TOAST subtypes: its influence upon doctors’ decisions of antihypertensive prescription at discharge for ischemic stroke patients

Jie Xu,^* Liping Liu,^* Yilong Wang, Xingquan Zhao, Chunxue Wang, Anxin Wang, Yongjun Wang, , Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

^*These authors contributed equally to this work

Aim: To investigate the influence of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes in doctors’ decisions to use antihypertensive prescriptions at discharge for ischemic stroke patients in a real-world setting.
Methods: Using the China National Stroke Registry, we analyzed data from 12,063 hospitalized patients who had been diagnosed with ischemic stroke. The cause of ischemic stroke was classified according to the TOAST criteria. The information about the prescription of antihypertensive medication at discharge was extracted from medical records. Multivariate logistic regression was used to assess the impact of TOAST subtypes on the prescription of antihypertensive medication at discharge.
Results: Multivariate analysis showed that, compared with large artery atherosclerosis patients with moderate (<70%) stenosis, large artery atherosclerosis patients with severe (≥70%) stenosis or patients with stroke of undetermined etiology were less likely to be prescribed antihypertensive medication at discharge (odds ratio [OR], 0.72; 95% confidence interval [CI]: 0.59–0.88; OR, 0.71; 95% CI: 0.64–0.79), while patients with small artery occlusion were more likely to be prescribed antihypertensives (OR, 1.50; 95% CI: 1.33–1.69).
Conclusion: The TOAST subtype is an important determinant of the prescription of antihypertensive medication for ischemic stroke patients at discharge in normal clinical practice.

Keywords: antihypertensive agents, ischemic stroke, TOAST classification