Controlling Hypertension and Stroke Prevention – From Guideline to Clinical Practice

2011 ◽  
Vol 3 (1) ◽  
pp. 30
Author(s):  
Anding Xu ◽  
Zefeng Tan ◽  
◽  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Stroke Prevention ◽  
Modifiable Risk Factors ◽  
Cerebrovascular Events

Hypertension is the most important of the prevalent and modifiable risk factors for stroke. Based on evidence, blood pressure (BP) lowering is recommended in guidelines for the prevention of stroke. However, there are still some uncertainties in the guidelines for controlling BP and preventing stroke in patients with previous cerebrovascular events, such as the goal BP, who to treat and which class of BP-lowering drugs to use. This article discusses these questions by reviewing guidelines and corresponding clinical trials, with the aim of reducing the gap between guidelines and clinical practice.

Abstract WP328: A Nurse-Led Initiative Improves Adherence Rates for Stroke Follow-up and Blood Pressure Management

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Darren T Larsen ◽  
Helmi L Lutsep
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Retention Rates ◽  
Matched Cohort ◽  
Stroke Patients ◽  
Stroke Risk Factor ◽  
Chi Square Analysis

Background and Issues Aggressive management of vascular risk factors reduces stroke rates. It is unknown whether structured nurse-led follow up increases adherence rates for stroke patients after hospital discharge. Purpose The purpose of this program is to improve secondary stroke risk factor management by instituting a nurse-led initiative called Stroke Therapy, Education, Prevention (STEP). Methods The pilot STEP program was based on protocols used for other stroke prevention trials. This nurse-led program includes inpatient initiation and outpatient maintenance of pharmacologic and lifestyle goals for stroke patients. Eligible patients have a non-disabling ischemic stroke or TIA and are without insurance restrictions and live within a distance allowing return to clinic for follow up. Prior to discharge, the STEP nurse completes patient education, and reviews outpatient goals. The STEP nurse makes phone contact with the patient 7-10 days after discharge to review medication compliance and reinforce education. At 30 days post discharge patients are seen in clinic by the STEP nurse where a resting blood pressure (BP) is measured. If the patient does not meet targets (<140 SBP or <130 SBP for DM) medications are adjusted by a stroke neurologist. We undertook a retrospective chart review of a consecutive cohort of patients matched to STEP eligibility criteria to determine whether the program improved retention rates and BP management. Chi-Square analysis was used to compare visit adherence and percentage achieving goal BPs at 30 days. Results In the STEP group 25/32(78%) patients completed the 30 day follow up compared to 14/32 (44%) patients in the historical matched cohort (p=0.0048). Target BP was achieved in 13/25(52%) STEP patients and 5/14 (36%) matched cohort patients (p=0.32) returning to clinic. Overall, target BP was achieved in 13/32 (41%) and 5/32 (16%) respectively (p=0.026). Conclusions In conclusion, follow up adherence and BP management in the group as a whole was better in the nurse-led model and is recommended for secondary stroke prevention. Long term follow up with this model may further increase in-target rates of BP control and other stroke risk factors.

Interdisciplinary Approach to Cardiovascular Diseases for Research and Everyday Clinical Practice Purposes

2019 ◽  
pp. 139-171
Author(s):  
Aleksander Goch ◽  
Anna Rosiek ◽  
Krzysztof Leksowski ◽  
Emilia Mikołajewska
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Cardiovascular Diseases ◽  
Interdisciplinary Approach ◽  
Social Awareness ◽  
Modifiable Risk Factors ◽  
Cvd Prevention ◽  
Interdisciplinary Effort ◽  
Professional Resources ◽  
Prevention And Therapy

Cardiovascular Diseases (CVD) are perceived a leading cause of death globally. Scientists and clinicians still search for more efficient prevention, treatment, rehabilitation and care programs suitable for patients with CVD. Common social awareness and interdisciplinary effort may significantly improve current situation, but the problem is more complex. This chapter, based on research and own experiences of authors, tries to answer the question: how maximize professional resources and optimize outcomes in clinical practice. Aim of this chapter is discuss current issues which may potentially influence efficiency of CVD prevention and therapy, including prevention, modifiable and non-modifiable risk factors, ways of cardiac rehabilitation (CR) and cardiac telerehabilitation (CTR), influence of researcher-subject relationship and patient-therapist relationship as far as placebo effect.

