Aggressive intervention may mediate stroke risk factor disparities for Black patients
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Key takeaways:
- Black patients who had a stroke were younger and more likely to have hypertension and diabetes vs. non-Black patients.
- After a 1-year intensive intervention, the disparity in diastolic blood pressure disappeared.
Large differences in some modifiable risk factors for stroke between Black and non-Black patients were resolved after a 1-year intensive intervention that included medical management, follow-up and lifestyle coaching, researchers reported.
“Modifiable stroke risk factor differences between Black and non-Black adults were found at enrollment; however, our study found these disparities may be resolved by tailoring care to include lifestyle coaching, medication alterations or additions if appropriate, access to routine health support and regular physician follow-up,” Ashley Nelson, DO, a neurology resident at the Medical University of South Carolina, said in a press release. “Intense risk factor management has an important role in improving or eliminating these risk factor disparities in Black adults.”
Nelson and colleagues analyzed data from 451 adults with stroke caused by severe intracranial atherosclerotic stenosis enrolled in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) randomized controlled trial, which compared medical management vs. stenting to prevent recurrent stroke. The trial was conducted at 50 sites in the U.S. from 2008 to 2011 and included 104 Black participants. Researchers compared data on CV risk factors at baseline and again at 1 year among participants in the medical management group only after the intervention was implemented. Intervention included initiation of dual antiplatelet therapy, intensive control of BP, cholesterol and type 2 diabetes, as well as smoking and physical activity levels, and included regular follow-ups with a health care team and lifestyle coaching.
The findings were published in Stroke.
Researchers observed differences at baseline among Black vs. non-Black patients, including mean age (58 vs. 61 years; P = .004), hypertension (95.2% vs. 87.5%; P = .027), diabetes (52.9% vs. 39.7%; P = .017), mean diastolic BP (82.4 mm Hg vs. 79.5 mm Hg; P = .035) and mean physician-based assessment and counseling for exercise score (2.7 vs. 3.3; P = .002). The mean diastolic BP and mean physician-based assessment and counseling for exercise scores at 1 year in Black vs. non-Black patients were 74.7 mm Hg vs. 75.5 mm Hg (P = .575) and 4.2 vs. 4.1 (P = .593), respectively. There were no other between-group disparities for other modifiable risk factors at 1 year, according to researchers.
“We tend to focus on systolic BP, yet diastolic BP is also a good marker for CV health and the integrity of the blood vessels,” Nelson said in the release. “Using a tailored approach resulted in better risk factor control for the participants.”
Reference:
- Disparities in Black adults’ stroke risk factors persist; risk factor control reduced gap. https://newsroom.heart.org/news/disparities-in-black-adults-stroke-risk-factors-persist-risk-factor-control-reduced-gap. Accessed Aug. 2, 2023.
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