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(Stroke. 2000;31:415.)
© 2000 American Heart Association, Inc.

Original Contributions

Blood Pressure Exceeding National Guidelines Among Women After Stroke

Walter N. Kernan, MD; Catherine M. Viscoli, PhD; Lawrence M. Brass, MD; Robert W. Makuch, PhD; Philip M. Sarrel, MD Ralph I. Horwitz, MD

From the Departments of Internal Medicine (W.N.K., C.M.V., R.I.H.), Epidemiology and Public Health (L.M.B., R.W.M., R.I.H.), Neurology (L.M.B.), Psychiatry (P.M.S.), and Obstetrics and Gynecology (P.M.S.), Yale University School of Medicine, New Haven, Conn; and the Veterans Administration Connecticut Healthcare System (L.M.B.).

Correspondence and reprint requests to Walter N. Kernan, MD, Primary Care Center, Yale-New Haven Hospital, 20 York St, New Haven, CT 06504. E-mail walter.kernan{at}yale.edu

Background and Purpose—After a transient ischemic attack or stroke, the risk for recurrence may be reduced by treatment of hypertension. The purpose of this study was to determine how commonly blood pressure exceeds national guidelines among patients who have had one of these events.

Methods—Subjects were 644 women participating in a randomized trial of estrogen for secondary stroke prevention. We measured blood pressure 1 month after the stroke or TIA while patients were under the care of their personal physicians. Among 536 patients, a second measure was made at an average of 2.9 years after the first.

Results—The mean age of participants was 71 years, and 73% reported a history of hypertension. At baseline, only 44% (280/644) of the women had blood pressure values within national guidelines (<140/90 mm Hg). With separate guidelines used for diabetics (<130/85 mm Hg) and nondiabetics (<140/90 mm Hg), the proportions of women within the guidelines were 27% and 44%, respectively. Overall, 39% of patients were within the diabetes-adjusted guidelines. Among patients whose blood pressure exceeded 140/90 mm Hg at first examination, 55% were still in excess at follow-up. Features associated with severe hypertension at first examination (>160/100 mm Hg) were history of hypertension, education less than college, and higher cognitive functioning.

Conclusions—Blood pressure values in excess of national guidelines are common after stroke and TIA, especially among diabetic patients. Efforts to lower blood pressure control may enhance secondary prevention.

Key Words: cerebrovascular disorders • hypertension • adherence • prognosis • randomized clinical trials • health services research

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