and hypertension. Microalbuminuria (MA) is the independent risk factor for developing cardiovascular and cerebrovascular morbidity and mortality in hypertension, suggesting that microalbuminuria (MA) could be a useful marker to assess the risk management of cardiovascular disease and renal disease.&#x0D; Objective: To assess the frequency of microalbuminuria in hypertension and to evaluate its association with left ventricular hypertrophy (LVH), ischemic heart disease (IHD), retinopathy, and stroke.&#x0D; Methods: This cross-sectional descriptive study was conducted at the Hypertension &amp; Research Centre, Rangpur from January 2010 to January 2012. A total of 75 hypertensives without diabetes mellitus and/or other conditions causing microalbuminuria were purposively selected. Urine albumin was assessed and microalbuminuria was defined as albumin excretion between 20-200 microg/min. The relationship of microalbuminuria with the duration, severity, body mass index (BMI), lipid profile, and target organ damage (TOD) like left ventricular hypertrophy (LVH), ischemic heart disease (IHD), hypertensive retinopathy, and stroke was assessed by univariate analysis.&#x0D; Results: The patients were in between the age of 20-79 years with mean age of 52.98±12.2. Out of 75 subjects, 47 (62.7%) patients were male and 28 (37.3%) were female. Of the study group, 53 patients had stage 1 and 22 patients had stage 2 hypertension. Among the stage-1 hypertensive (53), 5 patients had microalbuminuria and 6 patients had microalbuminuria in stage-2 hypertensive (22) (p=0.047). Microalbuminuria was significantly higher in those with longer duration and greater severity of hypertension (p =0.039). Older age (p =0.008), and adverse lipid profile (p =0.003) were the other identifiable risk factors for microalbuminuria. Stroke (OR=9.77), echocardiography-proven LVH (OR=6.25), ECG and/or echocardiographyproven IHD (OR=8.71) and hypertensive retinopathy (OR=4.14) were significantly higher in those with microalbuminuria.&#x0D; Conclusion: The prevalence of microalbuminuria in hypertensive subjects is high and patients with microalbuminuria have high odds of developing TOD like stroke, LVH, IHD, and hypertensive retinopathy. So the early detection of microalbuminuria in hypertensive as well as prompt treatment may reduce the burden of TOD.&#x0D; J Rang Med Col. March 2023; Vol. 8, No. 2:3-10

