ORCID

0000-0001-8192-494X (Brush)

Document Type

Article

Publication Date

2026

DOI

10.1161/jaha.126.051284

Publication Title

Journal of the American Heart Association

Volume

15

Issue

19

Pages

e051284 (19 pp.)

Abstract

Background

Hypertension is the leading modifiable risk factor for ischemic stroke, yet the adequacy of preventative hypertension care in routine clinical practice remains suboptimal, potentially representing missed opportunities for stroke prevention. We evaluated the association between hypertension care delivery and incident ischemic stroke.

Methods

 We conducted a retrospective, matched, nested case-control study among adults with hypertension using data from a large regional health system (2010-2024). Patients with a first-ever ischemic stroke were matched 1:2 to controls on age, sex, race and ethnicity, and calendar time. Three care metrics were assessed: (1) outpatient visits with blood pressure measurement per year; (2) number of antihypertensive medication ingredients; and (3) medication intensification score. Conditional logistic regression estimated adjusted odds ratios.

Results

The study included 13 476 cases and 26 952 matched controls. Cases had fewer blood pressure visits per year (median, 2.50 versus 3.01), similar number of medication ingredients (2.00 versus 2.00), and lower treatment intensification scores (-0.211 versus -0.125). Compared with ≤1 visit, >5 blood pressure visits per year was associated with lower stroke odds (adjusted odds ratio, 0.55 [95% CI, 0.51-0.59]). Use of 2 to 3 medication ingredients (versus 0) was also associated with reduced stroke odds (adjusted odds ratio, 0.80 [95% CI, 0.75-0.86]), whereas >3 ingredients was not. The highest quartile of treatment intensification showed the strongest association (adjusted odds ratio, 0.47 [95% CI, 0.44-0.51]). Findings were consistent across subgroup and sensitivity analyses.

Conclusions

Greater engagement in hypertension care was associated with lower odds of ischemic stroke, suggesting that gaps in routine management may represent missed opportunities for prevention.

Rights

© 2026 The Authors.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Original Publication Citation

Yang, H., Liu, Y., Kim, C., Huang, C., Sawano, M., Young, P., McFadden, J., Anderson, M., Burrows, J. S., Krumholz, H. M., Brush, J. E., Jr., & Lu, Y. (2026). Missed opportunities for stroke prevention in patients with hypertension: A retrospective case-control study. Journal of the American Heart Association, 15(19), Article e051284. https://doi.org/10.1161/jaha.126.051284

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