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Prevalence of inadequate blood pressure control among veterans after acute ischemic stroke hospitalization: a retrospective cohort.
Roumie CL, Ofner S, Ross JS, Arling G, Williams LS, Ordin DL, Bravata DM. Prevalence of inadequate blood pressure control among veterans after acute ischemic stroke hospitalization: a retrospective cohort. Circulation. Cardiovascular quality and outcomes. 2011 Jul 1; 4(4):399-407.
Reducing blood pressure (BP) after stroke reduces risk for recurrent events. Our aim was to describe hypertension care among veterans with ischemic stroke including BP control by discharge and over the 6 months after the stroke event.
METHODS AND RESULTS:
The Office of Quality and Performance Stroke Special Study included a systematic sample of veterans hospitalized for ischemic stroke in 2007. We examined BP control ( < 140/90 mm Hg) at discharge excluding those who died, enrolled in hospice, or had unknown discharge disposition (n = 3640, n = 3382 adjusted analysis). The second outcome was BP control ( < 140/90 mm Hg) within 6-months after stroke, excluding patients who died/readmitted within 30 days, were lost to follow-up, or did not have a BP recorded (n = 2054, n = 1915 adjusted analysis). The population was 62.7% white and 97.7% men; 46.9% were < 65 years of age; and 29% and 37% had a history of cerebrovascular or cardiovascular disease, respectively. Among the 3640 stroke patients, 1573 (43%) had their last documented BP before discharge as > 140/90 mm Hg. Black race (adjusted odds ratio, 0.77; 95% confidence interval, 0.65 to 0.91), diabetes (odds ratio, 0.73; 95% confidence interval, 0.62 to 0.86), and hypertension history (odds ratio, 0.51; 95% confidence interval, 0.42 to 0.63) were associated with lower odds for controlled BP at discharge. Of the 2054 stroke patients seen within 6 months from their index event, 673 (32.8%) remained uncontrolled. By 6 months after the event, neither race nor diabetes was associated with BP control, whereas history of hypertension continued to have lower odds of BP control. For each 10-point increase in systolic BP > 140 mm Hg at discharge, odds of BP control within 6 months after discharge decreased by 12% (95% confidence interval [8%, 18%]).
BP values in excess of national guidelines are common after stroke. Forty-three percent of patients were discharged with an elevated BP, and 33% remained uncontrolled by 6 months.