Abstract Body: Introduction: For stroke survivors, blood pressure (BP) reduction significantly lowers the risk of recurrence; a 10mmHg decrease in systolic BP is associated with a 20% risk reduction. Despite the magnitude of this benefit, existing data quantifying post-stroke BP control is limited to small cohorts, national surveys relying on self-report of stroke, and cross-sectional surveys from closed health systems. We aim to determine rates of post-stroke BP control from a broader population within the first year of stroke from multiple cohorts of patients, including from a large US fee-for-service health system, TriNetX (global data source), and two randomized control trials.

Methods: We analyzed rates of uncontrolled BP (>140/90 mmHg) after stroke in 4 cohorts of individuals 18 years or older: 1) patients in the Yale New Haven Health System (YNHHS) between 2015-2020 at 6 months after stroke (both ischemic and hemorrhagic) hospitalization, 2) patients in TriNetX from 01/01/20 to 07/20/2024 with hypertension (ICD-10 code I10) and a hospital diagnosis of ischemic stroke (ICD-10 code I63), 3) participants with ischemic stroke in the Insulin Resistance Intervention after Stroke (IRIS) trial, and 4) the control arm of the blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomized trial. For TriNetX, IRIS, and SPS3, BP was evaluated at one year after hospitalization.

Results: Among YNHHS patients with stroke [n=3,339; mean age 67, 21% Black race, 10% Hispanic ethnicity, 49% male], the rate of uncontrolled BP was 31%. Ischemic strokes accounted for 83.2% of population, while hemorrhagic strokes accounted for 16.8%. In TriNetX [n= 495,474; mean age 69, 17.7% Black race, 5.9% Hispanic ethnicity, 48.6% male], the rate of uncontrolled BP was 33.4%. In the IRIS trial [n=3,135; mean age was 63, 11% Black race, 4% Hispanic ethnicity, and 67% male], 29% of participants were classified with uncontrolled BP. In the SPS3 trial [n=1,519; mean age was 63, 17% Black race, 31% Hispanic ethnicity, 65% male], 40.1% of participants were classified as uncontrolled BP.

Conclusion: Among individuals with stroke in clinical trial and real-world cohorts, the rate of uncontrolled BP post-stroke ranged from 29 to 41%. These results support the tremendous need for improved BP management strategies for stroke survivors.