Development of an Algorithm for Stroke Prediction: A National Health Insurance Database Study in Korea

2018 ◽  
Vol 79 (3-4) ◽  
pp. 214-220 ◽  
Author(s):  
Seung Nam Min ◽  
Se Jin Park ◽  
Dong Joon Kim ◽  
Murali Subramaniyam ◽  
Kyung-Sun Lee
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Stroke Prevention ◽  
Normal Subjects ◽  
Control Group ◽  
Modifiable Risk Factors ◽  
Stroke Patients

Background: Stroke is the second leading cause of death worldwide and remains an important health burden both for the individuals and for the national healthcare systems. Potentially modifiable risk factors for stroke include hypertension, cardiac disease, diabetes, and dysregulation of glucose metabolism, atrial fibrillation, and lifestyle factors. Objects: We aimed to derive a model equation for developing a stroke pre-diagnosis algorithm with the potentially modifiable risk factors. Methods: We used logistic regression for model derivation, together with data from the database of the Korea National Health Insurance Service (NHIS). We reviewed the NHIS records of 500,000 enrollees. For the regression analysis, data regarding 367 stroke patients were selected. The control group consisted of 500 patients followed up for 2 consecutive years and with no history of stroke. Results: We developed a logistic regression model based on information regarding several well-known modifiable risk factors. The developed model could correctly discriminate between normal subjects and stroke patients in 65% of cases. Conclusion: The model developed in the present study can be applied in the clinical setting to estimate the probability of stroke in a year and thus improve the stroke prevention strategies in high-risk patients. The approach used to develop the stroke prevention algorithm can be applied for developing similar models for the pre-diagnosis of other diseases.

scholarly journals First Trimester Biomarkers in the Prediction of Later Pregnancy Complications

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Stefan C. Kane ◽  
Fabricio da Silva Costa ◽  
Shaun Brennecke
Keyword(s):  
Risk Factors ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Preterm Birth ◽  
High Risk ◽  
Gestational Diabetes ◽  
First Trimester ◽  
Obstetric Outcomes ◽  
High Risk Population ◽  
Maternal History

Adverse obstetric outcomes, such as preeclampsia, preterm birth, gestational diabetes, and fetal growth restriction, are poorly predicted by maternal history and risk factors alone, especially in nulliparae. The ability to predict these outcomes from the first trimester would allow for the early initiation of prophylactic therapies, institution of an appropriate model and location of care, and recruitment of a truly “high risk” population to clinical trials of interventions to prevent or ameliorate these conditions. To this end, development of adequately sensitive and specific predictive tests for these outcomes has become a significant focus of perinatal research. This paper reviews the biomarkers involved in these multiparametric tests and also outlines the performance of these tests and issues regarding their introduction into clinical practice.

scholarly journals Effects of walnut consumption on blood lipids and other cardiovascular risk factors: an updated meta-analysis and systematic review of controlled trials

2018 ◽  
Vol 108 (1) ◽  
pp. 174-187 ◽  
Author(s):  
Marta Guasch-Ferré ◽  
Jun Li ◽  
Frank B Hu ◽  
Jordi Salas-Salvadó ◽  
Deirdre K Tobias
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Blood Pressure ◽  
Clinical Trials ◽  
Body Weight ◽  
Cardiovascular Risk ◽  
Blood Lipids ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Control Groups

