Blood Pressure Status One Year Post-stroke: Findings from the Northern Manhattan Stroke Study
Objective To describe blood pressure (BP) status in a multi-ethnic community-based cohort of stroke survivors one year post-stroke. Background Hypertension (HTN) is a critical stroke risk factor with recent studies demonstrating increased risk even in borderline HTN. Further, uncontrolled HTN may contribute to recurrence and mortality among stroke survivors. Despite established treatment for HTN, control of BP in certain populations may be less than optimal. Methods As part of the Northern Manhattan Stroke Study, we prospectively followed a cohort of community based stroke survivors annually. At 1 year follow-up we collected outcomes, BP measurements, medical, demographic and behavioral data. BP status at 1 year post stroke was categorized as normal (<140 /90 mmHg), mildly elevated (≥ 140mmHg or ≥ 90 mmHg) or severely elevated (BP≥ 160 mmHg and /or BP ≥ 95 mmHg). Logistic regression was used to investigate predictors of BP status. Results There were 655 ischemic stroke cases eligible for follow-up. At one year, 107 were dead and 527 were seen in person. The cohort was 55% women; 17% white, 27% black, 54% Hispanic; mean age 69 ± 12 yrs. At follow-up, 51% (n=271) of cases had elevated BP; 19% (96) were severely elevated. Among the 271 cases with elevated BP, 45% had been discharged on antihypertensives following their stroke. Univariate predictors of elevated BP at 1 year were: < H.S. education (OR 1.7 p<.006), race-ethnicity [Hispanic vs white (OR 2.8, p<.0001) , black vs white (OR 2.0, p<.01)], younger age (OR 1.1, p<.008), and having few friends (OR 1.9, p<.06). Conclusion Adequate control of BP 1 year post stroke is sub-optimal. Our results suggest that despite the availability of efficacious treatments for HTN, underlying socio-demographic conditions continue to deter regulation of blood pressure.