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
(Our Organization is not
responsible for the content of Internet sites.)
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
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.
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