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Updated: May 5, 2026

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions

Published on: April 23, 2021

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Missed Opportunities for Stroke Prevention in Hypertensive Patients: A Retrospective Case-Control Study

Huanhuan Yang1,2,3, Yuntian Liu1,4, Chungsoo Kim1,3,5

  • 1Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA.

Medrxiv : the Preprint Server for Health Sciences
|May 4, 2026
PubMed

Insights

Consistent hypertension care, including regular blood pressure (BP) monitoring and medication adjustments, significantly lowers ischemic stroke risk. Gaps in routine management represent missed opportunities for stroke prevention.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Public Health

Background:

  • Hypertension is a primary modifiable risk factor for ischemic stroke.
  • Current preventative hypertension care in clinical practice is often suboptimal.
  • The link between hypertension management gaps and stroke prevention is unclear.

Purpose of the Study:

  • To investigate the association between hypertension care delivery and the risk of incident ischemic stroke.
  • To determine if suboptimal hypertension management represents missed stroke prevention opportunities.

Main Methods:

  • Retrospective, matched, nested case-control study using electronic health records (2010-2024).
  • Included 13,476 ischemic stroke cases and 26,952 matched controls (N=40,428).
  • Assessed outpatient BP visits, antihypertensive medication ingredients, and medication intensification scores.

Main Results:

  • More frequent BP visits (>5/year) were linked to significantly lower stroke odds (aOR, 0.55).
  • Using 2-3 medication ingredients correlated with reduced stroke risk (aOR, 0.80).
  • Higher treatment intensification demonstrated the strongest association with lower stroke odds (aOR, 0.47).

Conclusions:

  • Increased engagement in hypertension care is associated with decreased ischemic stroke risk.
  • Gaps in routine hypertension management may signify missed opportunities for stroke prevention.
  • Consistent follow-up and timely treatment adjustments are crucial for primary stroke prevention.
Abstract

Keywords:
Blood PressureCase-Control StudyHypertensionIschemic StrokeMissed OpportunitiesTreatment Intensification

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