An-Najah Staff

Background: Angiotensin-converting enzyme inhibitors (ACEIs), antiplatelets (APs), and statin are increasingly being prescribed for ischemic stroke prevention.
Objectives: The objective of the study was to examine whether previous combination therapy of ACEI with AP and/or statin has additive effect compared with ACEI alone on functional outcome after ischemic stroke. Furthermore, factors associated with improving functional outcome were investigated.
Methods: Ischemic stroke patients attending a Malaysian hospital in 2008 were categorized according to Barthel Index at discharge. Favorable outcome was defined as Barthel Index of 75 or greater. Data included demographic information, clinical characteristics, and previous medications with particular attention to ACEI, AP, and statin.
Results: Overall, 505 patients were included. Variables associated with good functional outcome were younger age (P = 0.002), first-ever attack (P = 0.016), lacunar (P = 0.015) or posterior circulation infarct stroke subtype (P = 0.034), minor Glasgow Coma Scale (P < 0.001), and previous use of ACEI alone or combined with AP and/or statin (P = 0.002). Using ACEI alone as the reference for ACEI + AP, ACEI + statin, or ACEI + AP + statin combinations, there was no significant difference among combinations on improving functional outcome (P = 0.852)
Conclusions: Prestroke use of ACEI either alone or combined with AP and/or statin was associated with better functional outcome. Previous use of ACEI in combination with AP and/or statin did not significantly differ from ACEI alone in their effect on outcome. Our study provides a potential rationale for optimizing the use of ACEI among individuals at risk of developing ischemic stroke. 

Background: Angiotensin-converting enzyme inhibitors (ACEIs), antiplatelets (APs), and statin are increasingly being prescribed for ischemic stroke prevention.
Objectives: The objective of the study was to examine whether previous combination therapy of ACEI with AP and/or statin has additive effect compared with ACEI alone on functional outcome after ischemic stroke. Furthermore, factors associated with improving functional outcome were investigated.  Methods: Ischemic stroke patients attending a Malaysian hospital in 2008 were categorized according to Barthel Index at discharge. Favorable outcome was defined as Barthel Index of 75 or greater. Data included demographic information, clinical characteristics, and previous medications with particular attention to ACEI, AP, and statin.
Results: Overall, 505 patients were included. Variables associated with good functional outcome were younger age (P = 0.002), first-ever attack (P = 0.016), lacunar (P = 0.015) or posterior circulation infarct stroke subtype (P = 0.034), minor Glasgow Coma Scale (P < 0.001), and previous use of ACEI alone or combined with AP and/or statin (P = 0.002). Using ACEI alone as the reference for ACEI + AP, ACEI + statin, or ACEI + AP + statin combinations, there was no significant difference among combinations on improving functional outcome (P = 0.852).
Conclusions: Prestroke use of ACEI either alone or combined with AP and/or statin was associated with better functional outcome. Previous use of ACEI in combination with AP and/or statin did not significantly differ from ACEI alone in their effect on outcome. Our study provides a potential rationale for optimizing the use of ACEI among individuals at risk of developing ischemic stroke.

Abstract BACKGROUND:  Hypertension and ischemic heart disease (IHD) are among the most prevalent modifiable risk factors for stroke. Clinical trial evidence suggests that antihypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients.
OBJECTIVES:  The objectives of this study were to analyze and evaluate the utilization of antihypertensive medication for acute ischemic stroke (AIS) or transient ischemic attack (TIA) survivors in relation to recent recommendations and guidelines and to compare their use among patients with or without IHD.
METHODS:  This was a retrospective cohort study of all patients with AIS/TIA attending the hospital from July 1, 2008 to December 31, 2008. Demographic data, clinical characteristics, different classes of antihypertensive medications, and different antihypertensive combinations prescribed to AIS/TIA survivors were analyzed among patients with and without IHD. Statistical Package for Social Sciences (SPSS) program version 15 was used for data analysis. RESULTS:  In all, 383 AIS/TIA survivors were studied, of which 66 (19.5%) had a documented history of IHD. Three quarters (n = 260; 76.9%) of AIS or TIA survivors received antihypertensive medication, mostly as monotherapy, at discharge. The majority of patients (n = 201, 59.5%) were prescribed angiotensin-converting enzyme inhibitors (ACEIs). Patients with IHD were significantly prescribed more β-blockers than patients without IHD (P = .003). A history of hypertension, a history of diabetes mellitus, and age were significantly associated with prescription of antihypertensive medications at discharge (P < .001, P < .001, and P < .001, respectively).
CONCLUSION:  Patterns of antihypertensive therapy were commonly but not adequately consistent with international guidelines. Screening stroke survivors for blood pressure control, initiating appropriate antihypertensive medications, and decreasing the number of untreated patients might help reduce the risk of recurrent strokes and increase survival.

