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Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure

Christianne L Roumie1, Alan J Zillich2, Dawn M Bravata2

  • 1From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.). Christianne.roumie@vanderbilt.edu.

Stroke
|January 1, 2015
PubMed

Insights

Patients discharged with high blood pressure after stroke often missed opportunities for treatment intensification. Focusing on pre-discharge medication management and adherence counseling can improve hypertension control and secondary stroke prevention.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Pharmacology

Background:

  • Elevated blood pressure is a significant risk factor for recurrent stroke.
  • Effective hypertension management is crucial for secondary stroke prevention.
  • Understanding treatment intensification patterns post-stroke is essential.

Purpose of the Study:

  • To examine blood pressure levels one year after hospital discharge for acute ischemic stroke.
  • To assess the association between discharge systolic blood pressure (SBP) and subsequent treatment intensification.
  • To identify opportunities for improving hypertension control in post-stroke patients.

Main Methods:

  • Analysis of a national cohort of Veterans discharged after acute ischemic stroke.
  • Stratification of systolic blood pressure (SBP) based on discharge levels (≤140, 141-160, >160 mm Hg).
  • Definition of hypertension treatment opportunities and measurement of treatment intensification rates.

Main Results:

  • 38% of 3153 patients experienced elevated outpatient SBP within one year post-stroke.
  • Patients discharged with higher SBP (>160 mm Hg) had more opportunities for intensification (average 2.4) and higher intensification rates (65%).
  • Even with elevated SBP, treatment intensification occurred in only 58%-65% of eligible visits.

Conclusions:

  • Significant opportunities exist to intensify hypertension treatment in patients post-stroke, particularly those with higher discharge SBP.
  • Secondary stroke prevention strategies should prioritize pre-discharge antihypertensive management, titration, and patient adherence counseling.
  • Improved medication management is key to optimizing blood pressure control and reducing recurrent stroke risk.
Abstract

Keywords:
health services researchhypertensionmedication adherencesecondary prevention

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