Control of Hypertension 5 Years After Stroke in the North East Melbourne Stroke Incidence Study

Abstract

Abstract-Control of blood pressure after stroke is important for reducing the risk of recurrent stroke. We examined the control of hypertension in a community-based population of 5-year stroke survivors. Cases of first-ever stroke from the North East Melbourne Stroke Incidence Study were interviewed at 5 years poststroke. Blood pressure, history of hypertension, and antihypertensive medications were recorded. Individuals were classified as normotensive (blood pressure Ͻ140/90 mm Hg, no history of hypertension, and no antihypertensive medications), controlled hypertensive (blood pressure Ͻ140/90 mm Hg, history of hypertension, and/or taking antihypertensive medications), uncontrolled hypertensive (blood pressure Ն140/90 mm Hg, history of hypertension, and/or taking antihypertensive medications), or uninformed hypertensive (blood pressure Ն140/90 mm Hg, no known history of hypertension, and no antihypertensive medications). At 5 years poststroke, 441 (45%) of 978 first-ever stroke cases were alive. Of these, 305 (69%) had complete data on blood pressure, antihypertensive medication use, and history of hypertension. No statistical differences existed between those with or without these data. Eight-two percent were hypertensive; 63% had controlled hypertension, 30% had uncontrolled hypertension, and 7% were unaware that they were hypertensive. Overall, 67% of individuals classified as uncontrolled or uninformed hypertensive subjects were receiving treatment that was insufficient to achieve target blood pressure levels. Uncontrolled hypertensive subjects were more likely to recall receiving advice to manage their hypertension with medication (PϽ0.02) and diet (PϽ0.09). Although the majority of hypertensive individuals had controlled hypertension at 5 years poststroke, considerable improvement can be made in the control of hypertension after stroke.

Risk Factor Management with Guideline-Based Medications for Prevention of Recurrent Ischemic Stroke: A Retrospective Chart Review

“…2 The NEMESIS study in Australia examined blood pressure control at five years post-stroke. 23 About 450 patients were evaluated in the study, but only 300 of them had complete data (blood pressure measurement, medication records, and survey). Results showed that 82% of the patients were diagnosed with hypertension; 52% were controlled (90% on therapy), and 30% were uncontrolled (67% on therapy).…”

Potassium Intake and Stroke Risk

“…4,5 Presently, for secondary prevention of stroke, achieving a target BP of 130/80 mm Hg with a combination of any available antihypertensive drugs is recommended. [5][6][7][8][9] Despite this, there is consistent evidence to suggest that BP is poorly controlled in a proportion of this high-risk as long as 5 years after stroke. [7][8][9] The North East Melbourne Stroke Incidence Study (NEMESIS) trial reported that 37% of hypertensive 5-year stroke survivors had above target BP readings, and that 18% were not taking any antihypertensive medications.…”

“…[5][6][7][8][9] Despite this, there is consistent evidence to suggest that BP is poorly controlled in a proportion of this high-risk as long as 5 years after stroke. [7][8][9] The North East Melbourne Stroke Incidence Study (NEMESIS) trial reported that 37% of hypertensive 5-year stroke survivors had above target BP readings, and that 18% were not taking any antihypertensive medications. 9 Although the reasons for poor BP control in this population are likely to be complex, emergent populations of both difficult-to-treat and resistant hypertensives are likely to contribute to this effect, 10 as is the side-effect profile associated with commonly prescribed antihypertensives.…”

“…[7][8][9] The North East Melbourne Stroke Incidence Study (NEMESIS) trial reported that 37% of hypertensive 5-year stroke survivors had above target BP readings, and that 18% were not taking any antihypertensive medications. 9 Although the reasons for poor BP control in this population are likely to be complex, emergent populations of both difficult-to-treat and resistant hypertensives are likely to contribute to this effect, 10 as is the side-effect profile associated with commonly prescribed antihypertensives. 11 Therefore, novel approaches of BP lowering within this population may be particularly useful, especially if they possess a unique mechanism of action or exhibit an improved side-effect profile.…”

Organized Blood Pressure Control Programs to Prevent Stroke in Australia

“…This estimate was based on evidence in the literature for prevention programs that have no additional Medicare incentive payments (eg, practice nurse payments). 22 …”