Background and objective  Anti-hypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients. The objective of this study was to analyze the use of anti-hypertensive therapy in acute ischemic stroke survivors.
Methods  All ischemic stroke survivors discharged from Al-watani governmental hospital in Palestine from August 2006 until September 2007 were investigated. Demographic data, clinical characteristics, and different classes of anti-hypertensive medications prescribed to stroke survivors were analyzed using SPSS 15. Results  One hundred and twenty four ischemic stroke survivors were identified, of which 80 (64.5%) had a documented history of hypertension (HTN). Two thirds of the survivors (n = 82; 66.1%) were prescribed anti-hypertensive medications, mostly as mono-therapy, at discharge. Angiotensin-converting enzyme inhibitors (ACEI) 65 (45.6%), followed by diuretics 41 (34.5%) were the most common drug classes prescribed. ACEI were used in combination with diuretics in 29 (23.4%) survivors. Among survivors with a documented history of HTN, 70 (85.5%) were prescribed anti-hypertensive medications at discharge while 12 (8.5%) of survivors with no history of HTN were prescribed anti-hypertensive medications at discharge.
Conclusion  In this study, the use of anti-hypertensive medications as a mono-therapy was common among those with a history of hypertension but not among those without a history of hypertension.

Background and objective  Anti-hypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients. The objective of this study was to analyze the use of anti-hypertensive therapy in acute ischemic stroke survivors.
Methods  All ischemic stroke survivors discharged from Al-watani governmental hospital in Palestine from August 2006 until September 2007 were investigated. Demographic data, clinical characteristics, and different classes of anti-hypertensive medications prescribed to stroke survivors were analyzed using SPSS 15. Results  One hundred and twenty four ischemic stroke survivors were identified, of which 80 (64.5%) had a documented history of hypertension (HTN). Two thirds of the survivors (n = 82; 66.1%) were prescribed anti-hypertensive medications, mostly as mono-therapy, at discharge. Angiotensin-converting enzyme inhibitors (ACEI) 65 (45.6%), followed by diuretics 41 (34.5%) were the most common drug classes prescribed. ACEI were used in combination with diuretics in 29 (23.4%) survivors. Among survivors with a documented history of HTN, 70 (85.5%) were prescribed anti-hypertensive medications at discharge while 12 (8.5%) of survivors with no history of HTN were prescribed anti-hypertensive medications at discharge.
Conclusion  In this study, the use of anti-hypertensive medications as a mono-therapy was common among those with a history of hypertension but not among those without a history of hypertension.

Background and objective  Anti-hypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients. The objective of this study was to analyze the use of anti-hypertensive therapy in acute ischemic stroke survivors.
Methods  All ischemic stroke survivors discharged from Al-watani governmental hospital in Palestine from August 2006 until September 2007 were investigated. Demographic data, clinical characteristics, and different classes of anti-hypertensive medications prescribed to stroke survivors were analyzed using SPSS 15. Results  One hundred and twenty four ischemic stroke survivors were identified, of which 80 (64.5%) had a documented history of hypertension (HTN). Two thirds of the survivors (n = 82; 66.1%) were prescribed anti-hypertensive medications, mostly as mono-therapy, at discharge. Angiotensin-converting enzyme inhibitors (ACEI) 65 (45.6%), followed by diuretics 41 (34.5%) were the most common drug classes prescribed. ACEI were used in combination with diuretics in 29 (23.4%) survivors. Among survivors with a documented history of HTN, 70 (85.5%) were prescribed anti-hypertensive medications at discharge while 12 (8.5%) of survivors with no history of HTN were prescribed anti-hypertensive medications at discharge.
Conclusion  In this study, the use of anti-hypertensive medications as a mono-therapy was common among those with a history of hypertension but not among those without a history of hypertension.

Background and objective

Anti-hypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients. The objective of this study was to analyze the use of anti-hypertensive therapy in acute ischemic stroke survivors.

Methods

All ischemic stroke survivors discharged from Al-watani governmental hospital in Palestine from August 2006 until September 2007 were investigated. Demographic data, clinical characteristics, and different classes of anti-hypertensive medications prescribed to stroke survivors were analyzed using SPSS 15.

Results

One hundred and twenty four ischemic stroke survivors were identified, of which 80 (64.5%) had a documented history of hypertension (HTN). Two thirds of the survivors (n = 82; 66.1%) were prescribed anti-hypertensive medications, mostly as mono-therapy, at discharge. Angiotensin-converting enzyme inhibitors (ACEI) 65 (45.6%), followed by diuretics 41 (34.5%) were the most common drug classes prescribed. ACEI were used in combination with diuretics in 29 (23.4%) survivors. Among survivors with a documented history of HTN, 70 (85.5%) were prescribed anti-hypertensive medications at discharge while 12 (8.5%) of survivors with no history of HTN were prescribed anti-hypertensive medications at discharge.

