African-Americans May
Not Be Treating Stroke Risk Factors
Study
finds problem even among African-Americans who have had a stroke
The
African-American population, at twice the risk for stroke compared to
Caucasian Americans, need a crash course on stroke prevention, a new
Chicago study has found.
A report
looking at 1,086 African-American men and women who had been out of
the hospital for only  about
six weeks after having strokes found that even those people were not
effectively treating the risk factors for stroke, particularly high
blood pressure.
"They
had seen doctors in the hospital and had one or two follow-up visits
afterwards, yet even despite this, a lot of the patients were unaware
of the risk factors in their profile, particularly high blood pressure,"
says study author Sean Ruland, a neurologist at the Rush Medical College
in Chicago.
"This
study is particularly distressing because these are men and women who
have been treated, and they are already under scrutiny. Further, they
have significant risks of having another stroke. One quarter of all
strokes are recurrent strokes," says Dr. Stanley Tuhrim, director of
the stroke program at New York City's Mount Sinai Hospital.
The
study, funded in part by the National Institutes of Health (NIH),
appears in a recent issue of the journal Neurology.
Ruland's
findings were culled from another study comparing the effectiveness
of an anti-clotting agent to aspirin in stroke and heart attacks. For
this study, Ruland looked at rates of awareness, treatment, and control
of risk factors for stroke, including hypertension, diabetes, and cholesterol
levels among the men and women stroke victims whose average age was
62.
High
Blood Pressure Often To Blame
Of
the three, high blood pressure was the most common risk among these
patients.
Eighty-seven
percent of the stroke patients in the study had high blood pressure,
Ruland and his colleagues found, yet a fourth of those patients took
no hypertension medicine. And, he says, even among those who did take
hypertension medicine, 70 percent still had elevated blood pressure.
Further, of the 143 patients with no reported hypertension or use of
medications, more than half had elevated blood pressure, above 130/85.
How
Is Blood Pressure Measured?
Two
numbers are recorded when measuring blood pressure. The higher number,
or systolic pressure, refers to the pressure inside the artery when
the heart contracts and pumps blood through the body. The lower number,
or diastolic pressure, refers to the pressure inside the artery when
the heart is at rest and is filling with blood. Both the systolic and
diastolic pressures are recorded as "mm Hg" (millimeters of mercury).
This recording represents how high the mercury column is raised by the
pressure of the blood.
High
Blood Pressure Increases Risk For Heart Attack and Stroke
High
blood pressure, or hypertension, directly increases the risk of coronary
heart disease (heart attack) and stroke (brain attack). With high blood
pressure, the arteries may have an increased resistance against the
flow of blood, causing the heart to pump harder to circulate the blood.
"Clearly,
African-Americans have a higher prevalence of hypertension than do white
Americans. It seems to be the only explanation why they are at increased
risk of stroke," Tuhrim says.
About
40 percent of the stroke victims had diabetes, and about 85 percent
were taking medication for their illness. A history of high cholesterol
or use of cholesterol-lowering medicine was reported by 39 percent of
the study participants.
Underuse
of Proven Therapies Is a Problem
Ruland
says underuse of proven effective therapies is a serious problem for
African-Americans and points to several possible reasons: physician
attitudes, problems with patient access to care, unawareness of the
importance of routine screening, and compliance with treatment.
"Physicians
may not have the time for necessary care and follow-ups or aren't aware
of the current guidelines for hypertension treatment," Ruland says.
Last
year, the Joint National Committee of the National Heart, Lung,
and Blood Institute lowered to 130/85 the threshold for treating
hypertension. Previously it had been 140/90, Ruland says.
Another
important consideration includes that fact that often hypertension has
few, if any, symptoms, so unless people are vigilant about taking their
blood pressure they might not know they have an elevated score.
Denial
Can Be Deadly
Lastly,
Ruland says, people whose blood pressure readings are high in his office
are often in denial that they have high blood pressure.
"They
tell me they just sat in traffic for an hour or walked up a hill," he
says when he reports that they have high blood pressure. "I've heard
everything in the book."
He
recommends that people with a reading above 130/85 should monitor their
own blood pressure regularly, several times a week, until it reaches
the recommended level. He tells patients to buy a blood pressure cuff
from the pharmacy or have it checked at one of the many public places
that offer blood pressure readings.
Always
consult your physician for more information.
Online
Resources
American
Heart Association
Circulation,
Journal of the American Heart Association
Joint
National Committee of the National Heart, Lung, and Blood Institute
National
Heart, Lung, and Blood Institute (NHLBI)
National
Institutes of Health (NIH)
Neurology
|
February
2003
African-Americans
May Not Be Treating Stroke Risk Factors
High
Blood Pressure Often To Blame
How
Is Blood Pressure Measured?
High
Blood Pressure Increases Risk For Heart Attack and Stroke
Underuse
of Proven Therapies Is a Problem
Denial
Can Be Deadly
Physicians
Urged to Watch Diabetics' Legs
Online
Resources
Find
a St. John's Mercy Physician
In
Other News About Your Heart Health:
Physicians
Urged to Watch Diabetics' Legs
Study
says treatment can cut heart attack and stroke risk
Aggressive
treatment to lower blood pressure in persons with diabetes with
clogged leg arteries significantly reduces the risk of heart attacks
and strokes, researchers say.
In
a recent study published in the Circulation, Journal
of the American Heart Association, researchers
say clogging of leg arteries, sometimes overlooked by primary care
physicians, can be a sign of serious coronary disease.
Diabetes
and high blood pressure are key risk factors for peripheral arterial
disease (PAD), a form of atherosclerosis that affects arteries leading
to the legs and feet. Cholesterol-laden plaque builds up in the
blood vessels and reduces blood flow to the legs. That limited blood
flow cannot meet the demand from legs when a person with PAD is
walking or exercising, and that shortfall results in pain, aching,
and fatigue in the legs.
Giving
blood pressure-lowering medications to those who have type 2 diabetes
(a condition in which the body either makes too little insulin or
cannot properly use the insulin it makes to convert blood glucose
to energy) and peripheral arterial disease substantially reduced
the risk of heart attacks and strokes, the study says.
"PAD
is very common, but it's under-recognized and under-treated," says
Dr. William R. Hiatt, the report's senior author and a professor
of medicine at the University of Colorado Health Sciences Center.
"It often presents itself as leg cramping during exercise, and physicians
don't tune in to it too much."
Measuring
blood pressure in the ankle can provide a crucial early warning
sign of coronary disease —and give physicians a chance
to reduce the risk of heart attack or stroke through intensive blood-pressure
control, the study found.
"The
point of this is if you've got [PAD] in your leg, it is a sign of
severe coronary disease, even in the absence of a heart attack,"
Hiatt says. "What we're discovering is if you treat those people
aggressively, you can prevent heart attack and stroke."
Researchers
also used the "ankle-brachial index," which compares the blood flow
in the arm and ankle arteries of patients, to detect PAD.
Hiatt
says the study provides more evidence of the importance of aggressive
blood-pressure control for persons with diabetes. He adds the type
of blood pressure medication—a calcium-channel blocker or
angiotensin-converting enzyme inhibitor—did not matter.
The
study's findings underscore the need for aggressive treatment to
lower blood pressure in PAD patients. Also of critical importance
is not just treating risk factors for heart attack and stroke, but
treating these risk factors aggressively.
PAD
affects eight million to 12 million Americans, according
to the American Heart Association.
Always
consult your physician for more information.
|
