Blood pressure control to prevent decline in cognition after stroke

Figures & data

Table 1 Patient description (n=166)

Assessment	Baseline (N=97)	12 months
Demographics
Men	93 (56)
Mean age, years (SD)	71.5 (12.4)
Less than 9 years of education	37 (22)
Stroke subtype
Cerebral infarction	149 (90)
Cerebral hemorrhage	17 (10)
Risk factors
Hypertension	96 (58)
Hyperlipidemia	92 (55)
Diabetes	20 (12)
Cigarette smoking (present)	39 (24)
Coronary heart disease	39 (24)
Atrial fibrillation	49 (30)
Daily alcohol use	32 (24)
BMI <25	96 (58)
Physical activity, minutes per week (SD)		183 (206)
Apo E 4 allele	38 (23)
OCSP classification
TACI	18 (11)
PACI	78 (47)
LACI	46 (28)
POCI	24 (15)
TOAST classification
Large-vessel disease	19 (13)
Cardio embolic disease	45 (30)
Small-vessel disease	48 (32)
Stroke of undetermined etiology	37 (25)
Precerebral arteries
Internal carotid artery disease ≥50%	22 (13)
Vertebral artery occlusion	5 (3)
Antihypertensive medication
Betablocker		69 (42)
ACE inhibitor		37 (22)
Angiotensin II receptor blocker		47 (28)
Calcium antagonist		36 (22)
Diuretics		54 (33)
Number of antihypertensive medication
0		40 (24)
1		51 (31)
2		41 (25)
3		22 (13)
4		12 (7)
Assessments
Systolic blood pressure, supine position (SD)	138.0 (24.6)*	138.3 (18.8)
Median (IQR)	135.5 (121–157)	137.0 (125–152)
Diastolic blood pressure, supine position (SD)	80.3 (14.4)*	75.4 (10.6)
Median (IQR)	78 (71.0–89.3)	76.0 (67.0–83.0)
NIHSS, median (IQR)	1.0 (0–2)**	1.0 (0–2)
BI, median (IQR)	20 (18–20)	20 (19–20)
mRS, median (IQR)	1 (1–2)	1 (1–2)
IQCODE (SD)***	3.10 (0.22)	3.3 (0.41)
MMSE (SD)	25.6 (4.6)	25.7 (5.8)
TMT A (SD)	78.3 (71.8)	66.9 (51.0)
TMT B (SD)	157.0 (86.7)	147.0 (85.3)
10-word test (SD)	21.0 (7.3)	23.1 (8.6)
Clock Drawing Test, correct	89 (53.6)	96 (57.8)
HADS total	7.5 (5.8)	6.9 (5.3)

Notes: Figures are in n(%) unless specified otherwise. Hyperlipidemia denotes total cholesterol >5 mmol/L or LDL-cholesterol >3 mmol/L. Coronary heart disease means previous myocardial infarction or present angina pectoris. Atrial fibrillation denotes permanent or paroxysmal atrial fibrillation. Anxiety and depressive symptoms were evaluated using HADS.

* n=150;

** NIHSS at discharge;

*** n=118–166 due to missing values in cognitive and emotional assessments.

Abbreviations: LDL, low-density lipoprotein; BMI, body mass index; Apo E 4, apolipoprotein E alleles; OCSP, Oxfordshire Community Stroke Project; TACI, total anterior circulation infarction; PACI, partial anterior circulation infarction; LACI, lacunar circulation infarction; POCI, posterior circulation infarction; TOAST, The Trial of Org 10172 in Acute Stroke Treatment; NIHSS, National Institute of Health Stroke Scale; IQR, interquartile range; BI, Barthel Activities of Daily Living Index; mRS, modified Rankin Scale; IQCODE, Informant Questionnaire on Cognitive Decline in the Elderly; MMSE, Mini Mental State Examination; TMT A, trail making test A; TMT B, trail making test B. HADS, Hospital Anxiety and Depression Scale.

Table 2 Results of unadjusted and adjusted regression models for associations between achievement of different blood pressure targets and cognitive test performances (outcome variables)

Explanatory variables	Cognitive test performance
	TMT A	TMT B	10-word test	MMSE	Clock Drawing Test*
SBP ≤125
Univariate	4.20 (−14.6, 23.0)	−12.8 (−47.5, 21.9)	−0.72 (−3.76, 2.32)	0.02 (−2.05, 2.09)	1.06 (0.52, 2.15)
Adjusted**	0.23 (−19.1, 19.6)	−20.2 (−55.1, 14.8)	−0.47 (−3.65, 2.72)	0.56 (−1.20, 2.32)	1.25 (0.44, 3.53)
SBP ≤140
Univariate	1.98 (−14.5, 18.4)	6.91 (−22.8, 36.6)	−0.74 (−3.42, 1.94)	0.09 (−1.92, 1.74)	1.29 (0.69, 2.42)
Adjusted**	2.23 (−15.3, 19.8)	21.3 (−10.8, 53.3)	−1.78 (−4.70, 1.14)	−0.45 (−2.06, 1.16)	1.96 (0.75, 5.09)
SBP ≤160
Univariate	−23.8 (−51.9, 4.30)	−21.3 (−76.9, 34.3)	2.39 (−2.19, 6.97)	2.04 (−0.98, 5.07)	0.69 (0.25, 1.95)
Adjusted**	−21.3 (−47.8, 5.09)	5.74 (−44.9, 56.4)	−1.24 (−5.87, 3.38)	0.005 (−2.47, 2.48)	1.95 (0.45, 8.41)
SBP reduction ≥10
Univariate	11.5 (−8.31, 31.4)	0.83 (−34.6, 36.3)	−0.19 (−3.27, 2.89)	−0.51 (−2.68, 1.66)	1.56 (0.77, 3.17)
Adjusted**	7.32 (−13.7, 28.4)	−11.7 (−49.3, 26.0)	−0.77 (−4.06, 2.51)	0.07 (−1.92, 1.78)	1.79 (0.63, 5.13)
DBP reduction ≥5
Univariate	−1.88 (−18.4, 14.6)	4.64 (−25.1, 34.4)	1.03 (−1.68, 3.74)	0.58 (−1.34, 2.50)	1.10 (0.59, 2.04)
Adjusted**	2.08 (−15.6, 19.8)	12.5 (−18.3, 43.4)	−0.35 (−3.23, 2.52)	−0.29 (−1.88, 1.29)	0.65 (0.25, 1.70)

Notes: Data are regression coefficient (95% CI) unless specified otherwise.

* Odds ratio;

** adjusted for age, sex, education, Apo E alleles, hyperlipidemia, diabetes, atrial fibrillation, coronary heart disease, current smoking, hip-waist-ratio, physical activity, NIHSS day 1, IQCODE (Informant Questionnaire on Cognitive Decline in the Elderly), HADS, OCSP, Barthel ADL index, and stroke type.

Abbreviations: CI, confidence interval; SBP, systolic blood pressure; DBP, diastolic blood pressure; TMT A, trail making test A; TMT B, trail making test B ; MMSE, Mini Mental State Examination; NIHSS, National Institute of Health Stroke Scale; HADS, Hospital Anxiety and Depression Scale; OCSP, Oxfordshire Community Stroke Project; ADL, Activities of daily living.