Antihypertensive medications prescribed at discharge after an acute ischemic cerebrovascular event

Hypertension is poorly controlled in stroke survivors, thereby placing them at increased risk for recurrent events. Clinical trial evidence suggests that antihypertensive treatment may be beneficial for stroke prevention in hypertensive and normotensive stroke patients. We aimed to evaluate the discharge antihypertensive prescription patterns in patients hospitalized for an ischemic cerebrovascular event and to determine factors associated with treatment utilization.

We analyzed patients diagnosed with ischemic stroke or transient ischemic attack (TIA) in the California Acute Stroke Prototype Registry (CASPR). We used generalized estimating equations to identify factors independently associated with receiving antihypertensives at the time of hospital discharge.

Data were collected on 764 consecutive patients with ischemic stroke or TIA encountered at 11 hospitals representative of facilities in the state of California. Overall, the rate of discharge with a prescription for any antihypertensive in the CASPR cohort was 69.4%. Hospital-specific rates were heterogeneous (P=0.04), varying from 55% to 100%. In multivariate analysis, independent predictors of prescription for antihypertensive medication at discharge were a history of hypertension (P<0.0001), diabetes (P=0.0009), and older age.

About two-thirds of patients hospitalized with acute ischemic cerebrovascular events are discharged from the hospital on > or =1 antihypertensive medication. However, there is great variability in prescription rates between hospitals and considerable room for improvement.