Differences between hypertensive and non-hypertensive ischemic stroke

Area of Science:

• Neurology
• Cardiovascular Medicine
• Epidemiology

Background:

• Hypertension is a major cardiovascular risk factor.
• Ischemic stroke subtypes have distinct risk factor profiles.
• Understanding hypertension's role in different stroke types is crucial for targeted prevention.

Purpose of the Study:

• To compare risk factors, clinical features, neuroimaging, and outcomes in hypertensive versus non-hypertensive ischemic stroke patients.
• To identify independent predictors of hypertensive ischemic stroke.
• To elucidate the specific associations between hypertension and ischemic stroke subtypes.

Main Methods:

• Bivariate analysis comparing features of hypertensive (n=768) and non-hypertensive (n=705) ischemic stroke patients.
• Multivariate analysis to determine independent predictors of hypertensive ischemic stroke.
• Assessment of clinical data, neuroimaging, and patient outcomes.

Main Results:

• Atherothrombotic infarction and lacunar infarct were more common in hypertensive patients.
• Hypertensive patients showed higher prevalence of older age, previous cerebral infarction, hyperlipidemia, acute stroke onset, lacunar syndrome, and pons topography.
• Multivariate analysis revealed lacunar syndrome, female gender, and previous infarction were directly associated with hypertensive ischemic stroke; advanced age (≥85) and valvular heart disease were inversely associated.

Conclusions:

• Hypertension is a significant risk factor primarily for lacunar and atherothrombotic infarction (small- and large-artery disease).
• Specific clinical features and demographics differentiate hypertensive from non-hypertensive ischemic stroke.
• These findings aid in refining risk stratification and understanding the pathophysiology of hypertension-related ischemic stroke.