Key result
High persistence (≥75%) with antihypertensive therapy significantly decreased the risk of stroke recurrence (OR 0.78) compared with low persistence in ischemic stroke patients over 1 year.
Why the study?
Does high persistence with antihypertensive therapy reduce stroke recurrence, combined vascular events, and death in ischemic stroke patients with hypertension?
Cohort (n=8,409)
Yes
Does high persistence with antihypertensive therapy reduce stroke recurrence, combined vascular events, and death in ischemic stroke patients with hypertension?
Odds Ratio: 0.78 (95% CI 0.68–0.89)
Absolute Event Rate: 13.7% vs 20%
High persistence (≥75%) with antihypertensive therapy in the first year after an ischemic stroke is associated with significantly reduced risks of stroke recurrence, combined vascular events, and death.
Supports targeting high persistence post-ischemic stroke; leaves open randomized confirmation of recurrence reduction.
BACKGROUND: The efficacy of antihypertensive (AH) treatment after stroke has been investigated in several randomized clinical trials. However, non-adherence to AH medication is common for stroke patients in "real world" setting. The purpose of this study was to assess the impact of persistence with AH agents on ischemic stroke (IS) outcomes. METHODS AND RESULTS: Using the China National Stroke Registry, we analyzed data from 8409 IS patients with hypertension. Persistence with AH therapy (high persistence ≥75%, low persistence <75%) was measured by patient self-report at 3, 6, and 12 months after stroke. Multivariate logistic regression model was used to assess the relationship between persistence and IS outcomes (stroke recurrence, combined vascular events and death) at 12 months. Of the 8409 patients in this study, 40.0% were female and the mean age at study entry was 66.7 years. 31.6% of patients had high persistence with AH drugs, and 68.4% had low persistence during 1 year after stroke onset. High persistence with AH drugs significantly decreased the risk of stroke recurrence (odds ratio, 0.78; 95% CI, 0.68 to 0.89), combined vascular events (0.71; 0.63-0.81) and death (0.44; 0.36-0.53) compared with low persistence. CONCLUSIONS: Our study reinforces the benefits of AH medications in routine clinical practice and highlights the importance of persistence with AH therapy among IS patients known to be hypertensive within the first year of an event.
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Xu et al. (2013) conducted a cohort in Ischemic stroke with hypertension (n=8,409). High persistence (≥75%) with antihypertensive therapy vs. Low persistence (<75%) with antihypertensive therapy was evaluated on Stroke recurrence at 12 months (OR 0.78, 95% CI 0.68-0.89). High persistence (≥75%) with antihypertensive therapy significantly decreased the risk of stroke recurrence (OR 0.78) compared with low persistence in ischemic stroke patients over 1 year.
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