To investigate the effect of enalaprilat folic acid on the outcomes of acute ischemic stroke patients with H-type hypertension.

The consecutive acute ischemic stroke patients with H-type hypertension were enrolled prospectively. They were randomly divided into either an enalaprilat folic acid treatment group or an enalaprilat treatment group. The enalaprilat folic acid group was treated with enalapril maleate and folic acid tablets (10 mg/0.8 mg daily); the enalaprilat treatment group was treated with enalapril maleate tablets (10 mg daily). Demographic characteristics and baseline clinical data of all the patients were collected. The modified Rankin scale (mRS) was used to evaluate the outcome at discharge and at day 90. The good outcome was defined as mRS score 0-2 and poor outcome was defined as mRS score >2.

A total of 248 patients were enrolled, and the males accounted for 66.5%. The mean homocysteine (Hcy) level was 18.513±9.700 μmol/L. There were 123 and 125 patients respectively in the enalaprilat folic acid treatment group and the enalaprilat treatment group. There were no significant differences in demography and baseline clinical data between the two groups. There was also no significant difference in the proportion of patients with poor outcome between the 2 groups (16.3% vs. 18.4%; χ²=0.198, P=0.738). All the cases in both groups were divided into a good outcome group and a poor outcome group. There were 205 patients (82.7%) in the good outcome group and 43 (17.3%) in the poor outcome group. The mean age in the good outcome group was significantly lower than that in the poor outcome group (69.22±11.12 years vs. 75.88±9.26 years; t=-4.826, P<0.001). The baseline systolic blood pressure (139.88±19.23 mmHg vs. 144.28±17.92)mmHg, 1 mmHg=0.133 kPa; t=2.138, P=0.033), National Institutes of Health Stroke Scale (NIHSS) score (2.454±2.340 vs. 13.605±6.415; t=-27.081, P<0.001), and proportions of the patients with large artery atherosclerotic stroke (58.50% vs. 74.4%; χ²=5.901, P=0.015) in the good outcome group were significantly lower than those in the poor outcome group, however, there were no significant differences in the Hcy level (18.524±10.339 μmol/L vs. 18.298±6.105 μmol/L; t=0.013, P=0.989) and the proportion of patients who were treated with enalaprilat folic acid (50.2% vs. 46.5%; χ²=0.198, P=0.738). Multivariate logistic regression analysis showed that large atherosclerotic stroke (odds ratio [OR] 1.025, 95% confidence interval [CI] 1.002-0.049; P=0.006) and the baseline NIHSS score (OR 2.4, 95%CI 1.734-3.322; P<0.001) were independent risk factors for poor outcome.

Hcy level is not an independent risk factor for poor outcome in acute ischemic stroke patients with H-type hypertension. Compared with enalaprilat, enalaprilat folic acid can not significantly improve the outcome of acute ischemic stroke patients with H-type hypertension.

Stroke; Brain Ischemia; Hypertension; Homocysteine; Enalapril; Folic Acid; Treatment Outcome