Prescription of antihypertensive medication at discharge influences survival following stroke

Nadine E Andrew¹, Joosup Kim¹, Amanda G Thrift¹, Monique F Kilkenny¹, Natasha A Lannin¹, Craig S Anderson¹, Geoffrey A Donnan¹, Kelvin Hill¹, Sandy Middleton¹, Christopher Levi¹, Steven Faux¹, Rohan Grimley¹, Nisal Gange¹, Richard Geraghty¹, Sharan Ermel¹, Dominique A Cadilhac²; Australian Stroke Clinical Registry Consortium

Collaborators, Affiliations

Collaborators

Australian Stroke Clinical Registry Consortium:
Craig Anderson, Dominique Cadilhac, Geoffrey Donnan, Julie Bernhardt, Paul Bew, Christopher Bladin, Greg Cadigan, Helen Castley, David Dunbabin, Anne Gordon, Andrew Granger, Rohan Grimley, Niall Johnson, Erin Lalor, Andrew Lee, Richard Lindley, Mark Mackay, Sandra Martyn, John McNeil, Sandy Middleton, Michael Pollack, Peter Somerford, Mark Simcocks, Frances Simmonds, Amanda Thrift, Helen Dewey, Steven Faux, Kelvin Hill, Natasha Lannin, Christopher Levi, Christopher Price, Pradeep Bambery, Tim Bates, David Blacker, Ernie Butler, Sean Butler, Douglas Crompton, Carolyn De Wytt, David Douglas, Martin Dunlop, Paula Easton, Sharan Ermel, Nisal Gange, Richard Geraghty, Melissa Gill, Graham Hall, Geoffrey Herkes, Karen Hines, Francis Hishon, James Hughes, Joel Iedema, Martin Jude, Paul Laird, Graham Mahaffey, Suzana Milosevic, Peter O'Brien, Stephen Read, Fiona Ryan, Arman Sabet, Noel Saines, Eva Salud, Amanda Siller, Christopher Staples, Richard White, Andrew Wong, Leonid Churilov, Alison Dias, Adele Gibbs, Brenda Grabsch, Monique Kilkenny, Francis Kung, Joyce Lim, Karen Moss, Sabrina Small, Renee Stojanovic, Steven Street, Emma Tod, Nadine Andrew

Affiliations

¹ From Stroke & Ageing Research (N.E.A., J.K., A.G.T., M.F.K., R.G., D.A.C.), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; Department of Medicine (N.E.A), Peninsula Clinical School, Central Clinical School, Monash University, Frankston; Florey Institute of Neuroscience and Mental Health (J.K., M.F.K., G.A.D., D.A.C.), University of Melbourne, Heidelberg; School of Allied Health (Occupational Therapy) (N.A.L.), La Trobe University, Bundoora; Occupational Therapy Department (N.A.L.), Alfred Health, Melbourne; Faculty of Medicine (C.S.A.), The University of New South Wales, Sydney; Stroke Foundation (K.H.), Melbourne; Nursing Research Institute (S.M.), St Vincent's Health Australia, Sydney and Australian Catholic University, Sydney; University of New South Wales and the Partnership for Health Education, Research and Enterprise (SPHERE) (C.L.), Sydney; Faculty of Medicine (S.F.), The University of New South Wales, Sydney and St Vincent's Health Australia, Sydney; Statewide Stroke Clinical Network (R.G.), Queensland Health, Brisbane; Sunshine Coast Clinical School (R.G), The University of Queensland, Birtinya; Toowoomba Hospital (N.G.), Toowoomba; Redcliffe Hospital (R.G.), Brisbane; and Bendigo Health (S.E.), Bendigo, Australia.
² From Stroke & Ageing Research (N.E.A., J.K., A.G.T., M.F.K., R.G., D.A.C.), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; Department of Medicine (N.E.A), Peninsula Clinical School, Central Clinical School, Monash University, Frankston; Florey Institute of Neuroscience and Mental Health (J.K., M.F.K., G.A.D., D.A.C.), University of Melbourne, Heidelberg; School of Allied Health (Occupational Therapy) (N.A.L.), La Trobe University, Bundoora; Occupational Therapy Department (N.A.L.), Alfred Health, Melbourne; Faculty of Medicine (C.S.A.), The University of New South Wales, Sydney; Stroke Foundation (K.H.), Melbourne; Nursing Research Institute (S.M.), St Vincent's Health Australia, Sydney and Australian Catholic University, Sydney; University of New South Wales and the Partnership for Health Education, Research and Enterprise (SPHERE) (C.L.), Sydney; Faculty of Medicine (S.F.), The University of New South Wales, Sydney and St Vincent's Health Australia, Sydney; Statewide Stroke Clinical Network (R.G.), Queensland Health, Brisbane; Sunshine Coast Clinical School (R.G), The University of Queensland, Birtinya; Toowoomba Hospital (N.G.), Toowoomba; Redcliffe Hospital (R.G.), Brisbane; and Bendigo Health (S.E.), Bendigo, Australia. dominique.cadilhac@monash.edu.

PMID: 29386279
DOI: 10.1212/WNL.0000000000005023

Multicenter Study

Prescription of antihypertensive medication at discharge influences survival following stroke

Nadine E Andrew et al. Neurology. 2018.

. 2018 Feb 27;90(9):e745-e753.

doi: 10.1212/WNL.0000000000005023. Epub 2018 Jan 31.

