For anyone who has had a stroke, should work to prevent that a second place to keep no. 1, blood pressure under control is an important part of this job.
A study published yesterday in the journal stroke showing that good control of blood pressure, stroke by more than half reduces the chances after a stroke on a repeat. But it brought bad news: less than a third of stroke survivors in the study managed to get their blood pressure under control.
In the report, researchers from the University of California crunched data from the vitamin intervention for stroke prevention (VISP) trial. This study had found that a daily pill containing high doses of three B-vitamins - folate, B6and B12 - did nothing to prevent a second stroke. But a great resource for other research data collected in this study.
The volunteers in VISP had checked their blood pressure in a doctor's Office several times in the course of the two-year study. Only 30% of the volunteers were able to keep their blood pressure in a good range (below 140/90) on at least 75% of the measurements. In the meantime more than a third of the participants had controlled blood pressure less than 25% of the time.
The chance of a second stroke were directly on blood pressure control - better control, less strokes; less control, more strokes. The same was true for the connection between blood pressure control and a heart attack or to die from heart disease.
Check BP at home
High blood pressure damages the arterial walls throughout the body. This damage can lead to stroke or heart attack. People who have survived a stroke or a heart attack are very high risk with another of the same - or the other. The new study shows blood pressure in stroke control a good way to reduce this risk.
There are many ways to control blood pressure. An advance that has helped a lot is the ability to check blood pressure at home. When the VISP study ended in 2003, almost the only way to check blood pressure was, in a doctor's Office, and then once every six months so the participants a few times at the beginning of the study validates their pressure. What happened in between, remains to be seen. Home blood pressure monitors are now readily available and relatively inexpensive. You get a more reliable look now on your blood pressure twice a year instead of a snapshot. Know the numbers is a great step towards the control of blood pressure.
Changes in the life style for all
Much too low blood pressure or it helps changes to your lifestyle to keep under control. These changes can also help prevent a heart attack or stroke, and can strengthen your body in other ways.
- Exercise often - at least 30 minutes five times a week. More is better.
- Losing weight, if necessary.
- Eat more fruits, vegetables and whole grains and less processed, or very refined food.
- Cut back on salt.
- Include food, rich in potassium in your diet, (unless you have kidney disease).
- If you drink alcohol, you keep it moderate – no more than two drinks per day for men, no more than a day for women.
- Do not smoke.
Medicines may be required
Many people need medicine in addition to changes in lifestyle to lower blood pressure. There are a number of proven options for drugs that lower blood pressure. Current guidelines recommend the following:
- If you are black and you have normal kidney function, you start with a low daily dose of Thiazide type diuretics (water pills) such as Chlortalidone, hydrochlorothiazide, or a calcium channel blocker. Another possibility is a pill that contains low doses of both types of drugs.
- If you're not black, and you have normal kidney function, start with a low dose of one of these drug types:
- Inhibitors of angiotensin-converting enzyme (ACE)
- Angiotensin receptor blocker (ARB)
- Thiazide type diuretic
- Calcium channel blocker
- A pill that contains low doses of two different drugs
- If your kidneys do not work as they should, your doctor may recommend you start on a low dose of an ACE inhibitor or ARB (but not together). These types of drugs can help protect the kidneys from further damage.
How low should you go?
Normal, healthy blood pressure can be anything under 120/80 people with high blood pressure were instructed to keep their pressure below 140/90. New recommendations suggest that for some people, it's okay slightly higher to allow blood pressure to below 150/90 drift. The thinking is that it reduces further problems such as feeling dizzy when standing up or out of bed, falls could cause. And low pressure is usually more medication that can cause harmful side effects.
The new stroke study and others provide clear evidence that the best target for stroke prevention is to keep blood pressure below 140/90. I plan to use a target blood pressure of less than 140/90 for my most of my patients. The exceptions are older people with high blood pressure at the sit or lie but low blood pressure when they stand up.
If you have high blood pressure, at least 75% as long as you don't feel dizzy aim of your blood pressure below 140/90 - if you stand up. If you or your blood pressure over 140/90 remain, let your doctor know.