Physicians' Attitudes Toward Elevated Blood Pressure and Recurrent Events After Acute Ischemic Stroke

Background: Strict blood pressure (BP) control among acute ischemic stroke (AIS) survivors would improve prognosis and decrease recurrent vascular events, which, however, has not been investigated in detail. Methods: AIS survivors at discharge who was admitted between 2010 and 2011 were included in the analysis dataset. Baseline characteristics were gathered through a multicenter prospective stroke registry (CRCS-K). BP measurements, clinic visit and prescription of BP-lowering medications after discharge were collected through medical records until 1 year (± 2 months of grace period). Recurrent vascular events until 1 year after stroke including stroke, myocardial infarction and death were gathered through a structured telephone interview by trained research registrars or medical records review. Individual treatment intensification (TI) scores were calculated by the following equation; (observed medication change - predicted medication change by a standard guideline) / number of clinic visit. TI scores were categorized into quintile groups and their associations with recurrent events were assessed by Cox proportional hazard models. Results: Of the 3482 AIS survivors, 2675 (77%) were diagnosed of hypertension and 1977 (57%) had BP-lowering medication prescription at discharge. Median NIHSS score at admission was 3 [1 - 6] points and 1573 (45.3%) had mRS score 0f 0 - 1 at discharge. TI score over 1-year after discharge was mean - 0.24 ± 0.30 and median - 0.15 [- 0.42, 0]. Compared to Q3 (third quintile; group TI score, - 0.15 ± 0.05), Q5 (group TI score, 0.04 ± 0.08) had higher proportion of cardioembolic stroke (32% vs 20%) and higher median NIHSS score (4 vs 3). Extreme groups of TI scores, Q1 or Q5, showed increased hazard for having mortality or composite events (see Table). Conclusions: Physicians’ attitudes toward elevated BP, represented by the TI score, was significantly associated with long-term vascular outcomes.