Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Erica Spatz

Abstract

Background: Hypertension (HTN) is the primary modifiable risk factor for stroke, with blood pressure (BP) control being paramount. Yet only one-fourth of patients with HTN who are receiving medical care have controlled BP. Accordingly, we aimed to elucidate patterns of BP control prior to incident stroke.Methods: We analyzed electronic health record data from patients who were hospitalized for a first stroke within the Yale New Haven Health system between 2015 and 2021. Patients were included if they had ≥2 outpatient visits in the 2 years prior to stroke to capture those regularly seeking care. BP measurements for all ambulatory visits were extracted. Systolic BP (SBP) and diastolic BP (DBP) were categorized as the number of BP measurements that were elevated (SBP >140mmHg or DBP >90mmHg), moderately elevated (SBP >160mmHg or DBP >100mmHg), and severely elevated (SBP >180mmHg or DBP >120mmHg), and by age group, sex, race, and ethnicity. Results: Among 6,047 patients with a first stroke, the mean age was 72 years, SD=15; 52% were female; 17% were Black/African American; and 8% were Hispanic/Latinx. Approximately 50% of patients had ≥2 elevated BP measurements and 1 in 5 patients had ≥2 measurements higher than 160/100 mmHg. Among the cohort, over 30% of patients had ≥2 mildly elevated BP measurements (140-160/90-100 mmHg), 14% had moderately elevated measurements (160-180/100-120 mmHg), and 4% had severely elevated BP measurements (>180/120 mmHg) in the 2 years prior to stroke. Patients who were aged 55-64 years, of Black/African American race, and of Hispanic/Latinx ethnicity were more likely to have severely elevated BP than their relative subgroups, with Black/African American patients having the highest proportion of BP elevation across all categories compared to other racial/ethnic groups. Conclusion: Despite receiving regular medical care, more than half of patients had ≥2 elevated BP measurements. Black/African American patients had the highest BP readings. Given that BP control is an important contributor to stroke, these data suggest that there were potentially missed opportunities to prevent stroke, especially among Black/African American patients.

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This is an Open Access Thesis.

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