The Periodical Third Issue, July 2003
|Editors Note||SAGAS Objectives||SAGAS News & Website Inauguration||In Memory of Dr Bin Huraib|
|Hypertension & Cerebrovascular Diseases||Hypertension Management in Acute Ischemic Stroke||The Periodical Quiz||The Periodical Case|
New Horizon Of Stroke Therapy
The third issue of this SAGAS periodical is dedicated to exploring recent developments in our knowledge of hypertension and its impact. Stressing, again, that it is the major risk factor of brain and heart vascular problems.
Subjects with blood pressure value higher than 180/110 mmHg exhibit a risk of stroke 10 times higher than those with optimal values <120/80.
Even a small, sustained lowering of blood pressure by 10 mg systolic and 5 mmHg diastolic for five years significantly reduced the relative risk of primary stroke by 30 - 40%. In addition recent studies have shown a 43% reduction of the relative risk of secondary stroke prevention by reducing blood pressure even in patients with high normal blood pressure.
Cerebrovascular damage is a pathophysiological process that gradually evolves as a silent disease over many years and include functional (e.g. cognitive impairment) and structural (e.g. white matter lesions) changes.
Brain damage starts early in hypertension. In a group of previously untreated asymptomatic essential hypertensive patients, who had no evidence of clinical vascular disease, the prevalance of white matter lesions was 41%, compared with 8% in normotensive subjects of a similar age.
A positive correlation was observed between the white matter lesion and ambulatory blood pressure. Patients with white matter lesions had higher blood pressure and adjusted left ventricular mass indices studied by echocardiography, suggesting more intense cardiovascular remodeling.
Very early, cognitive impairment was observed in those patients with white matter lesions. This seems to be relevant since longitudinal studies have identified a link between white matter lesions and future stroke and between cognitive decline and hypertension, suggesting the possibility of preventing both final outcomes with proper antihypertention treatment.
A recent study has shown that dementia or severe cognitive decline may be prevented by 65% or 55% respectively by active treatment in patients with recurrent stroke.
Increasing evidence, therefore, indicates that angiotension is an independent risk factor for stroke. The potential benefit of hypertension therapy on stroke and vascular dementia risk reduction in hypertensive and non-hypertensive patients is continuing to grow.
SAEED BOHLEGA, FRCPC, FRCP(Edin)