Common Risk Factors For Stroke Research Articles

MALE AND FEMALE ATRIAL FIBRILLATION PATIENT – DOES IT ACTUALLY COUNT IN PREDICTING HYPERTENSION-MEDIATED ORGAN DAMAGE?

Objective: Having as starting point the frequent association and strong interrelation between atrial fibrillation and hypertension in everyday medical practice, as well as atrial fibrillation particularity of being both a common manifestation and risk factor for stroke and heart failure in hypertensive patients, the objective of our study was to assess the potential predictive value of gender in evaluating hypertension-mediated organ damage risk in atrial fibrillation hypertensive patients.Design and method: Our analytic-observational study retrospectively analyzed, over a two years period, 925 hypertensive patients presenting with atrial fibrillation, grouped by gender, following the occurrence of four main hypertension-induced complications: stroke, heart failure, peripheral artery disease and renal dysfunction. Results: Regarding the risk of peripheral artery disease, results indicated a statistically significant difference (p = 0.001) between the two gender groups, with men being more frequently affected than women (44.5% versus 34.1%) and having a higher risk of developing this complication (odds ratio, 1.54; 95% confidence interval [CI], 1.18 to 2.02; p = 0.003). On the other hand, renal impairment, commonly detected by a reduced estimated glomerular filtration rate (eGFR), was more obvious in female patients (eGFR equals 54.25 ± 19.65 ml/min/1.73m2 in women versus 66.66 ± 23.35 ml/m2/min in men; p = 0.001). (Figure 1) Nevertheless, no statistically significant correlation between a specific gender group and other hypertension-related organ alterations was observed, both stroke and left ventricular dysfunction affecting women and men to a similar extent (p value was 0.0091 for stroke and 0.62 for heart failure). (Figure 2) Conclusions: By revealing a greater prevalence of peripheral artery disease in men and more severe kidney functional damage in women, the above presented results strongly suggest that the complete clinical evaluation preceding an optimal antihypertensive treatment decision may also require taking account of less considered aspects, such as patients gender. And even if efficient blood pressure control is mandatory in all patients, irrespective of gender, its potential predictive value and the hypothesis of a sex-differentiated organ damage susceptibility represent solid arguments favoring more individualized, patient-centered therapeutic strategies.

Hypertensive Patients' Knowledge of Risk Factors and Warning Signs of Stroke at Felege Hiwot Referral Hospital, Northwest Ethiopia: A Cross-Sectional Study.

Background Stroke is a neurological condition which is a major cause of death and disability in many low- and middle-income countries. However, several modifiable risk factors are becoming significant. Hypertension is the most common stroke risk factor globally as well as in our country, Ethiopia. Objective The aim of this study was to assess hypertensive patients' knowledge of risk factors and warning signs of stroke at Felege Hiwot Referral Hospital, Northwest Ethiopia, 2018. Method An institutional based cross-sectional study design was conducted in May 01–30/2018. A total of 278 hypertensive patients were enrolled and systemic random sampling technique was employed to select the study participants. Data was collected through an interviewer-administered questionnaire. The collected data was entered into Epi info 7 and exported to SPSS version 22 for analysis. Binary and multivariable logistic regressions were used and P value ≤ 0.05 was considered as statistically significant. Result Out of the total 284 selected hypertensive patients, 278 of them responded completely with a response rate of 97.9 %. Of these, more than three fourths, 214 (77%) and 201 (72.3%), of them did not identify any risk factors and warning signs of stroke, respectively, with an overall proportion of only 18.3% of them having good knowledge towards stroke. Risk factor of stroke most commonly known to the respondents was physical inactivity (21.58%), whereas hypertension was the least described risk factor (3.6%). Regarding stroke warning signs, sudden weakness on one side of the body (35.97%) was the most commonly known warning sign of stroke to the respondents. Being able to read and write, being young, urban residence, and having sufficient monthly income were significantly associated with the overall knowledge of hypertensive patients towards stroke. These findings suggest the need for emphasizing on stroke education regarding its risk factors and warning signs through public or social media and health education targeting to low-income high risk subjects.

