Abstract
Background and Objectives: Blood pressure (BP) is often not at goal in stroke survivors, leaving individuals vulnerable to additional vascular events. Given that BP is a highly heritable trait, we hypothesize that a higher polygenic susceptibility to hypertension (PSH) leads to worse BP control in stroke survivors.
Methods: We conducted a study within the UK Biobank evaluating persons of European ancestry who survived an ischemic or hemorrhagic stroke. To model the PSH, we created polygenic scores (PRS) for systolic and diastolic BP using 732 genetic variants. We divided the PRSs into quintiles and used linear/logistic regression to test whether higher PSH led to higher observed BP, uncontrolled BP (systolic BP >140 mmHg or diastolic BP >90 mmHg) and resistant BP (uncontrolled BP despite being on >=3 antihypertensive drugs). We conducted an independent replication using data from the Vitamin Intervention for Stroke Prevention (VISP) trial.
Results: We analyzed 5,940 stroke survivors. When comparing stroke survivors with very low versus very high PSH, the mean systolic BP was 137 (SD 18) versus 143 (SD 20, p<0.001), the mean diastolic BP was 81 (SD 10) versus 84 (SD 11, p<0001), the prevalence of uncontrolled BP was 42.8% versus 57.2% (p<0.001), and the prevalence of resistant hypertension was 3.9% versus 11% (p<0.001). Results remained significant using multivariable models (p<0.001) and were replicated in the VISP study (all tests with p<0.05).
Discussion: A higher PSH is associated with worse BP control in stroke survivors. These findings point to genetic predisposition as an important determinant of poorly controlled BP in this population.
- Received May 8, 2022.
- Accepted in final form November 16, 2022.
- © 2023 American Academy of Neurology
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