Correlation between H-type hypertension and intracranial arterial dolichoectasia in hypertensive patients with acute ischemic stroke

Abstract Background H-type hypertension was diagnosed with a combination of Hyperhomocysteine(HHCY) and hypertension. It is associated with cardiovascular and cerebrovascular disease. Nevertheless, the relationship between H-type hypertension and intracranial arterial dolichoectasia(IADE) is unclear. This study aimed to explore the relationship between H-type hypertension and IADE in hypertensive patients with acute ischemic stroke. Methods Patients with hypertension and acute ischemic stroke who were hospitalized in the Department of Neurology of Changzhou Second People's Hospital from June 2021 to February 2022 were consecutively collected. H-type hypertension is essential hypertension associated with serum homocysteine levels > 10 µmol/L. Patients were diagnosed with IADE (intracranial artery diameter, height of bifurcation of basilar artery, and laterality of basilar artery) based on MRI and CTA. IADE includes intracranial dolichoectasia and middle cerebral artery(ICDA), and vertebrobasilar artery dolichoectasia(VBD). ICDA was defined as internal carotid artery(ICA) diameter > 7mm and middle cerebral artery diameter(MCA) > 4mm. VBD was defined if the vertebral artery(VA) or basilar artery(BA) diameter was greater than 4.5mm and BA's lateral displacement and bifurcation height reached grade two or higher. To analyze the correlation between H-type hypertension and IADE. Univariate and multivariate logistic regression analyses were used. Results 355 patients with hypertension and acute ischemic stroke were enrolled, 102 had isolated hypertension, and 253 had H-type hypertension. Patients in the H-type hypertension group had a higher ratio of IADE (P = 0.002) and higher BAR score(P = 0.047) than the isolated hypertension group. The IADE group had a higher percentage of H-type hypertension(P = 0.002), a higher proportion of H-type hypertension grade (P = 0.003), and greater homocysteine levels (P = 0.009) than the non-IADE group. The degree of H-type hypertension was positively correlated with the BAR score(r = 0.125, P = 0.018). After controlling for age, sex, and uric acid, multivariate logistic regression analysis indicated that H-type hypertension was an independent risk factor for IADE patients (OR, 2.537; 95%CI, 1.281–5.023; P = 0.008). Conclusions H-type hypertension is independently related to IADE in hypertensive patients with acute ischemic stroke. Controlling blood pressure and lowering homocysteine may reduce the risk of IADE.