Treatment goals for ambulatory blood pressure and plasma lipids after stroke are often not reached

Area of Science:

• Cardiology
• Neurology
• Public Health

Background:

• Current secondary stroke prevention in Denmark relies on general practitioners using office blood pressure (OBP) for hypertension assessment.
• This study investigates the efficacy of OBP versus 24-hour ambulatory blood pressure (ABP) monitoring for post-stroke secondary prevention.
• Adherence to therapeutic goals for blood pressure and plasma lipids in stroke survivors is also assessed.

Purpose of the Study:

• To compare the accuracy of office blood pressure (OBP) assessment with ambulatory blood pressure (ABP) monitoring in post-stroke patients.
• To evaluate the adherence to recommended treatment targets for blood pressure and lipid levels in this patient group.
• To highlight the importance of diurnal blood pressure variation in secondary stroke prevention.

Main Methods:

• A prospective observational study involving 45 stroke patients (aged 25-64) undergoing intensive outpatient rehabilitation.
• Patients were monitored using both OBP and ABP approximately 1.3 years post-stroke.
• Data on additional risk factors and secondary prevention medications were collected.

Main Results:

• A significant majority of patients (71%) exceeded the OBP target of 130/80 mmHg, compared to 44% exceeding the daytime ABP target.
• 57% of patients exceeded the night-time ABP goal (115/65 mmHg), with abnormal nocturnal dipping observed in 59% (systolic) and 68% (diastolic).
• 60% of patients had inadequate antihypertensive medication, and 49% had elevated LDL cholesterol levels above 2.5 mmol/l.

Conclusions:

• Secondary prevention of cardiovascular risk factors in post-stroke patients is inadequate.
• Ambulatory blood pressure (ABP) monitoring provides more reliable data and crucial information on diurnal BP variation compared to OBP.
• Routine ABP monitoring post-stroke is recommended for improved patient management and secondary prevention.