Abstract WP313: Influence of Medical and Non-Medical Risk Factors on Discharge Medication Prescribing Antihypertensives After Stroke: Analysis on a Diverse Cohort

Introduction: Guideline-directed secondary prevention is critical to reduce recurrent stroke and cardiovascular events, including the prescription of antihypertensive medications at discharge for those with elevated blood pressure (BP). However, disparities in BP control after stroke persist. Non-medical factors such as insurance, demographics, and vascular risk may influence prescribing, yet their impact is not well defined. Identifying gaps in care early after stroke can guide interventions to reduce inequities. This study examined medical and non-medical factors associated with antihypertensive prescribing in patients with elevated BP during stroke hospitalization. Methods: We analyzed 540 patients with ischemic stroke, hemorrhagic stroke, or TIA enrolled in the VIRTUAL trial (March 2022–April 2025). The trial includes patients with prior hypertension or elevated BP during hospitalization in a 6-month telehealth intervention for BP control. Logistic and ordinal regression assessed associations between age, sex, race/ethnicity, insurance, hypertension, and vascular risk factors with (1) any antihypertensive prescription and (2) number of medications. Subgroup analysis was conducted among those with established hypertension. Results: Of 540 patients, 47% were female, median age 63, 22% uninsured, 31.5% Hispanic, 35.4% Non-Hispanic Black, and 30.7% Non-Hispanic White (Table 1). Among patients with hypertension, 87% received ≥1 antihypertensive at discharge. In adjusted analysis, older age (OR 1.03; 95% CI 1.01–1.05) and hypertension diagnosis (OR 17.71; 95% CI 3.78–129.21) were associated with prescribing. Among those with established hypertension, older age (OR 1.02; 95% CI 1.004–1.03) and Black race (OR 2.00; 95% CI 1.34–2.99) were linked to higher medication counts (Table 2). Despite treatment, average systolic BP at discharge remained higher in those prescribed medication (145.3 mmHg) compared to those not prescribed (136.8 mmHg). Conclusion: In this diverse stroke cohort, older age and Black race were linked to both likelihood and number of antihypertensives prescribed, suggesting under-prescribing in younger patients or greater treatment needs in older and Black individuals. Similar patterns observed for Black patients may indicate differences in prescribing or treatment resistance. Insurance status did not explain prescribing differences. Further research is needed to clarify prescribing practices and the trajectory of blood pressure control after stroke.