Pre-Stroke Antihypertensive Therapy Affects Stroke Severity and 3-Month Outcome of Ischemic MCA-Territory Stroke
Objectives: Whether different antihypertensive drug classes in high blood pressure (HBP) pre-stroke treatment affect dynamic cerebral autoregulation (dCA), stroke severity, and outcome. Methods: Among 337 consecutive ischemic stroke patients (female 102; median age 71 years [interquartile range, [IQ...
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MDPI AG
2024-03-01
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| Series: | Diseases |
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| Online Access: | https://www.mdpi.com/2079-9721/12/3/53 |
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| author | Lehel-Barna Lakatos Manuel Bolognese Mareike Österreich Laura Weichsel Martin Müller |
| author_facet | Lehel-Barna Lakatos Manuel Bolognese Mareike Österreich Laura Weichsel Martin Müller |
| author_sort | Lehel-Barna Lakatos |
| collection | DOAJ |
| description | Objectives: Whether different antihypertensive drug classes in high blood pressure (HBP) pre-stroke treatment affect dynamic cerebral autoregulation (dCA), stroke severity, and outcome. Methods: Among 337 consecutive ischemic stroke patients (female 102; median age 71 years [interquartile range, [IQR 60; 78]; NIHSS median 3 [IQR 1; 6]) with assessment of dCA, 183 exhibited the diagnosis of HBP. dCA parameters’ gain and phase were determined by transfer function analysis of spontaneous oscillations of blood pressure and cerebral blood flow velocity. Results: Patients used beta-blockers (<i>n</i> = 76), calcium channel blockers (60), diuretics (77), angiotensin-converting enzyme inhibitors (59), or angiotensin-1 receptor blockers (79), mostly in various combinations of two or three drug classes. dCA parameters did not differ between the non-HBP and the different HBP medication groups. Multinomial ordinal logistic regression models revealed that the use of diuretics decreased the likelihood of a less severe stroke (odds ratio 0.691, 95% CI 0.493; 0.972; <i>p</i> = 0.01) and that beta-blockers decreased the likelihood of a better modified Rankin score at 3 months (odds ratio 0.981, 95% CI 0.970; 0.992; <i>p</i> = 0.009). Other independent factors associated with stroke outcome were penumbra and infarct volume, treatment with mechanical thrombectomy, and the initial National Institute of Health Stroke Scale score. Interpretation: In this cohort of ischemic minor to moderate stroke patients, pre-stroke antihypertensive treatment with diuretics was associated with a more severe neurological deficit on admission and pre-stroke treatment with beta-blockers with a poorer 3-month outcome. The antihypertensive drug class used pre-stroke did not impact dCA. |
| first_indexed | 2024-04-24T18:23:05Z |
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| issn | 2079-9721 |
| language | English |
| last_indexed | 2024-04-24T18:23:05Z |
| publishDate | 2024-03-01 |
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| series | Diseases |
| spelling | doaj.art-07ad802be78e49a5a4bb5617b1143fcb2024-03-27T13:33:39ZengMDPI AGDiseases2079-97212024-03-011235310.3390/diseases12030053Pre-Stroke Antihypertensive Therapy Affects Stroke Severity and 3-Month Outcome of Ischemic MCA-Territory StrokeLehel-Barna Lakatos0Manuel Bolognese1Mareike Österreich2Laura Weichsel3Martin Müller4Department of Neurology and Neurorehabilitation, Lucerne Kantonsspital, 6000 Lucerne, SwitzerlandDepartment of Neurology and Neurorehabilitation, Lucerne Kantonsspital, 6000 Lucerne, SwitzerlandDepartment of Neurology and Neurorehabilitation, Lucerne Kantonsspital, 6000 Lucerne, SwitzerlandDepartment of Neurology and Neurorehabilitation, Lucerne Kantonsspital, 6000 Lucerne, SwitzerlandDepartment of Neurology and Neurorehabilitation, Lucerne Kantonsspital, 6000 Lucerne, SwitzerlandObjectives: Whether different antihypertensive drug classes in high blood pressure (HBP) pre-stroke treatment affect dynamic cerebral autoregulation (dCA), stroke severity, and outcome. Methods: Among 337 consecutive ischemic stroke patients (female 102; median age 71 years [interquartile range, [IQR 60; 78]; NIHSS median 3 [IQR 1; 6]) with assessment of dCA, 183 exhibited the diagnosis of HBP. dCA parameters’ gain and phase were determined by transfer function analysis of spontaneous oscillations of blood pressure and cerebral blood flow velocity. Results: Patients used beta-blockers (<i>n</i> = 76), calcium channel blockers (60), diuretics (77), angiotensin-converting enzyme inhibitors (59), or angiotensin-1 receptor blockers (79), mostly in various combinations of two or three drug classes. dCA parameters did not differ between the non-HBP and the different HBP medication groups. Multinomial ordinal logistic regression models revealed that the use of diuretics decreased the likelihood of a less severe stroke (odds ratio 0.691, 95% CI 0.493; 0.972; <i>p</i> = 0.01) and that beta-blockers decreased the likelihood of a better modified Rankin score at 3 months (odds ratio 0.981, 95% CI 0.970; 0.992; <i>p</i> = 0.009). Other independent factors associated with stroke outcome were penumbra and infarct volume, treatment with mechanical thrombectomy, and the initial National Institute of Health Stroke Scale score. Interpretation: In this cohort of ischemic minor to moderate stroke patients, pre-stroke antihypertensive treatment with diuretics was associated with a more severe neurological deficit on admission and pre-stroke treatment with beta-blockers with a poorer 3-month outcome. The antihypertensive drug class used pre-stroke did not impact dCA.https://www.mdpi.com/2079-9721/12/3/53strokearterial hypertensiondynamic cerebral autoregulationstroke severitystroke outcomeantihypertensive therapy |
| spellingShingle | Lehel-Barna Lakatos Manuel Bolognese Mareike Österreich Laura Weichsel Martin Müller Pre-Stroke Antihypertensive Therapy Affects Stroke Severity and 3-Month Outcome of Ischemic MCA-Territory Stroke Diseases stroke arterial hypertension dynamic cerebral autoregulation stroke severity stroke outcome antihypertensive therapy |
| title | Pre-Stroke Antihypertensive Therapy Affects Stroke Severity and 3-Month Outcome of Ischemic MCA-Territory Stroke |
| title_full | Pre-Stroke Antihypertensive Therapy Affects Stroke Severity and 3-Month Outcome of Ischemic MCA-Territory Stroke |
| title_fullStr | Pre-Stroke Antihypertensive Therapy Affects Stroke Severity and 3-Month Outcome of Ischemic MCA-Territory Stroke |
| title_full_unstemmed | Pre-Stroke Antihypertensive Therapy Affects Stroke Severity and 3-Month Outcome of Ischemic MCA-Territory Stroke |
| title_short | Pre-Stroke Antihypertensive Therapy Affects Stroke Severity and 3-Month Outcome of Ischemic MCA-Territory Stroke |
| title_sort | pre stroke antihypertensive therapy affects stroke severity and 3 month outcome of ischemic mca territory stroke |
| topic | stroke arterial hypertension dynamic cerebral autoregulation stroke severity stroke outcome antihypertensive therapy |
| url | https://www.mdpi.com/2079-9721/12/3/53 |
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