Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure

Christianne L. Roumie, Alan J. Zillich, Dawn M. Bravata, Heather A. Jaynes, Laura J. Myers, Joseph Yoder, Eric M. Cheng

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8 Scopus citations


BACKGROUND AND PURPOSE - : We examined blood pressure 1 year after stroke discharge and its association with treatment intensification. METHODS - : We examined the systolic blood pressure (SBP) stratified by discharge SBP (≤140, 141-160, or >160 mm Hg) among a national cohort of Veterans discharged after acute ischemic stroke. Hypertension treatment opportunities were defined as outpatient SBP >160 mm Hg or repeated SBPs >140 mm Hg. Treatment intensification was defined as the proportion of treatment opportunities with antihypertensive changes (range, 0%-100%, where 100% indicates that each elevated SBP always resulted in medication change). RESULTS - : Among 3153 patients with ischemic stroke, 38% had ≥1 elevated outpatient SBP eligible for treatment intensification in the 1 year after stroke. Thirty percent of patients had a discharge SBP ≤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 >160 mm Hg had an average of 2.4 intensification opportunities, and treatment intensification occurred in 65% of visits. CONCLUSIONS - : Patients with discharge SBP >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.

Original languageEnglish (US)
Pages (from-to)465-470
Number of pages6
Issue number2
StatePublished - Feb 6 2015



  • health services research
  • hypertension
  • medication adherence
  • secondary prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Roumie, C. L., Zillich, A. J., Bravata, D. M., Jaynes, H. A., Myers, L. J., Yoder, J., & Cheng, E. M. (2015). Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure. Stroke, 46(2), 465-470. https://doi.org/10.1161/STROKEAHA.114.007566