Impact of hypertension on stroke. Are there different age profiles?

INTRODUCTION Arterial hypertension is the most prevalent modifiable risk factor for stroke. We aim to establish if there is an association between hypertension and type of stroke, and if this varies with age.

METHODS Retrospective study of patients with a first stroke discharged from public hospitals in Seville (Spain) between 1999 and 2021. Only patients with hypertension as a risk factor were included. The sample was divided into 3 groups: patients ≤ 50 years, between 51-79 years and ≥ 80 years.

RESULTS Of 42,855 strokes, 2,141 (4.9%) hypertensive patients with a first stroke, mean age 68 (±15) years, and 1,010 (47.2%) women, were included. Included were 1,274 (59.5%) ischemic strokes and 867 (40.5%) hemorrhagic strokes, 309 (14.4%) patients ≤ 50 years of age, 1,253 (58.3%) patients between 51 and 79 years of age, and 579 (27.3%) patients ≥ 80 years. The percentage of patients with a previous diagnosis of hypertension was 24.3% vs. 51.3% vs. 79.4% (p < 0.001), with a mean time from diagnosis to stroke of 5.5 (±3.7) vs. 7.8 (±4.9) vs. 9.6 (±5.1) years (p < 0.001) respectively. The number of hemorrhagic strokes was: 171 (55.3%), 523 (41.7%) and 172 (29.7%) (p < 0.001), with mortality at one year being 3.2%, 10% and 35.6% respectively (p < 0.001).

CONCLUSIONS In hypertensive patients with a first stroke, the percentage of hemorrhagic strokes is higher than expected, especially in young patients, where it exceeds more than half of the cases. It is necessary to optimize prevention in these patients to reduce the enormous socio-sanitary burden that stroke represents.