43% of ischemic stroke patients discharged with high blood pressure

Forty-three percent of patients hospitalized with acute ischemic stroke were discharged with elevated blood pressure, and 33% had uncontrolled blood pressure six months later, a new analysis found.

Researchers examined a sample of patients (n=3,987) who had were admitted to a Veterans Affairs Medical Center for ischemic stroke in 2007. They analyzed blood pressure control (defined as <140/90 mm Hg) at discharge, and excluded those who had died, enrolled in hospice, or had unknown discharge disposition. Another 258 patients were excluded for missing race data, leaving 3,382 patients in 129 facilities for the first analysis. Researchers also examined all antihypertensive medications prescribed at admission and discharge, and compared to see if patients received a new prescription for a drug class at discharge. In a second analysis, they looked at blood pressure control within six months after stroke, excluding those who had died, were readmitted within 30 days, were lost to follow-up, or didn't have blood pressure or race recorded (n=1,915 in 125 facilities). Results were published online June 21 by Circulation: Cardiovascular Quality and Outcomes.

About sixty-three percent of the study population was white, and 98% were men. Forty-seven percent were younger than age 65, 29% had a history of cerebrovascular disease, and 37% had a history of cardiovascular disease. Among the stroke patients in the first analysis, 43% had their last documented blood pressure before discharge as above 140/90 mm Hg. Black race (adjusted odds ratio [OR], 0.77; 95% CI, 0.65 to 0.91), diabetes (OR, 0.73; 95% CI, 0.62 to 0.86), and hypertension history (OR, 0.51; 95% CI, 0.42 to 0.63) were associated with lower odds for controlled BP at discharge.

Of the stroke patients seen within six months of their index event, 32.8% still had uncontrolled blood pressure. By six months after the event, neither race nor diabetes was associated with blood pressure control, while history of hypertension continued to predict lower odds of control. For each 10-point increase in systolic blood pressure at discharge over 140 mm Hg, the odds of control six months after discharge decreased by 12%. Receipt of a new blood pressure medication at discharge wasn't associated with improved blood pressure control at six months, possibly because sicker patients are more likely to get new prescriptions and have poor control, the authors wrote.

The study data suggest that heightened efforts to improve management of hypertension at discharge and follow-up may benefit certain subgroups of patients, given that hypertension is causally involved in nearly 70% of all stroke cases and puts patients at risk for cardiovascular events, the authors said. Secondary prevention should include efforts to start risk factor control and antihypertensive medication before discharge. Future interventions could target those at highest risk for poorly controlled blood pressure, including those with a prior diagnosis of hypertension and multiple comorbidities, including diabetes, the authors said.