Heart Rate as a Predictor of Stroke in High-risk, Hypertensive Patients with Previous Stroke or Transient Ischemic Attack

• Published in: Journal of stroke and cerebrovascular diseases 2014-11, Vol.23 (10), p.2814-2818
• Main Authors: Sandset, Else Charlotte, MD, PhD, Berge, Eivind, MD, PhD, Kjeldsen, Sverre E., MD, PhD, Julius, Stevo, MD, ScD, Holzhauer, Björn, MSc, Krarup, Lars-Henrik, MD, PhD, Hua, Tsushung A., PhD
• Format: Article
• Language: English
• Subjects: Aged; Amlodipine - therapeutic use; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Antihypertensive Agents - therapeutic use; Calcium Channel Blockers - therapeutic use; Cardiovascular; Double-Blind Method; Female; Heart Rate; Humans; hypertension; Hypertension - complications; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - physiopathology; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - physiopathology; Linear Models; Male; Middle Aged; Multivariate Analysis; Neurology; predictors; Proportional Hazards Models; Recurrence; Risk Assessment; Risk Factors; Stroke; Stroke - diagnosis; Stroke - etiology; Stroke - physiopathology; Tetrazoles - therapeutic use; Time Factors; Treatment Outcome; Valine - analogs & derivatives; Valine - therapeutic use; Valsartan
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.009

Background Risk factors for first stroke are well established, but less is known about risk factors for recurrent stroke. In the present analysis, we aimed to assess the effect of heart rate and other possible predictors of stroke in a hypertensive population with previous stroke or transient ischemic attack (TIA). Methods The Valsartan Antihypertensive Long-Term Use Evaluation trial was a multicentre, double-masked, randomized controlled, parallel group trial comparing the effects of an angiotensin receptor blocker (valsartan) and a calcium channel blocker (amlodipine) in patients with hypertension and high cardiovascular risk. We used Cox proportional hazard models to investigate the effect of baseline variables on the risk of stroke. Quadratic terms of the continuous variables were entered in the models to test for linearity. Results Of 15,245 patients included in the trial, 3014 had a previous stroke or TIA at baseline and were included in the present analysis. Stroke recurrence occurred in 239 patients (7.9%) during a median of 4.5 years of follow-up. Resting heart rate (per 10 beats per minute; hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.18-6.58) and diabetes mellitus at baseline (HR, 1.47; 95% CI, 1.03-2.10) were significantly associated with an increased risk of stroke recurrence in the multivariable analysis. Conclusions In high-risk, hypertensive patients with previous stroke or TIA, resting heart rate was the strongest predictor of recurrent stroke.