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Blood pressure after recent stroke: baseline findings from the secondary prevention of small subcortical strokes
Carole L White1, Pablo E Pergola, Jeff M Szychowski
1School of Nursing, University of Texas Health Sciences Center at San Antonio, San Antonio, TX.
Insights
Over half of stroke patients had uncontrolled high blood pressure (hypertension) after their event. Controlling hypertension is key to preventing recurrent strokes, considering patient race and region.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Hypertension is a primary risk factor for stroke.
- Characterizing blood pressure in stroke survivors is crucial for secondary prevention.
Purpose of the Study:
- To analyze baseline blood pressure in patients from the Secondary Prevention of Small Subcortical Strokes trial.
- To identify factors associated with uncontrolled hypertension post-stroke.
Main Methods:
- Cross-sectional analysis of 3,020 participants.
- Categorization of baseline systolic blood pressure (SBP) into predefined ranges.
- Examination of demographic and clinical characteristics, including race and region.
Main Results:
- Mean SBP was 143±19 mm Hg, with 53% having SBP ≥ 140 mm Hg.
- Higher SBP correlated with longer hypertension history and white matter disease severity.
- Significant racial and regional disparities in SBP were observed; Black participants and those from the US had higher SBP.
Conclusions:
- More than half of symptomatic lacunar stroke patients had uncontrolled hypertension approximately 2.5 months post-stroke.
- Addressing regional, racial, and clinical differences is vital for improving hypertension control.
- Effective management is essential to reduce the risk of recurrent stroke.
Background:
Hypertension is the most powerful risk factor for stroke. The aim of this study was to characterize baseline blood pressure in participants in the Secondary Prevention of Small Subcortical Strokes trial.
Methods:
For this cross-sectional analysis, participants were categorized by baseline systolic blood pressure (SBP) < 120, 120-139, 140-159, 160-179, and ≥ 180 mm Hg and compared on demographic and clinical characteristics. Predictors of SBP < 140 mm Hg were examined.
Results:
Mean SBP was 143±19 mm Hg while receiving an average of 1.7 antihypertensive medications; SBP ≥ 140 mm Hg for 53% and ≥ 160 mm Hg for 18% of the 3,020 participants. Higher SBP was associated with a history of hypertension and hypertension for longer duration (both P < 0.0001). Higher SBPs were associated with more extensive white matter disease on magnetic resonance imaging (P < 0.0001). There were significant differences in entry-level SBP when participants were categorized by race and region (both P < 0.0001). Black participants were more likely to have SBP ≥ 140 mm Hg. Multivariable logistic regression showed an independent effect for region with those from Canada more likely (odds ratio = 1.7; 95% confidence interval, 1.29, 2.32) to have SBP < 140 mm Hg compared with participants from United States.
Conclusions:
In this cohort with symptomatic lacunar stroke, more than half had uncontrolled hypertension at approximately 2.5 months after stroke. Regional, racial, and clinical differences should be considered to improve control and prevent recurrent stroke.
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Hypertension (High blood pressure)
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