5613393 PREGNANCY OUTCOMES IN WOMEN WITH SICKLE CELL DISEASE IN IRELAND: A RETROSPECTIVE REVIEW

Background: Sickle cell disease (SCD) is one of the most common single gene disorders worldwide and is characterised by significant morbidity and early mortality.[1] Pregnancy in SCD is associated with an increased risk of maternal and foetal complications.[2,3] The 2011 RCOG and the 2021 BSH guidelines[5,6] on the management of pregnancy in SCD have provided the basis for best practice care in the UK over the past decade and is the guidance which we follow in Ireland. To date, there is no published data on outcomes for pregnant women with SCD in Ireland. The number of Irish patients with SCD has risen over the past 20 years. Without a national database, the exact prevalence is not known but currently there are at least 600 adults and children with SCD in Ireland, whose population is just over 5 million.[4] Aims: Our study assesses outcomes of pregnant patients with SCD from 2015 to 2022. Our aims were to: Assess adherence to current guidelines Assess pregnancy outcomes and maternal complications Assess transfusion rates amongst our patient cohort. Method: This is a retrospective cohort study. We do not have a directly matched cohort, but have compared our findings to published data on Irish pregnancy outcomes from the Irish Maternity Indicator System National Report and have correlated our findings with studies of women with SCD who were managed in UK centres.[8,9,10] Results: We reviewed outcomes of 29 pregnancies in 19 women over a 7-year period. The median age was 29 (range 20-41) and the predominant maternal sickle genotype was HbSS (65.5%). Before conception, 55.2% of cases had pre-existing complications of SCD, including acute chest syndrome (ACS), pulmonary hypertension (PHTN) and prior stroke. In accordance with current guidelines, 100% of women (n=29) were prescribed folic acid, penicillin, and aspirin prophylaxis. 51.7% (n=15) of women had documented maternal complications during pregnancy, including ACS (34%), vaso-occlusive crisis (34%), gestational diabetes (10%), VTE (3%) and UTI (3%). Two women (7%) developed Covid-19 pneumonitis despite vaccination. There was one case of maternal bacteraemia (3%). 65.5% of cases (n=19) required blood transfusion during pregnancy. One woman was already on a blood transfusion programme for disease modification prior to pregnancy. In 6 cases (20.6%), a transfusion programme was commenced during pregnancy due to prior pregnancy complications or intrauterine growth restriction. During pregnancy, 27.6% (n=8) of women required emergency red cell exchange for ACS. Prior studies have suggested that between 30% and 70% of pregnant women with SCD require at least one blood transfusion during pregnancy.[8,9,10] By comparison, only 2.6% of the Irish general obstetric population required transfusion during pregnancy.[7] 20.6% (n=6) of births were preterm at <37 weeks’ gestation. There was one live preterm birth (3%) at <34 weeks and one intrauterine death (3%) at 23 weeks’ gestation. Similar to UK data[9], 31% of women required critical care stay (n=9) during pregnancy, in comparison with 1.44% nationwide in 2020.[7] Conclusion: It is well established that pregnancy in SCD is high risk, and despite adherence to current guidelines, we have shown very high rates of critical care admission, significant transfusion requirement and hospital admissions. Our findings are comparable to published UK outcomes and they further support the need for a comprehensive specialist care setting for this patient cohort.

Angiotensin-converting enzyme gene insertion/deletion polymorphism and risk of ischemic stroke complication among patients with hypertension in the Ethiopian population.

Ischemic stroke is a complicated, multifaceted condition brought on by a confluence of vascular, environmental, and genetic variables. The burden of ischemic stroke is currently rising in terms of death, morbidity, and disability worldwide. Genetic variables also play significant roles in the pathophysiology of hypertension and ischemic stroke in addition to the greatest effects of demographic, clinical, and behavioral risk factors. The key functional variation of the ACE gene that has drawn the most interest is the ACE I/D variant. Even though the ACE gene I/D polymorphism has been widely studied, the findings of investigations on the involvement of this polymorphism in ischemic stroke were contradictory and provide conflicting data. The goal of this study was to look into the effect of the ACE gene I/D polymorphism on the risk of ischemic stroke in patients with hypertension. A hospital-based case-control study was carried out in 36 cases of patients with hypertensive IS and 36 age- and sex-matched healthy controls. Clinical and biochemical parameters were measured to assess the associated risk factors. The DNA was isolated from blood samples, and the ACE I/D genotypes were identified using polymerase chain reaction and analyzed by agarose gel electrophoresis. The ACE-DD genotype (OR = 3.71, 95% CI = 1.02-13.5; P < 0.05) and D allele (OR = 2.07, 95% CI = 1.06-4.03; P < 0.05) were significantly more common in patients than in controls, indicating that it is a risk factor for the development of ischemic stroke in hypertensive individuals. There is a significant correlation between the ACE gene I/D polymorphism and the development of ischemic stroke in patients with a history of hypertension in the Ethiopian population.

