Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada.
Stroke. 2010 Jul;41(7):1445-9. doi: 10.1161/STROKEAHA.110.579375. Epub 2010 May 27.
The majority of stroke fatalities occur in elderly women. We compared prescribing and adherence to antihypertensive therapies shown to reduce fatal and nonfatal stroke recurrence among elderly women and men with acute stroke.
Using the Registry of the Canadian Stroke Network, we identified all patients >or=66 years of age discharged home from 11 tertiary care centers with acute stroke (July 1, 2003, through March 31, 2006) in Ontario, Canada. Stroke cases were linked to the Ontario Drug Benefits Database and evaluated for prescription claims for thiazide diuretic, angiotensin converting enzyme inhibitor, beta blocker, angiotensin receptor blocker, or calcium channel blocker within 1 year of discharge from hospital. One-year adherence was assessed using the proportion of days covered with suboptimal adherence defined as a proportion of days covered <0.8.
A total of 3571 patients (51.6% women) >or=66 years of age with acute stroke were discharged home, with 87.6% of women and 84.7% of men treated with antihypertensive therapy within 1 year of stroke. Men were more likely than women to be prescribed angiotensin converting enzyme inhibitor monotherapy but just as likely to be prescribed angiotensin converting enzyme inhibitor/diuretic combination. Women were more likely to be prescribed all other classes of antihypertensive therapy. Suboptimal adherence occurred in 32% of patients receiving thiazide diuretics, 25% for angiotensin converting enzyme inhibitors, and 38% for angiotensin converting enzyme inhibitor/diuretic combination. There were no sex differences in adherence to these antihypertensive therapies. Patients who died after stroke had lower adherence to antihypertensive therapy compared with those who survived.
In a cohort of elderly stroke patients, women were generally just as likely or more likely than men to receive antihypertensive prescriptions after stroke. Drug adherence was similarly poor in women and men.
大多数中风死亡发生在老年女性中。我们比较了在患有急性中风的老年女性和男性中，降低致命和非致命中风复发的降压治疗方案的处方和依从性。
利用加拿大中风网络的登记处，我们确定了所有 2003 年 7 月 1 日至 2006 年 3 月 31 日在安大略省的 11 个三级护理中心出院回家的年龄大于等于 66 岁的急性中风患者。将中风病例与安大略省药物福利数据库相关联，并评估了出院后 1 年内噻嗪类利尿剂、血管紧张素转换酶抑制剂、β受体阻滞剂、血管紧张素受体阻滞剂或钙通道阻滞剂的处方情况。使用次优覆盖率比例（定义为覆盖率<0.8 的天数比例）评估一年的药物依从性。
共有 3571 名年龄大于等于 66 岁的急性中风患者出院回家，其中 87.6%的女性和 84.7%的男性在中风后 1 年内接受了降压治疗。与女性相比，男性更有可能被处方血管紧张素转换酶抑制剂单药治疗，但与女性一样有可能被处方血管紧张素转换酶抑制剂/利尿剂联合治疗。女性更有可能被处方所有其他类别的降压治疗药物。服用噻嗪类利尿剂、血管紧张素转换酶抑制剂和血管紧张素转换酶抑制剂/利尿剂联合治疗的患者中，分别有 32%、25%和 38%存在次优依从性。在这些降压治疗药物的依从性方面，男女之间没有差异。与存活患者相比，中风后死亡的患者对降压治疗的依从性较低。
在老年中风患者队列中，女性在中风后接受降压治疗的可能性与男性相当，或者比男性更有可能。女性和男性的药物依从性同样差。
