Background:
Hypertension (HTN) is a well-established, modifiable stroke risk factor. National HTN management trends among stroke survivors may provide important insight into secondary preventive treatment gaps. We investigated the adequacy of blood pressure (BP) control among stroke survivors and national antihypertensive (ATH) treatment trends.
Methods:
The National Health and Nutrition Examination Survey (NHANES) is a large, nationally representative cross-sectional survey conducted in 2-year cycles in the U.S. Evaluations include interviews, medication lists, physical examinations, and blood samples. We included participants aged >=20 years with HTN and history of stroke from 2005 to 2016. HTN was defined by self-report, ATH use, or uncontrolled HTN (BP >140/90) on physical examination. ATH medications were classified into calcium channel blockers, beta blockers, diuretics, and ACE inhibitors/angiotensin receptor blockers (ACE/ARBs). We report weighted frequencies and means using NHANES methodology, estimating the proportion of those with stroke with HTN. For all other analyses we examined those with stroke and HTN, summarizing number and classes of ATH, frequency of uncontrolled HTN, and associations between ATH classes and BP control. We examined trends in ATH use over time.
Results:
Among an estimated 6.4 million adults with history of stroke from 2005-2016, 78.2% had HTN but only 69.6% reported having been prescribed ATH medication. Among those with history of stroke and HTN (n=4971136), 37.1% (33.5-40.8%) had uncontrolled HTN on examination with 80.4% taking ATH. Most commonly used ATH medications were beta blockers (43.8%, 40.3-47.3%) and diuretics (41.5%, 37.2-45.8%). ATH classes associated with uncontrolled HTN included ACE/ARB (56.0%) and beta blockers (42.6%). Examining trends over time, diuretics have become less commonly used (49.4% in 2005-2006 vs. 35.7% in 2015-2016) whereas other classes remain more constant.
Conclusion:
Using a national survey, we found significant under-treatment of HTN in those with history of stroke, and >1/3 had uncontrolled HTN. Since HTN is a major stroke risk factor, this data demonstrates a significant missed opportunity nationally for secondary stroke prevention.
The Influence of Family History of Hypertension on Hypertension Prevalence, Management and Healthy Behaviors among Korean Adults: Results from the Korea National Health and Nutrition Examination Survey 2014–2016