Abstract DP143: Trajectory of Blood Pressure Control After Stroke

Introduction: BP is an important stroke risk factor. Little is known about trajectories of BP control post-stroke or if BP can be modified by better coordinated care. Methods: The Coordinated, Collaborative, Comprehensive, Family-Based, Integrated, and Technology-Enabled Care Trial (C3FIT) is a multicenter, cluster-randomized trial comparing two post-stroke care models: Comprehensive Stroke Center care (CSC-Only) or CSC care plus an Integrated Stroke Practice Unit coordinating care (IPSU+CSC). We evaluated SBP and DBP trajectories from discharge through 3-, 6-, and 12-months post-stroke overall and by whether BP was in control at discharge. In control was defined as SBP < 130. Linear mixed models with random intercepts for site and participant were used to account for within-site and within-person correlation, respectively. Adjusted models accounted for stroke severity, demographics, and risk factors. Analyses were conducted in the overall population as well as stratified according to discharge SBP control status. Results: From 3/20 to 10/23 C3FIT enrolled 1,196 patients: mean age 64 + 13, 45% female, 580 CSC-Only, 616 ISPU+CSC, with 459 in control at discharge. In the overall population , SBP decreased over time, while DBP did not change meaningfully over time. Both groups experienced decreases in mean SBP by 3 months. After 3-months, mean SBP remained stable in the CSC-Only group, while SBP decreased by 12 months in the ISPU+CSC group. Across timepoints, mean DBP was lower for the ISPU+CSC group versus CSC-Only, with significant differences at 6 and 12 months. In analyses stratified by BP control, different patterns in SBP and DBP over time were observed. For those in control at discharge, SBP and DBP increased by 3 months. Beyond 3-months, SBP remained stable for both treatment groups, whereas DBP was stable for CSC-Only and decreased slightly by 12 months for ISPU+CSC. For those not in control at discharge, SBP and DBP decreased by 3 months. After 3 months, SBP was stable for the CSC-Only group but decreased for the ISPU+CSC group, while DBP remained stable for both treatment groups. Figures 1 (SBP) and 2 (DBP) display the least squares means and 95% CIs estimated by the crude model. Adjusted models had similar findings. Conclusion: Coordinated post-stroke care showed lower BP levels by 12 months while those receiving CSC-Only care had an average SBP above target, suggesting that coordinated care is needed during the first-year post-stroke to reach BP goals.