title: One-Year Rates and Determinants of Poststroke Systolic Blood Pressure Control among Ghanaians.
abstract: OBJECTIVE
  Elevated systolic blood pressure (SBP) is potently associated with risk of recurrent strokes. In resource-limited settings, there is a dearth of data on the rates and determinants of uncontrolled SBP among stroke survivors at high risk of recurrent events. The objective of this study is to assess the rates and determinants of uncontrolled SBP over the first year post stroke.
  
  
  METHODS
  This is a retrospective observational study involving stroke survivors who enrolled into an outpatient neurology clinic in Kumasi, Ghana, between January 2012 and June 2014. Baseline demographic features, clinical characteristics, antihypertensive medications prescribed at each clinic visit, treatment modifications, and clinic blood pressure measurements were recorded. Predictors of uncontrolled SBP during follow-up were assessed using a multivariable logistic regression model.
  
  
  RESULTS
  A total of 602 stroke survivors enrolled for follow-up within the study period of which 89.8% had hypertension. Up to 35% of subjects had an SBP above 140 mmHg during follow-up clinic visits. Among those with uncontrolled SBP, 17% had antihypertensive treatment modifications during follow-up. Predictors of uncontrolled SBP were SBP at enrollment into clinic, with an adjusted odds ratio (OR [95% confidence interval {CI}]) of 1.31 (1.17-1.47)/10 mmHg increase, and average number of antihypertensive medications prescribed, with an adjusted OR (95% CI) of 1.30 (1.06-1.60) for an increase in the number of antihypertensives prescribed.
  
  
  CONCLUSIONS
  A third of stroke survivors had SBP not on target during follow-up possibly due to a combination of therapeutic inertia, apparent treatment resistance, and poor adherence to therapy. Longer-term prospective interventional studies on hypertension control among stroke survivors are warranted in sub-Saharan Africa.
authors.affiliation: Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana. Electronic address: stephensarfo78@gmail.com.
authors.forename: Fred Stephen
authors.initials: FS
authors.lastname: Sarfo
authors.affiliation: Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
authors.forename: Gloria
authors.initials: G
authors.lastname: Kyem
authors.affiliation: Neurology Department, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
authors.forename: John
authors.initials: J
authors.lastname: Akassi
authors.affiliation: Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
authors.forename: Osei
authors.initials: O
authors.lastname: Sarfo-Kantanka
authors.affiliation: Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
authors.forename: Martin
authors.initials: M
authors.lastname: Agyei
authors.affiliation: Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Badu
authors.affiliation: Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Adusei Mensah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D015898:Tomography Scanners, X-Ray Computed
keywords: Ghana; Resistant hypertension; Systolic BP; antihypertensive therapy; recurrence; stroke survivors; therapeutic inertia