ANTIHYPERTENSIVE PHARMACOTHERAPY USAGE PATTERNS FOR SECONDARY PREVENTION AND ASSOCIATED BLOOD PRESSURE OUTCOMES IN ISCHEMIC STROKE SURVIVORS AT THE TAMALE TEACHING HOSPITAL

Michael Kofi Ghunney, Martin Mumuni Danaah Malick*, Julius Kwabena Karikari, Cynthia Akumanue

Background: The burden of ischemic stroke continues to increase across Sub-Saharan Africa, including Ghana.  The use of pharmacological interventions for the secondary prevention of ischemic stroke, especially appropriate antihypertensive pharmacotherapy, is one of the most reliable and effective means of decreasing the recurrence of stroke. However, majority of these patients do not receive the recommended antihypertensive pharmacotherapies for secondary prevention, leading to prolonged recovery time with associated increased morbidity and mortality. Aim: To assess the antihypertensive Pharmacotherapy usage patterns for Secondary prevention in ischemic stroke survivors and associated outcomes at the Tamale Teaching Hospital (TTH). Methods: We reviewed the Hospital electronic database (LHIMS) of 200 Ischemic stroke survivors at the TTH from January 2022 to December 2023 who had documented evidence of Ischemic stroke diagnosis either through a CT scan or an MRI while those with a diagnosis of hemorrhagic stroke or Ischemic stroke with hemorrhagic transformation were excluded. . Details on patient’s demographics, Classes of antihypertensive medications use patterns and Blood Pressure (BP) values at diagnosis, comorbid conditions, renal and hepatic functions, were extracted into an Excel sheet. The blood pressure control at discharge was categorized as either controlled or uncontrolled based on the 2021 AHA/ASA Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (BP goal of <130/80). The data was imported into Stata/SE Version 17.0 for cleaning and statistical analysis. Results: Ischemic Stroke diagnosis based on CT scan or MRI: 193 (96.5%), No 7 (3.5%). Diagnosis of Hypertension: Yes 172 (86%), No 28 (14%). SBP at diagnosis, mmHg (Mean SD, 153 (±29); DBP at diagnosis, mmHg (Mean (SD), 93 (±19). BP status at diagnosis: Controlled   52 (26%), Uncontrolled 148 (74%). Initiation of Antihypertensive medication before discharge:  Yes 176 (88%), No 24 (12%). Class of antihypertensive medications initiated: ACEI Yes 41(20.5%), No 159 (79.5%); ARBs: Yes 68 (34%), No 132 (665); Beta Blockers: Yes 22 (11%), No l78 (89%). NDP-CCB: Yes 158 (79%), No 42 (21%). Diuretics: Yes 6 (3%), No 194 (97%).Blood pressure control at discharge: Controlled 92 (46%), Uncontrolled 108 (54%).  SBP at discharge, mmHg: Mean (SD) 128 (±16). DBP at discharge, mmHg: Mean (SD) 80 (±12). Conclusions: Majority of Stroke Survivors at the TTH received antihypertensive Pharmacotherapy and the most prescribed were DHP-CCB, ACEIs and ARBs. Most of the patients had poorly controlled blood pressures at diagnosis and the major determinants were hypertension and renal impairment.