Baseline brain imaging signs in patients with ischaemic stroke by the presence of atrial fibrillation: the ENCHANTED trial

BackgroundWe aimed to assess the association of atrial fibrillation (AF) on outcomes in a post hoc analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) and how this association is modified by baseline imaging features.MethodsInverse probability of treatment weight was used to remove baseline imbalances between those with and without AF. The primary outcome was the modified Rankin Scale (mRS) scores at 90 days. Secondary outcomes were symptomatic intracerebral haemorrhage (sICH), early neurological deterioration or death within 24 h, and death at 90 days. The logistic regression model was used to determine the associations.ResultsOf the 3285 patients included in this analysis, 636 (19%) had AF at baseline. Compared with non-AF, AF was not significantly associated with an unfavourable shift of mRS (odds ratio 1.09; 95% confidence interval, 0.96–1.24), but with sICH (2.82; 1.78-4.48; IST-3 criteria), early neurological deterioration or death within 24 h (1.31; 1.01-1.70), and death (1.42; 1.12-1.79). Among patients with acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions), AF was associated with the increased risk of all the poor outcomes (all P < 0.04 for interaction).ConclusionsWe found AF increased risk of sICH, early neurological deterioration or death and death, but not unfavourable functional recovery at day 90 after thrombolysis in patients with AIS. The presence of acute ischaemic brain imaging signs at stroke presentation could be used to improve risk stratification in the presence of AF.Trial registrationThe trial is registered at ClinicalTrials.gov (NCT01422616).

Determinants of hypertension crisis and stroke among hypertensive patients in South Wollo and Oromia special zones public hospitals

Background: Uncontrolled hypertension results in hypertension crisis, and it is an important public health concern around the world. The incidence of complicating hospitalizations with hypertension continues to grow and is associated with increased mortality and adverse discharge. Hypertension crisis and stroke are caused by numerous factors; however, there is a paucity of studies to identify determinants of hypertension crisis and stroke in Ethiopia, particularly the study area. Objective: To identify determinants of hypertension crisis and stroke among hypertensive patients in South Wollo zone and Oromia special zone public hospitals, 2022. Methods: An institution based cross-sectional study was conducted among 416 participants in South Wollo and Oromia special zones public hospitals. Systematic random sampling technique was used to select study participants. Data were entered into Epidata version 3.1 and analyzed using Statistical package for social sciences version 23. Variables having P&lt;0.25 in binary logistic regression was retained in the multivariable analysis to control the effect of confounding. Finally, determinants were identified based on adjusted odds ratio along with 95% confidence level at p-value less than 0.05. Model fitness was checked using Hosmer-Lemshow test. Results: In this study, the magnitude of hypertensive crisis was 35.6%(95%CI:31.1,40.4). Age(41-60years)(AOR=0.76,95%CI:0.42,0.98), Social support(AOR=0.82,95%CI:0.41,0.93), living in urban(AOR=0.56,95%CI:0.24,0.86) and good medication adherence(AOR=0.48,95%CI:0.29,0.83) were determinants of hypertensive crisis. Another, the magnitude of stroke was 5.0%(95%CI:3.1,7.8). Rural residence (AOR=3.4,95%CI:1.23,9.44), Systolic blood pressure (AOR=9.6,95%CI:2.71,34.06), family history of stroke (AOR=0.26,95%CI:0.07,0.79) were determinants of stroke. Conclusion and recommendation: The magnitude of hypertensive crisis was high, whereas the magnitude of stroke was relatively low. Age 41-60 years, urban residence, having social support and good medication adherence were determinants of hypertensive crisis, while rural residence, systolic blood pressure and family history of stroke were determinants of stroke. Thus, health care providers should screen aged patients and patients with family history of stoke.

Burden of hemorrhagic stroke and hypertensive heart disease attributed to alcohol consumption in China