The differences in functional recovery between HIV-positive and HIV-negative stroke survivors

This study aims to identify the differences in functional abilities between stroke survivors who are human immunodeficiency virus (HIV)-positive and HIV-negative. This was a retrospective, longitudinal record review of stroke survivors' files between April 2005 and December 2010. Of a total of 173 stroke survivors who were admitted to the rehabilitation unit, 141 (75 males, 66 females; mean age 52.7±14.3 years; range, 19 to 86 years) met the inclusion criteria. The patients were divided into two groups as HIV-positive (n=21) and HIV-negative (n=120). Functional ability was recorded using the admission and discharge BETA® scores. Ischemic strokes were more prevalent than hemorrhagic strokes (74.5% vs. 25.5%, respectively) with hypertension as the most common (31.9%) stroke risk factor. The mean age of stroke onset for HIV-positive patients and HIV-negative patients was 39.6 years and 54.9 years, respectively. In HIV-positive patients, the mean duration of rehabilitation was 7.5-day shorter than HIV-negative patients. After receiving rehabilitation from a multidisciplinary team, the HIV-positive group improved with a mean of 40 points and the HIV-negative group improved with a mean of 38 points. The similarities in functional outcome between the HIV-positive and HIV-negative group were related to the fact that HIV-positive stroke survivors were relatively younger than the HIV-negative group. Our study results show that patients who sustain a stroke, are HIV-positive, are receiving antiretroviral therapy and rehabilita- tion may recover similar to those who are HIV-negative, spending a similar length of stay in a rehabilitation clinic. Therefore, stroke survivors who are HIV-positive should receive full rehabilitation similar to any other stroke survivors.

Abstract P198: WNK-SPAK-NKCC1 Cascade Activation Contributes to Worsened Brain Damage in Mice With Hypertension Co-Morbidity after Ischemic Stroke

Objectives: The WNK-SPAK/OSR1 kinase complex plays an important role in renal salt handling and pathogenesis of hypertension by regulating ion transporters and channels. Hypertension is the most common risk factor for stroke and stroke patients with hypertension comorbidity have worsened outcome with an increased risk of dependency or death. However, the mechanisms underlying the worsened ischemic stroke pathophysiology with hypertension comorbidity remain poorly defined. In this study, we investigated roles of the WNK-SPAK-NKCC1 signaling pathway in ischemic brain damage in mice with hypertension comorbidity. Methods: Hypertension was induced in C57BL/6j male mouse (12-15 weeks) by subcutaneous infusion of 1000 ng/kg/min angiotensin II (AngII, mini-osmotic pump) for two weeks. Permanent ischemic stroke was induced by permanent occlusion of the distal branches of the left middle cerebral artery (pd-MCAO). Brain tissues were harvested for immunoblot assessment of expression levels of NKCC1, SPAK/OSR1 or WNK1-4. Infarct volume and hemisphere swelling were determined by TTC staining, and behavioral deficits were analyzed by foot fault test, cylinder test and adhesive tape removal test. Results: pd-MCAO stimulated expression of WNK proteins (isoforms 1, 2, 4), total and phosphorylated SPAK/OSR1 and NKCC1 proteins in ischemic brains of the AngII-infused hypertensive mice compared to normotensive saline controls. In parallel with the increased activation of WNK-SPAK-NKCC1 signaling, hypertensive mice displayed significantly larger infarct volume and hemispheric swelling at 24 h after pd-MCAO compared to normotensive controls. Moreover, hypertensive mice exhibited a slow recovery of neurological function after ischemic stroke compared to normotensive counterparts as assessed by sensory-motor sensitive tests. Conclusions: These results suggest that activation of the WNK-SPAK-NKCC1 complex in hypertensive ischemic brains associates, at least in part, with the worsened brain damage and neurological deficits. Pharmacological inhibition of WNK-SPAK complex has therapeutic potentials for stroke therapy with hypertension comorbidity.

