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  • Title: Apparent Treatment Resistant Hypertension Among Stroke Survivors in Ghana.
    Author: Sarfo FS, Ovbiagele B.
    Journal: J Stroke Cerebrovasc Dis; 2020 Dec; 29(12):105401. PubMed ID: 33096498.
    Abstract:
    BACKGROUND AND PURPOSE: There are limited data evaluating the characteristics of apparent treatment-resistant hypertension (aTRH) among stroke survivors in sub-Saharan Africa. We aimed to conduct a comparative analysis of the frequency and factors associated with aTRH among stroke survivors and stroke-free individuals with hypertension in Ghana. METHODS: Cross-sectional multicenter study involving five hospitals in Ghana conducted between July 2015 and June 2018. Clinic-based blood pressure was measured using a standardized protocol and antihypertensive medications assessed via review of medical records and inspection of pills. aTRH was defined as either office BP ≥140/90mmHg on ≥3 classes of antihypertensive medications or on ≥4 antihypertensive medications regardless of BP. Multivariate logistic regression models were constructed to assess for associations between aTRH and co-variates. RESULTS: Mean age of stroke survivors (n=1,169) was 59.3±13.3 years vs 58.4±12.4 years among stroke-free hypertensives (n=2,758), p=0.06. Among stroke survivors on ≥4 antihypertensive medications 18.1% had BP on a target of <140/90 mmHg and only 8.7% had BP <130/80mmHg. Prevalence of aTRH was 45.3%(95% CI: 42.4-48.2) among stroke survivors and 19.9%(18.4-21.4) among stroke-free hypertensives, p<0.0001. All stroke types were associated with aTRH with adjusted odds ratio (95% CI): hemorrhagic stroke 4.56(3.34-6.23), sub-arachnoid hemorrhage 4.10(1.70-9.90), ischemic stroke 2.85(2.32-3.50), and untyped stroke 1.92(1.41-2.60). Other predictors of aTRH were age <60 years, receiving care at a tertiary facility, and diabetes mellitus. CONCLUSIONS: Most stroke survivors encountered in this multisite study in Ghana had resistant hypertension. Tailored interventions are needed to mitigate the risk of recurrent adverse cardiovascular events in these patients.
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