Abstract 18: Determinants of Adequate Blood Pressure Control in Stroke Patients Post-Discharge

Abstract

Objective: Hypertension (HTN) is a major risk factor for stroke and transient ischemic attack (TIA). After a stroke or TIA, blood pressure control becomes even more essential for secondary prevention of stroke. Prior literature has shown that once-daily dosing of blood pressure (BP) medications improved adherence. We hypothesized that once daily BP medications may also improve BP control at follow up and aimed to determine factors that predict adequate BP control after stroke. Methods: We analyzed blood pressures at discharge and at follow-up in 172 adult stroke and TIA patients admitted to a single tertiary care center. Only those with known HTN at time of discharge and seen in follow-up were included in the analysis. Medication dosing was categorized as once-daily dosing vs. more than once daily dosing. Univariate and multivariate logistic regression analyses (adjusted for sex, age, and race) were performed to compare patients with adequate blood pressure control at follow up to those with poorly controlled blood pressure at follow up. Poor BP control was defined as systolic blood pressure (SBP) greater than 140mmHg. Results: The average age of this cohort was 65 yrs (+/- 14) and 51% (88 of 172) of patients were female. Sixty nine percent (118 of 172) of patients were white, 29% (50 of 172) of patients were black, and the remaining 2% (4 of 172) of patients were of other race-ethnicities. One hundred of the 172 patients (58%) were discharged on once daily blood pressure medications and at follow up, 59% (59 of 100) of them had adequate blood pressure control compared to 78% (54 of 69) of the patients on BP meds dosed more frequently. Once daily blood pressure medication frequency was associated with inadequate blood pressure control at follow up (p=0.0089, OR 3.00 CI 1.34-6.71). Fifty eight percent (50 of 87) of patients who did not receive home health, nursing, or therapy visits had adequate BP control at follow up compared to 76% (59 of 77) of patients who did. Patients with home health nurse or therapy visits were more likely to have adequate BP control at follow up (p=0.0095, OR 0.44; CI 0.21-0.96). Mean discharge SBP of those patients with adequate BP at follow-up was 135mmHg, whereas those with poor control at follow-up had a mean discharge SBP of 145mmHg. Adequate SBP at the time of discharge also predicted adequate blood pressure at follow up (p=0.0006, OR 1.42; CI 1.15-1.77). Conclusions: Contrary to our hypothesis, once daily dosed BP medications did not improve the effectiveness of BP control at follow-up. Elevated SBP at the time of hospital discharge was associated with poor blood pressure control. Those patients receiving outpatient home health and therapy visits after hospital discharge had better blood pressure control. Further studies need to be done to assess medication adherence to determine whether the poor control was related to choice of medication or patient medication-taking behavior.