Trends in antihypertensive medication use among individuals with a history of stroke and hypertension

1. In a large, national sample, approximately 37.1% of patients with stroke history had uncontrolled blood pressure.

2. Most patients on medication were taking angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, or calcium channel blockers.

Evidence Rating Level: 2 (Good)

Stroke is ranked as a leading cause of mortality and disability in the U.S. Hypertension among individuals with a history of stroke is both common and undertreated, serving as an area for improvement in stroke prevention. In this cross-sectional study, researchers utilized data on blood pressure and antihypertensive treatment trends among stroke survivors from the National Health and Nutrition Examination Survey (NHANES) to further characterize the relationship between the hypertension and stroke. These cross-sectional surveys of nationally-representative samples were conducted between 2005 and 2016. A total of 4,971,136 individuals with a history of hypertension and stroke were included in the analyses (M age = 67.1 years, 95% CI 66.1 to 68.1, 56.1% female). Of these individuals, 37.1% were determined to have uncontrolled blood pressure upon examination while 80.4% were prescribed and taking antihypertensive medication. Most of these patients were taking angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (59.2%, 95% CI 54.9 to 63.4) and beta-blockers (43.8%, 95% CI 40.3 to 47.3). Diuretics were used by 41.6% (95% CI 37.3 to 45.9) and calcium channel blockers were used by 31.5% (95% CI 28.2 to 34.8). When evaluating trends of antihypertensive use across time with linear regression models, diuretics became significantly less common in 2015-2016 compared to 2005-2006 (35.7% vs. 49.4%, p = 0.005). This study was the first to investigate national trends of medication use among stroke patients in the U.S. Limitations include lack of validation of stroke histories, such that stroke was self-reported by participants. Nonetheless, study findings demonstrate a significant need for improvement in secondary prevention in those with histories of stroke.

Click to read the study in JAMA Neurology

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