title: Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure.
abstract: OBJECTIVE
  We examined blood pressure 1 year after stroke discharge and its association with treatment intensification.
  
  
  METHODS
  We examined the systolic blood pressure (SBP) stratified by discharge SBP (≤140, 141-160, or >160 mm Hg) among a national cohort of Veterans discharged after acute ischemic stroke. Hypertension treatment opportunities were defined as outpatient SBP >160 mm Hg or repeated SBPs >140 mm Hg. Treatment intensification was defined as the proportion of treatment opportunities with antihypertensive changes (range, 0%-100%, where 100% indicates that each elevated SBP always resulted in medication change).
  
  
  RESULTS
  Among 3153 patients with ischemic stroke, 38% had ≥1 elevated outpatient SBP eligible for treatment intensification in the 1 year after stroke. Thirty percent of patients had a discharge SBP ≤140 mm Hg, and an average 1.93 treatment opportunities and treatment intensification occurred in 58% of eligible visits. Forty-seven percent of patients discharged with SBP 141 to160 mm Hg had an average of 2.1 opportunities for intensification and treatment intensification occurred in 60% of visits. Sixty-three percent of the patients discharged with an SBP >160 mm Hg had an average of 2.4 intensification opportunities, and treatment intensification occurred in 65% of visits.
  
  
  CONCLUSIONS
  Patients with discharge SBP >160 mm Hg had numerous opportunities to improve hypertension control. Secondary stroke prevention efforts should focus on initiation and review of antihypertensives before acute stroke discharge; management of antihypertensives and titration; and patient medication adherence counseling.
authors.affiliation: From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.). Christianne.roumie@vanderbilt.edu.
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
authors.affiliation: From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.).
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Zillich
authors.affiliation: From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.).
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
authors.affiliation: From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.).
authors.forename: Heather A
authors.initials: HA
authors.lastname: Jaynes
authors.affiliation: From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.).
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Myers
authors.affiliation: From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.).
authors.forename: Joseph
authors.initials: J
authors.lastname: Yoder
authors.affiliation: From the Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Nashville (C.L.R.); Department of Medicine, Vanderbilt University, Nashville, TN (C.L.R.); Center for Health Information and Communication, Health Service and Research Development, Roudebush Veterans Affairs Medical Center, Indianapolis, IN (A.J.Z., D.M.B., H.A.J., L.J.M., J.Y.); Department of Pharmacy Practice, Purdue University, West Lafayette, IN (A.J.Z.); Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis (D.M.B., L.J.M.); Health Services Research and Development Stroke Quality Enhancement Research Initiative (D.M.B.); Health Services Research Section, Regenstrief Institute, Indianapolis, IN (D.M.B., L.J.M.); Department of Neurology, Greater Los Angeles Veterans Affairs Medical Center, CA (E.M.C.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (E.M.C.).
authors.forename: Eric M
authors.initials: EM
authors.lastname: Cheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D001795:Blood Pressure Determination / Q000639:trends; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017741:Survivors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends; D014728:Veterans
chemical_list: D000959:Antihypertensive Agents
keywords: health services research; hypertension; medication adherence; secondary prevention