Abubakar S A, Obiako O R, Isa M S, Jamoy B Y
Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria Kaduna State, Nigeria.
Niger Postgrad Med J. 2015 Mar;22(1):56-60.
Hypertension is the most common modifiable risk factor for stroke and treatment of hypertension has been known to reduce the risk of recurrent stroke. There are no studies done to evaluate the optimal blood pressure (BP) control in long-term stroke survivors in Nigeria. This study is aimed at determining the proportion of stroke survivors attending stroke prevention clinic who have optimal BP control of hypertension one year post stroke and to determine what factors are associated with the suboptimal BP control.
The subjects were consecutively presenting long term stroke survivors attending Neurology Outpatients'Clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. After informed consent, socio-demographic data and clinical characteristic were obtained from the patient using structured questionnaire. Admission stroke severity was obtained retrospectively using National Institute of Health Stroke Score (NIHSS). Modified Rankin scale (mRs) was used to assess the level of handicap . The presence of depression was determined using the Hamilton Depression Rating Scale (HDRS). Blood pressure was measured in the dominant, non-stroke arm of the patients using mercury sphygmomanometer.
A total of 68 patients were studied with a mean age of 55.15±11.9 years. Most common co- morbid condition was diabetes mellitus. Only 3(4.4%) patients had a repeat stroke during the one year period. Twenty five (36.8%) of these patients still had sub-optimal BP control. Forty seven (69.1%) of these patients were on combination therapy (including angiotensin converting enzyme inhibitors and diuretics) and 18 (26.5%) were on calcium channel blockers alone. The difference in mean age of stroke survivors with optimal and sub-optima BP control was not statistically significant. However, the mean duration of formal education of the stroke survivors with optimally controlled blood pressure was significantly higher than those with sub-optimal BP control. Eighteen (26.5%) of long term stroke survivors had clinical depression. Significantly higher proportion of the clinically depressed patients had sub-optimal blood pressure at one year compared to those that were not depressed. Formally educated patients had a better blood pressure control compared to those without formal education. Following a multivariate logistic regression, the major independent determinants of sub-optimal blood pressure control at one year post stroke were presence of depression and low levels of formal educational attainment.
majority of stroke survivors attending the ABUTH neurology outpatients clinic have suboptimal blood pressure control and major determinant of suboptimal BP control were presence of clinical depression and low formal educational status.
高血压是中风最常见的可改变风险因素，已知治疗高血压可降低中风复发风险。在尼日利亚，尚未有研究评估长期中风幸存者的最佳血压控制情况。本研究旨在确定在中风预防诊所就诊的中风幸存者中，中风后一年血压得到最佳控制的比例，并确定哪些因素与血压控制不佳有关。
研究对象为连续就诊于阿哈穆杜·贝洛大学教学医院（ABUTH）扎里亚神经科门诊的长期中风幸存者。在获得知情同意后，使用结构化问卷从患者处获取社会人口学数据和临床特征。回顾性使用美国国立卫生研究院卒中量表（NIHSS）获取入院时的中风严重程度。改良Rankin量表（mRs）用于评估残疾程度。使用汉密尔顿抑郁量表（HDRS）确定是否存在抑郁。使用汞柱式血压计在患者优势侧（非中风侧）手臂测量血压。
共研究了68例患者，平均年龄为55.15±11.9岁。最常见的合并症是糖尿病。在一年期间，只有3例（4.4%）患者再次中风。这些患者中有25例（36.8%）血压控制仍不理想。这些患者中有47例（69.1%）接受联合治疗（包括血管紧张素转换酶抑制剂和利尿剂），18例（26.5%）仅使用钙通道阻滞剂。血压控制最佳和欠佳的中风幸存者的平均年龄差异无统计学意义。然而，血压得到最佳控制的中风幸存者的平均正规教育年限显著高于血压控制欠佳者。18例（26.5%）长期中风幸存者有临床抑郁。与未抑郁者相比，临床抑郁患者在一年时血压控制欠佳的比例显著更高。接受过正规教育的患者血压控制优于未接受正规教育者。经过多因素逻辑回归分析，中风后一年血压控制欠佳的主要独立决定因素是存在抑郁和正规教育程度低。
在ABUTH神经科门诊就诊的大多数中风幸存者血压控制欠佳，血压控制欠佳的主要决定因素是存在临床抑郁和正规教育程度低。
