Choices for long-term hypertensive control in patients after first-ever hemorrhagic stroke: a nationwide cohort study

Abstract

Background:To compare the long-term clinical outcomes of different antihypertensive drugs in stable patients after acute hemorrhagic stroke (HS).Methods:From January 2001 to December 2013, patients with first-ever primary HS were identified in the National Health Insurance Research Database, Taiwan. Patients with traumatic intracerebral hemorrhage and secondary HS were excluded. Those with first-ever HS were recruited and classified into three groups: (1) angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB); (2) calcium channel blocker (CCB); and (3) other antihypertensive drugs (comparison) groups. Propensity score matching was used to balance the distribution of baseline characteristics, stroke severity, and medications between any two of the three groups. A validation study was performed using the databank of the Stroke Registry in Chang-Gung Healthcare System to reduce the bias. Primary outcomes were recurrent HS, ischemic stroke, any stroke, and all-cause mortality.Results:Compared to the comparison group, the ACEI/ARB group [35.4% versus 39.3%; hazard ratio (HR), 0.84; 95% confidence interval (CI), 0.74–0.95] and CCB group (33.0% versus 41.9%; HR, 0.72; 95% CI, 0.64–0.81) had a lower risk of all-cause mortality during long-term follow up. The CCB group had a similar risk of all-cause mortality to the ACEI/ARB group. Risks of recurrent HS, ischemic stroke, or any stroke were not different between the study groups.Conclusions:Antihypertensive drug class could be important to long-term outcomes in HS patients in addition to the target control of blood pressure. Both ACEIs/ARBs and CCBs are associated with lower risks of all-cause mortality. Our results may be applied to inform future research on hypertensive control in HS patients.

Hypertension Among Hemorrhagic Stroke Patients in Northeast China: A Population-Based Study 2017–2019

“…Previous studies indicated that in hemorrhagic stroke survivors, the most effective method to improve prognosis and reduce mortality is preventing recurrent stroke [ 21 ], and blood pressure should be well and intensively controlled to prevent stroke recurrence [ 22 , 23 ]. Although the reduction of blood pressure in the acute phase of hemorrhagic stroke is still controversial, we should still emphasize the importance of long-term treatment of hypertension in patients with previous hemorrhagic stroke.…”

Сoagulation hemostasis indices after hemorrhagic stroke, developed as a complication of essential hypertension

“…Exclusion criteria were non-EH-related factors of hemorrhagic stroke development. The choice for examination of the patients in 6 months and more after the hemorrhagic stroke episode was due to the need for patients to be in a stable phase [14].…”

Telmisartan use and risk of dementia in type 2 diabetes patients with hypertension: A population-based cohort study

“…An ARB medication possession ratio � 80% was required for the patients in both study groups. Blood sugar and BP levels were not available in the NHIRD, and therefore we adjusted for the types and average numbers of oral antidiabetic drugs (OADs) and antihypertensive medications to mitigate the bias related to different levels of blood sugar and BP [32]. Cohort entry (index date) AU : IchangedCohortentrytoCo was defined as when the patient was diagnosed with T2DM and HTN and prescribed with antihypertensive and antidiabetic medications.…”