Antihypertensive and lipid-lowering drugs usage after primary stroke in a large representative sample of the French population.

Abstract

The aim of the study is to describe the use of antihypertensive and lipid-lowering drugs in post-stroke secondary prevention in France. This is a prospective cohort study based on a representative sample of the French health insurance system database. All patients aged 45 and over, hospitalized for a first stroke between 1 January 2009 and 31 December 2014 were included. For each drug class, identified using Anatomical Therapeutic Chemical (ATC) codes, patients were followed from the first drug supply after stroke until the end of study period (31 December 2017), or exit date of the database or death. Adherence was defined by the proportion of days covered and persistence by the absence of a treatment gap of more than 91 days. A total of 2674 patients were included, median age was 75.0 years (interquartile range 63.0-83.0) and 51.2% were women. For patients treated with a drug of interest after stroke, median follow-up was 4.8 years (interquartile range 3.4-6.5). Regarding antihypertensive drugs, adherence at 8 years was 84.1% and persistence was 71.0%. For lipid-lowering drugs adherence at 8 years was 68.6% and persistence was 49.4%. Adherence and persistence were lower for patients starting treatment at time of stroke (antihypertensive drugs: 70.9% for adherence and 52.6% for persistence; lipid-lowering drugs: 62.3% and 43.1%) compared to patients already treated (antihypertensive drugs: 87.2% and 75.2%; lipid-lowering drugs: 73.6% and 54.5%). In this large representative sample of patients hospitalized for a first stroke in France, post-stroke therapeutic management remains suboptimal compared to guidelines, notably regarding lipid-lowering drugs. This trend was more pronounced for newly treated patients.