Hypertension Linked to Ischemic Stroke in Young Indian Adults: Study Calls for Early Intervention and Prevention Strategies

The study shows the importance of strictly controlling hypertension through lifestyle changes and antihypertensive therapy. The research also indicates that as alcohol consumption and smoking rates rise among younger individuals, there is a growing need for early implementation of awareness programs focused on primary stroke prevention. The study is scheduled for publication in the July-September issue of Apollo Medicine and is now available online ahead of its print release.

The most common etiology of ischemic stroke was found to be large-artery atherosclerosis (LAA), followed by a stroke of other determined cause (OC).

"Our study stressed that stroke in the younger age group is an important entity and needs to be approached differently. Although less common, its impacts on individuals and society in terms of economic burden are far greater. While the general management remains similar, greater attention to primary prevention is warranted," the study author Dr. (Prof.) Pushpendra Nath Renjen, Department of Internal Medicine, Indraprastha Apollo Hospitals, told Medical Dialogues. Adding that "appropriate measures to reduce risk factors will go a long way in reducing the clinical burden of stroke in young."

He suggested a different approach for stroke in the young than stroke in the elderly. Stating that "particular importance in young adults such as hematological disorder, substance abuse, trauma, dissection, contraceptive abuse, pregnancy and postpartum state, and migraine."

Current estimates suggest that approximately 10% to 15% of stroke cases occur in young adults, which, despite being less common, significantly affects public health. Managing stroke in younger individuals necessitates different strategies due to a wider array of risks, with smoking and alcohol consumption being significant factors. Although general management approaches remain consistent, there is a particular need to prioritize primary prevention measures. Considering this, Shivangi Garg, Department of Internal Medicine, Indraprastha Apollo Hospital, New Delhi, India, and colleagues aimed to examine the clinical characteristics and underlying risk factors of acute ischemic stroke in patients aged 18–45.

For this purpose, the research team prospectively studied the etiology of patients 18–45 years of age with h acute ischemic stroke presenting to Indraprastha Apollo Hospital from September to December of the following year. They aimed for 80% statistical power at a 5% significance level with a precision of 0.15, which led to a calculated sample size of 39.

The study led to the following findings:

• Fifty patients were observed. The main risk factors identified were alcohol use (36%), hypertension (22%), and smoking (30%).
• Prothrombotic conditions were a notable risk factor in cases where the origin of the stroke remained unclear.
• The most common stroke subtype was large-artery atherosclerosis, which was followed by strokes with other underlying causes.
• There was a statistically significant association between hypertension and ischemic stroke subtypes.
• Hypertension was associated with small-vessel disease (92.3%) and strokes with undetermined causes (56.5%).
• Regarding the severity of stroke, the study revealed that 55.91% of patients had a moderate stroke at the time of admission, whereas 24.19% had a severe stroke, and 12.37% had a very severe stroke. Only 18.82% of patients had a minor stroke.

The findings showed that hypertension was associated with multiple stroke subtypes. Smoking and alcohol abuse were the common risk factors for ischemic stroke in young. Hence, primary prevention with antihypertensive and abstinence from smoking and alcohol is warranted.

Dr Renjen added "Our study also stresses the fact that illicit substance abuse should be kept in mind as the cause of stroke. The overall outcome of stroke in young patients is better than in older individuals. However, the primary prevention aimed at reducing the risk factors is of utmost importance."

According to Dr. Renjen, the limitations of the study are that it is an urban hospital-based study and they need to have larger numbers of patients.

"Our study is unique in the way that it very clearly brings about how important is a comprehensive history and clinical examination which should be performed," he concluded.

Reference: Garg S, Renjen PN, Ahmad K, Chaudhari DM, Priyal, Mishra A. Demography and etiology of ischemic stroke in 18–45 years. Apollo Med 2024; DOI:10.1177/09760016241239707