Abstract Body: Introduction: Cerebrovascular diseases are the second leading cause of death and the third cause of disability worldwide. The main risk factor is hypertension, and blood pressure (BP) control is crucial in the primary and secondary prevention of stroke. We studied the prevalence of stroke and hypertension control in a representative cohort of the Brazilian population over 50 years and the factors related to uncontrolled hypertension in individuals with previous stroke.
Methods: We performed a retrospective analysis of the ELSI-Brazil study, a nationally representative sample of adults aged 50 and over, including 9412 individuals. Individuals self-reported previous medical history of stroke (including TIA, ischemic and hemorrhagic stroke), hypertension, medication intake, and other vascular risk factors. The BP was measured three times with a 2-minute interval under adequate conditions. The 2020 AHA Guideline was used to define hypertension and target BP. Statistical analysis was performed using STATA/SE 17.0 software. A logistic regression analysis was performed to study the variables associated with uncontrolled hypertension in individuals with previous stroke.
Results: From the total sample, 536 (5.3%) reported previous stroke, 255 (51.4%) were male, with mean age of 68.3 (SD 10.6). The systolic BP was higher among individuals with previous stroke (p=0.003). Uncontrolled BP was observed in 60.9% of individuals with previous stroke. High blood pressure levels were detected in 13.2% of individuals with previous stroke who did not report a prior diagnosis of hypertension. In the logistic regression model, younger age and lower education levels were related to uncontrolled hypertension in individuals with previous stroke. Undiagnosed hypertension was associated with higher education, not having a medical appointment in the last year, and not having private health insurance.
Conclusion: More than half of individuals with a previous stroke have uncontrolled hypertension, which is associated with lower education and younger age in the Brazilian elderly population. Undiagnosed hypertension is related to not having a medical appointment in the past year and the absence of private health insurance. Understanding the factors associated with uncontrolled hypertension is a crucial component of public health policies to decrease stroke recurrence in developing countries.