Further evidence of interrelation between homocysteine and hypertension in stroke patients: A cross-sectional study

Background: A high total plasma homocysteine level is an independent risk factor for cardiovascular and cerebrovascular disease, but the evidence connecting plasma tHcy level with hypertension is inconsistent. Objective: To determine the association between plasma tHcy level and some common risk factors for cerebrovascular disease (recurrent stroke, diabetes mellitus, hypertension, ischemic heart disease and hyperlipidemia) in patients presenting with primary or recurrent acute ischemic strokes. Methods: This retrospective cross-sectional chart analysis was conducted in a university-affiliated referral hospital. During an 18 month period we identified 113 acute ischemic stroke patients (mean age 71.2), 25 of whom had a recurrent stroke. Plasma tHcy level, obtained 2-10 days after stroke onset, was determined by the high performance liquid chromatography method with fluorescence detection. A multi-variate logistic regression model was used to determine the independent relationship between each potential risk factor and tHcy level above or below the 75th percentile. Results: Hypertension was more frequent among patients with plasma tHcy level above than below the 75th percentile (51.7% vs. 80.8%, respectively, P = 0.012). After adjusting for demographic and clinical variables, the odds ratio for recurrent stroke and hypertension, with tHcy above or below the 75th percentile, was 3.4 (95% confidence interval 1.01-10.4, P = 0.037) and 4.02 (95% Cl 1.2-13.9, P = 0.028), respectively. Conclusions: A high plasma tHcy level is associated with history of hypertension and recurrent stroke among patients presenting with acute ischemic stroke. These results were independent of other risk factors such as atrial fibrillation, diabetes and hyperlipidemia. Hypertensive stroke patients with hyperhomocysteinemia should be identified as high risk patients as compared to non-hypertensive stroke patients, and more vigorous measures for secondary prevention may be warranted.