MedicalResearch.com Interview with:
Dr. Alain Lekoubou Looti, MD Msc
Department of Neurosciences
College of Medicine
Medical University of South Carolina
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hypertension is strongly associated with stroke. Individuals who suffer a stroke are more likely to have another stroke. They also die at a rate twice as high as those who experience a first event. We have evidence that treating hypertension reduces the risk of recurrence stroke among stroke survivors.
Prior hypertension guidelines defined hypertension for a systolic blood pressure (top number) equal or greater than 140 and a diastolic blood pressure (lower number) equal or greater than 90. The American college of cardiology/American heart association have published a new guideline to help healthcare providers identify and treat blood pressure including among stroke survivors. The threshold to define blood pressure has been lowered to 130 for the top number and 80 for the lower number for everyone. Unlike the general population, pharmacological treatment for stroke survivors is now recommended for systolic blood pressure greater than or equal than 130 and diastolic blood pressure greater than or equal to 80. In the same line achieving a blood pressure of less than 130/80 mmHg in stroke survivors is now recommended. In the stroke community, there has been mounting evidence to suggest that achieving lower blood pressure goal was desirable. When the new guidelines were published, we could not wait any longer to see the impact of the new guidelines on the proportion of stroke survivors with hypertension, recommended pharmacological treatment, and above blood pressure target. We were also curious to see how the new guidelines would potentially affect mortality among stroke survivors.
We have found that the new guidelines would result in a nearly 67% (from 29.9% to 49.8%) to relative increase in the proportion of U.S. stroke survivors diagnosed with hypertension and 54% (from 36.3% to 56%) relative increase in those not within the recommended BP target. We have also found that if the new guidelines were applied, this would result in a 33% relative drop in mortality.
MedicalResearch.com: What should readers take away from your report?
Response: With the new guidelines, the proportion and number of stroke survivors with hypertension will increase substantially. Unlike the general population where a modest increased increase is expected, stroke survivors recommended pills to treat their hypertension will spiral. This study also suggests that despite the anticipated challenges in implementing them into practice, adhering to the new guidelines could save more lives.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our estimates were based on a top-down approach. Prospective studies are needed to see if the magnitude of the effects of the new hypertension guidelines on stroke survivors obtained from this retrospective analysis is transcended in the real life. We hope that our findings serve as a catalyzer to raise awareness in the medical community and the community in general about the need to aim for lower numbers when treating blood pressure among stroke survivors.
MedicalResearch.com: Is there anything else you would like to add?
Response: It may sound ambitious, but we believe that achieving a blood pressure of less than 130/80 mmHg in a stroke survivor is feasible. We as a society have the required tools to achieve this goal. Physicians and medical providers are expected to play a pivotal role in this regard.
We, the authors of this article have no conflict of interest to declare.
Nationwide Impact of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines on Stroke Survivors
Alain Lekoubou, Kinfe G. Bishu, Bruce Ovbiagele
Journal of the American Heart Association. 2018;7:e008548
Originally published June 6, 2018
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