IDENTIFICATION AND MANAGEMENT OF STROKE RISK IN OLDER-PEOPLE - A NATIONAL SURVEY OF CURRENT PRACTICE IN PRIMARY-CARE

The current practice of stroke prevention was assessed among UK genera l practitioners (GPs) using a postal questionnaire. A random sample of 583 GPs (response rate 60%) in practice throughout the UK was examine d. Main outcomes were the reported practice in the identification of s troke risk, management of hypertension, and use of other interventions (particularly aspirin treatment) to reduce the risk of stroke. Most r espondents (451, 77%) reported that they specifically identified patie nts at high risk of stroke. However, of these only 301 (67%) used more than one major risk factor to do this and less than one-third used ei ther age or preexisting cardiovascular disease as an indicator. Thresh olds for drug treatment of hypertension increased markedly with patien t age with only 68%, 23% and 9% of respondents reporting treating elev ated systolic, diastolic and isolated systolic pressures respectively, in accord with the British Hypertension Society (BHS) guidelines for patients aged 70-79 years. Thresholds for blood pressure (BP) treatmen t in older patients did not differ by region but were higher among res pondents who had been in general practice for more than 10 years. The value of aspirin in preventing stroke in patients with pre-existing ca rdiovascular disease was recognized by almost all (560, 96%) responden ts. The results suggest that there is scope for increasing the benefit s of stroke prevention in primary care, by focusing on the management of patients at high absolute risk, in whom the greatest treatment bene fits are likely to be obtained.