Blood pressure control and risk profile in poststroke survivors: a comparison with the general population

Hypertension Management in Stroke Prevention: Time to Consider Primary Aldosteronism

Primary aldosteronism confers a higher risk of stroke, atrial fibrillation, and cardiovascular disease than blood pressure matched essential hypertension. It is the most common endocrine cause of secondary hypertension with prevalence estimates of up to 13% in primary care and 30% in referral centers around the world. Unlike essential hypertension, primary aldosteronism has targeted medical treatment and potentially curative surgical solutions which can ameliorate the associated cardiovascular risks. This narrative review highlights an evidence gap in the optimal diagnosis and targeted treatment of primary aldosteronism in secondary stroke prevention. Over half of the patients suffering a stroke have blood pressure in the hypertensive range and less than a third achieve optimal blood pressure control. There are no guideline recommendations to test for primary aldosteronism in these patients, although up to 30% of patients with resistant hypertension may have this disease. The accurate diagnosis of primary aldosteronism could significantly improve blood pressure, simplify the medication regimen and reduce the overall cardiovascular risk in these patients. The challenges associated with screening for primary aldosteronism following stroke may be overcome by novel blood tests which are less affected by antihypertensive medications routinely used in stroke care. Approximately one-quarter of all strokes occur in patients who have previously had a stroke. Modifying hypertension, the leading modifiable risk factor, would, therefore, have significant public health implications. As clinicians, we must increase our awareness of primary aldosteronism in patients with stroke, particularly in those with resistant hypertension, to enable targeted therapy and reduce the risk of stroke recurrence.

Clinical care & blood pressure control among hypertensive people living with human immune deficiency virus: Prospective cohort study

BACKGROUND

Hypertension has emerged as a new threat to the health and well-being of people living with human immune deficiency virus (PLHIV). However, no data exist on care delivery and blood pressure control over time in Ethiopia. We assessed clinical care & level of blood pressure control among hypertensive people living with Human Immune Deficiency Virus (HIV).

METHODS

We conducted a prospective cohort study among adult hypertensive PLHIV and HIV-negative patientsat chronic care clinics of Jimma University Medical Center in Ethiopia. We explored self-management practices and blood pressure control of study participants. Multivariable Cox-regression was used to identify the predictors of the outcome.

RESULTS

A total of 303 eligible participants with mean age of 43.30 ± 12.55years were followed and males comprised of 52.1%. After 12 months of follow-up, 60.2% of HIV-positive and 53% of HIV-negative patients showed uncontrolled blood pressure. The overall perception of self-management behaviors was 2.10 ± 0.77 (p = 0.122), which was at moderate level. An increased waist circumference [AHR: 2.16; 95% CI: (1.58-5.18);p = 0.021],chronic disease co-morbidity[AHR:3.94;95%CI:(2.24-8.74);p = 0.046],alcohol use history[AHR:1.26; 95%CI:(1.08-2.23);p = 0.031], HIV infection[AHR:3.06;95%CI:(1.93-11.34);p=0.042], infrequent use of fruits & vegetables [AHR:3.77;95%CI: (1.34-10.57);p=0.012], infrequent engagement on physical exercise[AHR:3.48;95%CI:(1.48-8.17);p = 0.004],frequent use of high fats food [AHR:2.56;95%CI: (1.25-5.25);p = 0.011] were an independent predictors of uncontrolled blood pressure.

CONCLUSION

The rate of uncontrolled blood pressure is significantly higher in the HIV- infected population. There was a gap in the clinical care of hypertension in terms of hypertension self-management among hypertensive HIV-positive patients. Our study highlights the need for better integration of hypertension care to HIV clinical setting.

Seguimiento de las recomendaciones en prevención secundaria cerebrovascular en atención primaria

Objetivo

Conocer el grado de seguimiento de las recomendaciones en prevención secundaria cerebrovascular en atención primaria e identificar factores asociados.

Diseño

Transversal multicéntrico.

Emplazamiento

Centros de salud de atención primaria de un área metropolitana (944.280 habitantes).

Participantes

Pacientes mayores de 18 años con diagnóstico de enfermedad cerebrovascular antes de 6 meses del estudio.

Mediciones principales

Extracción de historia clínica informatizada de variables demográficas, factores de riesgo y comorbilidad cardiovascular, fármacos, valores de presión arterial (PA), colesterol LDL y visitas por medicina y enfermería posteriores al episodio. Se consideró buen control: PA < 140/90 mmHg, colesterol LDL < 100 mg/dl, abstención tabáquica y prescripción de fármacos preventivos (antiagregantes/anticoagulantes, estatinas e IECA/ARA II o diurético) en los últimos 18 meses.

Resultados

Un total de 21.976 sujetos, media de edad 73,1 años (DE: 12,1), 48% mujeres, el 72,7% con accidente vascular cerebral establecido. Comorbilidad: 70,8% HTA, 55,1% dislipidemia, 30,9% DM, 14,1% fibrilación auricular, 13,5% cardiopatía isquémica, 12,5% insuficiencia renal crónica, 8,8% insuficiencia cardiaca, 6,2% arteriopatía periférica, 7,8% demencia. Sin registro de: hábito tabáquico 3,7%, PA 3,5% y colesterol LDL 6,5%. Grado de control: 75,4% abstención tabáquica, 65,7% PA < 140/90 y 41,0% colesterol LDL < 100 mg/dl. Tratamiento: 86,2% antiagregantes/anticoagulantes, 61,3% estatinas y 61,8% IECA/ARA II o diurético. El registro/grado de control fue superior en el grupo de 66-79 años e inferior en el de 18-40 años.

Conclusiones

El seguimiento de las recomendaciones de las guías clínicas para la prevención de la enfermedad cerebrovascular en atención primaria es mejorable, especialmente en los más jóvenes. Son necesarios cambios organizativos e intervención más activa de los profesionales, así como estrategias para combatir la inercia terapéutica.

Blood Pressure Control among Hypertensive Stroke Survivors in Nigeria

BACKGROUND

Hypertension is the dominant risk factor for first-ever and recurrent stroke. The objective of the present study was to assess control of blood pressure (BP) among hypertensive stroke survivors seen at 2 tertiary hospitals in Nigeria.

METHODS

Using a cross-sectional design, stroke survivors with hypertension as a risk factor were consecutively recruited in the outpatient clinics of the participating hospitals. After the necessary demographic and clinical information had been obtained, participants had their BP assessed in a standardized manner. A BP of <140/< 90 mmHg was defined as good control. Univariate binary logistic regression analysis was performed to determine the predictors of good BP control.

RESULTS

There were 284 subjects with a mean age of 59.0 ± 13.1 years. The overall mean systolic blood pressure was 142.7 ± 22.5 mmHg (male 144.9 ± 22.7, female 138.4 ± 21.6; P > .05) while the overall mean diastolic blood pressure was 85.6 ± 14.5 mmHg (male 85.8 ± 14.6, female 85.2 ± 14.4; P > .05). In spite of the fact that 270 (95.1%) of the subjects were on antihypertensives, only 39.8% (male 37.0%, female 44.1%; P > .05) had good BP control. In univariate analysis, having at least 12 years of formal education (OR 1.672, 95% CI 1.035-2.699; P < .05) and good compliance to antihypertensive medications (OR 9.732, 95% CI 3.391-27.930; P < .001) were the only variables associated with good BP control.

CONCLUSIONS

Control of BP is poor among Nigerian hypertensive stroke survivors and is associated with the level of formal education and drug compliance. Urgent measures are needed to improve on this poor BP control as these may potentially reduce stroke recurrence rate.