Abstract TP415: Regular Home Blood Pressure Monitoring Reduces the Risk of Stroke Recurrence

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Wenjun Deng ◽  
David McMullin ◽  
Lindsay Fisher ◽  
Richard Chou ◽  
Jared Jacobson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Stroke Prevention ◽  
Blood Pressure Monitoring ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention ◽  
Stroke Patients ◽  
Self Monitoring ◽  
Recurrent Strokes ◽  
At Home

Background: High blood pressure (BP) is a well recognized risk factor for ischemic stroke, and aggressive BP control is critical for secondary stroke prevention. However, hypertensive (HTN) outpatients are often found to have uncontrolled BP, in part due to poor compliance with daily at-home BP monitoring and consequent poor medication adherence. Here, we explore the association of patient home BP self-monitoring compliance with stroke recurrence. Method: Ischemic stroke patients with pre-existing HTN were prospectively recruited in accordance with IRB protocol for this observational study. All patients were trained on BP self-monitoring as per standard of care, and were asked to monitor BP at home daily consistently for 2 weeks. BP monitoring compliance, per completion of BP log, was assessed at each follow-up clinical visit by an investigator blinded to patient outcome. Stroke recurrence was followed for 5 years and independently adjudicated by two vascular neurologists. Result: In a total of 219 patients, only 36 patients (16.4%) were compliant in completing the home BP log as instructed. The compliant and non-compliant groups showed no baseline difference and no medication usage difference (p>0.05) (Table 1). Compliance with at-home BP monitoring was associated with well controlled systolic (p<0.001) and diastolic BP (p<0.001). Of note, 30 patients (16.4%) had recurrent strokes in the non-compliant group, while there were no recurrent strokes in the compliant group. BP self-monitoring compliance is associated with reduced incidence of stroke recurrence (p=0.030) and the significance remains robust after adjusting for multiple confounders (p=0.029) (Table 2). Conclusion: Regular home BP monitoring is associated with lower risk of stroke recurrence in HTN stroke patients. Study in expanded patient cohort is ongoing to leverage technology for better home BP monitoring and to create incentives for compliant behavior for better secondary stroke prevention.

Abstract T MP39: Could Difficult-to-treat Hypertension Be a Predictor of Bad Outcome in Ischemic Stroke?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Pedro Colla Machado ◽  
Maria C Zurru ◽  
Ariel Luzzi ◽  
Laura Brescacin ◽  
Claudia Alonzo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Clinical Practice ◽  
Stroke Prevention ◽  
Demographic Data ◽  
Stroke Recurrence ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Blood Pressure Targets ◽  
Adherence To Medication

Background and purpose: hypertension is the vascular risk factor most commonly related to stroke, making antihypertensive treatment a cornerstone of stroke prevention. Achieving targets of clinical practice guidelines could be difficult in some patients, requiring combination of drugs to maintain these goals. We aimed to evaluate the relationship between difficult-to-treat hypertension (DTTH) and stroke outcomes. Methods: acute ischemic stroke patients were prospectively included in PROTEGE-ACV, a multidisciplinary secondary stroke prevention program. Demographic data, vascular risk factors (VRF) profile and control, and stroke outcome (disability, mortality and stroke recurrence) were evaluated 30 days after stroke. Difficult-to-treat hypertension was defined as those requiring more than two drugs in hypertension management. Results: we analyzed data of the 1194 stroke patients included between December 2006 and December 2013. We found 186 DTTH patients, who had higher burden of VRF and poorer pre-stroke control (table); they had higher admission blood pressure (0 drugs 146/82 mmHg, 1 drug 151/84, 2 drugs 154/83, 3 drugs 153/83, 4 drugs 169/88; p 0.001 for SBP, 0.26 for DBP) and pulse pressure (63 mmHg, 66 mmHg, 70 mmHg, 67 mmHg, 81 mmHg respectively; p 0.0006). These patients had also worst 30-day outcome: m-Rankin >1 (24% in no-DTTH vs 54% in DTTH, 0.0001), mortality (1% vs 16%, p 0.001), composite disability + all cause death (44% vs 73%, p 0.001). We found no difference in early stroke recurrence. Conclusion: the number of drugs necessary to treat hypertension could be useful to identify barriers to achieve blood pressure targets for vascular disease prevention, as vascular aging, hemodynamic changes, adherence to medication and healthy lifestyle. This indicator is easy to collect and could help to decision making in daily clinical practice.

Abstract P132: Clinical Outcomes In Ischemic Stroke Patients With Uncontrolled Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Zahra Abuzaid ◽  
Sara Almuslem ◽  
Farah Aleisa
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Recurrent Stroke ◽  
Uncontrolled Hypertension ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Event ◽  
Uncontrolled Blood Pressure

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.

