Predictors of stroke pattern in hypertensive patients

Hypertension is a recognized risk factor for stroke. However, it is not clear why hypertensive patients may have different types and causes of stroke.

The possible role of coexisting factors was studied in 1057 patients with hypertension and first stroke admitted to a population-based stroke center. We used logistic regression analysis (multivariate and polychotomous) and the Lausanne Stroke Registry definitions of cerebral hemorrhage, cerebral infarction, lacunar infarction, cardioembolism and large artery disease.

Cerebral hemorrhage was not more frequent in these hypertensive patients (111/1057 = 10.5%) than in the total population of the registry (213/2145 = 10%). Cerebral infarction was associated with age above the median (69 years), diabetes, smoking history, family history of cardiac or cerebrovascular disease, hypercholesterolemia and previous TIA. In the ischemic group (n = 946), patients suffered from a lacunar infarction in 36% of the cases, large artery disease was present in 21% of them and cardioembolism in 14.5%. Large artery disease correlated with smoking history (odds ratio: 2.14; 95% confidence intervals: 1.55-2.95) and previous TIA (OR:1.96; 95% CI:1.39-2.75). Cardioembolism correlated with age over 69 years (OR:2.13; 95% CI:1.47-3.09). In patients with previous TIA and smoking history, large artery disease was presumed in 45% of the cases (vs 21%). Patients aged over 69, suffered a cardioembolic stroke in 29% of the cases (vs 14.5%). Lacunar infarction occurred in 49% of patients aged less than 70 years when no history of smoking or previous TIA was present (vs 36%).

The associations between hypertension, TIA, age and smoking history may partially explain why patients with hypertension are more likely to develop a cerebral hemorrhage, lacunar infarction, cardioembolic or a large artery disease stroke.