Abstract WP188: Temporal Trends And Sociodemographic Factors In Blood Pressure Awareness, Treatment, And Control Among U.S. Stroke Survivors

Abstract

Background: Blood pressure (BP) control is crucial for secondary stroke prevention. Previous studies have shown that one in five stroke survivors have unrecognized hypertension and one in three have poorly controlled BP. Little is known regarding recent trends in BP awareness, treatment, and control among stroke survivors in the U.S. Methods: Among adults (age>=18 years) with self-reported stroke who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we assessed temporal trends in BP awareness, treatment and control by age group, sex, race/ethnicity, education, and poverty income ratio (PIR). BP control was defined as Systolic Blood Pressure (SBP) <140/90 mm Hg. Factors associated with BP control were assessed with Poisson regression models adjusting for sociodemographic factors and antihypertensive use. Results: Among individuals with self-reported stroke (n=1,883), the age-adjusted proportion of individuals with BP awareness increased from 87% (82-91%) in 1999-2002 to 96% (93-98%) in 2007-2010, then decreased to 92% (88-95%) in 2015-2018 ( P =0.005, quadratic trend). For those with hypertension, antihypertensive use increased from 87% (76-93%) in 1999-2002 to 97% (93-98%) in 2007-2010 and 96% (93-98%) in 2015-2018 ( P =0.013, quadratic trend). BP control significantly increased from 40% (29-52%) in 1999-2002 to 63% (65-81%) in 2007-2010, then decreased to 58% (50-66%) in 2015-2018 ( P =0.014, quadratic trend). Factors associated with poorly controlled BP in 2011-2018 were age 75+ years (vs. 18-44) [PR 0.60 (0.44-0.82), P ≤0.01], female sex [PR 0.79 (0.66-0.94), P ≤0.01], Black race (vs. Non-Hispanic White race) [PR 0.79, P =0.01], and lack of health insurance (vs. Medicare) [PR 0.53 (0.33-0.86), P =0.01]. Conclusion: While BP awareness, treatment, and control among stroke survivors increased from 1999 to 2010, the trend reversed in 2011-2018. Future work could help identify reasons for the worrisome trends and target vulnerable stroke survivors for sustained optimal BP control.