Abstract 3356: Half the Stroke Survivors in the United States have Poorly Controlled Hypertension

Abstract

Background: National guidelines recommend antihypertensive treatment to lower the risk of secondary strokes in both hypertensive and normotensive patients. The degree to which blood pressure (BP) is treated and controlled among stroke survivors in the US has not been systematically investigated. In this analysis of a nationwide database, we assessed recent patterns, predictors, and prognoses of antihypertensive drug use among survivors of a stroke. Methods: We reviewed prevalence and control of hypertension among adults with a history of stroke (based on self report) who participated in the National Health and Nutrition Examination Survey 1999 to 2004 with mortality follow-up through December 31, 2006. Logistic regression was used to determine predictors of poorly-controlled BP (>140/90) and non-treatment. Cox models were used to examine the association between antihypertensive use vs. all-cause mortality, adjusting for confounders. Results: Among 9,145 participants aged ≥40 years, 490 reported previous stroke, corresponding to 4,755,372 (4%) of US adults. Of those with previous stroke, 72% had known hypertension, 47% had poorly controlled hypertension, and 8% had undiagnosed hypertension. Compared to those not taking antihypertensive medications, those on treatment were more likely to be significantly older, male, black non-Hispanic, diabetic, with elevated levels of BP, total cholesterol, and body mass index. In multivariable analyses, age (OR per year 1.05, 95% CI 1.02-1.09), female sex (OR 1.43, 95% CI 1.14-1.79), Hispanic ethnicity (OR 1.76, 95% CI 1.24-2.49) and diabetes (OR 2.12, 95% CI 1.50-2.99) were associated with poorly controlled BP, while subjects who had a previous myocardial infarction (OR 0.66, 95%CI 0.45-0.97), drank alcohol (OR 0.62, 95% CI 0.42-0.90) or were overweight (OR 0.62, 95% CI 0.49-0.78) were less likely to have poorly controlled BP. Among those with poorly controlled BP, hypercholesterolemia (OR 1.30, 95% CI 1.07-1.57) and male sex (OR 1.33, 95% CI 1.06-1.63) were predictors of non-treatment, whereas current smoking (OR 1.59, 95% CI 1.32-1.92) or overweight (OR 1.92, 95% CI 1.32-2.78) were linked to treatment. Those on antihypertensive medications had lower rates of all-cause mortality but this result did not reach significance (adjusted HR 0.87; 95% CI 0.33-2.32), and was not influenced by baseline BP or number of antihypertensive agents. Conclusion: Rates of antihypertensive therapy and BP control among stroke survivors in the United States are poor. One in two stroke survivors has poorly controlled hypertension. Several medical and lifestyle modification factors could be potential targets of intervention to bridge this evidence-practice gap.