Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry

Author:

Gordon Perue Gillian1ORCID,Ying Hao1,Bustillo Antonio1ORCID,Zhou Lili1ORCID,Gutierrez Carolina M.1ORCID,Gardener Hannah E.1ORCID,Krigman Judith1,Jameson Angus2ORCID,Dong Chuanhui1ORCID,Rundek Tatjana1ORCID,Rose David Z.2ORCID,Romano Jose G.1ORCID,Alkhachroum Ayham1ORCID,Sacco Ralph L.1ORCID,Asdaghi Negar1ORCID,Koch Sebastian1ORCID

Affiliation:

1. Department of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FL

2. University of South Florida Morsani College of Medicine Tampa FL

Abstract

Background Guideline‐based hypertension management is integral to the prevention of stroke. We examine trends in antihypertensive medications prescribed after stroke and assess how well a prescriber's blood pressure (BP) medication choice adheres to clinical practice guidelines (BP‐guideline adherence). Methods and Results The FSR (Florida Stroke Registry) uses statewide data prospectively collected for all acute stroke admissions. Based on established guidelines, we defined optimal BP‐guideline adherence using the following hierarchy of rules: (1) use of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker as first‐line antihypertensive among diabetics; (2) use of thiazide‐type diuretics or calcium channel blockers among Black patients; (3) use of beta blockers among patients with compelling cardiac indication; (4) use of thiazide, angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, or calcium channel blocker class as first line in all others; (5) beta blockers should be avoided as first line unless there is a compelling cardiac indication. A total of 372 254 cases from January 2010 to March 2020 are in the FSR with a diagnosis of acute ischemic stroke, hemorrhagic stroke, transient ischemic attack, or subarachnoid hemorrhage; 265 409 with complete data were included in the final analysis. Mean age was 70±14 years; 50% were women; and index stroke subtypes were 74% acute ischemic stroke, 11% intracerebral hemorrhage, 11% transient ischemic attack, and 4% subarachnoid hemorrhage. BP‐guideline adherence to each specific rule ranged from 48% to 74%, which is below quality standards of 80%, and was lower among Black patients (odds ratio, 0.7 [95% CI, 0.7–0.83]; P <0.001) and those with atrial fibrillation (odds ratio, 0.53 [95% CI, 0.50–0.56]; P <0.001) and diabetes (odds ratio, 0.65 [95% CI, 0.61–0.68]; P <0.001). Conclusions This large data set demonstrates consistently low rates of BP‐guideline adherence over 10 years. There is an opportunity for monitoring hypertensive management after stroke.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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