title: High homocysteine and blood pressure related to poor outcome of acute ischemia stroke in Chinese population.
abstract: OBJECTIVE
  To assess the association between plasma homocysteine (Hcy), blood pressure (BP) and poor outcome at hospital discharge among acute ischemic stroke patients, and if high Hcy increases the risk of poor outcome based on high BP status in a northern Chinese population.
  
  
  METHODS
  Between June 1, 2009 and May 31, 2013, a total of 3695 acute ischemic stroke patients were recruited from three hospitals in northern Chinese cities. Demographic characteristics, lifestyle risk factors, medical history, and other clinical characteristics were recorded for all subjects. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score ≥3 or death. The association between homocysteine concentration, admission blood pressure, and risk of poor outcome following acute ischemic stroke was analyzed by using multivariate non-conditional logistic regression models.
  
  
  RESULTS
  Compared with those in the lowest quartile of Hcy concentration in a multivariate-adjusted model, those in the highest quartile of Hcy concentration had increased risk of poor outcome after acute ischemic stroke, (OR = 1.33, P<0.05). The dose-response relationship between Hcy concentration and risk of poor outcome was statistically significant (p-value for trend  = 0.027). High BP was significantly associated with poor outcome following acute ischemic stroke (adjusted OR = 1.44, 95%CI, 1.19-1.74). Compared with non-high BP with nhHcy, in a multivariate-adjusted model, the ORs (95% CI) of non-high BP with hHcy, high BP with nhHcy, and high BP with hHcy to poor outcome were 1.14 (0.85-1.53), 1.37 (1.03-1.84) and 1.70 (1.29-2.34), respectively.
  
  
  CONCLUSIONS
  The present study suggested that high plasma Hcy and blood pressure were independent risk factors for prognosis of acute ischemic stroke, and hHcy may further increase the risk of poor outcome among patients with high blood pressure. Additionally, the results indicate that high Hcy with high BP may cause increased susceptibility to poor outcome among acute ischemic stroke patients in a northern Chinese population.
authors.affiliation: Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China.
authors.forename: Chongke
authors.initials: C
authors.lastname: Zhong
authors.affiliation: Department of Neurology, Xinganmeng People's Hospital, Xinganmeng, Inner Mongolia, China.
authors.forename: Liying
authors.initials: L
authors.lastname: Lv
authors.affiliation: Department of Neurology, Fuxin Center Hospital, Fuxin, LiaoNing, China.
authors.forename: Changjiang
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Neurology, Affiliated Hospital of Chengde Medical University, Chengde, HeBei, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China.
authors.forename: Mo
authors.initials: M
authors.lastname: Zhou
authors.affiliation: School of Food Science, Guangdong Pharmaceutical University, Zhongshan, China; School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Sun
authors.affiliation: Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, New Orleans, Louisiana, United States of America.
authors.forename: Tan
authors.initials: T
authors.lastname: Xu
authors.affiliation: Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China.
authors.forename: Weijun
authors.initials: W
authors.lastname: Tong
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002545:Brain Ischemia / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D002681:China / Q000453:epidemiology; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology
chemical_list: D006710:Homocysteine