{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:52:47Z","timestamp":1791355967742,"version":"4.3.1"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We conducted a retrospective, matched, nested case\u2013control study among adults with hypertension using data from a large regional health system (2010\u20132024). Patients with a first\u2010ever 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">The study included 13\u2009476 cases and 26\u2009952 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 (\u22120.211 versus \u22120.125). Compared with \u22641 visit, &gt;5 blood pressure visits per year was associated with lower stroke odds (adjusted odds ratio, 0.55 [95% CI, 0.51\u20130.59]). 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\u20130.86]), whereas &gt;3 ingredients was not. The highest quartile of treatment intensification showed the strongest association (adjusted odds ratio, 0.47 [95% CI, 0.44\u20130.51]). Findings were consistent across subgroup and sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.051284","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:34:08Z","timestamp":1789738448000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Missed Opportunities for Stroke Prevention in Patients With Hypertension: A\u00a0Retrospective Case\u2013Control Study"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8827-6372","authenticated-orcid":false,"given":"Huanhuan","family":"Yang","sequence":"first","affiliation":[{"name":"Yale New Haven Hospital","place":["New Haven, USA"]},{"name":"Vanke School of Public Health, Tsinghua University","place":["Beijing, China"]},{"name":"Yale School of Medicine","place":["New Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6571-6112","authenticated-orcid":false,"given":"Yuntian","family":"Liu","sequence":"additional","affiliation":[{"name":"Yale New Haven Hospital","place":["New Haven, USA"]},{"name":"Yale School of Medicine","place":["New Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1802-1777","authenticated-orcid":false,"given":"Chungsoo","family":"Kim","sequence":"additional","affiliation":[{"name":"Yale New Haven Hospital","place":["New Haven, USA"]},{"name":"Yale School of Medicine","place":["New Haven, USA"]},{"name":"Ajou University School of Medicine","place":["Suwon, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8624-4652","authenticated-orcid":false,"given":"Chenxi","family":"Huang","sequence":"additional","affiliation":[{"name":"Yale New Haven Hospital","place":["New Haven, USA"]},{"name":"Yale School of Medicine","place":["New Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2789-1758","authenticated-orcid":false,"given":"Mitsuaki","family":"Sawano","sequence":"additional","affiliation":[{"name":"Yale New Haven Hospital","place":["New Haven, USA"]},{"name":"Yale School of Medicine","place":["New Haven, USA"]},{"name":"Teikyo University","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Young","sequence":"additional","affiliation":[{"name":"Yale School of Medicine","place":["New Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"McFadden","sequence":"additional","affiliation":[{"name":"Yale School of Medicine","place":["New Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Anderson","sequence":"additional","affiliation":[{"name":"Sentara Health","place":["Norfolk, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Burrows","sequence":"additional","affiliation":[{"name":"Sentara Health","place":["Norfolk, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2046-127X","authenticated-orcid":false,"given":"Harlan M.","family":"Krumholz","sequence":"additional","affiliation":[{"name":"Yale New Haven Hospital","place":["New Haven, USA"]},{"name":"Yale School of Medicine","place":["New Haven, USA"]},{"name":"Yale School of Public Health","place":["New Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8192-494X","authenticated-orcid":false,"suffix":"Jr","given":"John E.","family":"Brush","sequence":"additional","affiliation":[{"name":"Sentara Health","place":["Norfolk, USA"]},{"name":"Macon & Joan Brock Virginia Health Sciences at Old Dominion University","place":["Norfolk, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5264-2169","authenticated-orcid":false,"given":"Yuan","family":"Lu","sequence":"additional","affiliation":[{"name":"Yale New Haven Hospital","place":["New Haven, USA"]},{"name":"Yale School of Medicine","place":["New Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001123"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00369-7"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.14545"},{"key":"e_1_3_2_5_2","volume-title":"Hypertension cascade: hypertension prevalence, treatment and control estimates among US adults aged 18\u2009years and older applying the criteria from the American College of Cardiology and American Heart Association's 2017 Hypertension Guideline\u2014NHANES 2017\u20132020","year":"2023","unstructured":"Hypertension cascade: hypertension prevalence, treatment and control estimates among US adults aged 18\u2009years and older applying the criteria from the American College of Cardiology and American Heart Association's 2017 Hypertension Guideline\u2014NHANES 2017\u20132020. Centers for Disease Control and Prevention (CDC); 2023. https:\/\/millionhearts.hhs.gov\/data\u2010reports\/hypertension\u2010prevalence.html"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.08.014"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/jch.14699"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.034787"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.108.838649"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2016.03.003"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000087"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2021.4996"},{"key":"e_1_3_2_13_2","first-page":"5","article-title":"Statistical methods in cancer research. Volume I \u2010 the analysis of case\u2010control studies","volume":"32","author":"Breslow NE","year":"1980","unstructured":"Breslow NE, Day NE. Statistical methods in cancer research. Volume I \u2010 the analysis of case\u2010control studies. IARC Sci Publ. 1980;32:5\u2013338.","journal-title":"IARC Sci Publ"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199001000-00010"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.metip.2023.100120"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000232"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/jch.14698"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.19590"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.21618"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00590-0"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.118.11308"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000002783"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.43001"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h158"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.20498"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.048385"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000090"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15073"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.021578"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.035850"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.126.051284","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:23:58Z","timestamp":1791354238000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.126.051284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":29,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2026,10,6]]}},"alternative-id":["10.1161\/JAHA.126.051284"],"URL":"https:\/\/doi.org\/10.1161\/jaha.126.051284","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"2026-04-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e051284"}}