Monday, February 14, 2011


We are seeing an increase in strokes, probably resulting from a concomitant increase in the incidence of hypertension and what the minister calls, chronic lifestyle disease.
A stroke occurs when a blood vessel to the brain suffers a brain attack ( neurologist borrowing a phrase from the cardiologist ). As in a heart attack, a brain attack is when an area of the brain is suddenly deprive of blood, oxygen and other nutrients, due a sudden blockage or rupture of a brain blood vessel. The neurological deficits in a stroke ( brain attack ), usually last for 24 hours or more and may be permanent. If the stroke ( brain attack ) is due to a complete blockage of a brain artery, we call it an ischemic stroke, and if it is due to a blood artery rupture, we call it a hemorrhagic stroke. Hemorrhagic strokes are mainly triggered by sudden rises in blood pressure and ischemic strokes are triggered by sudden blood clots forming in the brain blood vessels.
Invariably, following a stroke, the blood pressure will rise, as a compensatory mechanism, and sometimes the rise in blood pressure could be due to the sudden increase in brain pressure due to brain swellings following a stroke. It has been a medical delimma since my training days, as to whether we should lower the acute BP rise following strokes and if so, how quickly and to what degree.
Well, at the recent International Stroke Conference 2011 held in Los Angeles, the workers from Norway, led by Dr Eivind Berge, studied 2029 patients who had suffered a stroke ( ischemic and hemmorhagic ) and had BP > 140 mmHg systolic. Half of them were given Candesartan to lower their BP and the other half had placebo. The trial is called, " Scandinavian Candesartan Acute Stroke Trial " ( SCAST ). After 6 months followup, they found that lowering BP did not help in the recovery. Those on treatment did no better then those on placebo. In fact there is a trend ( non significant trend ) that lowering BP may aggravate the CNS deficits. Their recommendations was that in patients with acute rises of blood pressure, take good care of the stroke and CNS deficit and do not be too aggressive in lowering the BP. They usually do not use anti-hypertensives in the first 7 days.
So now we have some data to help us.
The same meeting also had numerous papers on the early ( less then 4.5 hrs ), use of IV thrombolytics in the management of acute ( white - ischemic ), strokes.
Stroke is a big issue in the developing and developed world. It kills, and in those who do not die, it incapacitates, and steals away your quality of life so much so that ultimately ( in those severely affected ), they would rather die, then be a living vegetable. And yet it is an illness that can be effectively prevented. Eat less salt ( no added salt ), is a very effective way of reducing hypertension and strokes.
No added salt in your food please. No soya sauce and no salt. Live longer and better.

No comments: