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Untreated hypertension and prognosis paradox in acute ischemic stroke

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Abstract

Introduction

This study is to explore the long-term functional outcome of antihypertensive medication-naïve, untreated hypertension (HTN) patients with acute ischemic stroke compared to those with no prior HTN and those with treated HTN.

Patients and methods

We analyzed a prospectively collected stroke registry of all patients with acute ischemic stroke consecutively admitted to Incheon St. Mary’s Hospital. Patients who received reperfusion therapy were excluded. Long-term functional outcomes were assessed at a 3-month follow-up visit using the modified Rankin Scale.

Results

A total of 1044 patients was enrolled. Compared to patients with no or treated HTN, those with untreated HTN had higher odds for more favorable outcomes (adjusted odds ratio (OR): 1.7 [95% CI: 1.0–2.7, p = 0.050*] and 1.7 [95% CI: 1.0–2.8, p = 0.047*], respectively) when the stroke was large vessel atherosclerosis (LAA)/cardioembolic (CE) with large vessel occlusion/stenosis. However, no such association was observed when there was no large vessel occlusion or stenosis, in total patients, or if the index stroke was related to SVO.

In untreated HTN patients with LAA/CE and large vessel occlusion/stenosis compared to patients in the lowest mean arterial pressure quartile (< 96.7 mmHg), patients in the second and third highest quartiles had higher odds of favorable outcomes.

Conclusions

Patients with untreated HTN had significantly more favorable outcomes at 3 months after ischemic stroke compared to those with no or treated HTN when the stroke was LAA/CE with large vessel occlusion/stenosis. Untreated HTN patients also showed an association between higher MAP and favorable outcomes.

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Data availability

The de-identified data supporting the findings of this study are available upon reasonable request to the corresponding author.

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Author information

Authors and Affiliations

  1. Department of Neurology, College of Medicine, Incheon St. Mary’s Hospital, the Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, South Korea

    Hyunji Cho, Taewon Kim, Young-Do Kim, Seunghee Na, Yun Ho Choi & In-Uk Song

  2. Seoul St. Mary’s Hospital, Seoul, Korea

    Jaseong Koo

  3. Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

    Jeong-Wook Park

Authors
  1. Hyunji Cho
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Contributions

TK, HC, and JK contributed to conception and design of the study. YDK, SN, YHC, IU, and JWP contributed to the analysis of the data. TK contributed to drafting the text and preparing the tables and figure.

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Correspondence to Taewon Kim.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Cho, H., Kim, T., Koo, J. et al. Untreated hypertension and prognosis paradox in acute ischemic stroke. Neurol Sci 44, 2087–2095 (2023). https://doi.org/10.1007/s10072-023-06653-8

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