Key result
At entry to cardiac rehabilitation, 64.3% of post-stroke patients met both systolic and diastolic blood pressure targets, with diabetes being the strongest predictor of poor blood pressure control.
Why the study?
Recurrent strokes account for one-third of all strokes and cause high disability, with blood pressure being the top modifiable risk factor, but target attainment upon entering cardiac rehabilitation remained unclear.
Cross-Sectional (n=1,804)
No
Up to one-third of post-stroke patients entering cardiac rehabilitation do not meet blood pressure targets, with diabetes and multiple antihypertensive prescriptions being strong predictors of poor control.
May warrant closer BP monitoring in diabetic post-stroke patients entering rehab; leaves open optimal intervention strategies.
BACKGROUND: Recurrent events account for approximately one-third of all strokes and are associated with greater disability and mortality than first-time strokes. Blood pressure (BP) is the most important modifiable risk factor. Objectives were to determine the proportion of post-stroke patients enrolled in cardiac rehabilitation (CR) meeting systolic and diastolic BP (SBP/DBP) targets and to determine correlates of meeting these targets. METHODS: A retrospective study of 1,804 consecutively enrolled post-stroke patients in a CR program was conducted. Baseline data (database records 2006-2017) included demographics, anthropometrics, clinical/medication history, and resting BP. Multivariate analyses determined predictors of achieving BP targets. RESULTS: Mean age was 64.1 ± 12.7 years, median days from stroke 210 (IQR 392), with most patients being male (70.6%; n = 1273), overweight (66.8%; n = 1196), and 64.2% diagnosed with hypertension (n = 1159), and 11.8% (n = 213) with sleep apnea. A mean of 1.69 ± 1.2 antihypertensives were prescribed, with 26% (n = 469) of patients prescribed 3-4 antihypertensives. SBP target was met by 71% (n = 1281) of patients, 83.3% (n = 1502) met DBP target, and 64.3% (n = 1160) met both targets. Correlates of meeting SBP target were not having diabetes, younger age, fewer prescribed antihypertensives, and more recent program entry. Correlates of meeting DBP target were not having diabetes, older age, fewer prescribed antihypertensives, and more recent stroke. CONCLUSIONS: Up to one-third of patients were not meeting BP targets. Patients with diabetes, and those prescribed multiple antihypertensives are at greater risk for poorly controlled SBP and DBP. Reasons for poor BP control such as untreated sleep apnea and medication non-adherence need to be investigated.
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Sawicki et al. (2020) conducted a cross-sectional in Stroke (n=1,804). Post-stroke status at entry to cardiac rehabilitation was evaluated on Meeting both systolic and diastolic blood pressure targets. At entry to cardiac rehabilitation, 64.3% of post-stroke patients met both systolic and diastolic blood pressure targets, with diabetes being the strongest predictor of poor blood pressure control.
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