Abstract 81: Translesional Pressure Gradient Alters the Relationship Between Blood Pressure and Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Disease

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xueyan Feng ◽  
Ka Lung Chan ◽  
Jill Abrigo ◽  
Linda Lan ◽  
Yannie Soo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pressure Gradient ◽  
Stroke Prevention ◽  
Primary Outcome ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention ◽  
Cfd Models ◽  
Intracranial Atherosclerotic Disease ◽  
The Relationship

Objective: Patients with symptomatic intracranial atherosclerotic stenosis (sICAS) have a high risk of stroke recurrence. There is debate over an optimal blood pressure (BP) lowering target in secondary stroke prevention in such patients, when some factors (e.g., impaired cerebral perfusion) may alter the relationship between BP and risk of stroke recurrence. In this study, we investigated whether translesional pressure gradient across sICAS lesions would also alter such relationship. Methods: We recruited patients with sICAS (50-99% stenosis) confirmed in CT angiography (CTA). Computational fluid dynamics (CFD) models were built based on CTA to simulate blood flow across sICAS and calculate the translesional pressure ratio (PR, the ratio of pressures distal and proximal to a lesion). PR ≤ median was defined as low PR, indicating larger translesional pressure gradient and hence restricted downstream perfusion. The primary outcome was recurrent ischemic stroke in the same territory in 1 year. We investigated the interaction of PR and mean systolic BP (SBP) during follow-up in determining the risk of the primary outcome. Results: Among 157 patients, the median PR was 0.93. Multivariate Cox regression revealed significant PR-SBP interaction on the primary outcome (p=0.025): in patients with normal PR, the risk of primary outcome significantly decreased with lower SBP during follow-up (for 10 mmHg decrement: HR 0.46; p=0.018); however, in those with low PR, mean SBP ≤130 mmHg was associated with significantly increased risk of primary outcome, compared with 130<SBP<150mmHg (HR 5.08; p=0.043) (Figure). Conclusion: Intensive BP lowering may increase the risk of stroke recurrence in sICAS patients with a large translesional pressure gradient, warranting further investigation. PR by CFD models may yield a promising indicator to differentiate sICAS patients for different BP management strategies for better secondary stroke prevention.

scholarly journals Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

2021 ◽  
Vol 23 (1) ◽  
pp. 51-60
Author(s):  
Yuesong Pan ◽  
Zixiao Li ◽  
Jiejie Li ◽  
Aoming Jin ◽  
Jinxi Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Acute Ischemic Stroke ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Antihypertensive Agents ◽  
Residual Risk ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention

Background and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.Methods Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.Results Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.Conclusions There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

Abstract WP94: Higher Mortality in Slow Blood Pressure Droppers: Blood Pressure Trajectory Groups of 1-Year After Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Keon-Joo Lee ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Joon-Tae Kim ◽  
Kang Ho Choi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Time Course ◽  
Information Criterion ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Composite Events

Introduction: Although the effect of blood pressure in post-stroke outcome is well recognized, the long-term time course of BP following acute ischemic stroke and it’s influence to outcomes have not been well elucidated. Method: From a multicenter prospective registry of acute ischemic stroke patients, a total of 5,514 patients with measurement of systolic blood pressure (SBP) in more than 2 of 7 prespecified time points up to 1 year after symptom onset were analyzed. The patients were grouped according to longitudinal SBPs of each patient using a group-based trajectory model, and number of groups were determined by the optimal delta-Bayesian Information Criterion. Outcome measures, which were stroke recurrence, mortality and composite of each events along with myocardial infarction were prospectively collected up to 1 year after symptom onset. Results: Patients were categorized into four groups according to their SBP trajectories: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%). After adjustment for pre-determined covariates, there were higher risk of stroke recurrence in persistently high SBP group (hazard ratio (HR), 2.28 [95% confidence interval (CI), 1.01-5.12]). Mortality was higher only in the slowly dropping SBP group (HR, 1.50 [95% CI, 1.09-2.05]). Composite events were higher in both persistently high (HR, 1.96 [95% CI, 1.02-3.75]) and slowing dropping (HR, 1.54 [95% CI, 1.18-2.00]) SBP groups. Conclusion: There were a group of patterns in long-term longitudinal SBP changes after acute ischemic stroke. Especially, slow BP droppers might have a distinct nature with higher mortality and would be a target for future investigations.

scholarly journals Factors Affecting Non-Adherence to Secondary Stroke Prevention Therapy in Ischemic Stroke Patients

2018 ◽  
Vol 8 (2) ◽  
pp. 90
Author(s):  
Zakky Cholisoh ◽  
Hidayah Karuniawati ◽  
Tanti Azizah ◽  
Zaenab Zaenab ◽  
Laila Nur Hekmah
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Antihypertensive Agents ◽  
Heart Association ◽  
Secondary Stroke Prevention ◽  
Stroke Patients ◽  
Factors Affecting ◽  
Prevention Therapy