Risk factors for ischemic stroke in patients with non-valvular atrial fibrillation and therapeutic international normalized ratio range.

IntroductionAtrial fibrillation (AF) is the most common cause of ischemic stroke (IS). Atrial fibrillation patients are recommended to use oral anticoagulants (OACs) as part of prevention against IS. However, despite having a therapeutic intensity of OAC therapy, IS can still occur in such patients. The aim of our study was to examine the configuration of IS risk factors in patients with non-valvular atrial fibrillation (NVAF) and within the therapeutic INR range (TINR).Material and methodsOur retrospective study involved 1835 patients with a recent IS. The experimental group consisted of 154 patients with acute IS, NVAF and TINR. The control group consisted of 1681 patients with acute IS but without AF.ResultsPatients with IS, NVAF and TINR were significantly older and more often female than patients with IS without NVAF (p < 0.001 and p < 0.001, respectively). In these patients, diabetes mellitus, dyslipidemia, hypertension, coronary heart disease, smoking and previous IS were significantly more frequent than in the patients with IS without NVAF (p = 0.036, p = 0.002, p < 0.001, p < 0.001, p < 0.001, p = 0.003). Based on a univariable and multivariable logistic regression model, we found that in the group of patients who suffered a stroke despite TINR compared to patients with IS without AF there were more smokers (OR = 20.337; OR = 147.589) and patients with previous stroke (OR = 6.556; OR = 11.094), hypertension (OR = 3.75; OR = 2.75) and dyslipidemia (OR = 2.318; OR = 2.294).ConclusionsThe group of patients with NVAF and TINR is significantly more burdened by other independent common risk factors for stroke.

The Epidemiological Characteristics of Stroke in Hunan Province, China.

Previous studies have shown that Hunan Province has a high incidence of stroke and a high proportion of intracerebral hemorrhage (ICH). Considering the changes over the past three decades, little is known about the current epidemiological characteristics of stroke in Hunan Province. In 2013, a cross-sectional study was conducted at seven national disease surveillance points (DSPs) in Hunan Province. A multistage cluster sampling method was used to select a representative sample. A total of 21,156 participants aged 20 years and older were examined. Among the 21,156 participants, the number of prevalent strokes, incident strokes and deaths was 307, 87, and 36, respectively. The 2010 China census-standardized prevalence, incidence and mortality were 1191.0 per 100,000 people [95% confidence interval (CI) 1044.8–1337.2], 333.6 per 100,000 person-years (95% CI 255.7–411.5) and 129.7 per 100,000 person-years (95% CI 81.1–178.3), respectively. Ischemic stroke (IS), ICH, subarachnoid hemorrhage (SAH), and stroke of undetermined type (UND) constituted 50.6, 41.4, 5.7, and 2.3% of all incident stroke cases, respectively. Tianxin, Liuyang, Wuling, and Hongjiang have high proportions of ICH (61.5, 58.3, 60, and 50%, respectively). Hypertension is the most common risk factor for prevalent stroke (71.34%), followed by smoking (30.62%) and alcohol use (25.73%). In conclusion, Hunan Province has an extremely heavy stroke burden. The high proportion of ICH is not limited to the Changsha community; it represents an important issue for all of Hunan Province.

Risk factors of acute ischemic stroke in patients presented to Beni-Suef University Hospital: prevalence and relation to stroke severity at presentation

BackgroundAcute ischemic stroke is one of the major causes of disability and death worldwide. Effective prevention remains the best approach for reducing the burden of stroke. The aim of this work was to study the prevalence of stroke risk factors and the possible relation between such risk factors and the disease severity at presentation in a sample of stroke patients presented to Beni-Suef University Hospital, north Upper Egypt.MethodsA sample of 167 patients of acute ischemic stroke recruited from Beni-Suef University Hospital was included in this cross-sectional descriptive study. All subjects were subjected to history taking, clinical, laboratory, and radiological evaluation. Stroke severity and disability were evaluated by National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) respectively.ResultsHypertension was detected in 104 patients (62.3%), dyslipidemia was detected in 79 patients (58.1%), and 69 patients (41.3%) were smokers. Diabetes mellitus was detected in 58 patients (34.7%) with high prevalence of cardio-embolic risk factor, 36 patients (21.6%) had rheumatic heart, and 44 patients (26.3%) had atrial fibrillation.NIHSS score was significantly higher in hypertensive patients (P value = 0.023) and in patients who had carotid stenosis ≥ 50% (P value = 0.011), whereas there was no significant relation between NIHSS score and diabetes mellitus (P = 0.221), dyslipidemia (P = 0.834), patients with history of cardio-embolic stroke (P = 0.085), previous ischemic stroke (P = 0.316), or sex (P = 0.343).mRS score was significantly higher in patients with age > 45 years old (P < 0.001), hypertension (P < 0.001), cardio-embolic risk factor (P = 0.044), and carotid stenosis ≥ 50% (P = 0.017), whereas there was no significant relation between mRS score and diabetes mellitus, previous ischemic stroke, or sex.ConclusionsThe most common risk factor for stroke was hypertension followed by dyslipidemia and then smoking with higher incidence of rheumatic heart diseases due to lowered living conditions. Age, hypertension, cardio-embolic risk factors, and carotid stenosis ≥ 50% have negative impact on stroke severity and disability.

Risk factor profile in patients with stroke at a young age

Background The distribution of risk factors for stroke is related to gender and age. The main objective of study was to determine the type and frequency of stroke risk factors in patients with first-in-life stroke before the age of 50.Methods Our study included patients under the age of 50 with first-in-life stroke. The following data obtained from all participants were analyzed: a neuroimaging of the head, wide panel of blood tests, electrocardiogram, transesophageal echocardiography, ultrasound of the carotid/cerebral arteries. 24-hour ECG monitoring and angio-MRI of head were performed in most patients.Results One hundred and eighty-four patients were qualified into the study; mean age – 39 years (female 45%). The female gender was significantly more often associated with diabetes, carotid/cerebral artery stenosis, myocardial infarction, cardiomyopathy and risk factors associated with lifestyle. More than half of the patients presented at least two risk stroke factors. The most frequent categories of risk factors were related to arteries and metabolic diseases. Vascular risk factors were among the most frequent in individual age categories. Hereditary stroke-burden was significant in the patient before the age of 20.15% of the patients haven’t got known stroke risk factor.Conclusions Angiopathy is the most common risk factor for stroke at a young age. More than half of the patients with stroke at a young age have at least two independent risk factors for stroke. In the first two decades of life, the most frequent risk factors for stroke are heart diseases; arterial diseases play a dominant role in the consecutive three decades.

The latest development of antihypertensive medication

Hypertension is the most common risk factor for cardiovascular disease, stroke, renal failure, and death. Recent drug monitoring studies found non-adherence to BP lowering therapy in 25% to 65% of patients with apparent treatment-resistant hypertension (TRH). This review focuses on the latest development of antihypertensive medication, such as vasopeptidase inhibitors, aldosterone synthase inhibitors, Soluble Epoxide Hydrolase Inhibitors, agonists of natriuretic peptide receptor, Vasoactive Intestinal Peptide Receptor Agonist, a novel mineralocorticoid receptor antagonist, inhibitors of aminopeptidase A, dopamine β-hydroxylase inhibitor, intestinal Na+/H+ exchanger 3 inhibitor and other agents.

