Hypertension and clusters of risk factors in different stroke subtypes (an analysis of Hungarian patients via Budapest Stroke Data Bank).

Our aim was to determine the frequency of hypertension in the Hungarian stroke population, and to compare it with the data of other stroke registries. We attempted to find characteristic cluster-like associations between hypertension and another nine risk factors in different stroke subtypes and to ascertain the role of hypertension in leukoaraiosis, in early mortality, in stroke recurrence and in the case fatality rate up to 10 years. Risk factor profile of 500 unselected acute stroke cases of the Budapest Stroke Data Bank were analysed. We compared data of hypertensive stroke patients to those of unaffected ones. LIFEREG procedure of the SAS software package, cluster analysis, logistic regression, Pearson's correlation coefficient and Student's t-test were used as statistical methods. Hypertension was documented in 75% of the patients. The largest clusters were formed by the following groups: atherosclerotic stroke, hypertension with ischaemic heart disease; lacunar stroke and haemorrhage, hypertension with elevated serum cholesterol, cardiogenic embolism, ischaemic heart disease with atrial fibrillation. The case fatality rate was significantly higher in the group of hypertensive patients with ischaemic heart disease relative to those without it during the 10 years follow-up period. In the leukoaraiosis-group, systolic blood pressure was significantly higher than in the non-leukoaraiosis group. The rate of hypertension was higher than in other stroke registries. Hypertension appears to be the most frequent risk factor in stroke patients but case fatality rate is determined by presence or absence of ischaemic heart disease.

[Risk factors for early death and recurrence in stroke]. / A stroke korai halálozását és az ismételt stroke kialakulását meghatározó tényezók.

The early case fatality rate (28-day mortality) in 500 acute stroke patients of Budapest Stroke Data Bank was 17% and it was 25% within the first year with an increase between 1-3% annually. In the group with early death significantly higher age (p < 0.0001), more serious neurological symptoms, impaired consciousness (p < 0.0001), and higher volume of the lesions (p < 0.0001) have been detected. In this group significantly more stroke in the territory of vertebrobasilar system, a higher number of ischemic heart disease, and atrial fibrillation have been registered. According to the stroke subtypes there were significantly more cardiogenic embolisms, and hemorrhages, but less lacunar infarcts. The level of blood sugar at admission, and the rate of low platelets were higher among patients, who died within 28 days. Significantly higher percentage of the regions in the right frontal, right parietal, right occipital lobes and right thalamus have been affected in the early death group than in the survivors' group, however no such difference have been found in the lesions of the left homological structures. Severity of recurrent strokes have been more serious, and among patients with repetitive stroke significantly more ischemic heart diseases have been demonstrated. Atherosclerosis is the main risk for a new cerebrovascular accident. The case recurrent rate in the first 28 days is 7%, and it is 16% within the first year. The annual increase was between 1-5%. 71% of the recurrent strokes had the same mechanism as the first one.

[Risk factors in various groups of stroke patients (Analysis of 500 cases of the Budapest Stroke Database)]. / Kockázati tényezök különbözö stroke-beteg csoportokban (A Budapesti Stroke Adatbank 500 esetének elemzése).

Risk factor profile of 500 consecutive acute++ stroke cases in the protocol of the Budapest Stroke Data Bank has been analysed. High frequency of risk factors and additive occurrence have been documented when compared with other stroke registries; hypertension 75%, hypercholesterolemia 68%, ischemic heart disease 61%, hypertriglycerolemia 39%, smoking 38%, serious hypercholesterolemia 36%, diabetes mellitus 30%, peripheral artery disease 10%, elevated hematocrit 7% and elevated number of platelets 7%. More than one risk factors have been registered in 85% of the patients. Three risk factors at the same patient have been found in 28%. The highest number of risk factors is seven at the same patient. The stroke subtypes have been characterized with "cluster-like" association of risk factors. In the hemorrhagic group (9.4% of all cases) hypertension and alcoholism are the main factors; in the atherosclerotic group (49.4%) more male, smoking peripheral artery disease and hypercholesterolemia have been registered; in the lacunar stroke group (27%) high frequency of hypertension, smoking, diabetes mellitus, hypercholesterolemia and hypertriglycerolemia have been found and in the cardiogenic embolia group (10.6%) more female, higher age, ischemic heart disease and atrial fibrillation are the recurrent risk factors. There is no difference between the risk factor profile++ registered in the left versus right hemispheral strokes, in the anterior versus posterior strokes and in the first ever or recurrent strokes.

[The Budapest "stroke data bank" (goals, methods)]. / Budapesti "stroke adatbank" (célkitüzések, metodika).

The Stroke Data Bank initiated by National Institute of Neurological and Communicative Disorders and Stroke (USA) has been adapted and published here in a short form. The original questionnaire has been extended with data of patients' diets and neuropsychology. A suitable computer data basis derived from 1292 questions in 22 groups provides information about the risk factors, etiology, symptoms, signs, diagnosis, prognosis of stroke, and the easy to use follow up of patients.