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Predictors of Optimal Post-Stroke Hypertension Control

Sico J, Myers L, Concato J, Williams LS, Bravata DM. Predictors of Optimal Post-Stroke Hypertension Control. [Abstract]. Stroke; A Journal of Cerebral Circulation. 2015 Apr 1; 46(4):ATP140.




Abstract:

Introduction: Significant patient- and facility-level predictors of optimal post-stroke hypertension (HTN) control have not been identified; their identification may inform future intervention studies. Methods: This was a secondary analysis of a retrospective cohort study that included 3965 Veterans who were admitted with ischemic stroke at 131 Veterans Health Administration (VHA) facilities (fiscal year 2007). Blood pressure (BP) values at 6-month post-stroke were used to define optimal ( < 140/90 mmHg) and suboptimal ( 140/90 mmHg) control among patients with a history of HTN. Among facilities that admitted at least 25 stroke patients annually, we used multivariate logistic regression with backward elimination to identify patient- (e.g., stroke severity) and facility-level (e.g., hospital level complexity) characteristics that independently predicted optimal BP control 6-months post-stroke while adjusting for age, race, marital status, and post-stroke follow-up care. Results: A total of 2541 (64.1%) patients had a history of HTN, with 33.4% of patients achieving goal BP at 6-months. A past medical history of congestive heart failure (CHF; adjusted OR [aOR]: 2.5, 95% CI: 1.02 to 6.26; p = 0.046) and being discharged on a lipid lowering agent (aOR: 2.5, 95% CI: 1.26 to 5.03) were associated with optimal BP control 6-months post-stroke. Admission stroke severity (aOR: 0.998, 95% CI: 0.996-1.110), Charlson comorbidity score (aOR: 0.875, 95% CI: 0.59-1.30), past history of ischemic stroke (aOR: 1.41, 95% CI: 0.74-2.67), and medical record documentation of a post-discharge plan for HTN management (aOR: 1.00, 95% CI: 0.99-1.02; p = 0.47) were not predictive of optimal BP control. Facility-level characteristics, including hospital level complexity (aOR: 0.998, 95% CI: 0.992-1.005; p = 0.16) and the number of stroke patients seen annually at a facility (aOR 0.997, 95% CI: 0.993-1.001; p = 0.17) were also not associated with optimal post-stroke BP control. Conclusions: Future work should seek to understand why current approaches to improving post-stroke BP control are inadequate for a majority of patients and whether lessons might be learned from the care of patients with stroke and CHF that could be applied to the general post-stroke population.





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