Abstract DP086: Post-Stroke Outpatient Blood Pressure Control and Quality of Care for Post-stroke Blood Pressure by Neurologists

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Background: Blood pressure (BP) control is an important risk factor for recurrent strokes. We evaluated associations between patient characteristics with BP control post-stroke and describe the actions taken by neurologists among Veterans with uncontrolled post-stroke BP. Methods: The cohort included Veterans [LM1] from 13 VA facilities who had a neurology consult completed by either VA or community care neurologists within 6 months of a stroke/TIA event. We collected administrative and chart review data for all completed consults to obtain information on blood pressure, demographics, co-morbidities, body mass index and quality of stroke care. BP Control was defined as BPs less than140/90 [LM2] mmHg [LM3] based on BPs documented in the medical record at the time of the neurology consult. BP medications and neurologists’ recommendations related to BP control were abstracted from medical records. Logistic regression was used to identify characteristics associated with uncontrolled BP. We then examined the relationship between BP control and four process of care measures. Results: Amongst 330 patients, 105 (31.8%) had uncontrolled BP at the time of neurology consult. Table 1 shows patient characteristics and quality measures of stroke care by BP control. Quality of stroke care was lower amongst Veterans with uncontrolled BP (P=0.010). Patients with a higher Charlson co-morbidity index and without a history of hypertension were more likely to have controlled BP (Table 2). There were no significant differences in BP medications by BP control except patients with uncontrolled BP were more likely to be on angiotensin receptor blocking medications. Amongst patients with uncontrolled BP, 39.4% of neurologists counseled on lifestyle, 38.1% of neurologists provided a BP goal, 23.1% deferred BP control to other physicians, 15.4% of neurologists recommended home blood pressure monitoring and 3.8% made any change to BP medications. 32.4% of neurologists took no action despite having a patient with uncontrolled BP. Conclusions: Despite 31.8% of patients with recent stroke/TIA having uncontrolled BP at the time of outpatient neurology follow up, neurologists rarely took direct action to improve BP control. Veterans with uncontrolled BP were also less likely to receive other elements of high-quality outpatient stroke care. Neurologists should take a more active role in improving BP to further help reduce their patients’ recurrent stroke risk.

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