Department of Public Health University of Tennessee Knoxville TN.
Department of Biostatistics University of Michigan Ann Arbor MI.
J Am Heart Assoc. 2022 Aug 2;11(15):e026678. doi: 10.1161/JAHA.122.026678. Epub 2022 Jul 19.
Background Relatively greater increases in hypertension prevalence among US rural residents may contribute to geographic disparities in recurrent stroke. There is limited US information on poststroke antihypertensive medication use by rural/urban residence. We assessed antihypertensive use and lifestyle characteristics for US rural compared with urban stroke survivors and residence-based trends in use between 2005 and 2019. Methods and Results US stroke survivors with hypertension were identified in the 2005 to 2019 national Behavioral Risk Factor Surveillance System surveys. We ascertained the survey-weighted prevalence of reported antihypertensive use and lifestyle characteristics (ie, physical activity, diabetes, cholesterol, body mass index, and smoking) among respondents with hypertension in odd years over this period by rural/urban residence. Separate trend analyses were used to detect changes in use over time. Survey-weighted logistic regression was used to calculate unadjusted and adjusted (sociodemographic and lifestyle factors) odds ratios for antihypertensive use by year. Our study included 82 175 individuals (36.4% rural residents). Lifestyle characteristics were similar between rural and urban residents except for higher smoking prevalence among rural residents. Antihypertensive use was similar between rural and urban stroke survivors in unadjusted and adjusted analyses (>90% in both populations). Trend analyses showed a small but significant increase in antihypertensive use over time among urban (=0.033) but not rural stroke survivors (=0.587). Conclusions Our findings indicate that poststroke antihypertensive use is comparable in rural and urban residents with a reported history of hypertension, but additional work is merited to identify reasons for a trend for increased use of these drugs among urban residents.
美国农村居民高血压患病率的相对增加可能导致复发性中风的地域差异。关于农村/城市居民中风后抗高血压药物使用的美国信息有限。我们评估了美国农村与城市中风幸存者的抗高血压药物使用情况和生活方式特征，以及 2005 年至 2019 年期间基于居住地的使用趋势。
在 2005 年至 2019 年全国行为风险因素监测系统调查中，我们确定了患有高血压的美国中风幸存者。我们通过农村/城市居住地，确定了在此期间奇数年份报告患有高血压的受访者中报告抗高血压药物使用和生活方式特征（即身体活动、糖尿病、胆固醇、体重指数和吸烟）的调查加权患病率。单独的趋势分析用于检测随时间的使用变化。使用调查加权逻辑回归计算按年计算的未调整和调整（社会人口统计学和生活方式因素）抗高血压药物使用的比值比。我们的研究包括 82175 人（36.4%为农村居民）。生活方式特征在农村和城市居民之间相似，除了农村居民的吸烟率较高。在未调整和调整分析中，农村和城市中风幸存者的抗高血压药物使用情况相似（两人群中均超过 90%）。趋势分析显示，城市中风幸存者的抗高血压药物使用随着时间的推移略有增加（=0.033），但农村中风幸存者则没有（=0.587）。
我们的研究结果表明，农村和城市有高血压病史的中风幸存者的抗高血压药物使用相似，但需要进一步努力确定城市居民这些药物使用增加的原因。
