Blood pressure control in patients with a previous stroke/transient ischaemic attack in primary care in Ireland: a cross sectional study

Abstract

Background Uncontrolled blood pressure (BP) is an important modifiable risk factor for recurrent stroke. Secondary prevention measures when implemented can reduce stroke re-occurrence by 80%. However, hypertension control rates remain sub-optimal, and little data is available from primary care where most management occurs. The aim of this study was to describe BP control in primary care-based patients with a previous stroke or transient ischaemic attack (TIA) in Ireland, and to concurrently examine antihypertensive medication-dosing. Methods Study participants most recent office-based BP reading was compared with the NICE (NG136) and European Society of Hypertension/ European Society of Cardiology (ESH/ESC 2013) goal of BP < 140/90 mmHg. Optimal anti-hypertensive medication dosing was determined by benchmarking prescribed doses for each drug with the World Health Organisation-Defined Daily Dosing (WHO-DDD) recommendations. Results We identified 328 patients with a previous stroke or TIA in 10 practices. Blood pressure was controlled in almost two thirds of patients when measured against the ESH/ESC and NICE guidelines (63.1%, n = 207). Of those with BP ≥140/90 ( n = 116), just under half ( n = 44, 47.3%) were adequately dosed in all anti-hypertensive medications when compared with the WHO-DDD recommendations. Conclusion Blood pressure control in patients post stroke/TIA appears sub-optimal in over one third of patients. A comparison of drug doses with WHO-DDD recommendations suggests that 47% of patients may benefit from drug-dose improvements. Further work is required to assess how best to manage blood pressure in patients with a previous stroke or TIA in Primary Care, as most consultations for hypertension take place in this setting.

Adequacy of blood pressure control in high-risk hypertensive patients: The DEGREE study

“…However, despite the broad availability of lifestyle interventions and drug treatment, BP targets are met in merely 28.4 to 38.8% in general cohort of hypertensive patients [2,7,8]. Similar rates were reported in particular subgroups, such as patients with a history of coronary artery disease or stroke [9,10]. However, no dedicated prospectively gathered data are available on the adequacy of BP control in a more heterogeneous, real-world cohort of high-risk patients as defined per-and treated according to contemporary guidelines [2,11].…”

Towards an integrated blood pressure self-monitoring solution for stroke/TIA in Ireland: a mixed methods feasibility study for the TASMIN5S IRL randomised controlled trial

“…General practices in counties Limerick and Clare, in the mid-west of Ireland, who had taken part in a recent cross-sectional survey of stroke and TIA [8] were invited to take part in the feasibility study. All practices used electronic medical records (EMRs) and cared for both public (funded through the Primary Care Reimbursement Service (PCRS) scheme [16]) and private (fee-paying) patients.…”

“…A survey of secondary prevention of stroke in Europe has shown that satisfactory levels of blood pressure control were found in less than 60% of countries [7]. A recent cross-sectional survey in Irish General Practice [8] demonstrated that one-third of patients did not have their blood pressure adequately controlled. The reasons for sub-optimal BP control are multi-faceted.…”

Long-Term Secondary Prevention: Management of Blood Pressure After a Transient Ischemic Attack or Stroke

“…For now, in light of the evidence described above, a target systolic BP of <130 mm Hg should apply to the vast majority of patients after TIA/stroke, except in severe intracranial atherosclerotic stenosis where a slightly more liberal target of <140 mm Hg is recommended. [60][61][62] Given that only a third of patients even achieve a BP of 130/80 mm Hg after stroke, [14][15][16] considerations of over-treatment in select patient groups should not deter pursuit of tight BP control.…”

“…[7][8][9] Randomized trials have established that lowering BP reduces this risk, 10 but long-term BP control after stroke in practice remains poor, due in part to widespread under-treatment and under-adherence. [11][12][13] Only a third of patients achieve guideline BP targets [14][15][16] and over 20% discontinue their antihypertensive drugs within the first year after stroke. 17 A lack of clarity surrounding best practice for assessment and control of BP in secondary prevention of stroke might be a contributing factor to inadequate BP management in current practice.…”