Management of hypertensive US adults with stroke versus those with myocardial infarction: Gaps in care and opportunities for intervention

The risk factors and subsequent secondary prevention strategies for stroke and myocardial infarction (MI) are similar. There is marked reduction in stroke recurrence from blood pressure (BP) and lipid control. However, little is known about the comparative provision of hypertension and hyperlipidemia care in post-stroke versus post-MI adults. We analyzed data from hypertensive adults in the National Health and Nutrition Examination Survey (NHANES) 1999-2004 using weighting, stratification, and cluster variables to obtain population estimates. Stroke and MI diagnoses, as well whether participants had received physician advice about antihypertensive medication, weight, exercise, or diet, was by self-report. BP and cholesterol were by examination. There were 279 hypertensive adults with stroke history (SH) (population estimate 2.5 million), and 340 hypertensive adults with MI history (MIH) (population estimate 3.3 million). The SH group had higher systolic (140.7 mm Hg vs. 135.2 mm Hg, p<.04) and diastolic BP (74.6 mm Hg vs. 70.9 mmHg, p<.04), and total cholesterol (212.5 mg/dL vs. 196.8 mg/dL, p=.001) than the MIH group. Fewer SH adults were advised to take antihypertensive medications (85.1% vs. 91.0%, p<.005) or exercise (58.6% vs. 70.4%, p<.04) than MIH adults. There were no differences in receipt of weight control or sodium restriction advice. Risk factor control among US hypertensive adults with a stroke history is poorer than that among those with an MI history. Despite this, post-stroke adults receive less advice about accepted secondary prevention strategies than post-MI adults. To prevent devastating recurrences, post-stroke care should optimize secondary prevention strategies using newer approaches.