Risk Of Stroke In Hypertensive Patients Research Articles

Multiomics Profiling of Plasma Reveals Molecular Alterations Prior to a Diagnosis with Stroke Among Chinese Hypertension Patients.

We aimed to investigate the correlation between plasma proteins and metabolites and the occurrence of future strokes using mass spectrometry and bioinformatics as well as to identify other biomarkers that could predict stroke risk in hypertensive patients. In a nested case-control study, baseline plasma samples were collected from 50 hypertensive subjects who developed stroke and 50 gender-, age- and body mass index-matched controls. Plasma untargeted metabolomics and data independent acquisition-based proteomics analysis were performed in hypertensive patients, and 19 metabolites and 111 proteins were found to be differentially expressed. Integrative analyses revealed that molecular changes in plasma indicated dysregulation of protein digestion and absorption, salivary secretion, and regulation of actin cytoskeleton, along with significant metabolic suppression. C4BPA, Caprolactam, Col15A1, and HBB were identified as predictors of stroke occurrence, and the Support Vector Machines (SVM) model was determined to be the optimal predictive model by integrating six machine-learning classification models. The SVM model showed strong performance in both the internal validation set (area under the curve [AUC]: 0.977, 95% confidence interval [CI]: 0.941-1.000) and the external independent validation set (AUC: 0.973, 95% CI: 0.921-0.999).

The link between hypertension and stroke

Introduction: Diet plays a crucial role in managing hypertension and preventing stroke. This study explores how different dietary patterns influence blood pressure and stroke risk in hypertensive patients. Objective: To investigate the relationship between dietary patterns and their impact on hypertension and stroke risk among hypertensive patients. Methods: At Pakistan Institute of Medical Sciences (PIMS), Islamabad, 58 hypertension patients with a stroke history participated in a cross-sectional study. Three dietary patterns were found by main component analysis of the food frequency questionnaire used to measure dietary intake: traditional, western, and health-conscious. Blood pressure readings were taken, and the relationship between eating habits and stroke risk was assessed using logistic regression analysis. Results: Lower systolic (140 ± 12 mm Hg) and diastolic (90 ± 8 mm Hg) blood pressure was recorded in participants following a health-conscious diet pattern than in those following Traditional (150 ± 15 mm Hg systolic, 95 ± 10 mm Hg diastolic) or Western (160 ± 18 mm Hg systolic, 100 ± 12 mm Hg diastolic). Stroke risk was increased with the Western eating pattern (OR = 1.35, p = 0.005) and decreased with the health-conscious pattern (OR = 0.75, p = 0.020). Conclusion: Dietary habits have a big impact on how well hypertensive people control their blood pressure and how likely stroke is. Changing to a health-conscious diet can help control hypertension and lower the risk of stroke, which emphasizes the importance of dietary therapies and public health initiatives to encourage good eating habits.

The Relationship between Hemodynamic Status and Stroke Risk in Hypertensive Patients at the General Hospital of South Aceh Regency

The Relationship between Hemodynamic Status and Stroke Risk in Hypertensive Patients at the General Hospital of South Aceh Regency

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.

Triglyceride-glucose index trajectory and stroke incidence in patients with hypertension: a prospective cohort study

BackgroundIt has been suggested that the baseline triglyceride-glucose (TyG) index, a simple surrogate measure for insulin resistance, is significantly associated with the occurrence of stroke. Nevertheless, the impact of longitudinal patterns of TyG on the stroke risk in hypertensive patients is still unknown. Hence, this study aimed to investigate the association between TyG index trajectory and stroke risk among hypertensive patients.MethodsThis prospective study included 19,924 hypertensive patients from the Kailuan Study who underwent three waves survey and were free of myocardial infarction, cancer and stroke before or during 2010. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2], and latent mixed modelling was used to identify the trajectory of TyG during the exposure period (2006–2010). Furthermore, the Cox proportional hazard models were applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) for incident stroke of different trajectory groups.ResultsFive distinct TyG trajectory were identified during 2006–2010: low-stable (n = 2483; range, 8.03–8.06), moderate low-stable (n = 9666; range, 8.58–8.57), moderate high-stable (n = 5759; range, 9.16–9.09), elevated-stable (n = 1741; range, 9.79–9.75), and elevated-increasing (n = 275; range, 10.38–10.81). During the median follow-up of 9.97 years, 1,519 cases of incident stroke were identified, including 1,351 with ischemic stroke and 215 with hemorrhage stroke. After adjusting for confounding variables, the HR and 95% CI of stroke were 2.21 (1.49,3.28) for the elevated-increasing group, 1.43 (1.13,1.83) for the elevated-stable group, 1.35 (1.10,1.64) for the moderate high-stable group, 1.26 (1.06,1.52) for the moderate low-stable group, respectively, when compare with the low-stable group. Similar results were observed in ischemic stroke, but a significant association was not found between TyG trajectory and risk of hemorrhage stroke.ConclusionA long-term elevated TyG index in hypertensive patients is associated with an increased risk of stroke, especially ischemic stroke. This finding implies that regular monitoring of TyG index may assist in identifying individuals at a higher risk of stroke among patients with hypertension.