Stroke is cardiovascular disease that causes the world's highest disability and is the most prevalence disease after heart disease and cancer. Stroke is caused by circulatory disorders with 80% of the sufferers are diagnosed with ischemic stroke and 20% of them are diagnosed with hemorrhagic stroke. Patients who survive from the first stroke have high risk to have recurrent stroke. American Heart Association/American Stroke Association and Perhimpunan Dokter Spesialis Syaraf Indonesia recommend secondary stroke prevention therapy including antiplatelet/anticoagulant, antihypertensive agents, and antidislipidemia to minimalize the risk of recurrent stroke. Secondary stroke prevention therapy is only the first step. Patients need to be adhere to those therapies. The non-adherence will increase the risk of recurrent stroke. The study aimed to determine factors which causing the non-adherence to secondary prevention therapy in patients with ischemic stroke. This was a case control study with concecutive sampling method by interviewing patients who met the inclusion criterias i.e., had been diagnosed and were inpatients due to ischemic stroke, but in the time of interview patients were outpatients, patients were able to communicate and agree to participate in the study.Data was analized by bivariate / chi square test and multivariate logistic regression test. During the study period, 184 respondents met the inclusion criterias. Factors affecting non-adherence in the use of secondary prevention therapy were No one reminded to take medicine p = 0.03; OR 4.51, denial of the disease p = 0,036 OR 214, and tired of taking medicine p = 0,045 OR 1,97.

scholarly journals Association between Modifiable Risk Factors and Stroke Recurrence in Patients with First Ever Ischemic Stroke

2017 ◽  
Vol 33 (2) ◽  
pp. 55-62
Author(s):  
Shahadat Hassan ◽  
Md Rafiqul Islam ◽  
Hasan Zahidur Rahman
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Recurrent Stroke ◽  
Adult Population ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Mortality And Morbidity ◽  
Uncontrolled Diabetes

Background: Stroke is the third leading cause of death in adult population throughout the world and is the most common cause of severe adult physical disability. It is increasing at an alarming rate in Asia including Bangladesh. The effect of recurrent stroke is devastating on patient as it is the main reason of mortality and morbidity among patients. Methods: A longitudinal, observational study was conducted from April 2018 to October 2018 in the department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka. All the patients of first ever ischemic stroke confirmed by neuroimaging (CT scan of head / MRI of brain), meeting the inclusion and exclusion criteria were included in the study. Our study was performed with sixty stroke patients. We followed up patient up to 90 days and observed for stroke recurrence. Results: Present study showed among the 60 stroke patients, only 4 (6.67%) suffered from stroke recurrence within 3 months. In our study, uncontrolled systolic blood pressure (p=0.04), uncontrolled diastolic blood pressure (p=0.027), dyslipidaemia (p=0.001), smoking (p=0.0003) and antiplatelet discontinuation (p=0.0001) were significantly associated with stroke recurrence whereas uncontrolled diabetes mellitus (p=0.46) and presence of atrial fibrillation (p=0.057) had no significant association. Conclusion: Smoking, hypercholesterolemia, uncontrolled systolic &/or diastolic blood pressure and discontinuation of antiplatelet therapy were significantly associated with stroke recurrence in this population. Therefore, early identification and control of these risk factors are essential to prevent recurrent stroke, thereby decrease morbidity and mortality. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 55-62

scholarly journals One-Year Systolic Blood Pressure Trajectory After Acute Ischemic Stroke

2021 ◽  
Author(s):  
Keon-Joo Lee ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Joon-Tae Kim ◽  
Kang Ho Choi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke ◽  
Adverse Outcomes ◽  
Stroke Onset ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
One Year

Abstract Although the effect of blood pressure on post-stroke outcome is well-recognized, the long-term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not yet been fully elucidated. From a multicenter prospective registry of acute ischemic stroke patients, 5,514 patients with measurements of systolic blood pressure (SBP) at more than 2 of 7 prespecified time-points, up to 1-year after stroke onset, were analyzed. Outcome measures, a composite of stroke recurrence, myocardial infarction and mortality, and each stroke recurrence and mortality, were prospectively collected up to 1-year after stroke onset. The study subjects were categorized into 4 groups according to their SBP trajectories: Low (27.0%), Moderate (59.5%), Persistently high (1.2%), and Slowly dropping (12.4%). After adjustments for pre-determined covariates, the Slowly dropping SBP Group was at higher risk of the composite outcome (hazard ratio, 1.32; 95% confidence interval, 1.05‒1.65), and mortality (1.35; 1.03‒1.78) compared to the Moderate SBP Group. Four main 1-year longitudinal SBP trajectories were identified after acute ischemic stroke. One trajectory, slowly dropping SBP, was particularly prone to adverse outcomes after stroke. These findings provide possible leads for future investigations of SBP control targets after stroke.

