STROKE SUBTYPES AND HYPERTENSION - PRIMARY HEMORRHAGE VS INFARCTION, LARGE-ARTERY VS SMALL-ARTERY DISEASE

Background: Hypertension is the major risk factor for stroke associate d with small-artery disease and large-artery disease, but the factors behind the development of a particular stroke subtype in individual pa tients are not known. Methods: We determined risk factors potentially predictive of stroke subtype in 822 of 2760 patients consecutively adm itted to a primary care stroke center with (1) first-ever stroke, (2) hypertension (blood pressure >160/90 mm Hg at least twice before the s troke), and (3) no cardioembolic source. We used logistic regression a nalysis to delineate factors associated with ischemic (brain infarct) vs hemorrhagic (primary hemorrhage) stroke and with large- vs small-ar tery disease. A scoring system was elaborated on the basis of the esti mated regression coefficients. Observed proportions and calculated ris ks were determined. Results: Age greater than 67 years, cigarette smok ing, hypercholesterolemia, and a family history of stroke or ischemic heart disease were independent predictors of ischemic vs hemorrhagic s troke. In women, diabetes mellitus was an additional risk factor for i schemic vs hemorrhagic stroke. Only one of 144 patients with primary h emorrhage had an ipsilateral carotid stenosis. In men with brain infar ct, cigarette smoking, cardiac ischemia, and a family history of strok e or ischemic heart disease were significantly and independently assoc iated with large- vs small-artery disease. In women with brain infarct , smoking was the only predictive factor for large- vs small-artery di sease. Conclusion: In patients with stroke and hypertension, associate d risk factors influence the subtype of stroke (hemorrhage vs brain is chemia, large- vs small-artery disease).