Friday, March 1, 2024

High Blood Pressure After Stroke

What Is A Tia

Adam’s stroke: a missed case of high blood pressure

TIA stands for Transient Ischaemic Attack. A TIA is a mini or temporary stroke, when the blood supply to the brain is cut off for a short time, and the blockage clears and the symptoms disappear. The symptoms are similar to a stroke, but they dont last as long, usually between a few minutes and few hours, and less than 24 hours.

If you notice the signs of stroke, never wait to see if the symptoms get better as its impossible to know how long they will last.

A TIA is a warning sign that you might be much more likely to have a full stroke in the near future. If you think you have had a TIA in the past but the symptoms have gone, make an urgent appointment with your GP.

Unsolved Issues In The Management Of High Blood Pressure In Acute Ischemic Stroke

Gordian J. HubertAcademic Editor: Received


High blood pressure is common in acute stroke patients. Very high as well as very low blood pressure is associated with poor outcome. Spontaneous fall of blood pressure within the first few days after stroke was associated both with neurological improvement and impairment. Several randomized trials investigated the pharmacological reduction of blood pressure versus control. Most trials showed no significant difference in their primary outcome apart from the INWEST trial which found an increase of poor outcome when giving intravenous nimodipine. Nevertheless, useful information can be extracted from the published data to help guide the clinician’s decision. Blood pressure should only be lowered when it is clearly elevated, and early after onset, reduction should be moderate but may be achieved rapidly. No clear recommendations can be given on the substances to use however, care should be taken with intravenous calcium channel blockers and angiotensin receptor antagonists. Two ongoing randomized trials will help to solve the questions on blood pressure management in acute stroke.

1. Introduction

High blood pressure occurs in around 80% of patients with acute ischemic stroke and usually decreases over the following 7 days .

This article focuses on currently available data, the contraries of the results, and potential solutions.

2. Initial Blood Pressure and Outcome

3. Spontaneous Change in Blood Pressure and Outcome

Aha News: Keeping High Blood Pressure At Bay For The Holidays

TUESDAY, Dec. 6, 2022 — No matter what winter holiday traditions you celebrate, you probably won’t find “think about blood pressure” on your to-do list, even after checking it twice.

But that would be a nice idea for your heart’s sake, experts say.

High blood pressure is a leading risk factor for heart attack and stroke, said Dr. Angela L. Brown, director of the hypertension clinic at the Washington University School of Medicine in St. Louis. Studies have shown that cardiovascular problems rise after Thanksgiving and peak in the new year.

People often put their health on the back burner this time of year, Brown said. But they shouldn’t. “The holiday season is a time for enjoyment,” she said. “You want to enter the holidays healthy, and you want to leave the holiday season healthy.”

With that goal in mind, here’s advice on keeping your blood pressure under control during the holidays.

Think before you feast

“All of us enjoy a good party,” Brown said. “But if you have high blood pressure in particular, you have to be conscious about what you’re eating.”

So if you’re stepping out, consider having a healthy meal at home first, she said, so you’re less likely to overdo it.

Similarly, Dr. Karen Griffin, a nephrologist at Loyola Medicine in Maywood, Illinois, suggested scouting before snacking at a family gathering.

The sodium outside is frightful

Limiting sodium is challenging this time of year, Griffin said, and always important.

Watch that cup of cheer

Have funukah

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How Is High Blood Pressure Diagnosed

You might have your blood pressure taken at a clinic, or you may be given a machine that records your blood pressure at home at regular intervals over a 24-hour period. You often need a few readings to check the reading over time, as blood pressure varies during the day.

How is blood pressure measured?

Measuring your blood pressure is quick and simple. An inflatable cuff is wrapped around your arm. This tightens and then slowly deflates. Your blood pressure reading shows up on an electronic screen.

Understanding your blood pressure reading

Your blood pressure reading is recorded as two numbers.

  • Systolic:the pressure when your heart beats.
  • Diastolic: the pressure in between heartbeats.

Both numbers are equally important, and blood pressure is counted as being high if either number is high.

What do the numbers mean?

Blood pressure is measured in millimetres of mercury, written as mmHg. For example:

90/60 mmHg.

The ideal blood pressure is between 90/60 mmHg and 120/80 mmHg.

High blood pressure is diagnosed if:

  • Its consistently above 140/90 mmHg.
  • Youre over 80, and your blood pressure is over 150/90 mmHg.
  • Its consistently above 135/85 when you measure it at home.
  • Its over 180/120, only one test is needed.

If you have diabetes or other conditions like kidney disease, you might be offered medication at 130/80.

Why is the target level lower for home blood pressure testing?

Stroke And High Blood Pressure

Recovery After Stroke

Stroke is a leading cause of death and severe, long-term disability. Most people whove had a first stroke also had high blood pressure.

High blood pressure damages arteries throughout the body, creating conditions in which they can burst or clog more easily. Weakened or blocked arteries in the brain put you at a much higher risk for stroke, which is why managing high blood pressure is critical to reducing your stroke risk.

