Improved Stroke Survival Outcomes With Antihypertensive Prescription at Discharge

Patients who have had a stroke or transient ischemic attack report better cardiovascular survival outcomes if they are prescribed antihypertensive medications at hospital discharge compared with patients who are not provided an antihypertensive prescription, according to study findings published in Neurology.

Patients with stroke and transient ischemic attack from the Australian Stroke Clinical Registry who were discharged from hospital care were included in this analysis (n=12,198). Investigators assessed the date and cause of death in this population by examining linked cases with the National Death Index, with particular attention focused on the association between the prescription of antihypertensive medications and 180-day postdischarge cardiovascular death. Participants were categorized into 5 quintiles after being ranked according to their propensity score.

In this cohort, a total of 8582 patients were prescribed antihypertensive medications at discharge to rehabilitation or to the community. Prescribing antihypertensive medications at hospital discharge was most often performed for older patients at a higher socioeconomic level who were managed in a stroke unit. The prescription of antihypertensive agents was also associated with a 36% to 37% reduction in cardiovascular disease-related death at 180 days following admission in quintile 2 and quintile 3 (subhazard ratio [SHR] 0.64; 95% CI, 0.43-0.97 and SHR 0.63; 95% CI, 0.46-0.86, respectively). Overall, there was a 23% reduction in the subhazard of cardiovascular death among those prescribed antihypertensive medications vs those who were not prescribed these therapies (SHR 0.77; 95% CI, 0.61-0.97).

It is possible that many patients who were not prescribed antihypertensive medications had contraindications to these agents, and not including a blood pressure measurement in the analysis may have had an impact on the findings. In addition, the investigators were unable to collect data on patient adherence to prescribed therapies at discharge, nor were they able to assess whether these patients were subsequently prescribed antihypertensive medications after hospital discharge.

The investigators of this study note the importance of prescribing antihypertensive medications at discharge because “once the patient is in the community, patients may not be prescribed antihypertensive medications due to lapses in continuity of care.”

Reference

Andrew NE, Kim J, Thrift AG, et al. Prescription of antihypertensive medication at discharge influences survival following stroke [published online January 31, 2018]. Neurology. doi: 10.1212/WNL.0000000000005023