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Antihypertensive treatment after first stroke in primary care: results from the General Practitioner Research Database

Objectives Secondary stroke prevention guidelines emphasize antihypertensive treatment (AHT). Routine data on recommended AHT are lacking. Aim To estimate the use of any antihypertensive and guideline-recommended antihypertensive use in first ever stroke patients and their effects on survival and recurrence after 1 year in an unbiased population. Methods The General Practitioner Research Database (GPRD) contains primary care information across the UK. Forty-eight thousand two hundred and thirty-nine registered patients with first stroke between 1997 and 2006 were identified. Guideline AHT was defined based on guidelines of the British Hypertension Society. The impact of AHT on survival or recurrence-free survival was estimated using Cox regression adjusting for treatment propensity scores. Results AHT was prescribed to 75% of hypertensive stroke patients surviving 3 months after stroke, increasing from 66% in 1997 to 83% in 2006 (P < 0.001). Eighteen per cent of hypertensive stroke patients surviving 3 months had no AHT prior to stroke, of whom 45% received any AHT after stroke but only 31% received AHT recommended by guidelines (increasing from 24% in 1997 to 37% in 2006; P < 0.001). AHT was associated with lower mortality [adjusted hazard ratio compared to no treatment 0.79, 95% confidence interval (CI) 0.63–1.00 for nonguideline treatment and hazard ratio 0.63, 95% CI 0.53–0.75 for guideline treatment); guideline treatment also reduced risk of recurrent stroke (hazard ratio 0.82, 95% CI 0.71–0.96). Conclusions Prescription of AHT and most appropriate AHT improved over time. Guideline-recommended AHT was beneficial compared with no or other AHT.