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Caring For Yourself After A Stroke

Whether or not you experience long-term deficits after a stroke, knowing you had a stroke in the first place can be an overwhelming feeling. Some steps to help you care for yourself after a stroke include:

  • Ask a doctor if theres a neurorehabilitation program in your area. These programs offer specialized services to help patients recover after a stroke.

How Is High Blood Pressure Treated

Your GP will advise you about reducing your blood pressure, including medication and lifestyle changes. Lowering your blood pressure, even by a small amount, can help you stay healthy.

Medication for high blood pressure

If youre diagnosed with high blood pressure and your GP thinks you are at risk of a stroke, they will recommend a medication they think will work for you.

For details about the different types of blood pressure medication available, turn to the below.

Whether youre offered medication depends on your individual risk of a stroke. Things that increase your risk include a previous stroke, heart problems, diabetes and taking certain medications.

Before starting medication you will have blood and urine tests, and you may have an electrocardiogram to check for heart problems.

If you are aged under 40 and youre diagnosed with high blood pressure, you should be referred for checks to look for the causes of your high blood pressure.

Tailoring your treatment

There are several different types of medication for high blood pressure, and we know that age, ethnicity and family history affect how they work. Other medications can also affect how they work. So your GP works with you to make sure your prescription is tailored to your needs.

Getting started with your medication

It can sometimes take a while to adjust to taking a long-term medication. You will have regular blood pressure checks, and you may be able to monitor your blood pressure at home.

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What Happens When You Have A Stroke

A stroke occurs when a blood vessel to the brain is narrowed or blocked by a clot or bursts . When that happens, part of the brain is no longer getting the blood and oxygen it needs so it starts to die. Your brain controls your movement and thoughts, so a stroke threatens your ability to think, move and function. Strokes also can affect language, memory and vision. Severe strokes may even cause paralysis or death.

A majority of strokes are ischemic strokes Watch an interactive animation of an ischemic stroke.

A much smaller percentage of strokes are hemorrhagic strokes that occur when a blood vessel ruptures in or near the brain, resulting in a subarachnoid hemorrhage on the surface of the brain or intracerebral hemorrhage deep within the brain. View a detailed animation of a hemorrhagic stroke.

A TIA is caused by a temporary clot. Often called a mini stroke, these warning strokes should be taken seriously. See what happens during a TIA.

Dont let high blood pressure lead to stroke:

Signs And Symptoms Of Stroke

Stroke Level High Blood Pressure

There is a mnemonic to remember the main symptoms of a stroke and it is the word FAST:

  • Face – look if the face has dropped on 1 side. The person may not be able to smile, displaying a crooked smile or their mount or eye may have dropped down.
  • Arms – the person suspected of having a stroke may not be able to lift both arms and keep them elevated, because there is weakness or numbness in 1 arm.
  • Speech – listen for slurred or garbled speech, or the person might not be able to speak at all despite appearing to be alert and awake. They may also have trouble understanding you.
  • Time – Call an ambulance immediately if you see any of these signs or symptoms. The sooner a person receives treatment for a stroke the less damage is likely to happen.3

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Evidence From Other Studies On Abpm For Secondary Prevention Of Stroke

As previously discussed, ABPM is currently considered the best predictor of target organ involvement thus, accurate definitions of its changes over the 24-hour cycle are of crucial importance in this population.

Many studies have focused on the nature and extent of alterations of circadian BP patterns after acute stroke, and a pathologically reduced or abolished circadian BP variation has been described in acute stroke . However, studies on alterations of circadian BP patterns after acute phase of stroke are scarce.

Castilla-Guerra et al. reported a chronic disruption of circadian rhythm of BP after the acute phase of stroke in a prospective study of 101 patients admitted within 24 hours after stroke onset and followed for one year although the BP tended to decline and normalize weeks or months after stroke with the effect of medication, this abnormal pattern of circadian rhythm persisted in the majority of stroke patients after a one-year follow-up period. The authors found that the normal diurnal variation in BP was abolished in 87.1% of patients during the acute phase of stroke, in 76.9% after six months, and in 74.6% after one year.

Prognosis Value Of Abpm After Stroke

As previously discussed, since the introduction of ABPM devices, target organ damage and cardiovascular morbidity and mortality are reportedly more closely correlated with ABP than casual BP. Moreover, a nondipping status, that is, a state whereby patients exhibit either an absence or reduced nocturnal BP dip, reportedly correlates with more advanced target organ damage and worsened prognosis than patients who maintained a dipping status. Therefore, ABP values are of prognostic value for the prediction of subsequent morbid events in patients with essential hypertension . However, the prognostic value of ABPM for established cerebrovascular disease has only occasionally been investigated.

In a study of one 177 patients with lacunar strokes and an ABPM performed from 14 to 30 days after stroke without administration of antihypertensive agents and tracked for a mean of 8.9 years of follow-up, Yamamoto et al. showed that high 24-hour SBP was an independent predictor for vascular events , and nondipping status was an independent predictor for subsequent development of dementia .

