Hypertension Awareness, Treatment, And Control Status Among Ischemic Stroke Survivors In Community

Objective:Improving the rates of awareness, treatment and control for hypertension are significant issues for secondary prevention of ischemic stroke. We assessed the awareness, treatment and control for hypertension and its influential factors among ischemic stroke survivors in community, and try to provide evidence for decreasing ratio of stroke recurrence.Methods:The survey was performed at two community venues, Suojin Village, Xuanwu Distict and Wangfuyuan, Baixia District, Nanjing, between October 2007 and April 2008. The survivors who suffered from ischemic stroke in the last five years were enrolled in this study. To investigate the frequency of awareness, treatment and control for hypertension, and their influential factors in ischemic stroke survivor, we designed a questionnaire by ourselves. During the survey, every patient's blood pressure was measured, and the disability or dependence in the daily activities were evaluated with modified Rankin Scale (mRS). Univariate factors were analyzed with Chi square for the factors related to the awareness; treatment and control for hypertension, and multivariate factors were used with stepwise Logistic regression.Results:There were 311 ischemic stroke survivors enrolled in this study in the surveyed district. The voluntary participants who filled in questionnaire completely were 254 (254/311,81.7%). There were 172 patients with hypertension and 132 of them (76.7%) known that they suffered from this disease and knew that hypertension was a risk factor for cerebrovascular diseases. Univariate analyses indicated that the influential factors include educational levels, family history of stroke, modified Rankin Scale (mRS) and health education (P＜0.05). Then, these risk factors were put into multivariate analysis, the significant risk factors were degree of accepted education (OR=2.816,95%CI:1.374-5.774, P=0.005), family history of stroke (OR=6.598,95%CI:2.198-19.812,P=0.001), mRS (OR=0.378,95%CI:0.148-0.963, P=0.043), and health education (OR=11.217,95%CI:4.441-28.331,P=0.000). Among the 172 patients, only 98 patients (57.0%) took antihypertensive drugs regularly. Univariate analysis indicated that the influential factors include accepted education, medical insurance, mRS and health education (P＜0.05). Step Logistic multivariate analysis analyzed these risk factors from univariate analysis, the degree of accepted education (OR=2.601,95%CI:1.427-4.740, P=0.002), medical insurance (OR=5.253,95%CI:2.434-11.337, P=0.000), mRS (OR=3.776,95%CI:1.781-8.008, P=0.001), and health education (OR=0.247,95%CI:0.106-0.575, P=0.001) were significanty different. The hypertension was controlled in 73 patients (42.4%). Univariate analysis indicated that the influential factors included the degree of accepted education, mRS, hospital grade and health education (P＜0.05). The degree of accepted education (OR=2.074,95%CI:1.236-3.478, P=0.006) and health education (OR=2.605,95%CI:1.300-5.222, P=0.007) were significant in the multivariate Logistic analysis.Conclusion:This study indicated that the rate of awareness, treatment and control of hypertension in ischemic stroke survivor is low in Chinese patients. The results indicated that health education is very important in secondary prevention of stroke. More attention should be paid to improve the patient education system and medical insurance system, to provide convenient services to the disability patients and to strengthen health education in stroke secondary prevention strategies. So that more stroke survivors will get hypertension control, to reduce the stroke recurrence.