Abstract
Background: Control of blood pressure (BP) is required in the year after a stroke because that is when the risk of stroke recurrence is highest. Although the management of BP has been improving in the general population, it has not been extensively studied in the post-stroke period. Our objective was to examine BP control and BP medication adherence and intensification in a cohort of Veterans in the year after their stroke. Method: We reviewed the medical charts of 3987 Veterans, representing an 80% subsample among all Veterans admitted with a diagnosis of acute ischemic stroke in fiscal year 2007 to a Veterans Administration (VA) Medical Center. We identified 2832 Veterans who had visits to VA primary care clinics both in the year prior to and in the year after the hospitalization for stroke. We used administrative databases to obtain BP values and prescribed BP medications in the year before and after index stroke hospitalization. Medication adherence was assessed by calculating the mean medication possession ratio among individual BP medications. We identified opportunities for treatment intensification if a Veteran had a systolic BP value ≥ 160 mm Hg (Stage 2 hypertension). We defined treatment intensification as any BP medication dose increase or addition of a new BP medication within 14 days of the intensification opportunity. We used paired t-tests to compare changes across the two years. Results: There were significant improvements in the mean systolic BP and the proportion of patients with controlled BP. Medication adherence was high both before and after the stroke. However, of the 640 opportunities for treatment intensification, we observed that intensification occurred only 193 (30%) times. Conclusion: Blood pressure control did improve in the year after a stroke. However, there remains a group who do not have their BP controlled. Among patients with very high systolic BP values, there remain missed opportunities for treatment intensification.
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