Finally, other authors reported that non-dipping status along with extensive small vessel diseases and chronic kidney disease were independently associated with cognitive impairment in a sample of 224 consecutive patients with symptomatic lacunar infarction who underwent magnetic resonance imaging and ABPM.

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Ways To Check Your Blood Pressure

When you want to have your blood pressure checked, you can visit your GP. A nurse can do it for you and sometimes they even have self-service machines at their clinic.

Typically, they will use a blood pressure monitor, called a sphygmomanometer. This is the first way and the most accurate one if done by a professional. I think we have all seen one of these monitors it consists of a measuring unit and a cuff that goes on your upper arm. If the cuff is manually inflated, you will also see the doctor or nurse use a stethoscope. The second way is people buy an automatic blood pressure monitor so they can monitor their blood pressure at home without the need to visit the doctor or pharmacy for testing. The third way is a wrist monitor that works similarly, but instead of putting the cuff on your upper arm, you place the cuff on your wrist.6

Remote Monitoring Could Enable Better Blood Pressure Control

Stroke In The Brain Artery Stock Vector

Dr. Towfighi says that since such a small number of stroke patients in this study kept control of their blood pressure more than 75% of the time, you can only imagine how poor blood pressure control is outside of the clinical trial setting.

  • Stroke kills almost 130,000 Americans every year the equivalent to 1 in every 19 deaths.
  • Around 87% of all strokes are ischemic when blood flow to the brain is blocked.
  • Stroke costs the US around $36.5 billion every year, including costs of health care services, medications to treat the condition and missed days of work.

Based on these findings, Dr. Towfighi says that changes in care may be required to ensure patients maintain consistent blood pressure control. She adds that rather than waiting for clinic visits, patients could check their own blood pressure at home using machines that can transmit data remotely.

There appears to be increasing availability of such devices. Last year, Medical News Today reported on a monitoring device called Scanadu Scout that can read a persons vital signs in 10 seconds and send them to a smartphone.

Most recently, researchers unveiled a health tracker called Wello a smartphone case that can also measure key vital signs, including blood pressure, heart rate and temperature.

As well as consistently monitoring and controlling blood pressure, Dr. Towfighi says patients should learn how to control overall risk factors for stroke.

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What Else Causes Stroke

Other health problemsThere are a number of health problems which raise your risk of stroke. These include:

  • high cholesterol which can cause a build-up of fat in the arteries, called , making them narrower and leading to blood clots
  • which can damage your blood vessels
  • being overweight or obese
  • which is a type of irregular heartbeat which can cause blood clots to form in the heart which can travel to the brain

LifestyleA number of factors can also raise your risk of stroke, such as smoking, drinking a lot of alcohol, lack of exercise and stress which can cause a temporary rise in blood pressure.

Other risk factorsA number of other factors which you cant change can also put you at a higher risk:

  • age being over 65 years of age
  • a family history of stroke if a close relative has had a stroke, namely a parent, grandparent, brother or sister
  • being of Asian, African or Caribbean descent
  • having had a TIA, stroke or heart attack in the past

Even though some of these cant be changed, you can still lower your risk of stroke by making changes to your lifestyle which improve your overall health, in fact, these lifestyle changes become even more important.

What Are The Signs And Symptoms Of Stroke

Remember F.A.S.T. which stands for Face, Arms, Speech, Time, to recognise if someone is having a stroke.

Face has their face fallen on one side? Can they smile?

Arms can they raise both arms and keep them there?

Speech is their speech slurred?

Time to call 999 if you see any single one of these signs of a stroke.The NHS and The Stroke Association both have more information on stroke and how to Act F.A.S.T.

A stroke can sometimes have the following symptoms too:

  • a sudden and extremely painful headache
  • feeling confused
  • feeling dizzy or unsteady or losing co-ordination
  • slurring words or struggling to find words or put sentences together
  • struggling to understand what people are saying
  • sudden loss of vision or blurred vision
  • being paralysed or feeling numb or weak on one side of the body
  • difficulty swallowing

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Its Not Enough To Control Blood Pressure Some Of The Time

Throughout the study period, fewer than 30% of stroke patients had consistent blood pressure control more than 75% of the time.

Of these patients, those who had high blood pressure at study baseline reduced their risk of experiencing a second stroke by 54%, compared with stroke patients who only maintained control of their blood pressure 25% of the time.

These results were true even after the team took other factors into account, such as age, sex and history of stroke and heart disease.

The researchers found that the participants who were most likely to maintain control of their blood pressure consistently were those with a history of heart attacks. The team says this suggests that patients and health care professionals may be more aware of blood pressure control after a heart attack, but are less conscientious after a stroke.

Its not enough to control blood pressure some of the time. Averages do not take into account variability in blood pressure readings from one check to the next. Fluctuations in blood pressure may be associated with greater cardiovascular risk.

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