Does the association between prescription of antihypertensive medication at discharge from acute care hospitals and post-discharge outcomes vary by stroke subtype?.

Background: Prescription of antihypertensive medication at discharge from hospital following stroke is recommended in clinical guidelines. How adherence to guidelines and associated outcomes vary by stroke subtype is unclear. Aim(s): To compare 90-180 day outcomes between patients who were and were not prescribed antihypertensive medication at discharge between transient ischemic attack (TIA), ischemic stroke and intracerebral hemorrhage (ICH). Method(s): We assessed patients discharged from 40 hospitals with a diagnosis of stroke and registered in the Australian Stroke Clinical Registry (AuSCR; 2010-2013). Multivariable analyses were adjusted for age, gender, previous stroke, socioeconomic status, stroke severity and patient clustering. Dependent variables were HRQoL (EQ-5D Visual Analogue Scale (VAS) 0-100) and 180-day mortality (National Death Index data). Combined HRQoL and death outcomes were calculated using the EQ-5D utility score (-1 to 1, deaths = 0). Result(s): Outcomes were available for 6,679 eligible registrants (median [Q1:Q3] age 76 [66:84] years, 45% female). Most (73%) were prescribed antihypertensive medications at discharge with minor variation by subtype (ICH 71%, ischemic 74%, TIA 72%, p = 0.02). Patients with ICH prescribed antihypertensive medications had better outcomes for the VAS (coefficient: 5.5, 95% CI 0.5, 10.4), survival at 180 days (aOR 3.3, 95% CI: 2.0, 5.6) and EQ-5D utility score (coefficient: 0.2, 95% CI: 0.1, 0.3) than those not prescribed these agents. Patients with ischemic stroke and prescribed antihypertensive medication had better survival (aOR: 2.1, 95% CI: 1.7, 2.6) than patients not prescribed these medications. Conclusion(s): Our findings highlight the importance of prescribing antihypertensive medications at discharge to improve stroke outcomes, especially for ICH.