Abstract TP413: Compliance to Consistent Home Blood Pressure Monitoring Reduces the Risk of Vascular Cognitive Impairment in Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Wenjun Deng ◽  
David McMullin ◽  
Lindsay Fisher ◽  
Richard Chou ◽  
Jared Jacobson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Small Vessel Disease ◽  
Blood Pressure Monitoring ◽  
Treatment Strategies ◽  
Home Monitoring ◽  
Vascular Cognitive Impairment ◽  
Home Blood Pressure ◽  
Stroke Patients ◽  
At Home

Background: Hypertension (HTN) is a well-recognized risk factor for vascular cognitive decline. Poorly controlled HTN is common in the outpatient setting, with multi-factorial components including a lack of consistent, continuous and accurate reporting of blood pressure (BP) to help clinicians to tailor therapy. In the current prospective study, we explore the association of stroke patients’ at-home BP self-monitoring compliance with clinical and imaging risk markers of developing cognitive impairment. Method: 146 consecutive stroke outpatients with diagnosed HTN were recruited per IRB protocol. All patients received BP education at their first clinical visit and were encouraged to monitor BP at home on a daily basis for two weeks three times during the course of the 5-year study. Compliance with BP monitoring was evaluated by completed BP log and questionnaire in follow-up visits at fixed intervals. At the end of the study, white matter disease (WMD) severity was estimated by Fazekas and Sheltens scores. Cognitive impairment was assessed using Montreal Cognitive Assessment (MoCA) scales. Result: Only 16.4% (n=24) patients had “good compliance,” monitoring their home BP regularly and consistently as instructed. The compliant group had better controlled systolic and diastolic BP (Figure A, p<0.05). As measured by Fazekas and Sheltens scales, patients compliant with BP monitoring had lower WMD burden (Figure B, p<0.05), and higher MoCA scores (Figure C, p=0.012) compared to noncompliant patients. Conclusion: Compliance with at-home BP monitoring is essential for better BP control in vascular cognitive impairment (VCI) patients post stroke. Consistent home BP monitoring resulted in decreased imaging-apparent small vessel disease and better long-term cognitive performance. Expanded study with a larger patient cohort is ongoing to account for other behavioral and psycho-social factors and to create improved home monitoring technology and treatment strategies.

scholarly journals Blood Pressure Variability Is Associated With White Matter Lesion Growth in Intracranial Atherosclerosis

2019 ◽  
Vol 32 (9) ◽  
pp. 918-924
Author(s):  
Bum Joon Kim ◽  
Sun U Kwon ◽  
Jong-Moo Park ◽  
Yang-Ha Hwang ◽  
Sung Hyuk Heo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
White Matter ◽  
Blood Pressure Variability ◽  
White Matter Lesion ◽  
Recurrent Stroke ◽  
Intracranial Atherosclerosis ◽  
Stroke Patients ◽  
Multivariable Analyses ◽  
At Home

Abstract BACKGROUND High blood pressure variability (BPV) is associated with recurrent stroke. We investigated the association between BPV, new ischemic lesions (NILs), and white matter lesion (WML) growth in patients with ischemic stroke due to intracranial atherosclerosis (ICAS). METHODS This study was performed as a post-hoc analysis of the STABLE-ICAS trial, which enrolled subacute ischemic stroke patients with symptomatic ICAS (>50% stenosis) and hypertension. BPV was measured at the office (visit by visit) and at home (day by day). Patients were divided into 3 groups (tertiles) according to their home BPV. WML growth and the occurrence of NILs were compared among the 3 groups. Multivariable analyses were performed to identify the independent risk factors of WML growth and NILs. RESULTS Of the 111 enrolled patients, 69 patients (67.6%) demonstrated WML growth and 15 patients (13.7%) had NILs. Patients with higher BPV demonstrated a more WML growth (50% vs. 61.8% vs. 83.8; P = 0.02, by tertiles) and more NILs (5.4% vs. 5.4% vs. 29.7%; P = 0.002, by tertiles). In multivariable analyses, old age [odds ratio (OR) = 1.052 (95% confidence interval (CI) = 1.005–1.101); P = 0.03] and home BPV [OR = 1.149 (95% CI = 1.013–1.304); P = 0.02] were independently associated with WML growth. Low mean diastolic blood pressure [OR = 0.913 (95% CI = 0.874–0.984); P = 0.02] and high home BPV [OR = 1.287 (95% CI = 1.086–1.526); P = 0.004] were independently associated with NILs at follow-up. CONCLUSIONS High BPV is associated with WML growth and NIL in ischemic stroke patients with symptomatic ICAS. BPV monitoring at home may be helpful.

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