Key result
Blood pressure was controlled (<140/90 mmHg) in 63.1% of primary care patients with a previous stroke or TIA, while 47.3% of those with uncontrolled blood pressure were inadequately dosed in their antihypertensive medications.
Why the study?
Hypertension control rates remain suboptimal and little data is available from primary care on blood pressure control and antihypertensive medication-dosing in patients with a previous stroke or transient ischaemic attack.
Cross-Sectional (n=328)
Yes
Over one-third of primary care patients with a previous stroke or TIA have sub-optimal blood pressure control, and nearly half of these patients are inadequately dosed on antihypertensive medications.
May support dose review in uncontrolled stroke/TIA patients; leaves open whether intensification trials can close the primary-care gap.
BACKGROUND: Uncontrolled blood pressure (BP) is an important modifiable risk factor for recurrent stroke. Secondary prevention measures when implemented can reduce stroke re-occurrence by 80%. However, hypertension control rates remain sub-optimal, and little data is available from primary care where most management occurs. The aim of this study was to describe BP control in primary care-based patients with a previous stroke or transient ischaemic attack (TIA) in Ireland, and to concurrently examine antihypertensive medication-dosing. METHODS: Study participants most recent office-based BP reading was compared with the NICE (NG136) and European Society of Hypertension/ European Society of Cardiology (ESH/ESC 2013) goal of BP < 140/90 mmHg. Optimal anti-hypertensive medication dosing was determined by benchmarking prescribed doses for each drug with the World Health Organisation-Defined Daily Dosing (WHO-DDD) recommendations. RESULTS: We identified 328 patients with a previous stroke or TIA in 10 practices. Blood pressure was controlled in almost two thirds of patients when measured against the ESH/ESC and NICE guidelines (63.1%, n = 207). Of those with BP ≥140/90 (n = 116), just under half (n = 44, 47.3%) were adequately dosed in all anti-hypertensive medications when compared with the WHO-DDD recommendations. CONCLUSION: Blood pressure control in patients post stroke/TIA appears sub-optimal in over one third of patients. A comparison of drug doses with WHO-DDD recommendations suggests that 47% of patients may benefit from drug-dose improvements. Further work is required to assess how best to manage blood pressure in patients with a previous stroke or TIA in Primary Care, as most consultations for hypertension take place in this setting.
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Doogue et al. (2020) conducted a cross-sectional in Previous stroke or transient ischaemic attack (TIA) (n=328). Antihypertensive medication dosing vs. Unexposed/reference group was evaluated on Blood pressure control (< 140/90 mmHg). Blood pressure was controlled (<140/90 mmHg) in 63.1% of primary care patients with a previous stroke or TIA, while 47.3% of those with uncontrolled blood pressure were inadequately dosed in their antihypertensive medications.
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