(HealthDay News) — Hypertensive patients may lower their stroke risk with folic acid supplements, according to a study published in the Journal of the American College of Cardiology.

Xiangyi Kong, MD, from Peking University First Hospital in China, and colleagues randomized 10,789 Chinese hypertensive adults (mean age 59.5 years; 38% male with no history of stroke and myocardial infarction) to daily treatments of 10 mg enalapril and 0.8 mg folic acid (5408 patients) or 10 mg enalapril alone (5381 patients).

The researchers found that over 4.2 years of follow-up, 371 first strokes occurred. The lowest rate of first stroke (3.3%) in the enalapril-alone group was seen among patients with high platelet count (PLT; quartiles 2 to 4) and low total homocysteine (tHcy) levels (<15 µmol/L), whereas the highest rate of first stroke (5.6%) in this group was in patients with low PLT (quartile 1) and high tHcy (≥15 µmol/L) levels. The high-risk group had a 73% reduction in risk of stroke following folic acid treatment (hazard ratio, 0.27; P=0.003). There was no significant effect of folic acid among the low-risk group.

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“If confirmed, PLT and tHcy could serve as biomarkers to identify high-risk individuals who would particularly benefit from folic acid treatment,” the authors write.

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Kong X, Huang X, Zhao M, Xu B, et al. Platelet Count Affects Efficacy of Folic Acid in Preventing First Stroke. J Am Coll Cardiol. 2018 May;71(19). DOI: 10.1016/j.jacc.2018.02.072
Spence JD and Hachinski V. B Vitamins for Stroke Prevention: Interaction of Low Platelet Count and High Plasma Total Homocysteine. J Am Coll Cardiol. 2018 May;71(19). DOI: 10.1016/j.jacc.2018.03.024