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Arterial Hypertension and Risk of Recurrent Event in Young Ischemic Stroke Patients

Published online by Cambridge University Press:  11 September 2020

Petra Divišová
Affiliation:
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
Daniel Šaňák*
Affiliation:
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
Jan Václavík
Affiliation:
Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
Michal Král
Affiliation:
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
Martin Hutyra
Affiliation:
Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
Jana Zapletalová
Affiliation:
Department of Biophysics and statistics, Palacký University Medical School, Olomouc, Czech Republic
Andrea Bártková
Affiliation:
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
David Franc
Affiliation:
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
Tomáš Dorňák
Affiliation:
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
Tomáš Veverka
Affiliation:
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
Miloš Táborský
Affiliation:
Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
Petr Kaňovský
Affiliation:
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
*
Correspondence to: Daniel Šaňák, MD, PhD, FESO, Comprehensive Stroke Center, Department of Neurology, Palacký Medical School and University Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic. E-mail: daniel.sanak@centrum.cz

Abstract:

Introduction:

In young patients, the cause of ischemic stroke (IS) remains often cryptogenic despite presence of traditional vascular risk factors (VRFs). Since arterial hypertension (AH) is considered the most important one, we aimed to evaluate the impact of AH and blood pressure (BP) levels after discharge on risk of recurrent IS (RIS) in young patients.

Methods:

The study set consisted of acute IS patients < 50 years of age enrolled in the prospective Heart and Ischemic STrOke Relationship studY registered on ClinicalTrials.gov (NCT01541163). Cause of IS was assessed according to the ASCOD classification.

Results:

Out of 319 enrolled patients <50 years of age (179 males, mean age 41.1 ± 7.8 years), AH was present in 120 (37.6%) of them. No difference was found in the rates of etiological subtypes of IS between patients with and without AH. Patients with AH were older, had more VRF, used more frequently antiplatelets prior IS, and had more RIS (10 vs. 1%, p = 0.002) during a follow-up (FUP) with median of 25 months. Multivariate logistic regression stepwise model showed the prior use of antiplatelets as only predictor of RIS (p = 0.011, OR: 6.125; 95% CI: 1.510–24.837). Patients with elevated BP levels on BP Holter 1 month after discharge did not have increased rate of RIS during FUP (3.8 vs. 1.7%, p = 1.000).

Conclusion:

AH occurred in 37.6% of young IS patients. Patients with AH had more frequently RIS. Prior use of antiplatelets was found only predictor of RIS in young IS patients with AH.

Résumé :

RÉSUMÉ :

Hypertension artérielle et risque de récurrence chez des patients âgés de moins de 50 ans qui ont été victimes d’un accident ischémique.

Introduction :

Chez les patients âgés de moins de 50 ans, l’étiologie des accidents ischémiques (AI) demeure souvent indéterminée malgré la présence de facteurs de risque vasculaire (FRV) traditionnels. Compte tenu que l’hypertension artérielle (HA) est considérée comme le facteur de risque le plus important, nous avons cherché à évaluer son impact ainsi que l’impact des valeurs de pression artérielle sur le risque de récurrence des AI une fois que des patients ont obtenu leur congé.

Méthodes :

Cette étude a reposé sur un groupe de patients âgés de moins de 50 ans ayant été victimes d’un AI aigu. Ces patients avaient été inclus préalablement dans une étude prospective (Heart and Ischemic Stroke Relationship Study ou HISTORY) enregistrée sur le site ClinicalTrials.gov (NCT01541163). Précisons que la cause des AI a été évaluée en fonction du système de classification ASCOD.

Résultats :

Sur un total de 319 patients âgés de moins de 50 ans (179 de sexe masculin ; âge moyen : 41,1 ± 7,8 ans), 37,6 % d’entre eux (n = 120) avaient été victimes d’un AI. Aucune différence n’a été constatée entre les patients souffrant d’HA et les autres n’en souffrant pas en ce qui regarde les taux de sous-types étiologiques des AI. Outre un risque de récurrence d’AI plus élevé (10 % contre 1% ; p = 0,002), les patients souffrant d’HA et rencontrés lors d’un suivi médian 25 mois plus tard étaient plus âgés, donnaient à voir plus de FRV et utilisaient davantage d’antiagrégants plaquettaires (AAP) avant leur AI. Un modèle de régression logistique multivariée par étapes (multivariate logistic regression stepwise model) a montré que l’utilisation antérieure d’AAP ne permettait que de prédire le risque de récurrence des AI (p = 0,011 ; RC : 6,125 ; IC 95 % 1,510-24,837). Les patients dont les valeurs de pression artérielle mesurées avec un appareil Holter étaient élevées un mois après leur congé n’ont pas montré un risque de récurrence des AI plus élevé au moment de leur suivi (3,8 % contre 1,7 % ; p = 1,000).

Conclusion :

Des manifestations d’HA ont été notées chez 37,6 % des patients à l’étude. Ces derniers ont aussi montré un plus grand risque de récurrence des AI. En somme, une utilisation antérieure d’AAP est apparue comme le seul prédicteur du risque de récurrence des AI chez des patients âgés de moins de 50 ans victimes d’un AI et souffrant d’HA.

Type
Original Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc.

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