ABSTRACT BACKGROUND Intervention studies suggest that incorporating walnuts into the diet may improve blood lipids without promoting weight gain. OBJECTIVE We conducted a systematic review and meta-analysis of controlled trials evaluating the effects of walnut consumption on blood lipids and other cardiovascular risk factors. Design We conducted a comprehensive search of PubMed and EMBASE databases (from database inception to January 2018) of clinical trials comparing walnut-enriched diets with control diets. We performed random-effects meta-analyses comparing walnut-enriched and control diets for changes in pre-post intervention in blood lipids (mmol/L), apolipoproteins (mg/dL), body weight (kg), and blood pressure (mm Hg). RESULTS Twenty-six clinical trials with a total of 1059 participants were included. The following weighted mean differences (WMDs) in reductions were obtained for walnut-enriched diets compared with control groups: −6.99 mg/dL (95% CI: −9.39, −4.58 mg/dL; P < 0.001) (3.25% greater reduction) for total blood cholesterol (TC) and −5.51 mg/dL (95% CI: −7.72, −3.29 mg/dL; P < 0.001) (3.73% greater reduction) for low-density lipoprotein (LDL) cholesterol. Triglyceride concentrations were also reduced in walnut-enriched diets compared with control [WMD = −4.69 (95% CI: −8.93, −0.45); P = 0.03; 5.52% greater reduction]. More pronounced reductions in blood lipids were observed when walnut interventions were compared with American and Western diets [WMD for TC = −12.30 (95% CI: −23.17, −1.43) and for LDL = −8.28 (95% CI: −13.04, −3.51); P < 0.001]. Apolipoprotein B (mg/dL) was also reduced significantly more on walnut-enriched diets compared with control groups [WMD = −3.74 (95% CI: −6.51, −0.97); P = 0.008] and a trend towards a reduction was observed for apolipoprotein A [WMD = −2.91 (95% CI: −5.98, 0.08); P = 0.057]. Walnut-enriched diets did not lead to significant differences in weight change (kg) compared with control diets [WMD = −0.12 (95% CI: −2.12, 1.88); P = 0.90], systolic blood pressure (mm Hg) [WMD = −0.72 (95% CI: −2.75, 1.30); P = 0.48], or diastolic blood pressure (mm Hg) [WMD = −0.10 (95% CI: −1.49, 1.30); P = 0.88]. Conclusions Incorporating walnuts into the diet improved blood lipid profile without adversely affecting body weight or blood pressure.

scholarly journals Risk Factors of Cardiovascular Disease in Elderly in Guguak Kabupaten 50 Kota, West Sumatera, Indonesia

2020 ◽  
Vol 5 (1) ◽  
pp. 348
Author(s):  
Debie Anggraini ◽  
Prima Adelin
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Central Obesity ◽  
Smoking Habit ◽  
The Elderly ◽  
Modifiable Risk Factors ◽  
Cvd Risk ◽  
Related Risk ◽  
Low Hdl

<p class="Default"><strong><em>Introduction</em></strong><em>: Cardiovascular disease (CVD) is a major cause of death and disability worldwide. The most stringent primary CVD screening guidelines in developed countries use absolute CVD risk scores or coronary heart disease, such as Framingham or SCORE (Systematic Coronary Risk Evaluation) there are two types of CVD risk factors namely modifiable risk factors and unmodified risk factors. <strong>The aim</strong> of the current study is to determine the profil of potentially modifiable and unmodified cardiovascular risk factors. <strong>Method</strong>: </em><em>This research consists of 41 elderly people which aged ≥ 60 years in Guguak, Kabupaten 50 Kota, West Sumatera, Indonesia. The data taken is modifiable risk factors consisting of diseases related risk factors </em><em>including blood pressure categories, lipid profile, central obesity, body mass index </em><em>and lifestyle related risk factors such as </em><em>smoking habit</em><em>. We also take data of unmodified risk factors such as age and gender</em><em>. <strong>The result</strong>: t</em><em>his study consists of 41 elderly people which aged ≥ 60 years in Guguak, Kabupaten 50 Kota, West Sumatera, Indonesia. The mean age of  elderly were 68</em><em>±</em><em>7.64861 years old that consisting of 29.3% men and 70.7% women, </em><em>34% of elderly with hypertension, the elderly with hypercholesterolemia 71%, hypertriglyceridemia 41%, and the elderly women with low HDL-C levels were 53%,  the elderly men with low HDL-C levels were 92%. <strong>Conclusion</strong><strong>: </strong>There are two types of risk factors CVD, modifiable risk factors and nonmodifiable risk factors. </em><em>The modifiable risk factors consisting of diseases related risk factors </em><em>including blood pressure categories, lipid profile, central obesity, body mass index </em><em>and lifestyle related risk factors such as </em><em>smoking habit.</em></p>

Modifiable risk factors for intracranial aneurysms: Evidence from genetic studies

2022 ◽  
pp. 174749302110656
Author(s):  
Xiaohui Sun ◽  
Bin Liu ◽  
Ying Chen ◽  
Linshuoshuo Lv ◽  
Ding Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Educational Attainment ◽  
Genome Wide Association Study ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Health Concern ◽  
Modifiable Risk Factors ◽  
Nucleotide Polymorphisms ◽  
Genome Wide ◽  
A Genome

