Alexander E. Merkler, MD

Mustanoja S, Putaala J, Gordin D, Tulkki L, Aarnio K, Pirinen J, et al. Acute-Phase Blood Pressure Levels Correlate With a High Risk of Recurrent Strokes in Young-Onset Ischemic Stroke. Stroke. 2016

Hypertension is one of the most important stroke risk factors and one in four adults has hypertension. Lowering blood pressure is associated with a decreased risk of cardiovascular mortality and recurrent strokes in the elderly. Although risk factors for stroke in the young are different, the prevalence of hypertension in young adults has already doubled in the past two decades, making it a significant risk factor for cardiovascular mortality even in young patients. In this study, Dr Mustanoja et al. evaluate whether acute blood pressure recordings during an ischemic stroke are associated with recurrent stroke.

The authors performed a retrospective single-center study of 1004 patients with acute ischemic stroke <50 years of age. Of these patients, 39% had pre-stroke hypertension and 36% used antihypertensive treatment. Over a median follow-up period of 8.9 years, 14% suffered a recurrent stroke (including ischemic and hemorrhagic). Patients with recurrent stroke had a significantly higher admission SBP, DBP, pulse pressure (PP), and mean arterial pressure (MAP) than patients without recurrent stroke. Using a cox proportional hazards model, having a SBP³160mmHg was significantly associated with a higher risk of recurrent stroke (Hazard ratio 3.3 (95% CI, 2.1-4.6) as compared to patients with an admission SBP<160mmHg. In addition, those patients with an admission SBP160mmHg were more likely to have a recurrent event earlier those patients with a SBP<160mmHg (at 13.9 versus 16.2 years). Similar findings were seen for DBP³100mmHg.

Certain limitations apply; for example, although the authors state that the their findings were unchanged irrespective of whether patients used anti-hypertensive treatment post-stroke, it’s unclear which agent, the duration of the agent, and most importantly, the efficacy of the agent. In addition, the findings may not be entirely generalizable as the study was conducted on only Caucasians at a single center in Scandanavia.

Despite these limitations, the results emphasize the importance of hypertension in stroke in the young and the necessity to aggressively control elevated blood pressure in adults of any age.