Association Between Hyperhomocysteinemia Combined with Metabolic Syndrome and Higher Prevalence of Stroke in Chinese Adults Who Have Elevated Blood Pressure.

BackgroundHyperhomocysteinemia (HHcy) and metabolic syndrome (MS) are established cardiovascular risk factors of stroke and are frequently associated with hypertension. However, studies on the association between HHcy combined with MS and stroke risk in hypertensive patients were absent.Material/MethodsIn 14 059 selected participants with elevated blood pressure, we assessed the prevalence of the MS and stroke. We defined HHcy as plasma total homocysteine >15 μmol/L. MS was defined according to the Chinese Diabetes Society (CDS) criterion. Multivariable analysis was used to examine the association of HHcy or (and) MS with stroke risk in different models.ResultsThe prevalence rates of HHcy and MS were 49.96% and 42.21%, respectively. Patients with stroke had higher plasma total homocysteine levels and a higher prevalence of MS (P<0.001). Multivariable analyses indicated that HHcy and MS are independently associated with higher prevalence of stroke (adjusted-odds ratio (OR): 1.36, 95% CI 1.17 to 1.58, P<0.001; adjusted-OR: 1.68, 95% CI 1.44 to 1.96, P<0.001, respectively). Those with combined HHcy and MS had higher odds of stroke than those with isolated HHcy or MS (adjusted-OR: 1.78, 95% CI 1.47 to 2.15, P<0.001; adjusted-OR: 1.39, 95% CI 1.13 to 1.70, P=0.002, respectively).ConclusionsHHcy combined with MS was associated with higher prevalence of stroke in Chinese adults with elevated blood pressure.

Association of visit-to-visit variability in blood pressure and first stroke risk in hypertensive patients with chronic kidney disease.

Data on the association between visit-to-visit variability (VVV) in blood pressure (BP) and the risk of stroke among hypertensive patients with chronic kidney disease (CKD) is limited. We aimed to evaluate the relation of VVV in BP with the risk of stroke, and examine any possible effect modifiers in hypertensive patients with mild-to-moderate CKD. This is a post-hoc analysis of the China Stroke Primary Prevention Trial. A total of 3091 patients with estimated glomerular filtration rate 30-60 ml/min per 1.73 m and/or proteinuria at baseline, without occurring stroke and with BP measurements of at least two visits from randomization to the 12-month visit were included. The main VVV in BP was expressed as SD. The primary outcome was first stroke. The median subsequent treatment duration was 3.7 years. After multivariable adjustment, including baseline SBP and mean SBP during the first 12-month follow-up, there was a significantly positive relationship of SD SBP with the risk of subsequent first stroke (per SD increment; odds ratio, 1.41; 95% confidence interval: 1.17-1.69) and first ischemic stroke (odds ratio, 1.55; 95% confidence interval: 1.26-1.90). Results were consistent across various subgroups, including age, sex, baseline SBP, treatment compliance, and mean SBP, concomitant usage of calcium channel blocker during the first 12-month follow-up period. Similar trends were also found for coefficient of variation SBP, and SD or coefficient of variation DBP. However, there was no significant association between BP variability and first hemorrhagic stroke. In hypertensive adults with mild-to-moderate CKD, visit-to-visit variability in BP was significantly associated with the risk of subsequent first stroke.

