Purpose: Hypertension is the most important modifiable risk factor for stroke. Few data are available on control of hypertension in younger ischemic stroke survivors.
Material and methods: We assessed clinic and ambulatory blood pressure (BP) measurements in 320 patients aged 15-60 years (mean 48 ± 10) included in the Norwegian Stroke in the Young Study during 3-months follow-up after the index stroke. Controlled hypertension was defined as ambulatory BP <130/80 mmHg. Carotid-femoral pulse wave velocity (PWV) was measured by applanation tonometry. Carotid plaque was considered present if focal intima-media thickness >1.5 mm.
Results: At hospital discharge, 58% of the patients were treated for hypertension. Another 9% of the total study population was diagnosed with new-onset hypertension during follow-up. At the 3-months follow-up visit, 56% of patients with treated hypertension were uncontrolled. Patients with uncontrolled treated hypertension were older, had higher body mass index (BMI) and PWV, and were more likely to have diabetes and carotid plaques compared to patients with normotension (p < .01). Compared to controlled treated hypertension, patients with uncontrolled treated hypertension had higher prevalence of carotid plaque (p < .01). In a multivariate logistic regression, uncontrolled treated hypertension was associated with higher PWV and BMI, and presence of carotid plaque, independent of the more intensified use of antihypertensive treatment (all p < .05).
Conclusion: Uncontrolled hypertension was highly prevalent in ischemic stroke survivors <60 years and associated with co-presence of obesity and functional and structural arterial damage. Our results highlight the unmet potential and challenge of optimization of hypertension diagnosis and management in order to prevent recurrent vascular events in ischemic stroke survivors.
Trial registration: ClinicalTrials.gov NCT01597453.
Keywords: Ischemic stroke; arterial damage; carotid intima-media thickness; pulse wave velocity; uncontrolled hypertension.