In Hypertension, Folic Acid Combo May Lower Stroke Risk

Individuals with hypertension with low platelet count and elevated total homocysteine (tHcy) levels have an increased risk of first-time stroke, according to new findings. However, enalapril plus folic acid treatment was shown to help mitigate this risk.

Researchers arrived at this conclusion following a study of 10,789 Chinese adults with hypertension without history of stroke and myocardial infarction. Follow-up lasted 4.2 years.
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All participants included in the current study were enrolled in the China Stroke Primary Prevention Trial, during which participants were randomly assigned to daily treatments of 10 mg enalapril and 0.8 mg folic acid (n = 5408) or 10 mg enalapril alone (n = 5381).

A total of 371 first-time strokes occurred over the course of follow-up. For patients treated with enalapril alone, the lowest rate of first-time stroke (3.3%) occurred in patients with high platelet count (quartiles 2 to 4) and less than 15 μmol/l tHcy, whereas the highest rate (5.6%) occurred in patients with low platelet count (quartile 1) and at least 15 μmol/l tHcy.

Results of the study indicated that folic acid treatment was associated with a 73% reduction in stroke among patients in the high-risk group (hazard ratio 0.27). However, no significant effect was observed for the low-risk group.

The researchers noted that, if these findings are confirmed, “[platelet count] and tHcy could serve as biomarkers to identify high-risk individuals who would particularly benefit from folic acid treatment.”

—Christina Vogt

Reference:

Kong X, Huang X, Zhao M, et al. Platelet count affects efficacy of folic acid in preventing first stroke. J Am Coll Cardiol. 2018;71(19). doi:10.1016/j.jacc.2018.02.072

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