Roumie Christianne L, Zillich Alan J, Bravata Dawn M, Jaynes Heather A, Myers Laura J, Yoder Joseph, Cheng Eric M
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.).
Stroke. 2015 Feb;46(2):465-70. doi: 10.1161/STROKEAHA.114.007566. Epub 2014 Dec 30.
We examined blood pressure 1 year after stroke discharge and its association with treatment intensification.
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).
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.
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.
我们对卒中出院1年后的血压情况及其与强化治疗的关联进行了研究。
我们在一个全国性急性缺血性卒中后出院的退伍军人群体中，根据出院时收缩压（SBP）分层（≤140、141 - 160或>160 mmHg）来检查收缩压。高血压治疗时机定义为门诊收缩压>160 mmHg或多次收缩压>140 mmHg。强化治疗定义为有降压药物调整的治疗时机的比例（范围为0% - 100%，其中100%表示每次升高的收缩压都导致药物改变）。
在3153例缺血性卒中患者中，38%在卒中后1年内有≥1次门诊收缩压升高符合强化治疗条件。30%的患者出院时收缩压≤140 mmHg，平均有1.93次治疗时机，58%的符合条件的就诊发生了强化治疗。47%出院时收缩压为141至160 mmHg的患者平均有2.1次强化治疗时机，60%的就诊发生了强化治疗。63%出院时收缩压>160 mmHg的患者平均有2.4次强化治疗时机，65%的就诊发生了强化治疗。
出院时收缩压>160 mmHg的患者有很多机会改善高血压控制情况。二级卒中预防工作应聚焦于急性卒中出院前启动和复查降压药物；降压药物的管理和滴定；以及患者用药依从性咨询。
