Background and Objectives: High blood pressure (BP) is a major modifiable cause of recurrent stroke. The prevalence of uncontrolled BP 90 days after stroke in contemporary populations of unselected stroke patients is unclear. We measured the prevalence and predictors of uncontrolled BP 90 days after stroke in a population-based stroke surveillance project.
Methods: Prospective cohort study of 214 Mexican American or non-Hispanic white adults aged ≥45 years with ischemic or hemorrhagic stroke and completed outcome assessments 90 day after stroke in the Brain Attack Surveillance in Corpus Christi (BASIC) project from March 2011 through June 2012. Trained personnel conducted in-home examinations following a standardized protocol to measure BP 90 days after stroke using an automated arm monitor (OmROn model 700 series). BP was measured in triplicate and the third BP reading was used. BP control was defined as BP<140/90 mm Hg. We investigated risk factors for uncontrolled BP 90 days after stroke using logistic regression and adjusting for ethnicity, age, sex, education, and insurance status as well as variables that were associated with uncontrolled BP.
Results: Median age was 66 years (interquartile range [IQR], 58-77 years), and 93% of strokes were ischemic. Median systolic BP was 128.5 mm Hg (IQR, 114-145) and diastolic BP was 76 mm Hg (IQR, 68 to 84). Overall, BP was uncontrolled in 35.1% (95% CI, 29.9% to 41.7%) of stroke survivors 90 days after stroke, and this did not differ by ethnicity (Mexican American, 34.3% [95% CI, 26.8% to 42.7%] vs. non-Hispanic white, 36.3%; [95% CI, 26.6% to 47.2%]; Wald P=0.58). Uncontrolled BP 90 days after stroke was more likely in stroke survivors with older age (adjusted odds ratio [aOR], 1.03 per 1 year increase; 95% CI, 1.00 to 1.06; P=0.03), no health insurance (aOR, 3.08; 95% CI, 1.19 to 7.96; P=0.02, and hypertension (aOR, 2.24; 95% CI, 0.96 to 5.26; P=0.06).
Conclusion: More than one third of stroke survivors has uncontrolled BP 90 days after stroke in this population-based study. Interventions designed to improve BP control and targeting older and uninsured stroke survivors are needed.