Secondary Prevention Strategies in Ischemic Stroke: Identification and Optimal Management of Modifiable Risk Factors

Flemming, Kelly D.; Brown, Robert D.

doi:10.4065/79.10.1330

Cited by 30 publications

(16 citation statements)

References 119 publications

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“…While prevention of stroke is crucial for all, individuals who have suffered a previous stroke are at increased risk of recurrence [4, 5]; hence secondary prevention becomes a major concern. Recurrent stroke, although known to be characterized by greater level of mortality and morbidity compared to first-ever stroke, is preventable [6, 7]. Consequently, guidelines for stroke management identify secondary prevention of stroke as one of the major goals of stroke care [8] while specific guidelines also exist for prevention of recurrent stroke [9].…”

Section: Introductionmentioning

confidence: 99%

Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

Vincent-Onabajo

Moses

2016

Stroke Research and Treatment

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Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke—whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk factor) was assessed using open-ended questionnaire. Data were treated with descriptive statistics and logistic regression analysis. Results. Sixty-nine stroke survivors (male = 72.5%; mean ± SD age = 49.7 ± 10.6 years) participated in the study. Thirty-four (49.4%) participants had knowledge of stroke risk factors. Only educational level was significantly associated with knowledge and participants with tertiary educational qualification were about 48 times (odds ratio = 48.5; CI = 7.6–309.8; P < 0.0001) more likely to be knowledgeable than those with no education. Conclusion. Less than half of the participants had knowledge of stroke risk factors. Participants with tertiary education were significantly more knowledgeable than those with lower educational qualifications. Effective means of educating stroke survivors on stroke risk factors should be identified and adopted.

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Section: Introductionmentioning

confidence: 99%

Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

Vincent-Onabajo

Moses

2016

Stroke Research and Treatment

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“…However, although current guidelines for secondary stroke prevention emphasize aggressive treatment of hypertension they do not recommend routine examination for postural hypotension 4 . Postural hypotension was not even listed as a ‘possible’ modifiable risk factor in a recent symposium on secondary stroke prevention 5 . This approach may be too simplistic and even detrimental in some situations.…”

Section: Patient Characteristics Tilt‐test Results and Follow Upmentioning

confidence: 99%

“…4 Postural hypotension was not even listed as a 'possible' modifiable risk factor in a recent symposium on secondary stroke prevention. 5 This approach may be too simplistic and even detrimental in some situations. Physiologists have long known that transient hypotension may cause impairment of collateral flow to an area of brain distal to a significant stenosis, resulting in focal ischaemia.…”

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confidence: 99%

Tilt‐test diagnosis of hypotensive transient ischaemic attacks

Jardine

Hurrell

Fink

2007

Internal Medicine Journal

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Eight elderly patients with postural hypotension who presented with transient ischaemic attacks are reported. Six patients underwent head-up tilt testing with continuous blood pressure monitoring. During tilt, postural hypotension was found in five patients and in three patients transient ischaemic attacks were reproduced. Postural hypotension is probably a rare cause of transient ischaemic attacks, but may be underrecognized.

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“…This finding suggests that progressive antihypertension treatment is not appropriate for patients with severe carotid stenosis. In the United States, a consensus among experts was reached that BP ≥140/90 mm Hg be allowed for intracranial stenosis …”

Section: Bp Management In Ischemic Strokementioning

confidence: 99%

Hypertension Criterion for Stroke Prevention—to Strengthen the Principle of Individualization in Guidelines

Chen

et al. 2015

J of Clinical Hypertension

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The diagnosis of hypertension, as recommended by most guidelines, is determined by systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. A threshold-based definition of hypertension, however, ignores sex and age, pathophysiology, and disparities in patient-specific conditions. Moreover, the harmful effects of hypertension-induced target organ damage cannot be ignored. Although the principle of individualization for hypertension management is recommended, especially for stroke prevention, how to practice it in a clinical setting has not been clearly elaborated. Therefore, we put forward a proposal for individualized hypertension management incorporating target organ damage, the main harmful effect of hypertension. We propose that hypertension should be diagnosed when an individual's blood pressure exceeds some difference from their own baseline in young adulthood, accompanied by any hypertension-induced target organ damage, confirmed by various detection methods. Application of this proposal to stroke prevention will hopefully strengthen the principle of individualized hypertension management.

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Secondary Prevention Strategies in Ischemic Stroke: Identification and Optimal Management of Modifiable Risk Factors

Cited by 30 publications

References 119 publications

Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

Tilt‐test diagnosis of hypotensive transient ischaemic attacks

Hypertension Criterion for Stroke Prevention—to Strengthen the Principle of Individualization in Guidelines

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