Do hypertensive post-stroke patients receive and act upon treatment recommendations to reduce recurrent stroke risk?

Background: Adults with a history of stroke remain at risk for stroke recurrence, which has a higher rate of mortality and disability than first-ever stroke. Hypertension is the most significant predictor of recurrent stroke, but there is strong evidence that blood pressure (BP) lowering treatments such as medication and lifestyle modification reduce stroke recurrence risk. However, it is unclear how well this evidence is being implemented in clinical practice.

Methods: We analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) 2005 using appropriate weighting, stratification, and cluster variables to get population estimates. Hypertensive adults with a self-reported stroke history reported whether they had ever received advice about taking medications, changing their diets, or exercising to control their BP. They also reported whether or not they were engaging in any of these behaviors to reduce their BP.

Results: There were 2133 hypertensive adults (population estimate=12.5 million) with a stroke history (mean age = 66.1 years, female 54%, race/ethnicity: Caucasian 68%, African-American/Black 17.7%, and Hispanic/Latino 6.9%). Among this sample, 62.4% were told to change their eating habits to control their BP; this was predictive of making a change in eating habits (p<.0001), with 85% of adults who were given advice making this change. Similarly, 68.3% of hypertensive adults with a prior stroke were told to reduce dietary sodium; receiving this advice was predictive of making this behavior change (p<.0001), with 85.3% of individuals engaging in the behavior. Among hypertensive adults with a stroke history, 72.9% were given exercise advice; 67.9% of those who had received advice about exercise reporting that they exercised to lower their BP (p<.0001). Finally, 94.8% of hypertensive adults with a prior stroke were told to take BP medications and 94.9% of those who received a recommendation to take medication reported that they take BP medications (p<.0001).

Conclusions: Despite evidence that hypertension treatment effectively reduces recurrent stroke risk, approximately 30% of hypertensive adults with a stroke history report not being given advice about lifestyle modification to reduce BP. When post-stroke adults report receiving treatment recommendations about diet and exercise, they generally engage in the suggested behaviors. Healthcare professionals working with post-stroke patients should emphasize recommendations for recurrent stroke prevention, using innovative means if needed, to reduce the mortality and morbidity associated with stroke recurrence.