Abstract TP462: Recruitment of African Americans in Blood Pressure Reduction Trials for Secondary Stroke Prevention

Abstract

Background and Purpose: Reductions in blood pressure (BP) after stroke are associated with dramatic reductions in stroke risk. African Americans (AA) have higher risk of recurrent stroke than Whites and higher rates of uncontrolled BP after stroke. Prior studies have shown under-representation of minorities in secondary prevention trials. We identified studies of BP control for secondary stroke prevention and explored minority representation in the trials. Methods: Relevant MeSH headings were used to conduct a PubMed search of randomized trials for secondary prevention of ischemic and hemorrhagic stroke and TIA, focused on BP reduction. We included studies published 1998 to 2018 that included participants from the US. We categorized articles according to timing post stroke, stroke type, intervention type, race/ethnic distribution, and mentioned efforts to increase minority proportions. Results: Of 703 abstracts identified from PubMed, 42 studies were retained, and 8 met criteria after manuscript review. Six were US based and 2 international. All included ischemic stroke and/ or TIA patients. None focused on hemorrhagic stroke. Six trials included behavioral modification as a component of the intervention. Enrollment period ranged from 0 to 180 days post-stroke. For US based studies, 5 reported AA race (race reporting complete for 3 studies). The proportion of AA participants ranged from 8.4% to 41.5% Three studies recruited from diverse populations. There was no specific mention of oversampling of AAs in any trial. Conclusion: Despite strong data to support BP reduction after stroke, there is a lack of US-based studies for secondary stroke prevention. More studies of BP control interventions to test medications and behavioral strategies for secondary stroke prevention in diverse patient populations are urgently needed.