Blood Pressure Control In The Hypertensive Patients With A History Of Stroke

The targets for lowering blood pressure (BP) in hypertensive stroke patients remain unclear. We assessed the current status of BP control in hypertensive patients with a history of stroke, investigating 413 hypertensive patients (age range, 19 to 93; mean age, 62 +/- 12 years) who visited the hypertension and stroke clinic at Kyushu University Hospital. We compared the clinical characteristics of these hypertensive patients with a history of stroke, including brain infarction, transient ischemic attack, and brain hemorrhage (age range, 29-86; mean age, 66 +/- 12 years; n = 95) with those of patients without such a history (age range, 19-93; mean age, 61 +/- 12 years; n = 318). Clinic BP was measured by physicians with a mercury sphygmomanometer, and the averaged BP determined at 2 occasions in 2002 was used for analysis. Systolic BP was similar among the patients with and without a history of stroke (134 +/- 15 vs 137 +/- 14 mm Hg; P = not significant), but diastolic BP was significantly lower in patients with stroke than in those without stroke (76 +/- 10 vs 82 +/- 10 mm Hg; P < .05). When strict BP control was defined as <130/85 mm Hg, the rate of strict BP control was higher in the stroke patients than in those without stroke (35.8% vs 19.8%; P < .01). The average number of antihypertensive drug classes used was similar in the 2 groups (1.7 +/- 0.9 and 1.8 +/- 1.0, respectively). Calcium antagonists were the most frequently used drugs in both groups. Diuretics and beta-blockers were prescribed less frequently to the patient with ischemic stroke than to those without stroke. BP levels were lower in the patients with brain hemorrhage than in those with lacunar and atherothrombotic infarction. In our outpatient clinic, BP levels were lower in the stroke patients than in the patients without stroke, which may reflect physicians' awareness of the importance of strict BP control in stroke patients, as has been suggested by several recent clinical intervention trials.