Background: Intracranial aneurysm (IA) is a crucial health concern with limited strategies for prevention and treatment. Aim: To identify potentially modifiable risk factors, such as socioeconomic, behaviors, dietary, and cardiometabolic factors, for IA and its subtypes. Methods: Summary statistics for IA were derived from a genome-wide association study with an overall 79,429 participants. Single nucleotide polymorphisms associated with modifiable risk factors at genome-wide significance ( P = 5 × 10–8) were used as instrumental variables. The inverse-variance-weighted method, weighted-median method, Mendelian randomization (MR)-Egger regression, MR-Pleiotropy RESidual Sum and Outlier, and multivariable MR analyses were performed to evaluate the effect estimates. Results: Genetically predicted educational attainment, insomnia, smoking, and systolic and diastolic blood pressure (SBP and DBP) were significantly associated with the risk of IA. The odds ratios (ORs) were 0.44 (95% confidence interval (CI): 0.37–0.52) for educational attainment, 1.15 (95% CI: 1.08–1.23) for insomnia, 1.56 (95% CI: 1.38–1.75) for smoking initiation, 2.69 (95% CI: 1.77–4.07) for cigarette per day, 2.65 (95% CI: 1.72–4.08) for lifetime smoking, 1.07 (95% CI: 1.06–1.09), and 1.06 (95% CI: 1.04–1.10) for SBP and DBP, respectively. Similar effect estimates were observed for unruptured IAs and aneurysmal subarachnoid hemorrhage. Conclusions: This study provided genetic evidence that several modifiable risk factors, including blood pressure, smoking, educational attainment, and insomnia were associated with the risk of IA.

Change of Positional Blood Pressure and Indication of Ephedrine in Hypotension During Spinal Anesthesia for Cesarean Delivery

2013 ◽  
Vol 21 (Number 2) ◽  
pp. 18-23
Author(s):  
Md. A Matin ◽  
J Banu ◽  
K Sultana ◽  
S M Shahana
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Clinical Practice ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Lateral Position ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
The Mean

Hypotension during spinal anaesthesia for caesarean section remains a common scenario in clinical practice. Certain risk factors play a role in altering the incidence of hypotension. A cross sectional observational study was done on sixty patients undergone cesarean delivery spinal anesthesia in Holy Family Red Crescent Medical College Hospital to evaluate the correlation between pre-anesthetic change of positional blood pressure and predictive necessity of Ephedrine to mange per-operative hypotension. The mean age of the patients included in the study was 25.85 ± 4.24 years and weighted 63.60 ± 6.91 kg (Mean ± sco. The haemodynamic outcomes of the patients are summarized in Table-I as mean systolic blood pressure increased (118 ± 12.02 and 132 ± 14.11 mm of Hg) after change of position from baseline (supine position) to right lateral position. The positional blood pressure varied from 2 to 32 mm of Hg and was observed in 54 patients. But only 35 patients were hypotensive (58.33%) after spinal anesthesia among them only 28 patients required Ephedrine (46.6%). But there was no significant correlation was observed in patients needed Ephedrine who hypotension but not obvious with positional change of pre-anesthetic blood pressure.

scholarly journals Risk Factor Management in Atrial Fibrillation

2018 ◽  
Vol 7 (2) ◽  
pp. 118 ◽  
Author(s):  
Axel Brandes ◽  
Marcelle D Smit ◽  
Bao Oanh Nguyen ◽  
Michiel Rienstra ◽  
Isabelle C Van Gelder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Management Strategy ◽  
Oral Anticoagulant Therapy ◽  
Rhythm Control ◽  
Current Evidence ◽  
Modifiable Risk Factors ◽  
Early Management ◽  
Risk Factor Management

Atrial fibrillation (AF) is the most common clinical arrhythmia and is associated with increased morbidity and mortality. There is growing evidence that numerous cardiovascular diseases and risk factors are associated with incident AF and that lone AF is rare. Beyond oral anticoagulant therapy, rate and rhythm control, therapy targeting risk factors and underlying conditions is an emerging AF management strategy that warrants better implementation in clinical practice. This review describes current evidence regarding the association between known modifiable risk factors and underlying conditions and the development and progression of AF. It discusses evidence for the early management of underlying conditions to improve AF outcomes. It also provides perspective on the implementation of tailored AF management in daily clinical practice.

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