Importancia de la hipertensión en pacientes con primer episodio de ictus isquémico: estudio retrospectivo de 20 años

Abstract

Background and objectives

Hypertension (HT) is a key risk factor for stroke. We evaluated whether the importance of hypertension on the risk of ischemic stroke has increased in recent decades.

Methods

Retrospective study of patients with ischemic stroke discharged from 3 hospitals in Seville (Spain), during the periods: 1999-2001, 2014-2016 and 2019-2020.

Results

1,379 patients were included, 42.6% women, mean age 69.1 (± 11) years. HT was the most prevalent vascular risk factor in all periods, with a progressive increase in hypertensive patients (65.9% vs 69.6% vs 74%; P = .029). HT was especially frequent in patients ≥ 80 years (73% vs 81.9% vs 85.2%; P = .029). At discharge, progressively more antihypertensive drugs were used (in 65% vs 85.1 vs 90.2% of patients; P = .0001), with a clear increase in the number of antihypertensive drugs used (mean 0.9 ± 0.8 vs 1.5 ± 1 vs 1.8 ± 0.8 drugs, P = .0001). The use of diuretics (13.7%-39.3%-65.3%; p = 0.0001), ACE inhibitors (35.5%-43.3%-53.4%; P = .0001) and angiotensin receptor blockers (12.2%-24%-32.4%; P = .0001) increased progressively. On the contrary, the use of calcium antagonists decreased (24%-19.9%-13.7%; P = .0001).

Conclusions

In the last 2 decades there has been a greater role for HT among patients with their first ischemic cerebrovascular event. Greater and better control of HT is necessary to reduce the enormous burden of cerebrovascular disease.