Abstract TP038: Impact of Guideline-Based Antihypertensive Prescribing After Stroke on 30-Day Outcomes: Insights from the Florida Stroke Registry

Background: There is emerging evidence that, in addition to blood pressure control intensity, the choice of antihypertensives matters for improving secondary outcomes. Our prior research has shown a gap in prescribers’ medication choices compared to guideline-recommended therapies at discharge. This study evaluates trends in antihypertensive prescribing following stroke, prescriber adherence to evidence-based hypertension management (Prescriber-Choice Adherence), and its impact on 30-day readmissions. Methods: We used data from the linked Florida Stroke Registry–AHCA dataset (2017–2019), including 38,954 acute ischemic stroke patients. Prescriber-Choice Adherence was defined using a hierarchical set of evidence-based rules for antihypertensive selection. The primary exposure was whether patients received guideline-compliant antihypertensives. Logistic regression assessed the association between receipt of guideline-recommended prescriptions and 30-day readmission, adjusting for age, sex, comorbidities, and stroke severity. Results: Among the population (mean age 70, 49.5% female, 68% white, 18% African American, 13% Hispanic), only 49.6% received guideline-recommended antihypertensives. Adherence to specific hierarchical rules ranged from 45% to 57%, highest in diabetic patients (57.03%). Notably, 15.5% were prescribed beta-blockers without a compelling cardiac indication, contrary to guidelines (table 1). No statistically significant associations were found between Prescriber-Choice Adherence and 30-day readmission (table 2). Conclusions: Only half of post-stroke patients received guideline-concordant therapy, underscoring persistent gaps and challenges in real-world implementation of post-stroke blood pressure guidelines. The lack of significant association with 30-day readmission may reflect an insufficient timeframe for antihypertensive effects to manifest. These findings highlight the need to re-evaluate both the strength of current evidence and the relevance of short-term outcome measures. Future studies should assess longer-term outcomes and whether post-stroke hypertension guidelines require updating.