Effects of early antihypertensive treatment on cognitive function in patients with acute ischemic stroke with different neurofilament light chain levels

Hong Li; Deyu Yang; Shudong Liu; Zhengbao Zhu; Mengyao Shi; Tan Xu; Jing Chen; Yonghong Zhang; Jiang He; Chongke Zhong; Xiaoqing Bu

doi:10.1016/j.jstrokecerebrovasdis.2024.108206

Effects of early antihypertensive treatment on cognitive function in patients with acute ischemic stroke with different neurofilament light chain levels

J Stroke Cerebrovasc Dis. 2024 Dec 19:108206. doi: 10.1016/j.jstrokecerebrovasdis.2024.108206. Online ahead of print.

Authors

Hong Li¹, Deyu Yang², Shudong Liu², Zhengbao Zhu³, Mengyao Shi³, Tan Xu³, Jing Chen⁴, Yonghong Zhang³, Jiang He⁴, Chongke Zhong³, Xiaoqing Bu⁵

Affiliations

¹ Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China.
² Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China.
³ Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, China.
⁴ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
⁵ Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China. Electronic address: xbu@cqmu.edu.cn.

PMID: 39708937
DOI: 10.1016/j.jstrokecerebrovasdis.2024.108206

Abstract

Background: It is unclear whether the extent of neuroaxonal damage, as measured by circulating levels of neurofilament light chain (NfL), would modify the effects of early antihypertensive therapy on cognitive performance following stroke. This study aimed to investigate the effects of early blood pressure reduction on the risk of post-stroke cognitive impairment (PSCI) among patients with different plasma NfL levels.

Methods: A total of 622 eligible patients from a pre-planned ancillary study of CATIS (China Antihypertensive Trial in Acute Ischemic Stroke) were included in this study. The electrochemiluminescence immunoassay technique was used to evaluate Plasma NfL levels at baseline, and the Mini-Mental State Examination (MMSE) in Chinese was used to assess cognition at the 3-month follow-up. An MMSE score of less than 27 was considered PSCI.

Results: The effect of antihypertensive therapy on PSCI differed according to NfL levels at the 3-month follow-up. In the low NfL group, compared with the control group, antihypertensive treatment reduced the risk of PSCI [adjusted odds ratio (OR), 95% confidence interval (CI): 0.50 (0.31-0.81)]. However, in the high NfL group, antihypertensive treatment increased the risk of PSCI compared with the control group [adjusted OR, 95% CI: 1.93 (1.16-3.20)].

Conclusions: Antihypertensive therapy in the acute phase reduced the risk of PSCI in patients with low plasma NfL levels, but increased the risk in patients with high NfL levels.

Keywords: Acute ischemic stroke; Antihypertensive therapy; Neurofilament light chain; Post-stroke cognitive impairment.