Conclusion

In this study, the use of anti-hypertensive medications as a mono-therapy was common among those with a history of hypertension but not among those without a history of hypertension.

Background and objective: Anti-hypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients. The objective of this study was to analyze the use of anti-hypertensive therapy in acute ischemic stroke survivors.
Methods: All ischemic stroke survivors discharged from Al-watani governmental hospital in Palestine from August 2006 until September 2007 were investigated. Demographic data, clinical characteristics, and different classes of anti-hypertensive medications prescribed to stroke survivors were analyzed using SPSS 15.
Results: One hundred and twenty four ischemic stroke survivors were identified, of which 80 (64.5%) had a documented history of hypertension (HTN). Two thirds of the survivors (n=82; 66.1%) were prescribed anti-hypertensive medications, mostly as mono-therapy, at discharge. Angiotensin-converting enzyme inhibitors (ACEI) 65 (45.6%), followed by diuretics 41 (34.5%) were the most common drug classes prescribed. ACEI were used in combination with diuretics in 29 (23.4%) survivors. Among survivors with a documented history of HTN, 70 (85.5%) were prescribed anti-hypertensive medications at discharge while 12 (8.5%) of survivors with no history of HTN were prescribed anti-hypertensive medications at discharge.
Conclusion: In this study, the use of anti-hypertensive medications as a mono-therapy was common among those with a history of hypertension but not among those without a history of hypertension. 

BACKGROUND: Hypertension and ischemic heart disease (IHD) are among the most prevalent modifiable risk factors for stroke. Clinical trial evidence suggests that antihypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients.
OBJECTIVES: The objectives of this study were to analyze and evaluate the utilization of antihypertensive medication for acute ischemic stroke (AIS) or transient ischemic attack (TIA) survivors in relation to recent recommendations and guidelines and to compare their use among patients with or without IHD.
METHODS: This was a retrospective cohort study of all patients with AIS/TIA attending the hospital from July 1, 2008 to December 31, 2008. Demographic data, clinical characteristics, different classes of antihypertensive medications, and different antihypertensive combinations prescribed to AIS/TIA survivors were analyzed among patients with and without IHD. Statistical Package for Social Sciences (SPSS) program version 15 was used for data analysis.RESULTS: In all, 383 AIS/TIA survivors were studied, of which 66 (19.5%) had a documented history of IHD. Three quarters
(n = 260; 76.9%) of AIS or TIA survivors received antihypertensive medication, mostly as monotherapy, at discharge. The majority of patients (n = 201, 59.5%) were prescribed angiotensin-converting enzyme inhibitors (ACEIs). Patients with IHD were significantly prescribed more β-blockers than patients without IHD (P = .003). A history of hypertension, a history of diabetes mellitus, and age were significantly associated with prescription of antihypertensive medications at discharge (P < .001, P < .001, and P < .001, respectively
CONCLUSION: Patterns of antihypertensive therapy were commonly but not adequately consistent with international guidelines. Screening stroke survivors for blood pressure control, initiating appropriate antihypertensive medications, and decreasing the number of untreated patients might help reduce the risk of recurrent strokes and increase survival.

Objective: Stroke is a major health problem, yet no studies on stroke have been reported from Palestine. This one-year, hospital-based study was conducted to determine the prevalence of risk factors and the in-hospital mortality rate in patients with ischemic stroke.
Method: All patients admitted to Al-Watani government hospital and diagnosed with ischemic stroke between September 2006 and August 2007 were included in the study. Data were obtained by retrospective review of medical charts. Pearson Chi-square and independent t test were used in the univariate analysis. Multiple logistic regression analysis was used to determine the independent predictors of in-hospital mortality rates among the patients. Statistical testing and graphics were carried out using SPSS 15.
Results: We identified 153 ischemic stroke patients (83 females and 70 males) of whom 92 were having a first-ever stroke (FES). Patients had several prevalent modifiable risk factors such as hypertension (HTN) (66%), diabetes mellitus (DM) (45.8%), and renal reduced renal function (crcl < 60 ml/ min) (33.9%). Twenty-six (17%) of the patients died during hospitalization. Four variables were significantly associated with in-hospital mortality: history of previous stroke (P= 0.004), crcl at admission (P=0.004), number of post-stroke complications (P=0.001), and age (P=0.043). Multiple logistic regression analysis indicated that the number of post-stroke complications (P= 0.001) and previous stroke (P=0.03) were significant independent predictors of in-hospital mortality.
Conclusion: Screening and better control of risk factors, especially HTN, DM and renal dysfunction, are required to decrease the incidence and in-hospital mortality among patients with ischemic stroke.