Journal of Stroke and Cerebrovascular Diseases
Original ArticleBlood Pressure 1 Year after Stroke: The Need to Optimize Secondary Prevention
Section snippets
Patients and Methods
The study protocol was approved by the regional ethics committee, and all participants gave written informed consent. The protocol is registered at Clinical Trials.gov (NCT 00253097). In April 2004, the Cohort Study of Risk Factors for Recurrent Stroke, MI, and Death Following Stroke or transient ischemic attack (TIA) (RIALTO) was initiated at Copenhagen University Hospital, Hvidovre, Denmark. Later, the study was extended to 2 other Copenhagen University Hospitals, Bispebjerg Hospital and
Results
We included 349 of the 470 eligible patients (74%) in PREVENT (Fig 1). Five patients had a revised diagnosis, leaving 344 patients in the study. Among those in the intervention group who completed follow-up, 1 patient had only 2 of the 4 scheduled intervention visits, and 2 patients had only 3 visits. One patient dropped out after 4 visits. Participants were recruited between November 2005 and September 2007, and interventions were carried out between December 2005 and August 2008. The 1-year
Discussion
In this trial, we did not succeed in lowering BP. However, due to a significant increase in DBP in the control group, we found a significant difference in mean DBP at follow-up. No improvement in BP was detected between discharge from the hospital and the 1-year follow-up.
As shown in Table 1, we enrolled patients with intracerebral hemorrhage as well as ischemic stroke and TIA. We did so because the control of hypertension is important in all 3 categories of cerebrovascular disease.
Because BP
Conclusion
Our patients were compliant with the prescribed medication and with the recommendation to visit their GPs. However, there was no difference between the 2 groups in the frequency of visits to the GP. Despite an increase in the proportion of patients receiving antihypertensive medication in the intervention group, hypertension remained poorly controlled, because the necessary combination therapy was not widely used 1 year after stroke. Overcoming this barrier may require a reconsideration of
Acknowledgment
We thank study nurses Ingrid Nilsson, Tove Brink-Kjær, Helene Rønne, Karina Jacobsen, and Camilla Bech and study physiotherapist Hanne Birke for performing the interventions and collecting data. We thank Günther Momsen for assisting with the database, Susie Lendal for working out the data set, and Yoshio Suzuki for helping with data management. We also thank the staff of the stroke units at Hvidovre Hospital, Bispebjerg Hospital, Frederiksberg Hospital, and the Clinical Research Centre at
References (29)
- et al.
Effectiveness of a postdischarge care management model for stroke and transient ischemic attack: A randomized trial
J Stroke Cerebrovasc Dis
(2002) - et al.
Stop Stroke: development of an innovative intervention to improve risk factor management after stroke
Patient Educ Couns
(2008) - et al.
Stroke recurrence: Predictors, severity, and prognosis. The Copenhagen Stroke Study
Neurology
(1997) - et al.
The Greater Cincinnati/Northern Kentucky Stroke Study: Preliminary first-ever and total incidence rates of stroke among blacks
Stroke
(1998) - et al.
Measuring accuracy of discharge diagnoses for a region-wide surveillance of hospitalized strokes
Stroke
(2005) - et al.
Control of hypertension and risk of stroke recurrence
Stroke
(2002) Trials on blood pressure-lowering and secondary stroke prevention
Am J Cardiol
(2003)- et al.
Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention: Principal results of a prospective randomized controlled study (MOSES)
Stroke
(2005) - et al.
Blood pressure reduction and secondary prevention of stroke and other vascular events: a systematic review
Stroke
(2003) - et al.
Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators
N Engl J Med
(2000)
Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack
Lancet
PROGRESS results: Implementation in stroke guidelines
J Hypertens Suppl
Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke, cosponsored by the Council on Cardiovascular Radiology and Intervention
Circulation
Antihypertensive medications prescribed at discharge after an acute ischemic cerebrovascular event
Stroke
Cited by (33)
Factors Influencing Quality of Life in Stroke Patients: Focus on Eating Habits
2019, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :The interventions in which nurses had a primary role were effective on improving medical and behavioral risk factors such as physical activity, diet, medication adherence, as well as knowledge of risk factors as part of secondary prevention of stroke.12 Therefore, intensive interventions which provided education regarding medication and the importance of compliance might be important for mixed effect on eating habits.30,31 There is a limitation to generalize the obtained results because we investigated at only 1 hospital and interviewed small-sized subjects.
Secondary prevention and health promotion after stroke: Can it be enhanced?
2014, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :In our study we found that secondary prevention after stroke was not well regulated as reported previously.3,9,11,23 Persons living with the consequences of stroke need not only physical measurements and interventions, but also counseling,9 because many of them have experienced changes in their life situation. Although all patients had received oral and written information before discharge from the hospital, the experience of having a stroke can often be defined as a trauma, leading to difficulties to grasp the full implications in daily life.
A Gap in Post-Stroke Blood Pressure Target Attainment at Entry to Cardiac Rehabilitation
2021, Canadian Journal of Neurological SciencesCardiovascular medications and long-term mortality among stroke survivors in the Brazilian Study of Stroke Mortality and Morbidity (EMMA)
2022, Geriatrics and Gerontology InternationalMultiprofessional intervention to improve adherence to medication in stroke patients: a study protocol for a randomised controlled trial (ADMED AVC study)
2022, European Journal of Hospital Pharmacy
Supported by the Ludvig and Sara Elsass Foundation, Servier Danmark A/S, the Lundbeck Foundation, the Danish Heart Foundation (Grant 07-4-B703-A1378-22384F), Hvidovre Hospital, the AP Møller Foundation, the Eva and Henry Frænkels Foundation, the Wedel-Wedelsborg Foundation, and the Sophus Jacobsen and Astrid Jacobsen Foundation.