Prescription of antihypertensive medication at discharge influences survival following stroke

Nadine E. Andrew, Joosup Kim, Amanda G. Thrift, Monique F. Kilkenny, Natasha A Lannin, Craig Anderson, Geoffrey Donnan, Kelvin Hill, Sandy Middleton, Christopher Royce Levi, Steven Faux, Rohan Grimley, Nisal Gange, Richard Geraghty, Sharan Ermel, Dominique A. Cadilhac

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective To investigate the risk of death from cardiovascular disease between patients who were and were not prescribed antihypertensive medication following stroke or TIA.

Methods 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.

Results 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).

Conclusions 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.
Original languageEnglish
Pages (from-to)e745-e753
Number of pages9
JournalNeurology
Volume90
Issue number9
DOIs
Publication statusPublished - Feb 2018

Cite this

Andrew, Nadine E. ; Kim, Joosup ; Thrift, Amanda G. ; Kilkenny, Monique F. ; Lannin, Natasha A ; Anderson, Craig ; Donnan, Geoffrey ; Hill, Kelvin ; Middleton, Sandy ; Levi, Christopher Royce ; Faux, Steven ; Grimley, Rohan ; Gange, Nisal ; Geraghty, Richard ; Ermel, Sharan ; Cadilhac, Dominique A. / Prescription of antihypertensive medication at discharge influences survival following stroke. In: Neurology. 2018 ; Vol. 90, No. 9. pp. e745-e753.
@article{195e1f623b9e4417ae2ae63e5f3ab91f,
title = "Prescription of antihypertensive medication at discharge influences survival following stroke",
abstract = "Objective To investigate the risk of death from cardiovascular disease between patients who were and were not prescribed antihypertensive medication following stroke or TIA.Methods 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.Results 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).Conclusions 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.",
author = "Andrew, {Nadine E.} and Joosup Kim and Thrift, {Amanda G.} and Kilkenny, {Monique F.} and Lannin, {Natasha A} and Craig Anderson and Geoffrey Donnan and Kelvin Hill and Sandy Middleton and Levi, {Christopher Royce} and Steven Faux and Rohan Grimley and Nisal Gange and Richard Geraghty and Sharan Ermel and Cadilhac, {Dominique A.}",
year = "2018",
month = "2",
doi = "10.1212/WNL.0000000000005023",
language = "English",
volume = "90",
pages = "e745--e753",
journal = "Neurology",
issn = "0028-3878",
publisher = "AAN Enterprises",
number = "9",

}

Andrew, NE, Kim, J, Thrift, AG, Kilkenny, MF, Lannin, NA, Anderson, C, Donnan, G, Hill, K, Middleton, S, Levi, CR, Faux, S, Grimley, R, Gange, N, Geraghty, R, Ermel, S & Cadilhac, DA 2018, 'Prescription of antihypertensive medication at discharge influences survival following stroke' Neurology, vol. 90, no. 9, pp. e745-e753. https://doi.org/10.1212/WNL.0000000000005023

Prescription of antihypertensive medication at discharge influences survival following stroke. / Andrew, Nadine E.; Kim, Joosup; Thrift, Amanda G.; Kilkenny, Monique F.; Lannin, Natasha A; Anderson, Craig; Donnan, Geoffrey; Hill, Kelvin; Middleton, Sandy; Levi, Christopher Royce; Faux, Steven; Grimley, Rohan; Gange, Nisal; Geraghty, Richard; Ermel, Sharan; Cadilhac, Dominique A.

In: Neurology, Vol. 90, No. 9, 02.2018, p. e745-e753.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Prescription of antihypertensive medication at discharge influences survival following stroke

AU - Andrew, Nadine E.

AU - Kim, Joosup

AU - Thrift, Amanda G.

AU - Kilkenny, Monique F.

AU - Lannin, Natasha A

AU - Anderson, Craig

AU - Donnan, Geoffrey

AU - Hill, Kelvin

AU - Middleton, Sandy

AU - Levi, Christopher Royce

AU - Faux, Steven

AU - Grimley, Rohan

AU - Gange, Nisal

AU - Geraghty, Richard

AU - Ermel, Sharan

AU - Cadilhac, Dominique A.

PY - 2018/2

Y1 - 2018/2

N2 - Objective To investigate the risk of death from cardiovascular disease between patients who were and were not prescribed antihypertensive medication following stroke or TIA.Methods 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.Results 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).Conclusions 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.

AB - Objective To investigate the risk of death from cardiovascular disease between patients who were and were not prescribed antihypertensive medication following stroke or TIA.Methods 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.Results 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).Conclusions 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.

U2 - 10.1212/WNL.0000000000005023

DO - 10.1212/WNL.0000000000005023

M3 - Article

VL - 90

SP - e745-e753

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 9

ER -