Department of Neurology and Stroke Program University of Michigan Ann Arbor MI USA.
Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI USA.
J Am Heart Assoc. 2024 Aug 20;13(16):e034252. doi: 10.1161/JAHA.124.034252. Epub 2024 Aug 19.
High blood pressure (BP) increases recurrent stroke risk.
We assessed hypertension prevalence, treatment, control, medication adherence, and predictors of uncontrolled BP 90 days after ischemic or hemorrhagic stroke among 561 Mexican American and non-Hispanic White (NHW) survivors of stroke from the BASIC (Brain Attack Surveillance in Corpus Christi) cohort from 2011 to 2014. Uncontrolled BP was defined as average BP ≥140/90 mm Hg at 90 days poststroke. Hypertension was uncontrolled BP or antihypertensive medication prescribed or hypertension history. Treatment was antihypertensive use. Adherence was missing zero antihypertensive doses per week. We investigated predictors of uncontrolled BP using logistic regression adjusting for patient factors. Median (interquartile range) age was 68 (59-78) years, 64% were Mexican American, and 90% of strokes were ischemic. Overall, 94.3% of survivors of stroke had hypertension (95.6% Mexican American versus 92.0% non-Hispanic White; =0.09). Of these, 87.9% were treated (87.3% Mexican American versus 89.1% non-Hispanic White; =0.54). Among the total population, 38.3% (95% CI, 34.4%-42.4%) had uncontrolled BP. Among those with uncontrolled BP prescribed an antihypertensive, 84.5% reported treatment adherence (95% CI, 78.8%-89.3%). Uncontrolled BP 90 days poststroke was less likely in patients with stroke who had a primary care physician (adjusted odds ratio [aOR], 0.45 [95% CI, 0.24-0.83]; =0.01), greater stroke severity (aOR per-1-point-higher National Institutes of Health Stroke Scale score, 0.96 [95% CI, 0.93-0.99]; =0.02), or more depressive symptoms (aOR per-1-point-higher Personal Health Questionnaire Depression Scale-8 score, 0.95 [95% CI, 0.92-0.99] among those with a history of hypertension at baseline; =0.009).
Greater than one third of survivors of stroke have uncontrolled BP at 90 days poststroke in this population-based study. Interventions are needed to improve BP control after stroke.
高血压（BP）会增加复发性中风的风险。
我们评估了 2011 年至 2014 年来自 BASIC（科珀斯克里斯蒂脑卒中队列）队列的 561 名墨西哥裔美国人和非西班牙裔白人（NHW）中风幸存者中风后 90 天的高血压患病率、治疗、控制、药物依从性以及未控制血压的预测因素。未控制的血压定义为中风后 90 天平均血压≥140/90mmHg。高血压是指未控制的血压或开了降压药或有高血压病史。治疗是指使用降压药。依从性是指每周漏服零片降压药。我们使用逻辑回归调整患者因素来调查未控制血压的预测因素。中位（四分位距）年龄为 68（59-78）岁，64%为墨西哥裔美国人，90%的中风为缺血性。总的来说，94.3%的中风幸存者患有高血压（95.6%为墨西哥裔美国人，92.0%为非西班牙裔白人；=0.09）。其中，87.9%接受了治疗（87.3%为墨西哥裔美国人，89.1%为非西班牙裔白人；=0.54）。在总人群中，38.3%（95%CI，34.4%-42.4%）存在未控制的血压。在那些开了降压药但血压未得到控制的患者中，84.5%报告了治疗依从性（95%CI，78.8%-89.3%）。在有初级保健医生的中风患者中，中风后 90 天未控制血压的可能性较低（调整后的优势比[OR]，0.45[95%CI，0.24-0.83]；=0.01），中风严重程度较高（每增加 1 分国立卫生研究院卒中量表评分，OR 为 0.96[95%CI，0.93-0.99]；=0.02），或抑郁症状较多（基线时有高血压病史的患者，每增加 1 分健康问卷-8 项抑郁量表评分，OR 为 0.95[95%CI，0.92-0.99]；=0.009）。
在这项基于人群的研究中，超过三分之一的中风幸存者在中风后 90 天存在未控制的血压。需要采取干预措施来改善中风后的血压控制。
