Blood pressure control is a paramount goal in secondary stroke prevention; however, high prevalence of uncontrolled blood pressure and use of multiple antihypertensive medication classes in stroke patients suggest this goal is not being met. In a recent study, Dr. Virginia Howard, professor in the department of epidemiology at the University of Alabama at Birmingham, and a team of researchers determined the prevalence and factors associated with apparent treatment-resistant hypertension in persons with/without stroke or transient ischemic attack. UAB co-investigators include department colleagues Dr. Rikki Tanner, research assistant; Dr. Ryan Irvin, assistant professor; and Dr. Paul Muntner, professor and vice chair; as well as Drs. David A. Calhoun, and Suzanne Oparil, professors in UAB’s division of cardiovascular disease.
Data came from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based cohort of 30,239 black and white adults 45 years or older, enrolled between January 2003 and October 2007, restricted to 11,719 participants with treated hypertension. Apparent treatment-resistant hypertension was defined as: 1) uncontrolled blood pressure (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg) with three or more antihypertensive medication classes, or 2) use of four or more antihypertensive medication classes, regardless of blood pressure level. Poisson regression was used to calculate characteristics associated with apparent treatment-resistant hypertension.
Results indicate that among hypertensive participants, prevalence of apparent treatment-resistant hypertension was 24.9 percent and 17.0 percent in individuals with and without history of stroke or transient ischemic attack, respectively. After adjustment for cardiovascular risk factors, the prevalence ratio for apparent treatment-resistant hypertension for those with versus without stroke or transient ischemic attack was 1.14 (95 percent confidence interval: 1.03-1.27). Among hypertensive participants with stroke or transient attack, male sex, Black race, larger waist circumference, longer duration of hypertension, and reduced kidney function were associated with apparent treatment-resistant hypertension.
Dr. Howard and her colleagues concluded that the high prevalence of apparent treatment-resistant hypertension among hypertensive persons with history of stroke or transient ischemic attack suggests the need for more individualized blood pressure monitoring and management.
“Apparent Treatment-Resistant Hypertension among Individuals with History of Stroke or Transient Ischemic Attack” was published online in March 2015 in The American Journal of Medicine.
Journal article: http://www.amjmed.com/article/S0002-9343(15)00179-5/abstract