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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Pre-Stroke Cardiovascular Pharmacotherapy and Early Systemic Hemodynamics After Acute Ischemic Stroke: A Prospective Multicenter Cohort Study

  • Piotr Gutknecht1
  • Bartosz G. Trzeciak1
  • Marek Tałałaj2
  • Krzysztof Dziewiatowski3
  • Grzegorz Wochyń3
  • Walenty M. Nyka4
  • Alicja Bortkiewicz5
  • Dariusz Świetlik6
  • Janusz Siebert1
6 affiliations
  1. 1Department of Family Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
  2. 2Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education, 05-400 Otwock, Poland
  3. 3Department of Neurology, 7th Navy Hospital, 80-305 Gdańsk, Poland
  4. 4Department of Neurology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
  5. 5Department of Work Physiology and Ergonomics, Nofer Institute of Occupational Medicine, 91-348 Łódź, Poland
  6. 6Division of Biostatistics and Neural Networks, Medical University of Gdańsk, 80-211 Gdańsk, Poland
Open at sourceDOICite

Abstract

Background/Objectives: Whether pre-stroke cardiovascular treatment is reflected in the early systemic hemodynamic phenotype after acute ischemic stroke (AIS) is uncertain. We examined associations between major medication classes, early impedance-cardiography measures, and 6-month mortality. Methods: This prospective multicenter cohort included 233 patients with AIS and available pre-stroke medication data. Hemodynamics were assessed within 24 h of hospital admission. Four drug–physiology pairs were prespecified: beta-blockers–heart rate, renin–angiotensin system inhibitors–systemic vascular resistance index (SVRI), calcium-channel blockers–SVRI, and loop/thiazide(-like) diuretics–thoracic fluid content (TFC). Because technical equivalence of absolute TFC output between acquisition platforms was not established, inferential TFC analyses were restricted to CardioScreen/Niccomo observations. Primary hemodynamic models used HC3 robust standard errors with Holm correction; mortality models used FDR correction. Results: Mean age was 73.7 ± 12.1 years, 53.2% were women, and median NIHSS was 7 [4–12]. None of the four primary associations was supported after Holm correction. Adjusted differences were +0.23 bpm for beta-blockers–heart rate, +192 dyn·s·cm−5·m2 for RAAS inhibitors–SVRI, +254 dyn·s·cm−5·m2 for calcium-channel blockers–SVRI, and −3.72 1/kΩ for diuretics–TFC in the CardioScreen/Niccomo-restricted analysis (nominal p = 0.013; Holm p = 0.053). No secondary association survived FDR correction (all q ≥ 0.406). Forty-seven of 208 patients (22.6%) died within 6 months; no medication class was independently associated with mortality (all q ≥ 0.711). Conclusions: Documented pre-stroke cardiovascular medication use was not robustly associated with the early systemic hemodynamic phenotype or adjusted 6-month mortality after AIS. Modest class-specific associations cannot be excluded.

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Cite

BibTeXRIS
BibTeX
@article{gutknecht2026prestroke,
  title = {{Pre-Stroke Cardiovascular Pharmacotherapy and Early Systemic Hemodynamics After Acute Ischemic Stroke: A Prospective Multicenter Cohort Study}},
  author = {Piotr Gutknecht and Bartosz G. Trzeciak and Marek Tałałaj and Krzysztof Dziewiatowski and Grzegorz Wochyń and Walenty M. Nyka and Alicja Bortkiewicz and Dariusz Świetlik and Janusz Siebert},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218386},
  url = {https://www.mdpi.com/2077-0383/15/21/8386},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Pre-Stroke Cardiovascular Pharmacotherapy and Early Systemic Hemodynamics After Acute Ischemic Stroke: A Prospective Multicenter Cohort Study
AU  - Piotr Gutknecht
AU  - Bartosz G. Trzeciak
AU  - Marek Tałałaj
AU  - Krzysztof Dziewiatowski
AU  - Grzegorz Wochyń
AU  - Walenty M. Nyka
AU  - Alicja Bortkiewicz
AU  - Dariusz Świetlik
AU  - Janusz Siebert
PY  - 2026
DA  - 2026/10/28
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218386
UR  - https://www.mdpi.com/2077-0383/15/21/8386
AB  - Background/Objectives: Whether pre-stroke cardiovascular treatment is reflected in the early systemic hemodynamic phenotype after acute ischemic stroke (AIS) is uncertain. We examined associations between major medication classes, early impedance-cardiography measures, and 6-month mortality. Methods: This prospective multicenter cohort included 233 patients with AIS and available pre-stroke medication data. Hemodynamics were assessed within 24 h of hospital admission. Four drug–physiology pairs were prespecified: beta-blockers–heart rate, renin–angiotensin system inhibitors–systemic vascular resistance index (SVRI), calcium-channel blockers–SVRI, and loop/thiazide(-like) diuretics–thoracic fluid content (TFC). Because technical equivalence of absolute TFC output between acquisition platforms was not established, inferential TFC analyses were restricted to CardioScreen/Niccomo observations. Primary hemodynamic models used HC3 robust standard errors with Holm correction; mortality models used FDR correction. Results: Mean age was 73.7 ± 12.1 years, 53.2% were women, and median NIHSS was 7 [4–12]. None of the four primary associations was supported after Holm correction. Adjusted differences were +0.23 bpm for beta-blockers–heart rate, +192 dyn·s·cm−5·m2 for RAAS inhibitors–SVRI, +254 dyn·s·cm−5·m2 for calcium-channel blockers–SVRI, and −3.72 1/kΩ for diuretics–TFC in the CardioScreen/Niccomo-restricted analysis (nominal p = 0.013; Holm p = 0.053). No secondary association survived FDR correction (all q ≥ 0.406). Forty-seven of 208 patients (22.6%) died within 6 months; no medication class was independently associated with mortality (all q ≥ 0.711). Conclusions: Documented pre-stroke cardiovascular medication use was not robustly associated with the early systemic hemodynamic phenotype or adjusted 6-month mortality after AIS. Modest class-specific associations cannot be excluded.
SN  - 2077-0383
ER  -