a Department of Neurology , Center for Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour , Nijmegen , the Netherlands.
b Department of Neurology, Clinical Neurosciences , University of Helsinki , Helsinki , Finland.
Ann Med. 2019 Feb;51(1):68-77. doi: 10.1080/07853890.2018.1564358. Epub 2019 Feb 14.
Knowledge on the use of secondary preventive medication in young adults is limited.
We included 936 first-ever ischemic stroke 30-day survivors aged 15-49, enrolled in the Helsinki Young Stroke Registry, 1994-2007. Follow-up data until 2012 came from Finnish Care Register, Statistics Finland, and Social Insurance Institution of Finland. Usage thresholds were defined as non-users, low (prescription coverage <30%), intermediate (30-80%) and high users (>80%). Adjusted Cox regression allowed assessing the association of usage with all-cause mortality and recurrent vascular events.
Of our patients, 40.5% were non-users, 7.8% had low usage, 11.8% intermediate usage and 40.0% high usage. Median follow-up was 8.3 years. Compared to non-users, risk of mortality and recurrent stroke or TIA was lower for patients with low-intermediate (HR 0.40, 95% CI 0.22-0.65; HR 0.31, 95% CI 0.18-0.53) and high usage (HR 0.25, 95% CI 0.15-0.42; HR 0.30, 95% CI 0.19-0.46), after adjustment for confounders.
Use of antihypertensives was suboptimal in one-third of patients in whom antihypertensives were initially prescribed. Users were at lower risk of mortality and recurrent stroke or TIA compared to non-users. Key Messages The use of antihypertensive medication is suboptimal in one-third of patients in whom antihypertensive medication was initially prescribed after ischemic stroke at young age. The risk of mortality and recurrent stroke or TIA is lower for users of antihypertensive medication after ischemic stroke at young age compared to non-users, after adjustment for relevant confounders including pre-existing hypertension and prior use of antihypertensive medication. Specific guidelines on antihypertensive medication use after ischemic stroke at young age are lacking. However, our results may motivate doctors and patients in gaining better usage of antihypertensive medication, since better usage was associated with more favorable outcome in this study.
关于年轻成年人使用二级预防药物的知识有限。
我们纳入了 1994 年至 2007 年期间，936 名年龄在 15-49 岁的首次缺血性卒中 30 天幸存者，他们均来自赫尔辛基青年卒中登记处。随访数据截至 2012 年，来源于芬兰护理登记处、芬兰统计局和芬兰社会保险机构。使用阈值定义为非使用者、低（处方覆盖率<30%）、中（30-80%）和高使用者（>80%）。调整后的 Cox 回归允许评估使用与全因死亡率和复发性血管事件的相关性。
我们的患者中，40.5%为非使用者，7.8%为低使用者，11.8%为中使用者，40.0%为高使用者。中位随访时间为 8.3 年。与非使用者相比，低-中使用者（HR0.40，95%CI0.22-0.65；HR0.31，95%CI0.18-0.53）和高使用者（HR0.25，95%CI0.15-0.42；HR0.30，95%CI0.19-0.46）的死亡率和复发性卒中和 TIA 风险较低，在调整混杂因素后。
在最初被开处降压药的患者中，有三分之一的患者降压药的使用并不理想。与非使用者相比，使用者的死亡率和复发性卒中和 TIA 风险较低。
在最初因缺血性卒中而开处降压药的患者中，有三分之一的患者降压药的使用并不理想。在调整了包括既往高血压和既往使用降压药在内的相关混杂因素后，与非使用者相比，年轻缺血性卒中后使用降压药的患者的死亡率和复发性卒中和 TIA 风险较低。目前缺乏关于年轻缺血性卒中后使用降压药的具体指南。然而，我们的研究结果可能会促使医生和患者更好地使用降压药，因为在这项研究中，更好的使用与更有利的结果相关。
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