Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA Neurol. 2020 Nov 1;77(11):1382-1389. doi: 10.1001/jamaneurol.2020.2499.
Hypertension is a well-established, modifiable risk factor for stroke. National hypertension management trends among stroke survivors may provide important insight into secondary preventive treatment gaps.
To investigate the adequacy of blood pressure control among stroke survivors and antihypertensive treatment trends using National Health and Nutrition Examination Survey (NHANES) data.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional surveys conducted between 2005 and 2016 of nationally representative samples of the civilian US population were analyzed from March 2019 to January 2020. The NHANES is a large, nationally representative cross-sectional survey conducted in 2-year cycles in the United States. Evaluations include interviews, medication lists, physical examinations, and laboratory tests on blood samples. Among 221 982 140 adults 20 years or older in the NHANES from 2005 through 2016, a total of 4 971 136 had stroke and hypertension and were included in this analysis, with 217 011 004 excluded from the primary analysis.
Hypertension was defined by self-report, antihypertensive medication use, or uncontrolled blood pressure (>140/90 mm Hg) on physical examination. Antihypertensive medication was classified as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, diuretics, β-blockers, calcium channel blockers, or other.
Weighted frequencies and means were reported using NHANES methods, estimating the proportion of individuals with stroke and hypertension. For all other analyses, 4 971 136 individuals with stroke and hypertension were examined, summarizing number and classes of antihypertensive medications, frequency of uncontrolled hypertension, and associations between antihypertensive classes and blood pressure control. Trends in antihypertensive medication use over time were examined.
Among 4 971 136 individuals with a history of stroke and hypertension, the mean age was 67.1 (95% CI, 66.1-68.1) years, and 2 790 518 (56.1%) were women. In total, 37.1% (33.5%-40.8%) had uncontrolled blood pressure on examination, with 80.4% (82.0%-87.5%) taking antihypertensive medication. The most commonly used antihypertensive medications were angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (59.2%; 95% CI, 54.9%-63.4%) and β-blockers (43.8%; 95% CI, 40.3%-47.3%). Examining trends over time, diuretics have become statistically significantly less commonly used (49.4% in 2005-2006 vs 35.7% in 2015-2016, P = .005), with frequencies of other antihypertensive classes remaining constant.
In this cross-sectional study that used national survey data, substantial undertreatment of hypertension was found in individuals with a history of stroke, and more than one-third had uncontrolled hypertension. Because hypertension is a major risk factor for stroke, these data demonstrate a missed opportunity nationally for secondary stroke prevention.
高血压是一种已被充分证实的、可改变的中风风险因素。中风幸存者的国家高血压管理趋势可能为二级预防治疗差距提供重要的见解。
使用国家健康和营养检查调查（NHANES）的数据，调查中风幸存者的血压控制是否充分以及降压治疗趋势。
设计、地点和参与者：对 2005 年至 2016 年期间进行的全国代表性美国人口的横断面调查进行了分析，分析于 2019 年 3 月至 2020 年 1 月进行。NHANES 是一项在美国每两年进行一次的大型、全国代表性的横断面调查。评估包括访谈、药物清单、体检和血液样本的实验室测试。在 2005 年至 2016 年 NHANES 中 20 岁或以上的 221982140 名成年人中，共有 4971136 人患有中风和高血压，包括在本分析中，217011004 人因主要分析而被排除在外。
高血压通过自我报告、使用降压药物或体检时血压控制不佳（>140/90 mmHg）来定义。降压药物分为血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、利尿剂、β受体阻滞剂、钙通道阻滞剂或其他。
使用 NHANES 方法报告加权频率和平均值，估计有中风和高血压的个体比例。对于所有其他分析，检查了 4971136 名有中风和高血压的个体，总结了降压药物的种类和数量、未控制高血压的频率，以及降压药物种类与血压控制之间的关联。还检查了随时间推移降压药物使用的趋势。
在 4971136 名有中风和高血压病史的个体中，平均年龄为 67.1（95%CI，66.1-68.1）岁，2790518 人（56.1%）为女性。共有 37.1%（33.5%-40.8%）在体检时血压控制不佳，80.4%（82.0%-87.5%）服用降压药物。最常用的降压药物是血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（59.2%；95%CI，54.9%-63.4%）和β受体阻滞剂（43.8%；95%CI，40.3%-47.3%）。随时间推移观察趋势，利尿剂的使用频率明显下降（2005-2006 年为 49.4%，2015-2016 年为 35.7%，P = .005），而其他降压药物类别的频率保持不变。
在这项使用全国性调查数据的横断面研究中，发现中风幸存者的高血压治疗严重不足，超过三分之一的人血压未得到控制。由于高血压是中风的一个主要危险因素，这些数据表明全国范围内错过了二级中风预防的机会。
