Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Stroke remains the second leading cause of death (11.6%) and the third leading cause disability, globally in 2019. Despite the growing burden of stroke in Sub-Saharan Africa, including Ethiopia, high-quality evidence remains limited due to the scarcity of rigorously designed studies. This study will provide valuable insights in the management of stroke patients. <bold>Objective:</bold> To assess the survival of stroke patients according to hypertension status and its predictors at Tikur Anbesa Specialized Hospital from January 1, 2021 to December 31, 2024, in Addis Ababa, Ethiopia. <bold>Methods:</bold> A hospital-based retrospective cohort study was conducted among 363 registered first-ever stroke patients. Simple random sampling technique was used to select individuals. The data was exported and cleaned for analysis using STATA statistical software. The Kaplan Meier curve was used to estimate survival time and Log rank test was used to compare survival curve. To identify the predictors, the Cox proportional hazards analysis model was fitted. The association between dependent and independent variables was expressed using adjusted hazard ratio with a 95% confidence interval and statistical significance was declared at p-value of <0.05. <bold>Results:</bold> A total of 363 first ever adult stroke patients were observed for 2685 person-days (1813 person-days for hypertensive and 872 person-days for non-hypertensive). The median follow-up time was 6 days and interquartile range of (4-9) days. A total of 75 patients were died during their follow up time with median survival time of 27 days. Hypertension status did not significantly influence survival outcomes. Independent predictors of survival were patients with severe brain injury (adjusted hazard ratio=9.50, 95% CI: 4.42,20.4, p<0.001), Aspiration pneumonia (adjusted hazard ratio =2.41, 95% CI: 1.15,5.03, p=0.019), increased intracranial pressure (adjusted hazard ratio =2.14, 95% CI: 1.10,4.16, p=0.026), and rheumatic valvular heart disease (adjusted hazard ratio =2.38, 95% CI: 1.26,4.51, p=0.008). <bold>Conclusion:</bold> The study demonstrates that hypertension was associated with a lower risk of mortality, though does not independently affect stroke survival. Instead, neurological severity, stroke complications (aspiration pneumonia and increased intracranial pressure), and rheumatic valvular heart diseases are the strongest predictors of survival. </p>