Stroke: associated hypertension is often undertreated

  • Santos D & al.
  • JAMA Neurol
  • 27/07/2020

  • Susan London
  • Clinical Essentials
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Takeaway

  • More than a third of patients with a history of both stroke and hypertension have uncontrolled BP.

Why this matters

Key results

  • Prevalences:
    • 37.1% of cohort had uncontrolled BP on examination.
    • 80.4% of this subset were receiving antihypertensive medication.
  • Among all 84.7% of individuals receiving antihypertensive medication:
    • 59.2% were receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.
    • 43.8% were receiving β-blockers.
    • 41.6% were receiving diuretics.
    • 31.5% were receiving calcium channel blockers.
  • Proportion with controlled BP was highest among thiazide diuretic users (70.5%), lowest among users of "other" antihypertensives (51.2%).
  • Between 2005-2006 and 2015-2016:
    • Use of diuretics declined (from 49.4% to 35.7%; P=.005).
    • Use of other antihypertensives remained stable.

Study design

  • The US nationally representative cross-sectional survey using data from 2005 to 2016 for 4,971,136 individuals aged ≥20 years with history of both stroke and hypertension (National Health and Nutrition Examination Survey).
  • Main outcome: uncontrolled BP (>140/90 mm Hg) on physical examination.
  • Funding: None disclosed.

Limitations

  • Analyses were limited by unmeasured and residual confounding.
  • Stroke was self-reported.
  • Subtypes of stroke were unknown.
  • BP was measured just once.
  • Generalizability is unknown.