(P-178) Patterns of Antihypertensive Drugs Use After Primary Stroke in the General Population

Background: Hypertension is a primary and modifiable major risk factor for stroke. Patterns of antihypertensive drugs use in post-stroke secondary prevention remain poorly documented in France.

Objectives: To describe in France, use of antihypertensive drugs after a primary stroke between 2009 and 2017.

Methods: A prospective cohort study was conducted using a permanent sample of the French health insurance system database representative of the French population. All patients aged 45 and over, hospitalized for a first stroke between January 1, 2009 and December 31, 2014, living over 91 days after the end of hospitalization for any stroke were included in the cohort. Patients were followed from the first drug supply identified using ATC codes within 122 days after discharge, until the end of study period (December 31, 2017), exit date of database or death, whichever happened first (censored to a maximum of 8 years). For each month during follow-up, the prevalence of exposure to antihypertensive drugs during at least one day in the month was calculated, the denominator being the number of patients still followed up during this month. Exposure was described for each drug individually and in combination.

Results: A total of 2,674 patients hospitalized for a primary stroke were included in the study. Median age was 75.0 years (Q1 63.0; Q3 83.0), 51.2% were women and 72.3% had antihypertensive drug supply. For patients with antihypertensive drug supply already treated before their stroke (N=1,572; 58.8% of the sample), the three most frequent drugs in the first month of follow-up were converting enzyme inhibitors (9.7%), beta-blockers (9.2%), and calcium channel blockers (7.9%). For patients newly treated after their stroke, the three most frequent drugs in the first month of follow-up were converting enzyme inhibitors (35.2%), calcium channel blockers (16.9%), and converting enzyme inhibitors with diuretic (9.1%). At 8 years, the prevalence of patients treated with antihypertensive drugs was 88.8% for patients already treated, and 73.3% for patients newly treated.

Conclusions: Post-stroke therapeutic management in France seems in line with guidelines. However, newly treated patients appeared to less treated at 8 years. This study reinforces the importance of therapeutic education to improve secondary stroke prevention for newly treated patients.