Denny M Carter, Almohamad Maha, Ebirim Emmanuel, Morell Adriana, Okpala Munachi, Hwang Kevin O, Savitz Sean, Sharrief Anjail
Department of Neurology, Georgetown University Medical Center and MedStar Health: Washington, D.C., United States.
Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston, TX, United States; Center for Health Equity, Department of Epidemiology, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, TX, United States.
J Stroke Cerebrovasc Dis. 2025 May;34(5):108282. doi: 10.1016/j.jstrokecerebrovasdis.2025.108282. Epub 2025 Mar 8.
Hypertension is the most important modifiable risk factor for secondary stroke prevention; however, blood pressure (BP) remains uncontrolled for at least 50 % of stroke survivors following an incident stroke. Accurate in-clinic assessment of BP is important for appropriate medication titration. We evaluated misclassification of clinic BP control in a racially diverse stroke clinic population using two BP measurement methods.
We followed ischemic stroke, intracerebral hemorrhage, and transient ischemic attack patients after hospital discharge in a comprehensive stroke clinic. Casual BP was obtained using a standard office automated machine, attended by a medical assistant. BP was also measured with an unattended automated office BP (AOBP) machine and was categorized as concordant control, concordant uncontrolled, pseudoresistant hypertension, and masked uncontrolled. Multinomial logistic regression was used to assess relationships between demographic/clinical variables and misclassification categories, controlling for confounders. Among 216 patients, mean age was 59.5 (SD 12.9); 57 % were male, and by race, 50.5 % were non-Hispanic Black/ African American, 21.3 % Hispanic, and 25.5 % non-Hispanic White. BP control was misclassified by casual office BP for 27.3 % of patients. Race was significantly associated with misclassification in regression analysis. The odds ratio for masked uncontrolled compared to concordant controlled BP was 12.2 (95 % CI 1.5, 99.2) for non-Hispanic Black/ African American and 9.9 (95 % CI 1.1, 87.4) for Hispanic compared to non-Hispanic White patients.
These findings highlight barriers to assessment of BP control using standard office measurements among stroke survivors. Accurate BP measurement tools, including AOBP, home BP, and ambulatory BP monitoring, should be utilized to optimize BP treatment after stroke.
高血压是二级卒中预防中最重要的可改变风险因素；然而，在发生卒中后，至少50%的卒中幸存者血压仍未得到控制。准确的门诊血压评估对于适当的药物滴定很重要。我们使用两种血压测量方法评估了一个种族多样化的卒中门诊人群中门诊血压控制的误分类情况。
我们在一家综合性卒中门诊对缺血性卒中、脑出血和短暂性脑缺血发作患者出院后进行了随访。由医疗助理使用标准的办公室自动机器测量随机血压。还使用无人值守的自动办公室血压（AOBP）机器测量血压，并将其分类为一致性控制、一致性未控制、假性难治性高血压和隐匿性未控制。使用多项逻辑回归评估人口统计学/临床变量与误分类类别之间的关系，并对混杂因素进行控制。在216名患者中，平均年龄为59.5岁（标准差12.9）；57%为男性，按种族划分，50.5%为非西班牙裔黑人/非裔美国人，21.3%为西班牙裔，25.5%为非西班牙裔白人。27.3%的患者随机门诊血压对血压控制的分类有误。在回归分析中，种族与误分类显著相关。与非西班牙裔白人患者相比，非西班牙裔黑人/非裔美国人隐匿性未控制与一致性控制血压的比值比为12.2（95%可信区间1.5，99.2），西班牙裔为9.9（95%可信区间1.1，87.4）。
这些发现凸显了在卒中幸存者中使用标准门诊测量评估血压控制的障碍。应使用包括AOBP、家庭血压和动态血压监测在内的准确血压测量工具来优化卒中后的血压治疗。
