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

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 as 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.