OBJECTIVE: To identify the factors that predispose to ischemic versus hemorrhagic stroke in hypertensive patients.

DESIGN: Cohort study.

PLACE AND DURATION OF STUDY: The study was conducted at the Aga Khan University Hospital (AKUH), Karachi, from August 1999 to May 2001.

MATERIALS AND METHODS: All the hypertensive patients, who were registered in AKUH acute stroke outcome data base, over a period of 22 months, were identified and from this cohort the patients with first ever stroke were selected. The data regarding demographics, stroke type (ischemic vs. hemorrhagic), pre-existing medical problems, laboratory and radiological investigations was recorded and analyzed.

RESULTS: Five hundred and nineteen patients with either ischemic stroke or parenchymal hemorrhage were registered over a period of 22 months. Three hundred and forty-eight patients (67%) had hypertension and of these, 250 had first ever stroke at the time of admission. Presence of diabetes mellitus (OR: 3.76; CI:1.67-8.46) and ischemic heart disease (OR: 6.97; CI:1.57-30.98) were found to be independent predictors of ischemic strokes.

CONCLUSION: Presence of diabetes mellitus and ischemic heart disease predict ischemic stroke in a patient with hypertension.