title: Heart rate as a predictor of stroke in high-risk, hypertensive patients with previous stroke or transient ischemic attack.
abstract: BACKGROUND
  Risk factors for first stroke are well established, but less is known about risk factors for recurrent stroke. In the present analysis, we aimed to assess the effect of heart rate and other possible predictors of stroke in a hypertensive population with previous stroke or transient ischemic attack (TIA).
  
  
  METHODS
  The Valsartan Antihypertensive Long-Term Use Evaluation trial was a multicentre, double-masked, randomized controlled, parallel group trial comparing the effects of an angiotensin receptor blocker (valsartan) and a calcium channel blocker (amlodipine) in patients with hypertension and high cardiovascular risk. We used Cox proportional hazard models to investigate the effect of baseline variables on the risk of stroke. Quadratic terms of the continuous variables were entered in the models to test for linearity.
  
  
  RESULTS
  Of 15,245 patients included in the trial, 3014 had a previous stroke or TIA at baseline and were included in the present analysis. Stroke recurrence occurred in 239 patients (7.9%) during a median of 4.5 years of follow-up. Resting heart rate (per 10 beats per minute; hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.18-6.58) and diabetes mellitus at baseline (HR, 1.47; 95% CI, 1.03-2.10) were significantly associated with an increased risk of stroke recurrence in the multivariable analysis.
  
  
  CONCLUSIONS
  In high-risk, hypertensive patients with previous stroke or TIA, resting heart rate was the strongest predictor of recurrent stroke.
authors.affiliation: Department of Neurology, Oslo University Hospital, Oslo, Norway. Electronic address: else@sandset.net.
authors.forename: Else Charlotte
authors.initials: EC
authors.lastname: Sandset
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Berge
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Stevo
authors.initials: S
authors.lastname: Julius
authors.affiliation: Novartis Pharma, Basel, Switzerland.
authors.forename: Björn
authors.initials: B
authors.lastname: Holzhauer
authors.affiliation: Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Lars-Henrik
authors.initials: LH
authors.lastname: Krarup
authors.affiliation: Novartis Pharma, East Hanover, NJ.
authors.forename: Tsushung A
authors.initials: TA
authors.lastname: Hua
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013777:Tetrazoles / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D013777:Tetrazoles; D017311:Amlodipine; D000068756:Valsartan; D014633:Valine
keywords: Stroke; heart rate; hypertension; predictors; recurrence