Abstract T MP39: Could Difficult-to-treat Hypertension Be a Predictor of Bad Outcome in Ischemic Stroke?
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.
Author Disclosures: P. Colla Machado: None. M.C. Zurru: None. A. Luzzi: None. L. Brescacin: None. C. Alonzo: None. L. Camera: None. G. Waisman: None. E. Cristiano: None.
- © 2015 by American Heart Association, Inc.