Thursday, January 29, 2015

Hypertension management in stroke patient post discharge

From a new paper in Stroke:

Background and Purpose—We examined blood pressure 1 year after stroke discharge and its association with treatment intensification...

Results—Among 3153 patients with ischemic stroke, 38% had greater than or equal to 1 elevated outpatient SBP eligible for treatment intensification in the 1 year after stroke. Thirty percent of patients had a discharge SBP less than or equal to 140 mm Hg, and an average 1.93 treatment opportunities and treatment intensification occurred in 58% of eligible visits. Forty-seven percent of patients discharged with SBP 141 to160 mm Hg had an average of 2.1 opportunities for intensification and treatment intensification occurred in 60% of visits. Sixty-three percent of the patients discharged with an SBP greater than 160 mm Hg had an average of 2.4 intensification opportunities, and treatment intensification occurred in 65% of visits.

Conclusions—Patients with discharge SBP greater than 160 mm Hg had numerous opportunities to improve hypertension control. Secondary stroke prevention efforts should focus on initiation and review of antihypertensives before acute stroke discharge; management of antihypertensives and titration; and patient medication adherence counseling.

I do have concerns with the authors' last suggestion that some patients' regimens need to be intensified while they are still in the hospital. It is common practice, and in accordance with the guidelines, to allow “permissive hypertension” in the early stages post ischemic stroke. Sometimes we even withhold patients' pre-admission antihypertensives. It is difficult at times to know just when to resume such medications let alone intensify a patient's regimen.

More from ACP Hospitalist Weekly.

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