PP.17.09] THE RELATIONSHIP BETWEEN CAROTID STENOSIS AND STROKE IN HYPERTHENSIVE DIABETIC AND NON DIABETIC PATIENTS

Objective: Essential arterial hyperthension (EHAT) is one of the main risk factors for ischemic stroke. The evaluation of intimal thickening of carotid is an important parameter in preclinical diagnosis of atherosclerosis and stroke risk in hypertensive patients The aim of study was to see if there is a relationship between thickening of carotid wall and brain damage in hypertensive patients with/ without diabetes. Design and method: Our study has been done on 100 patients admited in Neurological Clinique over two years. At admission, the patients have been neurologicaly examined, being divided into two groups of 50 patients each:group A with type II diabetes and group B non diabetic,symptomatic with stroke or asymptomatic,mean age:62.31+/−6.9 years old Carotid Doppler ultrasound examination and cranial NMR were evaluated Results: NMR findings were white matter lesions and infarctions they were more frequent in hyperthensive diabetic group. In hyperthenisve non diabetic there were insignificant correlations between abnormal NMR findings and thickening of carotid wall versus non diabetic. In diabetic, the associations among cortical lesions,clinically symptomatic stroke, and iincreasing in carotid wall thickness were found to be statistically significant in comparison with non diabetic patients. NMR abnormalities were present in 90 % in group A and 72% in group B consisting of arterial constriction or an atheromatous plaque confirmed in Doppler examination. Conclusions: Measurements of carotid wall thickness via Doppler were considered to be valuable in prediction of risk of brain damage and future stroke due to hypertension in diabetic and non diabetic patients.

GW24-e2941 Ten-year Stroke Risk in Hypertensive Patients Visiting the Outpatient Departments of Cardiology of a Tertiary Hospital

ObjectivesTo investigate the 10-year stroke risk and the status of primary preventions of stroke in hypertensive patients visiting the outpatient departments of cardiology of a tertiary hospital in China.MethodsThe patients...

Probability of stroke in Korean hypertensive patients visiting community-based hospitals: using a risk profile from the Framingham study

Hypertension is the most important single modifiable risk factor of stroke. The purpose of this study was to investigate the distribution patterns of risk factors of stroke and 10-year probability of stroke in hypertensive patients visiting community-based hospitals. A total of 1088 hypertensive patients who visited 61 community-based hospitals nationwide were enrolled. Risk factors of stroke were evaluated using a series of laboratory tests and physical examinations, and the 10-year probability of stroke was determined by applying the Framingham stroke risk equation. The proportion of patients who have uncontrolled hypertension despite the use of antihypertensives was 63.3% (59.6% women, 68.7% men; P=0.006). The average 10-year probability of stroke in hypertensive patients was 16.05% (14.68% women, 17.99% men; P<0.001). The 10-year probability of stroke in patients with hypertension gradually increased in proportion to age. In patients treated with antihypertensives, 10-year probability of stroke gradually increased in proportion to blood pressure. The 10-year risk of stroke in hypertensive patients was approximately 4.6 times higher than that of stroke in the general population. In conclusion, as the 10-year risk of stroke in hypertensive patients was approximately 4.6 times higher than that of stroke in the general population, more aggressive interventions are needed to reduce blood pressure and stroke risk in hypertensive patients.

Predicting stroke risk in hypertensive patients with coronary artery disease: a report from the INVEST.

Our understanding of factors influencing stroke risk among patients with coronary artery disease is incomplete. Accordingly, factors predicting stroke risk in hypertensive, clinically stable coronary artery disease patients were determined with data from the INternational VErapamil SR-trandolapril STudy (INVEST). The effect of baseline characteristics and on-treatment blood pressure (BP) were analyzed to determine the risk of stroke (fatal or nonfatal) among the 22 576 patients enrolled. Cox proportional-hazards models (unadjusted, adjusted, and time dependent) were used to identify predictors of stroke among subgroups with these characteristics present at entry and on-treatment BP. Excellent BP control (at 24 months, >70% <140/90 mm Hg) was achieved during 61 835 patient-years of follow-up, as 377 patients had a stroke (6.1 strokes/1000 patient-years) and 28% of those patients had a fatal stroke. Increased age, black race, US residency, and history of prior myocardial infarction, smoking, stroke/transient ischemic attack, arrhythmia, diabetes, and coronary bypass surgery were associated with an increased risk of stroke. Achieving a systolic BP <140 mm Hg and a diastolic BP <90 mm Hg was associated with a decreased risk of stroke. There was no statistically significant difference in stroke risk comparing the verapamil SR-based with the atenolol-based treatment strategy (adjusted hazard ratio=0.87; 95% CI, 0.71 to 1.06; P=0.17). Among hypertensive patients with chronic coronary artery disease, stroke was an important complication associated with significant mortality. Black race, US residency, and conditions associated with increased vascular disease severity and arrhythmia predicted increased stroke risk, whereas achieving a BP <140/90 mm Hg on treatment predicted a reduced stroke risk.

