Blood Pressure 1 Year after Stroke: The Need to Optimize Secondary Prevention

Clinical Research Center, Hvidovre Hospital, 2650 Hvidovre, Denmark.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association (Impact Factor: 1.67). 02/2011; 20(1):16-23. DOI: 10.1016/j.jstrokecerebrovasdis.2009.10.002
Source: PubMed


Lowering blood pressure (BP) in stroke survivors reduces the risk of recurrent stroke. We tested the hypothesis that a nurse-led nonpharmacologic intervention would lower the BP of participants in an intervention group compared with a control group. A total of 349 patients who had sustained acute stroke or transient ischemic attack were randomly assigned to either usual care or to 4 home visits by a nurse. During the visits, the nurse measured and recorded BP and provided individually tailored counseling on a healthy lifestyle. A total of 303 patients completed the 1-year follow up. No change in systolic BP was noted in either the intervention group or the control group. Because of an increase in diastolic BP in the control group (P = .03), a difference in mean diastolic BP between the 2 groups was found at follow-up (P = .007). Mean BP at follow-up was 139/82 mm Hg in the intervention group and 142/86 mm Hg in the control group. Linear regression analysis demonstrated that BP at the point of discharge was the strongest predictor of BP 1 year later (P < .0001). The proportion of patients on antihypertensive medication increased in the intervention group (P = .002). Patients were compliant with antihypertensive therapy, and 92% of the hypertensive patients in the intervention group followed the advice to see a general practitioner (GP) for BP checkups. At follow-up, 187 patients (62%) were hypertensive, with no difference in the rate of hypertension seen between the groups. Our data indicate that home visits by nurses did not result in a lowering of BP. Patients complied with antihypertensive therapy and GP visits in the case of hypertension. Nonetheless, the majority of patients were hypertensive at the 1-year follow up.

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    • "Control groups were described as receiving “usual care” in 4 of 7 studies. In the other studies, control care included generic risk factor advice once from a stroke nurse specialist,18 health education from a neurologist,17 and advice on healthy lifestyle choices from the multidisciplinary stroke team.19 "
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    ABSTRACT: The purpose of this study was to determine whether interventions including components to improve adherence to antihypertensive medications in patients after stroke/transient ischemic attack (TIA) improve adherence and blood pressure control. We searched MEDLINE, EMBASE, CINAHL, BNI, PsycINFO, and article reference lists to October 2012. Search terms included stroke/TIA, adherence/prevention, hypertension, and randomized controlled trial (RCT). Inclusion criteria were participants with stroke/TIA; interventions including a component to improve adherence to antihypertensive medications; and outcomes including blood pressure, antihypertensive adherence, or both. Two reviewers independently assessed studies to determine eligibility, validity, and quality. Seven RCTs were eligible (n=1591). Methodological quality varied. All trials tested multifactorial interventions. None targeted medication adherence alone. Six trials measured blood pressure and 3 adherence. Meta-analysis of 6 trials showed that multifactorial programs were associated with improved blood pressure control. The difference between intervention versus control in mean improvement in systolic blood pressure was -5.3 mm Hg (95% CI, -10.2 to -0.4 mm Hg, P=0.035; I(2)=67% [21% to 86%]) and in diastolic blood pressure was -2.5 mm Hg (-5.0 to -0.1 mm Hg, P=0.046; I(2)=47% [0% to 79%]). There was no effect on medication adherence where measured. Multifactorial interventions including a component to improve medication adherence can lower blood pressure after stroke/TIA. However, it is not possible to say whether or not this is achieved through better medication adherence. Trials are needed of well-characterized interventions to improve medication adherence and clinical outcomes with measurement along the hypothesized causal pathway.
    Full-text · Article · Jul 2013 · Journal of the American Heart Association
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    • "According to the data for Turkey, in 2002, 15% of deaths in hospitals were from cerebrovascular causes, and in 2003, these accounted for 11.2% of all deaths. About 25% of hospital admissions with acute stroke are due to recurrent stroke (Hornnes et al. 2011). Stroke occurs with complications; it can cause disability without proper treatment and significantly lower the quality of life (Bottemiller et al. 2006; Ones et al. 2005). "
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    ABSTRACT: To test the reliability and validity of the Turkish version of the Stroke-Specific Quality of Life Scale (SS-QOL). Stroke is a leading cause of activity limitation and participation restriction that negatively affect health-related quality of life. The assessment of SS-QOL in stroke patients has not been validated in Turkey. Cross-sectional and methodological research design was used. Five hundred stroke survivors who had been diagnosed with stroke at least 6 months previously were included in this cross-sectional study. The reliability of the SS-QOL was based on internal consistency, item correlation. Construct validity was evaluated by Exploratory Factor Analysis. Cronbach's alpha coefficient was calculated for the total score of the SS-QOL to establish the internal consistency of the instrument. Construct validity was assessed by comparing patients' scores on the SS-QOL with those obtained by other test methods: SF-36 Health Survey and Katz Index of Activities of Daily Living. In the process of adaptation to the Turkish population, the scale was converted to 48 items. The correlation coefficient for the test-retest scores of the SS-QOL was calculated as 0.81. Internal consistency for the scale showed Cronbach's alpha = 0.97. As a result of applying factor analysis to the scale, eight factors were obtained, which accounted for 77.47% of the scale's total variance. SS-QOL is a reliable and valid instrument for measuring self-reported health-related quality of life at group level among people with stroke who are diagnosed with stroke at least 6 months previously in the Turkish population.
    Full-text · Article · Jun 2012 · International Nursing Review
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    Full-text · Article · Jul 2012 · Sports Medicine
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