183309 Management of hypertensive US adults with stroke versus those with myocardial infarction: Gaps in care and opportunities for intervention

Wednesday, October 29, 2008: 9:35 AM

Jennifer P. Friedberg, PhD , Research & Development Service (151), VA New York Harbor Healthcare System/New York University School of Medicine, New York, NY
Ankit Parikh, MSIV , New York University School of Medicine, New York, NY
Stuart R. Lipsitz, ScD , Brigham and Women's Hospital/Harvard Medical School, Boston, MA
Henry Black, MD , Center for Cardiovascular Disease Prevention, New York University School of Medicine, New York, NY
Sundar Natarajan, MD, MSc , Research and Development Service, Department of Veterans Affairs New York Harbor Healthcare System & New York University, New York, NY
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.

Learning Objectives:
1. Understand differences in cardiovascular risk factor control between hypertensive adults with a history of stroke and hypertensive adults with a history of myocardial infarction. 2. Identify how physician advice about controlling hypertension through diet, medication, and exercise recommendations differs for adults with a stroke history and those with an MI history. 3. Discuss how post-stroke care can improve by placing an increased focus on risk factor control.

Keywords: Hypertension, Disease Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have developed and implemented interventions for hypertension risk factor control and adherence to treatment
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.