Impact of Losartan on Stroke Risk in Hypertensive Patients in Primary Care

While a number of conditions and risk factors that increase stroke risk have been identified, arterial hypertension is the most consistent and powerful predictor. The angiotensin II type 1 receptor antagonist (angio-tensin receptor blocker [ARB]) losartan has been shown in the LIFE (Losartan Intervention for Endpoint Reduction in Hypertension) study to decrease stroke risk in hypertensive patients to a substantially greater extent than conventional therapy. We aimed to assess the impact of the blood pressure-lowering effect of losartan therapy on stroke risk in hypertensive patients in primary care. A total of 2977 primary-care practices throughout Germany included 22 499 consecutive unselected patients with a confirmed diagnosis of hypertension in an open-label, prospective, observational study. In addition to demographics, known risk factors for stroke were documented on standardised questionnaires. The 10-year predicted risk of first stroke was calculated according to the Framingham Stroke Risk Score at baseline and after a mean of 94 +/- 24 days of losartan (+/- hydrochlorothiazide [HCTZ]) therapy. The mean patient age was 64.1 +/- 10.6 years, and 52.4% were males. Mean systolic/diastolic blood pressure decreased from 160 +/- 15/93 +/- 9 mm Hg at baseline by -21 +/- 14/-11 +/- 9 mm Hg. Besides hypertension, 84.9% of patients had other co-morbidities, of which the most frequent were hypercholesterolaemia (53.0%), diabetes mellitus (36.1%), coronary heart disease (31.1%) and left ventricular hypertrophy (24.2%). The average predicted 10-year stroke risk was 28.0 +/- 21.9% at baseline, and 22.1 +/- 19.5% at study end (relative risk reduction 24 +/- 16%, p<0.05). In subgroups of patients with diabetes or nephropathy, similar effects were noted. Drug-related adverse events were reported in 18 patients; all of these were non-serious. Because of the high prevalence of co-morbidities and risk factors, the hypertensive patient population observed in this study presented with a high 10-year stroke risk. Treatment with losartan (+/- HCTZ) was well tolerated and led to a substantial decrease in blood pressure and associated stroke risk.

The evaluation of carotid stenosis as risk factor for stroke in hypertensive diabetic and non-diabetic patients

The evaluation of intima-media thickening (IMT) of carotid artery is an important parameter in preclinical diagnosis of atherosclerosis and stroke risk in hypertensive patients. Measurements of carotid wall thickness via Doppler were considered to be valuable in prediction of risk of brain damage and future stroke due to hypertension in diabetic and non-diabetic patients.

Reducing Stroke Risk in Hypertensive Patients: Asian Consensus Conference Recommendations

Stroke results in substantial morbidity and mortality globally. Asia-Pacific countries bear a disproportionate share of the burden of stroke, a burden that will grow as their populations' life expectancies rise. Hypertension is the single most important reversible risk factor for stroke, and effective measures to reduce blood pressure contribute significantly to reducing the incidence of stroke. The Asia-Pacific Consensus Conference on Stroke Prevention in Hypertensive Patients assembled leading experts from the region to reach an actionable consensus aimed at reducing stroke-induced morbidity and mortality in Asia through the evidence-based treatment of hypertension. The discussions of the group focused on how best to improve blood pressure control, how to promote lifestyle changes at the population level, and how to reduce the clinical and health system barriers and other challenges facing developing and low-income countries. The experts concluded that physicians must place an increased priority on reducing their patients' risk of stroke and recognise that all hypertensive patients are at greater risk of having a stroke compared with nonhypertensive individuals. They advocated that physicians must educate hypertensive patients about the risk of stroke, promote lifestyle modification to all patients diagnosed with hypertension, and prescribe rigorous antihypertensive treatment to get patients to recommended blood pressure goals.