Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure

Christianne L Roumie¹, Alan J Zillich², Dawn M Bravata², Heather A Jaynes², Laura J Myers², Joseph Yoder², Eric M Cheng²

Affiliations

¹ From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.). Christianne.roumie@vanderbilt.edu.
² From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.).

PMID: 25550374
PMCID: PMC4308422
DOI: 10.1161/STROKEAHA.114.007566

Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure

Christianne L Roumie et al. Stroke. 2015 Feb.

. 2015 Feb;46(2):465-70.

doi: 10.1161/STROKEAHA.114.007566. Epub 2014 Dec 30.

Authors

Christianne L Roumie¹, Alan J Zillich², Dawn M Bravata², Heather A Jaynes², Laura J Myers², Joseph Yoder², Eric M Cheng²

Affiliations

¹ From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.). Christianne.roumie@vanderbilt.edu.
² From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.).

PMID: 25550374
PMCID: PMC4308422
DOI: 10.1161/STROKEAHA.114.007566

Abstract

Background and purpose: We examined blood pressure 1 year after stroke discharge and its association with treatment intensification.

Methods: We examined the systolic blood pressure (SBP) stratified by discharge SBP (≤140, 141-160, or >160 mm Hg) among a national cohort of Veterans discharged after acute ischemic stroke. Hypertension treatment opportunities were defined as outpatient SBP >160 mm Hg or repeated SBPs >140 mm Hg. Treatment intensification was defined as the proportion of treatment opportunities with antihypertensive changes (range, 0%-100%, where 100% indicates that each elevated SBP always resulted in medication change).

Results: Among 3153 patients with ischemic stroke, 38% had ≥1 elevated outpatient SBP eligible for treatment intensification in the 1 year after stroke. Thirty percent of patients had a discharge SBP ≤140 mm Hg, and an average 1.93 treatment opportunities and treatment intensification occurred in 58% of eligible visits. Forty-seven percent of patients discharged with SBP 141 to160 mm Hg had an average of 2.1 opportunities for intensification and treatment intensification occurred in 60% of visits. Sixty-three percent of the patients discharged with an SBP >160 mm Hg had an average of 2.4 intensification opportunities, and treatment intensification occurred in 65% of visits.

Conclusions: Patients with discharge SBP >160 mm Hg had numerous opportunities to improve hypertension control. Secondary stroke prevention efforts should focus on initiation and review of antihypertensives before acute stroke discharge; management of antihypertensives and titration; and patient medication adherence counseling.

Keywords: health services research; hypertension; medication adherence; secondary prevention.

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Figures

**Figure 2**
Systolic blood pressure trajectory in the year post stroke.* *Quadratic model adjusted for sex, race, Charlson score, number of antihypertensive drugs at discharge, and interactions for discharge blood pressure by time

**Figure 3**
Medication possession ratio (adherence) and relationship to treatment intensification* *Relationship between adherence and treatment intensification p= 0.71.

See this image and copyright information in PMC

References

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Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure

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Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure

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