Abstract WP281: Multicenter Analysis of Stroke Risk Factor Treatment

The majority of the 800,000 strokes occurring in the US each year are first-time strokes. To understand how these can be prevented, our study assessed primary care (PC) treatment of common stroke risk factors (RF) in the year prior to a first-time stroke. We compared hospitals in three major health systems – a California County (OVMC), VA (WLAVA), and Kaiser HMO (KSD), both before and after the Affordable Health Care Act (ACA). Methods: We identified patients who suffered a first-time stroke in 2013 and 2015 at all three sites. We then assessed the three most recent PC visits for these patients in the year before their stroke for “missed opportunities” (MO) in stroke preventative care. MOs included: Systolic blood pressure (SBP) &gt;140 not addressed, elevated A1C not addressed, LDL never checked or &gt;100 but not addressed, antiplatelet medication not refilled, and no RF counseling (smoking, alcohol, obesity, or physical activity). MOs were compared between sites, before (2013) and after the ACA (2015). Results: 85 patients from OMVC, 88 patients from KSD and 64 patients from WLAVA met entry criteria. All sites had an increase in the number of patients who had PC visits prior to first-time stroke between 2013 and 2015 (OVMC 2013: 1/26, 2015 15/59 (25.4%). KSD 2013: 50/67 (74.6%), 2015 16/21 (76.2%). VA 2013: 24/33 (72.7%) 2015 28/31 (90.3%). In 2013, only one OVMC patient had primary care. In 2013, the WLAVA had significantly less MO than Kaiser (23.6% vs 59.0%, p&lt;0.001). In 2015, there was no significant difference in MO between the three sites (p=0.21). The most common MOs were in addressing hypertension, elevated LDL, and lack of RF counseling. Conclusions: Stroke RFs were often not addressed during PC visits at all 3 sites. All sites had an increase in PC visits among first-time stroke patients after the ACA, particularly within the LA County system. It is unclear if this resulted in increased stroke RF counseling and intervention. Efforts to promote primary stroke prevention are still needed.

Predictors for Intracranial Hemorrhage Following Intravenous Thrombolysis in Posterior Circulation Stroke.

Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90. Overall, 11 (7%) patients had ICH. Atrial fibrillation (p = 0.004), neurological deficit at time of treatment in the National Institutes of Health Stroke Scale (p = 0.016), decreased level of consciousness (p = 0.003), occlusion of basilar artery (p = 0.007), occlusion of PCA (p = 0.001), and additional endovascular therapy (p = 0.001) were identified by logistic regression analysis as significant predictors for ICH in PCS. Patients with ischemic lesion in the brainstem, occlusion of vertebral artery, or absence of basilar and posterior cerebral artery occlusion might be considered for treatment with IVT even in borderline cases. Those patients seem to have less frequently favorable outcomes without an increase in ICH rate. Time to IVT in PCS seems not to influence ICH risk or chances for favorable outcomes as significantly as it does in ACS.

Predictive value of the CHA2DS2-VASc score in atrial fibrillation patients at high risk for stroke despite oral anticoagulation: Algerian experience

The risk of stroke in atrial fibrillation is heterogeneous and depends upon underlying clinical conditions included in current risk stratification schemes. Recently, the CHA2DS2-VASc score has been included in guidelines to be more inclusive of common stroke risk factors seen in everyday clinical practice, and useful in defining “truly low risk” subjects. We aimed to assess the usefulness of CHA2DS2-VASc score to give us an additional prognostic perspective for adverse events and mortality among “real world” anticoagulated patients with atrial fibrillation who are often elderly with many comorbidities. Consecutive outpatients with permanent/paroxysmal nonvalvular atrial fibrillation with CHA2DS2-VASc > ou = a 2 and stabilized oral anticoagulation (international normalized ratio 2.0–3.0) for at least the preceding 6 months were recruited. Patients with CHA2DS2-VASc ≥ 2 were selected. Adverse cardiovascular events including stroke, acute coronary syndrome, or heart failure; major bleeds; and mortality were recorded during more than 2-year follow-up. Of 393 patients (93.5%) assessed, 260 were males, median age 75 (71–81) years. After a follow-up of 690 (432–805) days, 11.6% patients had adverse cardiovascular events, 8.5% patients had major bleeds, 10.7% patients died, and 24.4% major adverse events (composite endpoint). Increasing CHA2DS2-VASc score by 1 point had a significant impact on the occurrence of cardiovascular events (hazard ratio = 1.27; 95% confidence interval, 1.13–1.44; P < 0.001), mortality (hazard ratio = 1.36; 95% confidence interval, 1.19–1.54, P < 0.001); and major adverse events (hazard ratio = 1.23; 95% confidence interval, 1.13–1.34; P < 0.001). CHA2DS2-VASc score was not associated with major bleeding episodes. Among high-risk atrial fibrillation patients on oral anticoagulation, CHA2DS2-VASc successfully predicts cardiovascular events and mortality, but not major bleeds.

