Risk factors of ischemic stroke in hypertensive patients
DOI:
https://doi.org/10.14739/2310-1237.2017.3.118751Keywords:
risk factors, essential hypertension, stroke, ambulatory blood pressure monitoring, platelet aggregationAbstract
There is necessity to find specific independent risk factors of cerebrovascular complications in hypertensive patients due to lack of sufficient therapeutic approach in its prediction.
The aim of the study was to determine dependent and independents risk factors of ischemic stroke among ambulatory blood pressure monitoring, heart rate variability and adenosine-induced (ADF) platelet aggregation data in hypertensive patients.
Materials and methods. A total number of 88 patients with essential hypertension (EH) was divided in two groups. In this population, the first subgroup (n=39) was identified as EH individuals with an acute hemispheric ischemic stroke (IS) and the second one − patients (n=49) with well controlled arterial hypertension. In all the patients ambulatory blood pressure monitoring (ABPM), 24-h heart rate variability (HRV) and ADF-induced platelet aggregation (10,0×10-6 mole/l) were conducted. Method of logistic regression analyzes was used.
Results. No statistician difference were found between the groups in age (63 ± 9,1 versus 64 ± 11,0 yrs.; р = 0,682, respectively), however, it was in sex parameter (64% male versus 39%; р=0,018, respectively). Onset risk of ischemic hemispheric stroke was associated with ABPM parameters as average systolic BPday (SBP) >132 mmHg; average diastolic BPnight (DBP) >70 mmHg; pulse BP24 >60 mmHg; pulse BPday >58,6 mmHg; pulse BPnight >57,9 mmHg; indexes of hypertension (BP SBP24 load>44, 7% and DBP24 load>37,0%; time index DBPnight >62,6%; square index SBP24 >94,3 mmHg×h and DBP24 >58,4 mmHg×h); AASI24 >0,52; mean BP24 >94,8 mmHg and mean BPnight >87,1 mmHg; pulse BPday variability >11,8 mmHg and pulse BPnight variability >8,2 mmHg; “double multiplication” index > 86,3 mmHg×bmp). Also there is association with HRV parameters as SDNN24 ≤ 91 mc and SDNNday ≤83 mc; SDANN24 ≤99 mc and SDANNday ≤ 76 mc; VLFday ≤63,7%; LFday > 27,1%; index[(HF+LF)/VLF] > 0,56. And with max level of platelet aggregation parameter with ADF as aggregation inductor as >65,2%. In model independent risk factors of IS was SDNNday (OR = 56,6; р = 0,011); SBP24 load (OR = 40,9; р = 0,033); average SBPday (OR = 30,0; р = 0,021) and PBPnight variability (OR = 15,1; р = 0,043).
Conclusions. The independent risk factors of ischemic hemisphere stroke in hypertensive individuals are daily SDNN, blood pressure load of diurnal systolic blood pressure and night variability of pulse blood pressure. The maximum level of ADF-induced platelet aggregation more than 65,2% is a dependent risk factor, which augmented odd rate of ischemic stroke in 6,5 times (р = 0,007).
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