Date collection
Retrospective data was obtained from EMR of LiYuan Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2020 to April 2022. All data include type of stroke, diagnosis date, frequency, gender, age, area, marital status, alcohol drinking, smoking, family history of stroke, Modified Rankin Scale score, intracranial and extracranial arteriostenosis, psychosis/great psychological pressure, chronic diseases history and antihypertensive therapy. The inclusion criteria: diagnosed with ischemic stroke by neurologist and all cases have complete clinical information, neurological examination, laboratory tests (blood biochemical examination) and demographic characteristics. The exclusion criteria: patients with cancer, severe head trauma, brain tumor, brain surgery, hydrocephalus, multiple sclerosis, central nervous system infections and other severe diseases. We recruited 658 ischemic stroke cases, 45 ischemic stroke patients were excluded because of incomplete information. Finally, 613 patients were enrolled.
Diagnostic criteria and definition
1. Diabetes mellitus: HbA1c ≥ 6.5% OR FPG ≥ 126 mg/dl (7.0mmol/l) (Fasting is defined as no caloric intake for at least 8 h) OR 2-h plasma glucose ≥ 200 mg/dl (11.1mmol/l) during an OGTT OR random plasma glucose ≥ 200 mg/dl (11.1mmol/l) OR taking hypoglycemic drugs6.
2. Hypertension: Systemic blood pressure equal to or exceeding 140/90mmHg OR taking antihypertensive agents.
3. Dyslipidemia: Triglycerides ≥ 2.26mmol/l OR total cholesterol ≥ 6.22mmol/l OR LDL-C ≥ 4.14mmol/l OR HDL-C < 1.04mmol/l OR taking lipid regulating agents7.
4. Smoking: ≥1 cigarette per day in last 3 months8.
5. Alcohol drinking: ≥ 100mL spirit alcohol more than three times a week8.
6. Family history of stroke: ≥1 person has stroke in parents and compatriots.
7. Arial fibrillation (AF): AF was defined by either with history of persistent AF OR supported by past electrocardiogram (ECG)8.
8. Coronary atherosclerotic cardiopathy: Having typical symptoms or signs of myocardial ischemia OR chest CT showed calcified plaque in the coronary arteries OR supported by past ECG.
9. Intracranial and extracranial arteriostenosis: Intracranial and extracranial artery intimal thickening or plaque or stenosis was confirmed by color ultrasound or MRA or CTA or DSA.
10. Modified Rankin scale9:
0
|
no symptoms
|
1
|
no significant disability, despite symptoms: Able to perform all usual duties and activities
|
2
|
slight disability: Unable to perform all previous activities but able to look after own affairs without assistance
|
3
|
moderate disability: Requires some help, but able to walk without assistance
|
4
|
moderately severe disability: Unable to walk without assistance and unable to attend to own bodily needs without assistance
|
5
|
severe disability: Bedridden, incontinent, and requires constant nursing care and attention
|
6
|
dead
|
11. Target blood pressure: SBP < 130mmHg and DBP < 80mmHg (< 140/80 in elderly patients)10.
12. Psychosis/great psychological pressure: Psychosis diagnosed by a psychiatrist OR the patients have sleep disorders, poor appetite, abnormal mood or other mental stress.
Statistical analysis
Statistical analysis was performed with SAS version 9.4 for Windows. The age distribution was normal, expressed as mean ± standard deviation; Categorical variables were expressed by rate/constituent ratio. The ischemic stroke patients were divided into case group and control group according to whether they were combined with hypertension, chi-square test was used for the distribution differences of risk factors among different groups, and pairwise comparisons within groups were performed. Risk factors included age, gender, area, marital status, diabetes mellitus, auricular fibrillation, dyslipidemia, transient ischemic attacks, smoking, alcohol drinking, family history of stroke, frequency, mRs score, coronary atherosclerotic cardiopathy, intracranial and extracranial arteriostenosis, chronic inflammation, psychosis/great psychological pressure. Variables were subjected to multivariate analysis with a logistic regression after univariate analysis. The presence or absence of hypertension (coded as 0 or 1, respectively.) was the dependent variable. An unconditional multiple logistic regression model was used to calculate odds ratios (OR) and 95% confidence interval (CI). Population attributable risk proportion was estimated for each risk factor. Antihypertensive medication adherence and blood pressure control rate were analyzed using the chi-square test. Significance was set at P < 0.05.