Prospective assessment of patients with stroke in Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia.

IntroductionThe burden of stroke is increasing in many low- and middle-income countries. In Ethiopia, stroke has become a major cause of morbidity, long-term disability, and mortality. Time from stroke onset to hospital presentation is a critical factor in acute stroke care. This study aimed to describe risk factors for stroke and clinical presentation of patients presenting to the emergency centre with stroke.MethodsWe conducted a cross sectional study conducted from August 2015 to January 2016 in an urban tertiary care centre in Addis Ababa, Ethiopia. Descriptive statistics and multivariable logistic regression models were used to evaluate associations between stroke types and stroke risk factors, and delayed presentation and clinical indicators. P-values less than .05 were considered statistically significant.ResultsA total of 104 patients were included. The mean age was 53 years, and 56% were male. Only 30% of patients arrived using an ambulance service. The most common presenting symptoms were altered mental status (48%), hemiparesis (47%), facial palsy (45%), hemiplegia (29%), and aphasia (25%). Hypertension was the most common risk factor (49%), followed by cardiovascular disease (20.2%) and diabetes mellitus (11%). The majority of strokes were haemorrhagic in aetiology (56%). The median arrival time to the emergency centre was 24 h after symptoms onset; only 15% presented within three hours. Patients with hypertension, or presented with loss of consciousness were significantly more likely to have haemorrhagic stroke (p < .001 and p = .01 respectively). The only risk factor robustly associated with ischaemic stroke was cardiac illness (odds ratio 3.99, p = .01).DiscussionOur study identified hypertension to be the most common risk factor for stroke. The predominant aetiology type in this cohort is haemorrhagic stroke. Lastly, the median arrival time to an emergency centre was 24 h after symptom onset.

Blood Pressure Management for Acute Ischemic and Hemorrhagic Stroke: The Evidence.

Hypertension is the most common modifiable risk factor for stroke (both ischemic and hemorrhagic types). In the hyperacute phase, a majority of patients shows an elevated blood pressure (BP) at the time of presentation because of sympathetic hyperactivity or a physiological response to tissue ischemia. Therefore, BP may decrease spontaneously in a few hours and may drop further when complete recanalization is achieved. In stroke guidelines, an elevated BP is usually left untreated up to a systolic BP (SBP) of 220 mm Hg and a diastolic BP of 120 mm Hg. This recommendation is based on the BP level that corresponds to the upper limit of the pressure autoregulation zone above which cerebral blood flow is directly dependent on BP. However, in patients in whom administration of recombinant tissue-type plasminogen activator is indicated, BP should be controlled to a level < 185/110 mm Hg before infusion and should be maintained at levels < 180/105 mm Hg to limit the risk of intracerebral hemorrhage (ICH). In cases where endovascular thrombectomy is considered, the optimal intra- and postprocedural BP target have not yet been clearly identified. Expert opinion recommends that intraprocedural BP reduction could be associated with a risk of poor outcomes, and therefore, SBP may be reduced only to 120 to 140 mm Hg after successful reperfusion therapy. However, this recommendation is primarily based on observational studies and requires validation in prospective trials. It has been observed that in patients presenting with an ICH, there is no perihematomal penumbra noted and rapid BP reduction is generally well tolerated without a risk of neurological worsening. Multiple trials describing acute reduction of BP recommend SBP reduction only to 140 mm Hg because while there is no benefit of better functional outcomes below that level, there exists a definite risk of increased renal complications.

