Blood pressure control in long-term stroke survivors evaluated one year post stroke

Hypertension is the most common modifiable risk factor for stroke and treatment of hypertension has been known to reduce the risk of recurrent stroke. There are no studies done to evaluate the optimal blood pressure (BP) control in long-term stroke survivors in Nigeria. This study is aimed at determining the proportion of stroke survivors attending stroke prevention clinic who have optimal BP control of hypertension one year post stroke and to determine what factors are associated with the suboptimal BP control.

The subjects were consecutively presenting long term stroke survivors attending Neurology Outpatients'Clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. After informed consent, socio-demographic data and clinical characteristic were obtained from the patient using structured questionnaire. Admission stroke severity was obtained retrospectively using National Institute of Health Stroke Score (NIHSS). Modified Rankin scale (mRs) was used to assess the level of handicap . The presence of depression was determined using the Hamilton Depression Rating Scale (HDRS). Blood pressure was measured in the dominant, non-stroke arm of the patients using mercury sphygmomanometer.

A total of 68 patients were studied with a mean age of 55.15±11.9 years. Most common co- morbid condition was diabetes mellitus. Only 3(4.4%) patients had a repeat stroke during the one year period. Twenty five (36.8%) of these patients still had sub-optimal BP control. Forty seven (69.1%) of these patients were on combination therapy (including angiotensin converting enzyme inhibitors and diuretics) and 18 (26.5%) were on calcium channel blockers alone. The difference in mean age of stroke survivors with optimal and sub-optima BP control was not statistically significant. However, the mean duration of formal education of the stroke survivors with optimally controlled blood pressure was significantly higher than those with sub-optimal BP control. Eighteen (26.5%) of long term stroke survivors had clinical depression. Significantly higher proportion of the clinically depressed patients had sub-optimal blood pressure at one year compared to those that were not depressed. Formally educated patients had a better blood pressure control compared to those without formal education. Following a multivariate logistic regression, the major independent determinants of sub-optimal blood pressure control at one year post stroke were presence of depression and low levels of formal educational attainment.

majority of stroke survivors attending the ABUTH neurology outpatients clinic have suboptimal blood pressure control and major determinant of suboptimal BP control were presence of clinical depression and low formal educational status.