Patterns and Predictors of Blood Pressure Treatment, Control, and Outcomes among Stroke Survivors in the United States

Ali Razmara; Bruce Ovbiagele; Daniela Markovic; Amytis Towfighi

doi:10.1016/j.jstrokecerebrovasdis.2015.12.027

Patterns and Predictors of Blood Pressure Treatment, Control, and Outcomes among Stroke Survivors in the United States

J Stroke Cerebrovasc Dis. 2016 Apr;25(4):857-65. doi: 10.1016/j.jstrokecerebrovasdis.2015.12.027. Epub 2016 Jan 14.

Authors

Ali Razmara¹, Bruce Ovbiagele², Daniela Markovic³, Amytis Towfighi⁴

Affiliations

¹ Department of Neurology, University of California, Irvine, Orange, California. Electronic address: arazmara@uci.edu.
² Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
³ Department of Biomathematics, University of California, Los Angeles, Los Angeles, California.
⁴ Department of Neurology, University of Southern California, Los Angeles, California; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California.

PMID: 26778599
DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.027

Abstract

Background: Expert consensus guidelines recommend antihypertensive treatment to lower secondary stroke risk, but patterns and predictors of blood pressure (BP) treatment and control among stroke survivors in the United States remain unknown. Understanding predictors of poor control can facilitate development of targeted strategies.

Methods: We reviewed the prevalence and control of hypertension among adults 40 years or older with self-reported stroke who participated in the National Health and Nutrition Examination Surveys 1999-2004 with mortality follow-up through 2006. Predictors of poorly controlled BP (>140/90 mm Hg) and nontreatment were determined via logistic regression. Independent association between antihypertensive use and mortality was determined using Cox models.

Results: Among 9145 participants, 490 reported previous stroke; 72% had known hypertension, 8% had undiagnosed hypertension, and 47% had poorly controlled BP. In multivariable analyses, age (odds ratio [OR] per year 1.06, 95% confidence interval [CI] 1.03-1.09), female sex (OR 1.70, 95% CI 1.12-2.57), non-Mexican Hispanic ethnicity (OR 4.54, 95% CI 1.76-11.70), black race (OR 3.15, 95% CI 1.59-6.25), hypercholesterolemia (OR 2.46, 95% CI 1.44-4.21), and diabetes (OR 1.96, 95% CI 1.16-3.33) were associated with poorly controlled BP. Obesity was associated with lower odds of poorly controlled BP (OR .51, 95% CI .26-.99). Non-Mexican Hispanic ethnicity (OR 7.37, 95% CI 2.25-24.10) and black race (OR 3.13, 95% CI 1.05-9.34) were predictors of nontreatment, whereas diabetes was linked to treatment (OR 3.57, 95% CI 1.21-10.43). There was no association between antihypertensive treatment and mortality after adjustment for demographics and comorbidities.

Conclusions: One in 2 stroke survivors in the United States has poorly controlled BP; the most vulnerable groups include women, non-Mexican Hispanics, blacks, diabetics, and older individuals. Understanding causes of this evidence-practice gap may assist in developing effective targeted interventions.

Keywords: Blood pressure; outcome; stroke; vascular death.

MeSH terms

Adult
Aged
Blood Pressure / physiology*
Body Mass Index
Cholesterol
Female
Humans
Male
Middle Aged
Physical Examination
Retrospective Studies
Statistics, Nonparametric
Stroke* / epidemiology
Stroke* / mortality
Stroke* / therapy
Survival Analysis
Treatment Outcome*
United States / epidemiology

Substances

Cholesterol