Pre-Stroke Cardiovascular Pharmacotherapy and Early Systemic Hemodynamics After Acute Ischemic Stroke: A Prospective Multicenter Cohort Study

Background/Objectives: Whether pre-stroke cardiovascular treatment is reflected in the early systemic hemodynamic phenotype after acute ischemic stroke (AIS) is uncertain. We examined associations between major medication classes, early impedance-cardiography measures, and 6-month mortality. Methods: This prospective multicenter cohort included 233 patients with AIS and available pre-stroke medication data. Hemodynamics were assessed within 24 h of hospital admission. Four drug–physiology pairs were prespecified: beta-blockers–heart rate, renin–angiotensin system inhibitors–systemic vascular resistance index (SVRI), calcium-channel blockers–SVRI, and loop/thiazide(-like) diuretics–thoracic fluid content (TFC). Because technical equivalence of absolute TFC output between acquisition platforms was not established, inferential TFC analyses were restricted to CardioScreen/Niccomo observations. Primary hemodynamic models used HC3 robust standard errors with Holm correction; mortality models used FDR correction. Results: Mean age was 73.7 ± 12.1 years, 53.2% were women, and median NIHSS was 7 [4–12]. None of the four primary associations was supported after Holm correction. Adjusted differences were +0.23 bpm for beta-blockers–heart rate, +192 dyn·s·cm−5·m2 for RAAS inhibitors–SVRI, +254 dyn·s·cm−5·m2 for calcium-channel blockers–SVRI, and −3.72 1/kΩ for diuretics–TFC in the CardioScreen/Niccomo-restricted analysis (nominal p = 0.013; Holm p = 0.053). No secondary association survived FDR correction (all q ≥ 0.406). Forty-seven of 208 patients (22.6%) died within 6 months; no medication class was independently associated with mortality (all q ≥ 0.711). Conclusions: Documented pre-stroke cardiovascular medication use was not robustly associated with the early systemic hemodynamic phenotype or adjusted 6-month mortality after AIS. Modest class-specific associations cannot be excluded.