Abstract 211: Socioeconomic and Patient Factors Associated with Pre-stroke Treatment of Hypertension
Background: Identifying high risk populations for stroke that are not receiving treatment for hypertension can help improve targeted care. Hypertension is the major modifiable risk factor for stroke. Treatment of hypertension is mainstay of primary and secondary stroke prevention and is usually conducted by physicians in primary care settings. New York City has private and public health systems that theoretically make access to hypertension treatment available to its citizens regardless of socioeconomic status and insurance status.
Objective: To determine if socioeconomic or other patient factors may be associated with pre-stroke treatment of hypertension.
Methods: This cross sectional analysis used data from SWIFT (Stroke Warning Information and Faster Treatment), a prospective population-based ethnically diverse stroke preparedness cohort of ischemic stroke/TIA survivors. The study population of untreated hypertension (UHTN) was defined as SBP ≥ 140 mmHg, DBP ≥ 90, and no history of hypertension prior to event. Regression models examined relationship between UHTN and race/ethnicity, gender, age, level of education, nativity, primary care visits, native languages, and insurance status.
Results: Among 1193 stroke/TIA patients, 809 had hypertension and of that group, 94 (11.6%) were undiagnosed prior to the index event. Bivariate and logistic regression models for race, gender, age, language, education, nativity do not explain differences in pre-stroke treatment of hypertension. In the full model, patients without health insurance (2.29, 95% C.I. 1.29, 4.13) and those with less than 1 visit per year to a primary care physician were (2.94, 95% C.I. 1.86, 4.65) were significantly associated with untreated hypertension.
Conclusion: Alternate strategies that do not rely on primary care may be necessary to reach patients without insurance or primary care physicians to treat hypertension prior to stroke. Future studies should investigate other screening opportunities such as health fairs, emergency department visits, or workplace screening.
Author Disclosures: P. Chatterjee: None. E.T. Roberts: None. B. Boden-Albala: Research Grant; Significant; NIH NINDS and NIMHD funding.
- © 2015 by American Heart Association, Inc.