Hypertension often undertreated after hospitalization for stroke

Patients who were hospitalized for an ischemic stroke often had a systolic blood pressure (SBP) above 160 mm Hg at discharge and at subsequent outpatient visits, a recent study found.

Researchers in the Veterans Health Administration analyzed 3,153 patients hospitalized and discharged after an acute ischemic stroke. The patients' outpatient visits in the year after discharge were analyzed for the patients' SBPs and the clinicians' use of opportunities for treatment intensification (whether antihypertensive therapy was increased in response to a reading >160 mm Hg or multiple readings >140 mm Hg). Results were published online by Stroke on Dec. 30.

Overall, at discharge, 62.6% of the patients had a SBP <140 mm Hg, 26.0% had an SBP between 141 and 160 mm Hg, and 11.4% had an SBP >160 mm Hg. In the year after discharge, 62% of the patients had no opportunities for treatment intensification because their blood pressure never went over 140 mm Hg. However, even among those who left the hospital with an SBP <140 mm Hg, 30% had a treatment intensification opportunity, only 58% of which clinicians acted on. In the middle group (141 to 160 mm Hg), 47% of patients had an intensification opportunity, with only 60% of those resulting in intensification. Finally, in the patients who were discharged with SBP >160 mm Hg, 63% had a treatment intensification opportunity, and 65% of those were acted on.

The study also looked for a relationship between medication adherence and treatment intensification but found none. Among the patients who had an intensification opportunity, about 48% adhered to medications before their stroke, a rate that dropped to 46% after discharge. The results suggest that there are many opportunities to improve stroke patients' hypertension control, and given the relationship between discharge blood pressure and subsequent readings, “the place to affect the most change in the poststroke BP trajectory is before discharge,” the study authors concluded.

They recommended improvements on 3 fronts. First, hospital clinicians should increase efforts to improve hypertension management before discharge. Second, physicians in all settings should assure that patients are on the correct medications and titrate those medications to achieve blood pressure control. Finally, more work should be done on improving adherence, including counseling about adherence and assessment of barriers to taking medication, some of which might have resulted from the stroke itself.