Joint association of growth hormone and cerebral small vessel disease with antihypertensive treatment burden after stroke: an exploratory prospective study.

Growth hormone (GH) and cerebral small vessel disease (SVD) may influence blood pressure regulation. This study investigated the individual and joint associations of GH and SVD severity with antihypertensive management following stroke. We prospectively enrolled patients admitted for acute stroke between October 2020 and December 2022. Patients with pre-existing or newly diagnosed hypertension during the initial hospitalization were included. We examined whether baseline GH levels and severe SVD burden (total SVD score ≥2) during the index hospitalization were associated with high antihypertensive medication burden defined as the use of ≥2 antihypertensive agents, as well as with high antihypertensive treatment intensity using an antihypertensive treatment intensity score (TIS) ≥ 1 at 12 months post-stroke. Among 171 registered patients, 129 were included (107 ischemic stroke/transient ischemic attack and 22 intracerebral hemorrhage; median age, 60 years; 95 male). High antihypertensive medication burden at 12 months was observed in 19 patients (15%). Elevated GH levels (≥0.49 ng/mL) and severe SVD burden were independently associated with high antihypertensive medication burden and TIS ≥ 1. Moreover, the coexistence of elevated GH and severe SVD burden was significantly associated with high antihypertensive medication burden and TIS ≥ 1 compared with the absence of both factors. Elevated GH levels and severe SVD burden were independently associated with antihypertensive medication burden and treatment intensity 12 months after stroke. The combined presence was associated with both outcomes, suggesting a potential joint contribution of neuroendocrine and structural vascular factors to post-stroke blood pressure management.