Prescribers' Choice Adherence After Stroke

In 1997, the Sixth Report of the Joint National Committee (JNC) on Prevention, Detection, Evaluation and Treatment of High Blood Pressure^{15 (link)} established recommendations for first-line therapy based on race-ethnicity and medical comorbidities. The term “a compelling medical indication” was first introduced in the JNC6 based on multiple randomized trials that demonstrated benefit of one or more class of drugs based on patients’ medical comorbidities. While stroke was not specifically listed as a compelling indication, the included meta-analysis demonstrated that high dose diuretics and ACEI were preferred for stroke prevention and while beta blockers were potentially harmful. The recommendations for stroke as a compelling indication was include in the JNC Seventh guideline and have been reaffirmed with subsequent iterations of the JNC (Eighth Reports)^{12 (link)-14 (link), 16 (link), 17 (link), 19 (link)} and the 2020 International Society of Hypertension Global Hypertension Practice Guidelines^{13 (link)} with the recommendation for BP medication choice (Prescribers’-Choice Adherence) after stroke specifically incorporated. Based on this body of knowledge, we designed 5 simple hierarchical rules that can be used to determine Prescribers’-Choice Adherence:
This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting checklist. We collected baseline demographic information, insurance status, past medical history and other variables of interest including: final clinical diagnosis related to stroke; stroke etiology for acute ischemic stroke based on the Trial of ORG10172 in Acute Stroke Treatment (TOAST) classification^{25 (link)}; medication list prior to stroke admission; antihypertensive medications at discharge; discharge disposition; and modified Rankin score(mRS) at discharge;