Stroke in Pregnancy.

Pregnancy and the postpartum period confer an increased risk of stroke. The risk appears to be increased for all strokes during the puerperium and for hemorrhagic strokes during pregnancy. During pregnancy, physiologic systems are under increased stress to accommodate the growing fetus, which results in substantial hemodynamic, cardiovascular, hematologic, immunologic, and structural connective tissue changes that account for much of this increased risk. In addition, preeclampsia-eclampsia has major effects on the vascular system, and this disorder, unique to pregnancy, is another major contributor to this risk. The common independent vascular risk factors for stroke, such as hypertension, diabetes, hyperlipidemia, and smoking, may also be present to contribute to the risks conferred by pregnancy. Though uncommon, stroke during pregnancy and in the postpartum period causes substantial morbidity and mortality in affected women, and it poses a significant risk to the fetus. This review will discuss the epidemiology of pregnancy-associated stroke, specific risk factors and mechanisms, clinical presentation and management, and future directions.

Lecithin derived from \u03c9-3 PUFA fortified eggs decreases blood pressure in spontaneously hypertensive rats

Hypertension is the most common risk factor for stroke, coronary heart disease and heart failure, which are the leading causes of death worldwide. Dietary patterns and supplements intakes are becoming important factors in the hypertension. The aim of this study was to estimate the effects of new generation egg yolk phospholipids rich in lecithin (SL) esterified with omega-3 and omega-6 fatty acids on blood pressure in hypertensive rats (SHR). Here we have reported that lecithin (SL) derived from egg yolk lowers blood pressure in pathology of hypertension. The SHR rats treated with SL had significantly lower blood pressure than control group (157/104 vs. 178/121 mmHg; P < 0.05) and down-regulated mesenteric artery over-response to norepinephrine and potassium chloride, giving similar arterial response as for normotensive Wistar Kyoto rats (WKY). Hypertensive rats treated by SL demonstrated significantly lower serum level of inflammatory factors. This work also indicates that SL treatment lowers heart rate and reduces the serum level of oxidative stress marker - nitrotyrosine - by 30–34% in both hypertensive and normotensive animals. Phospholipids with lecithin derived from PUFA fortified eggs may be a valuable dietary supplement in prophylaxis of hypertension and in patients with hypertension, however, this requires further studies on humans.

Hypertension Prevalence, Awareness, Treatment, and Control Among Adults Aged ≥18 Years - Los Angeles County, 1999-2006 and 2007-2014.

Hypertension is an important and common risk factor for heart disease and stroke, two of the leading causes of death in adults in the United States. Despite considerable improvement in increasing the awareness, treatment, and control of hypertension, undiagnosed and uncontrolled hypertension remain public health challenges (1). Data from the National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension, as well as awareness, treatment, and control of hypertension among adults aged ≥18 years in Los Angeles County compared with adults aged ≥18 years in the United States during 1999-2006 and 2007-2014. During 2007-2014, the prevalence of hypertension was 23.1% among adults in Los Angeles County, lower than the prevalence of 29.6% among all U.S. adults. Among adults with hypertension in Los Angeles County, substantial improvements from 1999-2006 to 2007-2014 were found in hypertension awareness (increase from 73.8% to 84.6%), treatment (61.3% to 77.2%), and control (28.5% to 48.3%). Similar improvements were also seen among all U.S. adults. Although the prevalence of hypertension among adults in Los Angeles County meets the Healthy People 2020 (https://www.healthypeople.gov/) goal of ≤26.9%, continued progress is needed to meet the Healthy People 2020 goal of ≥61.2% for control of hypertension.

