Ten-Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry.
Ten-Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry.
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DOI：
10.1161/jaha.123.030272
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发表时间：
2023-11-20
影响因子：
5.4
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基于指南的高血压管理是预防卒中不可或缺的一部分。我们检查了中风后处方的抗高血压药物的趋势，并评估处方者的血压（BP）药物选择是否符合临床实践指南（BP-指南依从性）。FSR（佛罗里达中风登记处）使用前瞻性收集的所有急性中风入院的全州数据。根据已建立的指南，我们使用以下规则层次定义了最佳BP指南依从性：（1）在糖尿病患者中使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂作为一线降压药;（2）在黑人患者中使用噻嗪类利尿剂或钙通道阻滞剂;（3）在具有强制性心脏适应症的患者中使用β受体阻滞剂;（4）使用噻嗪类、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂或钙通道阻滞剂类作为所有其他药物的一线治疗;（5）除非有强制性心脏适应症，否则应避免将β受体阻滞剂作为一线治疗。2010年1月至2020年3月，FSR中共有372，254例病例被诊断为急性缺血性中风、出血性中风、短暂性脑缺血发作或蛛网膜下腔出血;最终分析中纳入了265，409例数据完整的病例。平均年龄为70±14岁; 50%为女性;指数卒中亚型为74%急性缺血性卒中、11%脑出血、11%短暂性脑缺血发作和4%蛛网膜下腔出血。BP指南对每项特定规则的依从性范围为48%至74%，低于80%的质量标准，黑人患者的依从性更低（比值比，0.7 [95%CI，0.7-0.83]; P<0.001）和房颤患者（比值比，0.53 [95%CI，0.50-0.56]; P<0.001）和糖尿病（比值比，0.65 [95%CI，0.61-0.68]; P<0.001）。这一大型数据集表明，10年来BP指南依从率始终较低。卒中后有机会监测高血压管理。
Guideline‐based hypertension management is integral to the prevention of stroke. We examine trends in antihypertensive medications prescribed after stroke and assess how well a prescriber's blood pressure (BP) medication choice adheres to clinical practice guidelines (BP‐guideline adherence). The FSR (Florida Stroke Registry) uses statewide data prospectively collected for all acute stroke admissions. Based on established guidelines, we defined optimal BP‐guideline adherence using the following hierarchy of rules: (1) use of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker as first‐line antihypertensive among diabetics; (2) use of thiazide‐type diuretics or calcium channel blockers among Black patients; (3) use of beta blockers among patients with compelling cardiac indication; (4) use of thiazide, angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, or calcium channel blocker class as first line in all others; (5) beta blockers should be avoided as first line unless there is a compelling cardiac indication. A total of 372 254 cases from January 2010 to March 2020 are in the FSR with a diagnosis of acute ischemic stroke, hemorrhagic stroke, transient ischemic attack, or subarachnoid hemorrhage; 265 409 with complete data were included in the final analysis. Mean age was 70±14 years; 50% were women; and index stroke subtypes were 74% acute ischemic stroke, 11% intracerebral hemorrhage, 11% transient ischemic attack, and 4% subarachnoid hemorrhage. BP‐guideline adherence to each specific rule ranged from 48% to 74%, which is below quality standards of 80%, and was lower among Black patients (odds ratio, 0.7 [95% CI, 0.7–0.83]; P<0.001) and those with atrial fibrillation (odds ratio, 0.53 [95% CI, 0.50–0.56]; P<0.001) and diabetes (odds ratio, 0.65 [95% CI, 0.61–0.68]; P<0.001). This large data set demonstrates consistently low rates of BP‐guideline adherence over 10 years. There is an opportunity for monitoring hypertensive management after stroke.