Pre-stroke glycemia in patients with diabetes.

AIMS: Hyperglycemia in type 2 diabetes mellitus (T2D) remains uncontrolled in approximately 50% of patients in the United States. Uncontrolled T2D is associated with various vascular complications, including stroke. We studied demographic and clinical factors association with pre-stroke glycemia, indicated by glycated hemoglobin (HbA1c), in acute stroke patients with T2D. METHODS: Using a questionnaire, we collected demographic, socioeconomic, and clinical information from 300 acute ischemic and hemorrhagic stroke patients in one hospital. We analyzed factors associated with HbA1c in patients with history of T2D. RESULTS: There were 111 patients with history of T2D and HbA1c measured on admission. In multivariable analyses factors associated with higher HbA1c were treatment with insulin (p=0.05), history of hyperlipidemia (p=0.01), and total cholesterol level (p=0.02). Poor adherence to T2D treatment was associated with higher HbA1c levels (p=0.006) only in a subgroup of patients with HbA1c ≥8%. CONCLUSION: Insulin treatment and hyperlipidemia are associated with higher HbA1c levels in acute stroke patients with T2D. Poor adherence to diabetes treatment is associated with higher HbA1c levels only among patients with HbA1c ≥8%.

Left ventricular hypertrophy in acute stroke patients with known hypertension.

BACKGROUND: Despite effective treatments, hypertension remains uncontrolled in nearly half of the people with hypertension in the United States. Uncontrolled hypertension leads to end organ damage, such as left ventricular hypertrophy (LVH). To identify reasons for uncontrolled hypertension, we interviewed acute stroke patients with a history of hypertension and evaluated for LVH. METHODS: Using a standardized questionnaire, we collected demographic, socioeconomic, and health-care data in 300 acute ischemic and hemorrhagic stroke patients in one hospital. We also collected relevant clinical data from medical records. We analyzed factors associated with echocardiographic LVH as a marker of uncontrolled hypertension in 190 acute stroke patients with a history of hypertension. RESULTS: Overall, 46% (88/190) of patients had LVH. In univariate analysis, lower household income and self-reported poor adherence to hypertension treatment were significantly associated with increased risk of LVH. In multiple logit modeling, only poor adherence to hypertension treatment remained significantly associated with LVH, odds ratio 1.77 (95% CI: 1.01-3.11), p < 0.05. CONCLUSIONS: In acute stroke patients, poor adherence to hypertension treatment is a significant independent predictor of LVH. A clear reason for poor adherence to treatment is elusive in a large proportion of these patients in our study. Further research is needed to identify and develop strategies to combat the key factors responsible for poor adherence to hypertension treatment.