Stroke Prevention—An API Priority
May 25, 2000
By Diana Lau
Traditionally, May is the National Stroke Alert Month. However, for health professionals, educating the public on the disease continues year round. Last month, St. Mary’s Medical Center in San Francisco conducted a free community blood pressure screening during the Cherry Blossom Festival in San Francisco. There, some 465 people were screened for high blood pressure, of whom 270 had Asian names.
At this event and other free screenings, many people have been unpleasantly surprised by these blood pressure screening results: either they did not know that they had high blood pressure, or they learned their blood pressure was not under control. Both are major risk factors for stroke.
Because stroke is one of the most debilitating diseases, the American Heart Association has put a major emphasis on decreasing the incidence of stroke by 25 percent by the year 2008, and the American Stroke Association has been created as a division of the American Heart Association in support of this ambitious goal.
According to the National Center for Health Statistics, stroke is the third leading cause of death in the world, and it is the most frequent cause of disability. Moreover, the cost of stroke in 1999, including hospitalization, physician fees, rehabilitation and lost productivity, was estimated at $45.3 billion.
Stroke is most commonly caused by a blockage of blood flow to the brain (75-85 percent of all stroke cases), but in some, bleeding in the brain due to the bursting of blood vessels can cause stroke. The incidence of bleeding stroke is known to be slightly higher in people of Asian descent than in those of other racial backgrounds.
From the stroke fact sheets published by the American Heart Association, it is estimated that about 600,000 people suffer a new or recurrent stroke each year. About 500,000 are first attacks and 100,000 are recurrent attacks.
Although stroke has a significant mortality rate, most victims do survive the first attack, many with residual disability that inflicts a tremendous impact on the society. Those with moderate to severe impairments have a diminished quality of life. And about half of all stroke victims develops one-sided weakness or paralysis, and need assistance in daily activities.
Of the many risk factors attributed to causing strokes, the most important one—which is preventable—is high blood pressure. Unfortunately, according to a 1997 study by the National Heart, Lung, and Blood Institute (NHLBI), only 68 percent of the people with high blood pressure are aware of it, and 54 percent are being treated. Only about 27 percent are adequately controlled, which leaves 73 percent of the individuals with uncontrolled high blood pressure as potential stroke victims.
Community Blood Pressure Screenings
In an April 1999 news release Trends in Hypertension, Claude Lenfant, M.D., NHBLI Director, mentioned that “the majority of coronary heart disease and stroke occurs at lower stages of hypertension.” It is, therefore, not enough to just control high blood pressure. Rather, how well it is controlled is what counts.
During St. Mary’s screenings, many individuals who were found to have high blood pressure were aware of their condition and were on medication, which they claimed they took as prescribed. However, it is a well-known fact among clinicians that patient non-compliance is the most common risk factor in causing uncontrolled blood pressure. In addition, one should never assume that treatment is effective. Often times it takes multiple trials to find the right combination of drugs and dosages to control high blood pressure. And as one ages or health condition change over time, medication will need to be fine-tuned again.
Controlling High Blood Pressure
Both African Americans and Asians have a high prevalence of high blood pressure and need to stay on alert for the symptoms of stroke. The southeastern part of the United States. has been coined the “Stroke Belt” due to the high concentration of African American stroke victims living in those areas. There is a potential for the formation of an “Asian Stroke Belt” in areas such as New York and California where there is a high concentration of Asians.
That may be preventable, though. Treatment for high blood pressure follows a risk-stratified approach, which takes into consideration factors such as smoking, high cholesterol, diabetes, age, or organ damage.
For most individuals, initial counseling on lifestyle modification is tried for up to 12 months, and if the blood pressure is still not under control, then drug therapy will be implemented.
Lifestyle modifications used to control high blood pressure include quitting smoking, losing weight if needed, eating a low sodium and adequate potassium diet, limiting alcohol intake, and exercising for 30-45 minutes at least four times a week.
It is highly advisable for individuals with high blood pressures to keep two items handy at home: a blood pressure measurement kit to facilitate frequent blood pressure measurement and a scale for monitoring body weight to avoid excessive weight gain.
For more information about stroke prevention, symptom recognition, and other relevant information, contact your local division of the American Heart Association, or visit the web site at www.americanheart.org.
Diana Lau, RN, MS, CNS is the Special Projects Coordinator, St. Mary’s Medical Center in San Francisco, Immediate Past Chair, Board of Directors, American Heart Association, San Francisco Division Host/Producer, Health Talk Segment, Chinese Star Radio, FM 90.3.
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