Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry
Background Guideline‐based hypertension management is integral to the prevention of stroke. We examine trends in antihypertensive medications prescribed after stroke and assess how well a prescriber's blood pressure (BP) medication choice adheres to clinical practice guidelines (BP‐guideline ad...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.030272 |
| _version_ | 1827697389729742848 |
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| author | Gillian Gordon Perue Hao Ying Antonio Bustillo Lili Zhou Carolina M. Gutierrez Hannah E. Gardener Judith Krigman Angus Jameson Chuanhui Dong Tatjana Rundek David Z. Rose Jose G. Romano Ayham Alkhachroum Ralph L. Sacco Negar Asdaghi Sebastian Koch |
| author_facet | Gillian Gordon Perue Hao Ying Antonio Bustillo Lili Zhou Carolina M. Gutierrez Hannah E. Gardener Judith Krigman Angus Jameson Chuanhui Dong Tatjana Rundek David Z. Rose Jose G. Romano Ayham Alkhachroum Ralph L. Sacco Negar Asdaghi Sebastian Koch |
| author_sort | Gillian Gordon Perue |
| collection | DOAJ |
| description | Background Guideline‐based hypertension management is integral to the prevention of stroke. We examine trends in antihypertensive medications prescribed after stroke and assess how well a prescriber's blood pressure (BP) medication choice adheres to clinical practice guidelines (BP‐guideline adherence). Methods and Results The FSR (Florida Stroke Registry) uses statewide data prospectively collected for all acute stroke admissions. Based on established guidelines, we defined optimal BP‐guideline adherence using the following hierarchy of rules: (1) use of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker as first‐line antihypertensive among diabetics; (2) use of thiazide‐type diuretics or calcium channel blockers among Black patients; (3) use of beta blockers among patients with compelling cardiac indication; (4) use of thiazide, angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, or calcium channel blocker class as first line in all others; (5) beta blockers should be avoided as first line unless there is a compelling cardiac indication. A total of 372 254 cases from January 2010 to March 2020 are in the FSR with a diagnosis of acute ischemic stroke, hemorrhagic stroke, transient ischemic attack, or subarachnoid hemorrhage; 265 409 with complete data were included in the final analysis. Mean age was 70±14 years; 50% were women; and index stroke subtypes were 74% acute ischemic stroke, 11% intracerebral hemorrhage, 11% transient ischemic attack, and 4% subarachnoid hemorrhage. BP‐guideline adherence to each specific rule ranged from 48% to 74%, which is below quality standards of 80%, and was lower among Black patients (odds ratio, 0.7 [95% CI, 0.7–0.83]; P<0.001) and those with atrial fibrillation (odds ratio, 0.53 [95% CI, 0.50–0.56]; P<0.001) and diabetes (odds ratio, 0.65 [95% CI, 0.61–0.68]; P<0.001). Conclusions This large data set demonstrates consistently low rates of BP‐guideline adherence over 10 years. There is an opportunity for monitoring hypertensive management after stroke. |
| first_indexed | 2024-03-10T13:09:19Z |
| format | Article |
| id | doaj.art-0df465e4958048e0be8f018736851175 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-10T13:09:19Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-0df465e4958048e0be8f0187368511752023-11-21T10:53:12ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-11-01122210.1161/JAHA.123.030272Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke RegistryGillian Gordon Perue0Hao Ying1Antonio Bustillo2Lili Zhou3Carolina M. Gutierrez4Hannah E. Gardener5Judith Krigman6Angus Jameson7Chuanhui Dong8Tatjana Rundek9David Z. Rose10Jose G. Romano11Ayham Alkhachroum12Ralph L. Sacco13Negar Asdaghi14Sebastian Koch15Department of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLUniversity of South Florida Morsani College of Medicine Tampa FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLUniversity of South Florida Morsani College of Medicine Tampa FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLDepartment of Neurology, Leonard M. Miller School of Medicine University of Miami Miami FLBackground Guideline‐based hypertension management is integral to the prevention of stroke. We examine trends in antihypertensive medications prescribed after stroke and assess how well a prescriber's blood pressure (BP) medication choice adheres to clinical practice guidelines (BP‐guideline adherence). Methods and Results The FSR (Florida Stroke Registry) uses statewide data prospectively collected for all acute stroke admissions. Based on established guidelines, we defined optimal BP‐guideline adherence using the following hierarchy of rules: (1) use of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker as first‐line antihypertensive among diabetics; (2) use of thiazide‐type diuretics or calcium channel blockers among Black patients; (3) use of beta blockers among patients with compelling cardiac indication; (4) use of thiazide, angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, or calcium channel blocker class as first line in all others; (5) beta blockers should be avoided as first line unless there is a compelling cardiac indication. A total of 372 254 cases from January 2010 to March 2020 are in the FSR with a diagnosis of acute ischemic stroke, hemorrhagic stroke, transient ischemic attack, or subarachnoid hemorrhage; 265 409 with complete data were included in the final analysis. Mean age was 70±14 years; 50% were women; and index stroke subtypes were 74% acute ischemic stroke, 11% intracerebral hemorrhage, 11% transient ischemic attack, and 4% subarachnoid hemorrhage. BP‐guideline adherence to each specific rule ranged from 48% to 74%, which is below quality standards of 80%, and was lower among Black patients (odds ratio, 0.7 [95% CI, 0.7–0.83]; P<0.001) and those with atrial fibrillation (odds ratio, 0.53 [95% CI, 0.50–0.56]; P<0.001) and diabetes (odds ratio, 0.65 [95% CI, 0.61–0.68]; P<0.001). Conclusions This large data set demonstrates consistently low rates of BP‐guideline adherence over 10 years. There is an opportunity for monitoring hypertensive management after stroke.https://www.ahajournals.org/doi/10.1161/JAHA.123.030272blood pressuredisparitiesethnicityFloridahypertensionrace |
| spellingShingle | Gillian Gordon Perue Hao Ying Antonio Bustillo Lili Zhou Carolina M. Gutierrez Hannah E. Gardener Judith Krigman Angus Jameson Chuanhui Dong Tatjana Rundek David Z. Rose Jose G. Romano Ayham Alkhachroum Ralph L. Sacco Negar Asdaghi Sebastian Koch Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease blood pressure disparities ethnicity Florida hypertension race |
| title | Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry |
| title_full | Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry |
| title_fullStr | Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry |
| title_full_unstemmed | Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry |
| title_short | Ten‐Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry |
| title_sort | ten year review of antihypertensive prescribing practices after stroke and the associated disparities from the florida stroke registry |
| topic | blood pressure disparities ethnicity Florida hypertension race |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.030272 |
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