Abstract
Objective: The goal was to investigate the relationship that hypertension has on the ability for patients to functionally recover from acute ischemic stroke (AIS) post-discharge based on discharge destination using data acquired from a tertiary care stroke center.
Background: Understanding how to best manage patients’ care following AIS is of great importance to minimize disability and maximize recovery.
Design/Methods: This study was a retrospective cohort study which evaluated a change in the modified Rankin Scale (mRS) as a measure of change in functional independence. The mRS values were assigned at time of hospital discharge and again at each patient’s clinic follow-up appointment. Functional improvement was defined as a decrease in mRS by one or more. Those who did not return to follow-up, were admitted for reasons other than AIS, or were discharged to a location other than home, home with services, or acute rehab were excluded from the study. Logistic regressions were performed to assess the impact of hypertension and other stroke risk factors, demographics, presenting NIH Stroke Scale, and treatments.
Results: A pre-existing diagnosis of hypertension did not impact the recovery for patients discharged home; however, in patients with hypertension discharged to acute rehab, there were higher odds of not achieving a functional improvement between time of hospital discharge and clinic follow-up (OR 2.53, 95% CI: 1.02–6.59). Sensitivity analysis demonstrated that patients discharged to acute rehab with antihypertensives had higher odds of undergoing no functional improvement at clinic follow-up (OR 2.36, 95% CI: 1.08, 5.24).
Conclusions: Patients with a pre-existing diagnosis of hypertension discharged to acute rehab post-AIS have higher odds of not achieving functional improvement compared to patients discharged home. The proposed reasoning for this is the result of rehabilitation care teams overzealously controlling hypertension with antihypertensives, which may impair collateral circulation supporting penumbral tissue instead of allowing for permissive hypertension.
Disclosure: Ms. Pudlo has nothing to disclose. Ms. Cote has nothing to disclose. Ms. Jost-Price has received personal compensation for serving as an employee of Rhythm Pharmaceuticals. Dr. Leung has received research support from NIH.
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