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Title: Prescription of antihypertensive medication at discharge influences survival following stroke.
Austin Authors: Andrew, Nadine E;Kim, Joosup;Thrift, Amanda G;Kilkenny, Monique F;Lannin, Natasha A;Anderson, Craig S;Donnan, Geoffrey A ;Hill, Kelvin;Middleton, Sandy;Levi, Christopher;Faux, Steven;Grimley, Rohan;Gange, Nisal;Geraghty, Richard;Ermel, Sharan;Cadilhac, Dominique A
Affiliation: Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
School of Allied Health (Occupational Therapy), La Trobe University, Bundoora, Victoria, Australia
Occupational Therapy Department, Alfred Health, Melbourne, Victoria, Australia
Faculty of Medicine, The University of New South Wales, Sydney
Stroke Foundation, Melbourne, Victoria, Australia
Nursing Research Institute, St Vincent's Health Australia, Sydney, New South Wales, Australia
Australian Catholic University, Sydney, New South Wales, Australia
University of New South Wales and the Partnership for Health Education, Research and Enterprise (SPHERE), Sydney, New South Wales, Australia
Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
St Vincent's Health Australia, Sydney, New South Wales, Australia
Statewide Stroke Clinical Network, Queensland Health, Brisbane, Queensland, Australia
Sunshine Coast Clinical School, The University of Queensland, Birtinya, Queensland, Australia
Toowoomba Hospital, Toowoomba, Queensland, Australia
Redcliffe Hospital, Brisbane, Queensland, Australia
Issue Date: 27-Feb-2018 2018-01-31
Publication information: Neurology 2018; 90(9): e745-e753
Abstract: To investigate the risk of death from cardiovascular disease between patients who were and were not prescribed antihypertensive medication following stroke or TIA. This was a large cohort study using routinely collected prospective data from the Australian Stroke Clinical Registry. Patients registered between 2009 and 2013 who were discharged to the community or rehabilitation were included. Cases were linked to the National Death Index to determine the date and cause of death. Propensity score matching with stratification was utilized to compare between similar subgroups of patients. Multivariable competing risks regression, with noncardiovascular death as a competing risk, was conducted to investigate the association between the prescription of antihypertensive medications and cardiovascular death at 180 days after admission. Among 12,198 patients from 40 hospitals, 70% were prescribed antihypertensive medications. Patients who were older, were treated in a stroke unit, and had better socioeconomic position were more often discharged from hospital with an antihypertensive medication. Including only patients within propensity score quintiles with acceptable levels of balance in covariates between groups (n = 8,786), prescription of antihypertensive medications was associated with a 23% greater reduction in the subhazard of cardiovascular death compared to those who were not prescribed these agents (subhazard ratio 0.77; 95% confidence interval 0.61 to 0.97). People who are prescribed antihypertensive medications at discharge from hospital after a stroke or TIA demonstrate better cardiovascular and all-cause survival outcomes than those not prescribed these agents.
DOI: 10.1212/WNL.0000000000005023
ORCID: 0000-0001-8162-682X
PubMed URL: 29386279
Type: Journal Article
Appears in Collections:Journal articles

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