Objective: To describe the prevalence of alcohol consumption and the burden of hemorrhagic stroke and hypertensive heart disease attributed to alcohol consumption in adults aged ≥20 years in 31 provinces in China from 2005 to 2018. Methods: Data from several national representative surveys was used to estimate provincial alcohol exposure level of adults aged ≥20 years from 2005 to 2018 by using kriging interpolation and locally weighted regression methods. Global disease burden research method and data, and China's death cause surveillance data were used to calculate the population attributable fraction (PAF) of hemorrhagic stroke and hypertensive heart disease and the deaths due to alcohol consumption in men and women aged ≥20 years in 31 provinces in China. China census data of 2010 were used to calculate the attributable standardized mortality rate. Results: In 2005 and 2018, the prevalence of alcohol consumption was 58.7% (95%CI: 57.8%-59.5%) and 58.4% (95%CI: 57.6%-59.3%), respectively, in men and 17.0% (95%CI: 16.6%-17.4%) and 18.7% (95%CI:18.1%-19.3%), respectively, in women. The daily alcohol intake was 24.6 (95%CI: 23.8-25.3) g and 27.7 (95%CI: 26.8-28.7) g, respectively, in men and 6.3 (95%CI: 6.0-6.5) g and 5.3 (95%CI: 5.0-5.6) g, respectively, in women. Alcohol exposure level was higher in the provinces in central and eastern China than in western provinces. The lowest exposure level was found in northwestern provinces. From 2005 to 2018, the PAF of hemorrhagic stroke death due to alcohol consumption increased from 5.5% to 6.8%, the attributable deaths increased from 50 200 to 59 100, while the PAF of hypertensive heart disease death due to alcohol consumption increased from 7.0% to 7.7%, the attributable deaths increased from 15 200 to 29 300. The PAF of hypertensive heart disease and hemorrhagic stroke was higher in men than in women, and in central and eastern provinces than in western provinces. In 2018, the standardized mortality rates of hemorrhagic stroke and hypertensive heart disease attributed to alcohol consumption were 4.58/100 000 and 2.11/100 000, respectively. Conclusions: The prevalence of alcohol consumption in men and daily alcohol intake of drinkers were relatively high in China, especially in eastern provinces. Alcohol exposure level was lower in women than in men. Regional measures should be taken to reduce the alcohol intakes in men and current drinkers in order to reduce the health problems caused by alcohol consumption.

Hippocampal Vascular Supply and Its Role in Vascular Cognitive Impairment.

The incidence of age-related dementia is increasing as the world population ages and due to lack of effective treatments for dementia. Vascular contributions to cognitive impairment and dementia are increasing as the prevalence of pathologies associated with cerebrovascular disease rise, including chronic hypertension, diabetes, and ischemic stroke. The hippocampus is a bilateral deep brain structure that is central to learning, memory, and cognitive function and highly susceptible to hypoxic/ischemic injury. Compared with cortical brain regions such as the somatosensory cortex, less is known about the function of the hippocampal vasculature that is critical in maintaining neurocognitive health. This review focuses on the hippocampal vascular supply, presenting what is known about hippocampal hemodynamics and blood-brain barrier function during health and disease, and discusses evidence that supports its contribution to vascular cognitive impairment and dementia. Understanding vascular-mediated hippocampal injury that contributes to memory dysfunction during healthy aging and cerebrovascular disease is essential to develop effective treatments to slow cognitive decline. The hippocampus and its vasculature may represent one such therapeutic target to mitigate the dementia epidemic.

Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial.

