Use of antihypertensive medication after ischemic stroke in young adults and its association with long-term outcome

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van Dongen , M M E , Aarnio , K , Martinez-Majander , N , Pirinen , J , Sinisalo , J , Lehto , M , Kaste , M , Tatlisumak , T , de Leeuw , F-E & Putaala , J 2019 , ' Use of antihypertensive medication after ischemic stroke in young adults and its association with long-term outcome ' , Annals of Medicine , vol. 51 , no. 1 , pp. 68-77 . https://doi.org/10.1080/07853890.2018.1564358

Title: Use of antihypertensive medication after ischemic stroke in young adults and its association with long-term outcome
Author: van Dongen, Myrna M. E.; Aarnio, Karoliina; Martinez-Majander, Nicolas; Pirinen, Jani; Sinisalo, Juha; Lehto, Mika; Kaste, Markku; Tatlisumak, Turgut; de Leeuw, Frank-Erik; Putaala, Jukka
Contributor: University of Helsinki, Clinicum
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, Kardiologian yksikkö
University of Helsinki, Clinicum
University of Helsinki, HUS Neurocenter
University of Helsinki, Department of Neurosciences
Date: 2019-01-02
Language: eng
Number of pages: 10
Belongs to series: Annals of Medicine
ISSN: 0785-3890
URI: http://hdl.handle.net/10138/301424
Abstract: Background: Knowledge on the use of secondary preventive medication in young adults is limited. Methods: We included 936 first-ever ischemic stroke 30-day survivors aged 15-49, enrolled in the Helsinki Young Stroke Registry, 1994-2007. Follow-up data until 2012 came from Finnish Care Register, Statistics Finland, and Social Insurance Institution of Finland. Usage thresholds were defined as non-users, low (prescription coverage 80%). Adjusted Cox regression allowed assessing the association of usage with all-cause mortality and recurrent vascular events. Results: Of our patients, 40.5% were non-users, 7.8% had low usage, 11.8% intermediate usage and 40.0% high usage. Median follow-up was 8.3 years. Compared to non-users, risk of mortality and recurrent stroke or TIA was lower for patients with low-intermediate (HR 0.40, 95% CI 0.22-0.65; HR 0.31, 95% CI 0.18-0.53) and high usage (HR 0.25, 95% CI 0.15-0.42; HR 0.30, 95% CI 0.19-0.46), after adjustment for confounders. Conclusions: Use of antihypertensives was suboptimal in one-third of patients in whom antihypertensives were initially prescribed. Users were at lower risk of mortality and recurrent stroke or TIA compared to non-users.Key Messages The use of antihypertensive medication is suboptimal in one-third of patients in whom antihypertensive medication was initially prescribed after ischemic stroke at young age. The risk of mortality and recurrent stroke or TIA is lower for users of antihypertensive medication after ischemic stroke at young age compared to non-users, after adjustment for relevant confounders including pre-existing hypertension and prior use of antihypertensive medication. Specific guidelines on antihypertensive medication use after ischemic stroke at young age are lacking. However, our results may motivate doctors and patients in gaining better usage of antihypertensive medication, since better usage was associated with more favorable outcome in this study.
Subject: Brain ischemia
drug therapy
follow-up studies
hypertension
recurrence
risk
stroke
young adults
HOSPITAL DISCHARGE REGISTER
UNDETERMINED SOURCE
EMBOLIC STROKES
FOLLOW-UP
ADHERENCE
EVENTS
DEATH
RISK
CLASSIFICATION
PREDICTORS
3112 Neurosciences
3124 Neurology and psychiatry
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