Relationship between Sleep Duration and Risk Factors for Stroke.

Stroke is a leading cause of death and disability worldwide. While various risk factors have been identified, sleep has only been considered a risk factor more recently. Various epidemiologic studies have associated stroke with sleep such as sleep duration, and laboratory and clinical studies have proposed various underlying mechanisms. The pathophysiology is multifactorial, especially considering sleep affects many common risk factors for stroke. This review aims to provide an outline of the effect of sleep duration on common stroke risk factors. Appropriate sleep duration, especially in patients who have stroke risk factors, and increasing awareness and screening for sleep quality may contribute to primary prevention of stroke.

Common and specific risk factors for ischemic stroke in elderly: Differences based on type of ischemic stroke and aging

BackgroundThe risk factors among the types of ischemic stroke (atherothrombotic cerebral infarction: ATI, cardio-embolic infarction: CEI, lacunar infarction: LI) in aged stroke patients have rarely been compared to each other. MethodsWe compared the clinical parameters of 300 elderly patients with ischemic stroke, age 65–98years, to 100 age-matched control patients. ResultsComparison by parametric test and logistic regression analysis between all 300 and 100 control patients showed higher systolic and diastolic blood pressures (p<0.001, p=0.03), lower estimated glomerular filtration rate (eGFR) (p=0.01), larger cardiothoracic ratio (CTR) (p<0.001), smoking (p<0.01) and possibly poor adherence to anti-hypertensive agents in the ischemic stroke patients (p<0.001). Comparisons among three types (n=100 for each) showed the highest atheromatous risk factors for ATI to be hemoglobin A1c (p=0.01) and low-density lipoprotein (p<0.001) and for CEI to be largest cardiac load, indicated by largest left atrial dimension (p<0.001), and CTR (p<0.001). Triglyceride level was found to be a borderline risk factor for LI (p=0.054). Comparison between those aged <74 versus ≥75years (n=150 for each) showed a lower eGFR (p=0.02) and larger right atrial dimension (p<0.001) in patients ≥75. ConclusionThe risk factors were quite different among the subtypes and aging.

A PROSPECTIVE OBSERVATIONAL STUDY ON PRESCRIBING TRENDS AND ADVERSE DRUG REACTIONS IN STROKE PATIENTS

Objective: To evaluate medication use pattern and adverse drug reactions (ADRs) among stroke patients admitted in Neurology department of a multi-speciality hospital.Methods: A prospective observational study was carried out for a period of 6 mo, in a 750 bedded multi-speciality hospital in Bangalore. The clinical pharmacist analysed the medication use pattern and occurrence of ADRs in stroke patients.Results: Out of 100 patients, 75% had an ischemic stroke and 25% had a hemorrhagic stroke. The incidence of stroke was found to be higher in males (66%) compared to females (34%). Most of the patients were of the age group&gt;60 y (52%). The common risk factors for stroke were hypertension (31%), diabetes (24%), and dyslipidemia (21%). The average number of drugs prescribed per patient was 7.67±3.1. The most common class of drugs prescribed were antihypertensives (14.3%), neuroprotectors (14.1%), antiplatelets (11.5%) and antihyperlipidemic (10.4%). Aspirin monotherapy was more prevalent in this study. Only 4 patients received thrombolytics. During the study, a total of 18 ADRs were reported from 14 patients (18%). Amlodipine (16.6%) and fondaparinux (11%) were the more frequent to cause ADRs. The most common reactions were bleeding (33.3%), pedal edema (16.6%) and headache (11.1%).Conclusion: The study helps to identify drug utilization pattern and in addition to monitor adverse drug reactions among stroke patients. The study also emphasises the need for creating awareness regarding early recognition of stroke symptoms, which helps to prevent the occurrence of stroke.