Intensive blood pressure lowering may adversely affect evolving cerebral ischaemia. We aimed to determine whether intensive blood pressure lowering altered the size of cerebral infarction in the 2196 patients who participated in the Enhanced Control of Hypertension and Thrombolysis Stroke Study, an international randomised controlled trial of intensive (systolic target 130-140mm Hg within 1h; maintained for 72h) or guideline-recommended (systolic target <180mm Hg) blood pressure management in patients with hypertension (systolic blood pressure >150mm Hg) after thrombolysis treatment for acute ischaemic stroke between March 3, 2012 and April 30,2018. All available brain imaging were analysed centrally by expert readers. Log-linear regression was used to determine the effects of intensive blood pressure lowering on the size of cerebral infarction, with adjustment for potential confounders. The primary analysis pertained to follow-up computerised tomography (CT) scans done between 24 and 36h. Sensitivity analysis were undertaken in patients with only a follow-up magnetic resonance imaging (MRI) and either MRI or CT at 24-36h, and in patients with any brain imaging done at any time during follow-up. This trial is registered with ClinicalTrials.gov, number NCT01422616. There were 1477 (67.3%) patients (mean age 67.7 [12.1] y; male 60%, Asian 65%) with available follow-up brain imaging for analysis, including 635 patients with a CT done at 24-36h. Mean achieved systolic blood pressures over 1-24h were 141mm Hg and 149mm Hg in the intensive group and guideline group, respectively. There was no effect of intensive blood pressure lowering on the median size (ml) of cerebral infarction on follow-up CT at 24-36h (0.3 [IQR 0.0-16.6] in the intensive group and 0.9 [0.0-12.5] in the guideline group; log Δmean-0.17, 95% CI-0.78 to 0.43). The results were consistent in sensitivity and subgroup analyses. Intensive blood pressure lowering treatment to a systolic target <140mm Hg within several hours after the onset of symptoms may not increase the size of cerebral infarction in patients who receive thrombolysis treatment for acute ischaemic stroke of mild to moderate neurological severity. National Health and Medical Research Council of Australia; UK Stroke Association; UK Dementia Research Institute; Ministry of Health and the National Council for Scientific and Technological Development of Brazil; Ministry for Health, Welfare, and Family Affairs of South Korea; Takeda.

LncRNAs NEAT1, HOTAIR, and GAS5 expression in hypertensive and non-hypertensive associated cerebrovascular stroke patients, and its link to clinical characteristics and severity score of the disease.

Cerebrovascular stroke (CVS) is a potentially fatal disease. The most common risk factor for CVS is hypertension. While most studies in the field have focused on the functional roles of long noncoding RNAs (lncRNAs) NEAT1, GAS5, and HOTAIR in CVS, less attention has been paid to their clinical relevance to stroke incidence and prognosis. Also, a link has not yet been made between these lncRNAs and hypertension, our study aim was to investigate whether the expression of these lncRNAs differed between CVS with and without hypertension, as well as to compare each group to controls. In total, 181 CVS patients were enrolled, including 91 chronic hypertensive patients with stroke, 90 stroke patients without hypertension, and 51 control subjects. blood samples were collected on the day of recruitment from patients with CVS and controls. Real-time qRT-PCR was used to detect the expression of target lncRNAs in serum. When compared to controls, there was a statistically higher level of lncNEAT1 in each case group (median (IQR) = 3.68 (1.35-7.35) and 3.05 (0.95-6.45) for the hypertensive and non-hypertensive groups, respectively, with a significantly higher level in the hypertensive group (P = 0.04). When compared to controls, lncHOTAIR was significantly downregulated in all case groups (medians in hypertensive and non-hypertensive patients were 0.13, and 0.34, respectively), with a significantly lower level in the hypertensive group (P = 0.05). LncGAS5 levels in patients were significantly lower (median (IQR) = 0.16 (0.02-0.55) and 0.25 (0.03-0.99) for the hypertensive and non-hypertensive groups, respectively) compared to controls, with a significantly lower level in the hypertensive group (P = 0.02). There was a significant positive correlation between NEAT1 and GAS5, but a significant negative correlation between each with HOTAIR in both patients' groups. We also detected a significant negative correlation between each NEAT1 or GAS5 and NIHSS score while a significant positive correlation between HOTAIR and NIHSS. ROC curve analysis for GAS5 was able to differentiate patients with CVS hypertensive from patients with CVS non-hypertensive. Patients in each case group had statistically higher levels of NEAT1 and lower levels of HOTAIR and GAS5 compared to control levels, with higher significant NEAT1 but lower significant HOTAIR and GAS5 in the hypertensive group. Therefore, lncRNAs NEAT1, HOTAIR, and GAS5 could be used as diagnostic and prognostic biomarkers of CVS that correlate with NIHSS score and could produce a novel target for CVS therapy.