Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure.

Roumie CL, Zillich AJ, Bravata DM, Jaynes HA, Myers LJ, Yoder J, Cheng EM. Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure. Stroke. 2015 Feb 1; 46(2):465-70.

Related HSR&D Project(s)

• RRP 11-267 – Blood Pressure Management in the Year after a Stroke

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Abstract:

BACKGROUND AND PURPOSE: We examined blood pressure 1 year after stroke discharge and its association with treatment intensification. METHODS: We examined the systolic blood pressure (SBP) stratified by discharge SBP ( = 140, 141-160, or > 160 mm Hg) among a national cohort of Veterans discharged after acute ischemic stroke. Hypertension treatment opportunities were defined as outpatient SBP > 160 mm Hg or repeated SBPs > 140 mm Hg. Treatment intensification was defined as the proportion of treatment opportunities with antihypertensive changes (range, 0%-100%, where 100% indicates that each elevated SBP always resulted in medication change). RESULTS: Among 3153 patients with ischemic stroke, 38% had = 1 elevated outpatient SBP eligible for treatment intensification in the 1 year after stroke. Thirty percent of patients had a discharge SBP = 140 mm Hg, and an average 1.93 treatment opportunities and treatment intensification occurred in 58% of eligible visits. Forty-seven percent of patients discharged with SBP 141 to160 mm Hg had an average of 2.1 opportunities for intensification and treatment intensification occurred in 60% of visits. Sixty-three percent of the patients discharged with an SBP > 160 mm Hg had an average of 2.4 intensification opportunities, and treatment intensification occurred in 65% of visits. CONCLUSIONS: Patients with discharge SBP > 160 mm Hg had numerous opportunities to improve hypertension control. Secondary stroke prevention efforts should focus on initiation and review of antihypertensives before acute stroke discharge; management of antihypertensives and titration; and patient medication adherence counseling.