Stroke survivors could gain the most from new blood pressure guidelines

June 06, 2018

DALLAS, June 6, 2018 -- Treating high blood pressure in stroke survivors more aggressively, could cut deaths by one-third, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

"The potential to reduce mortality and recurrent stroke is immense, because more than half of all strokes are attributable to uncontrolled high blood pressure," said Alain Lekoubou, M.D., M.S., study lead author and clinical instructor in neurology at the Medical University of South Carolina in Charleston.

In the AHA/ACC guideline for hypertension, released in 2017, the threshold for stage 1 hypertension, or high blood pressure was changed to at or above 130 mmHg for the top number or 80 mmHg for the bottom number. The previous threshold for high blood pressure was, at or above 140/90 mmHg.

Overall, while many more people will be diagnosed with hypertension under the new guideline, there will be only a small increase in the percentage of people who require medication. However, blood pressure-lowering medications are recommended for all stroke survivors with blood pressures of 130/80 mmHg or higher, and additional drugs if needed to reduce blood pressure below that threshold.

In the new study, researchers used data from the National Health and Nutrition Examination Surveys to estimate the nationwide impact of applying that approach. The surveys, conducted between 2003 and 2014, included blood pressure measurement and asked participants about their stroke history and blood pressure treatment.

If clinicians fully shift from the previous guidelines to the new ones, the researchers calculated the impact on stroke would be: "The new guideline offers physicians and policymakers a unique opportunity to reinforce the already decreasing stroke-related mortality trends of the last few decades," Lekoubou said. "It is our responsibility to ensure that stroke survivors identified with hypertension are treated more aggressively and to ensure that those on treatment remain on treatment."

While the potential to prevent recurrent strokes and save lives is large, the researchers acknowledge that there are special challenges in treating blood pressure in stroke survivors.

"Stroke survivors can face many hurdles in adhering to treatment, including major neurological impairments and depression, which can reduce the motivation to take medication. Caring for stroke survivors may be complicated because it is primarily a disease of the elderly, who are often taking several medications to treat their medical conditions," said Lekoubou.

The study is limited by relying on self-reports of a history of stroke and the inability to separately analyze the impact of the new guidelines on survivors of clot-caused or bleeding strokes.

"The true magnitude of the impact of these changes in high blood pressure definition and treatment recommendations will best be evaluated by prospective studies, which will also offer the opportunity to identify gaps and improve treatment protocols among stroke survivors," Lekoubou said.
-end-
Co-authors are Kinfe G. Bishu, Ph.D. and Bruce Ovbiagele, M.D., M.Sc., M.A.S., M.B.A. Author disclosures are on the manuscript.

Additional Resources:

Available multimedia is on the right column of the release link https://newsroom.heart.org/news/stroke-survivors-could-gain-the-most-from-new-blood-pressure-guidelines?preview=a7f2d1e0de2d64c85006e76fe0f2b1d9

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at http://www.heart.org/corporatefunding.

About the American Heart Association

The American Heart Association is devoted to saving people from heart disease and stroke - the two leading causes of death in the world. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation's oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country. Follow us on Facebook and Twitter.

American Heart Association

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