Authors

Collaborators

Australian Stroke Clinical Registry Consortium:
Craig Anderson, Dominique Cadilhac, Geoffrey Donnan, Julie Bernhardt, Paul Bew, Christopher Bladin, Greg Cadigan, Helen Castley, David Dunbabin, Anne Gordon, Andrew Granger, Rohan Grimley, Niall Johnson, Erin Lalor, Andrew Lee, Richard Lindley, Mark Mackay, Sandra Martyn, John McNeil, Sandy Middleton, Michael Pollack, Peter Somerford, Mark Simcocks, Frances Simmonds, Amanda Thrift, Helen Dewey, Steven Faux, Kelvin Hill, Natasha Lannin, Christopher Levi, Christopher Price, Pradeep Bambery, Tim Bates, David Blacker, Ernie Butler, Sean Butler, Douglas Crompton, Carolyn De Wytt, David Douglas, Martin Dunlop, Paula Easton, Sharan Ermel, Nisal Gange, Richard Geraghty, Melissa Gill, Graham Hall, Geoffrey Herkes, Karen Hines, Francis Hishon, James Hughes, Joel Iedema, Martin Jude, Paul Laird, Graham Mahaffey, Suzana Milosevic, Peter O'Brien, Stephen Read, Fiona Ryan, Arman Sabet, Noel Saines, Eva Salud, Amanda Siller, Christopher Staples, Richard White, Andrew Wong, Leonid Churilov, Alison Dias, Adele Gibbs, Brenda Grabsch, Monique Kilkenny, Francis Kung, Joyce Lim, Karen Moss, Sabrina Small, Renee Stojanovic, Steven Street, Emma Tod, Nadine Andrew

Affiliations

¹ From Stroke & Ageing Research (N.E.A., J.K., A.G.T., M.F.K., R.G., D.A.C.), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; Department of Medicine (N.E.A), Peninsula Clinical School, Central Clinical School, Monash University, Frankston; Florey Institute of Neuroscience and Mental Health (J.K., M.F.K., G.A.D., D.A.C.), University of Melbourne, Heidelberg; School of Allied Health (Occupational Therapy) (N.A.L.), La Trobe University, Bundoora; Occupational Therapy Department (N.A.L.), Alfred Health, Melbourne; Faculty of Medicine (C.S.A.), The University of New South Wales, Sydney; Stroke Foundation (K.H.), Melbourne; Nursing Research Institute (S.M.), St Vincent's Health Australia, Sydney and Australian Catholic University, Sydney; University of New South Wales and the Partnership for Health Education, Research and Enterprise (SPHERE) (C.L.), Sydney; Faculty of Medicine (S.F.), The University of New South Wales, Sydney and St Vincent's Health Australia, Sydney; Statewide Stroke Clinical Network (R.G.), Queensland Health, Brisbane; Sunshine Coast Clinical School (R.G), The University of Queensland, Birtinya; Toowoomba Hospital (N.G.), Toowoomba; Redcliffe Hospital (R.G.), Brisbane; and Bendigo Health (S.E.), Bendigo, Australia.
² From Stroke & Ageing Research (N.E.A., J.K., A.G.T., M.F.K., R.G., D.A.C.), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; Department of Medicine (N.E.A), Peninsula Clinical School, Central Clinical School, Monash University, Frankston; Florey Institute of Neuroscience and Mental Health (J.K., M.F.K., G.A.D., D.A.C.), University of Melbourne, Heidelberg; School of Allied Health (Occupational Therapy) (N.A.L.), La Trobe University, Bundoora; Occupational Therapy Department (N.A.L.), Alfred Health, Melbourne; Faculty of Medicine (C.S.A.), The University of New South Wales, Sydney; Stroke Foundation (K.H.), Melbourne; Nursing Research Institute (S.M.), St Vincent's Health Australia, Sydney and Australian Catholic University, Sydney; University of New South Wales and the Partnership for Health Education, Research and Enterprise (SPHERE) (C.L.), Sydney; Faculty of Medicine (S.F.), The University of New South Wales, Sydney and St Vincent's Health Australia, Sydney; Statewide Stroke Clinical Network (R.G.), Queensland Health, Brisbane; Sunshine Coast Clinical School (R.G), The University of Queensland, Birtinya; Toowoomba Hospital (N.G.), Toowoomba; Redcliffe Hospital (R.G.), Brisbane; and Bendigo Health (S.E.), Bendigo, Australia. dominique.cadilhac@monash.edu.

PMID: 29386279
DOI: 10.1212/WNL.0000000000005023

Abstract

Objective: To investigate the risk of death from cardiovascular disease between patients who were and were not prescribed antihypertensive medication following stroke or TIA.

Methods: This was a large cohort study using routinely collected prospective data from the Australian Stroke Clinical Registry. Patients registered between 2009 and 2013 who were discharged to the community or rehabilitation were included. Cases were linked to the National Death Index to determine the date and cause of death. Propensity score matching with stratification was utilized to compare between similar subgroups of patients. Multivariable competing risks regression, with noncardiovascular death as a competing risk, was conducted to investigate the association between the prescription of antihypertensive medications and cardiovascular death at 180 days after admission.

Results: Among 12,198 patients from 40 hospitals, 70% were prescribed antihypertensive medications. Patients who were older, were treated in a stroke unit, and had better socioeconomic position were more often discharged from hospital with an antihypertensive medication. Including only patients within propensity score quintiles with acceptable levels of balance in covariates between groups (n = 8,786), prescription of antihypertensive medications was associated with a 23% greater reduction in the subhazard of cardiovascular death compared to those who were not prescribed these agents (subhazard ratio 0.77; 95% confidence interval 0.61 to 0.97).

Conclusions: People who are prescribed antihypertensive medications at discharge from hospital after a stroke or TIA demonstrate better cardiovascular and all-cause survival outcomes than those not prescribed these agents.

PubMed Disclaimer

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Prescription of antihypertensive medication at discharge influences survival following stroke

Collaborators

Affiliations

Prescription of antihypertensive medication at discharge influences survival following stroke

Authors

Collaborators

Affiliations

Abstract

Publication types

MeSH terms

Substances