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Antihypertensive treatment after stroke and all-cause mortality – An analysis of the General Practitioner Research Database (GPRD)
Cerebrovascular Diseases, 06/08/09

Toschke AM et al. – A high proportion of hypertensive stroke pts did not receive antihypertensive treatment. The protective effect of antihypertensive treatment on survival was higher in this general population than reported in randomized controlled trials; an effect of antihypertensive treatment on late stroke recurrence was borderline, but not significant.

Methods

Analysis of the effect of antihypertensive treatment on survival and recurrence in an unselected of general population sample
Data from the General Practice Research Database
Cox regression to estimate effect of antihypertensive treatment on survival and stroke recurrence >1 yr
Subjects: 44,244 first-ever strokes in UK from 1997 to 2006
Adjustment by propensity score analysis for gender, age, general practice, stroke yr, drug prescriptions, and diagnostic codes from other diseases

Results

EU standardized stroke incidence: 118 per 100,000
90-day case fatality: 19%
By 90 days after stroke 20,147 (58%) diagnosed with hypertension, of whom 75% had received antihypertensive treatment after stroke
After 5 yrs 68% of hypertensive stroke pts receiving antihypertensive treatment were alive vs 59% for pts not prescribed antihypertensive treatment
Potential confounders with adjusted relative risk of 0.62 for antihypertensive treatment and premature death could not explain findings
Adjusted relative risk of antihypertensive treatment on stroke recurrence after 1 yr in 35% until 5 yrs after stroke: 0.92

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