Treatment of High Blood Pressure

Reducing even mild to moderate blood pressure using drug therapy -- primarily diuretics and beta blockers -- has been shown to lower the risk of stroke by as much as 42%. Treatment of hypertension is most effective if instituted early. Drug therapy is generally recommended if even mild hypertension does not respond to changes in diet and lifestyle within three to six months. Patients with hypertension who discontinue drug therapy greatly increase their risk of hemorrhagic stroke. It should be noted that people with hypertension who develop an enlargement of the heart (cardiac hypertrophy) remain at risk for stroke even after their blood pressure is under control.

Use of Statins

An analysis of major studies has found that use of cholesterol-managing drugs known as HMG-CoA reductase inhibitors, commonly called statins, such as simvastatin (Zocor), reduces the risk of stroke by about 30% in people with existing coronary artery disease. Statins are known to raise HDL levels and help open up arteries.

Alcohol limited

Alcohol consumption should be limited to an average of no more than two drinks a day, which is protective. Heavy drinking increases the risk of stroke and many other diseases.

Diet and Exercise

Studies consistently find a lower incidence of stroke in people who exercise regularly. People whose diets are rich in fruits and vegetables also appear to have a significantly lower risk of both ischemic and hemorrhagic stroke. A higher intake of milk was associated with a lower incidence of stroke in men, although milk drinking may simply coincide with a healthier life style. One recent study indicated that middle-aged men without heart disease who had the highest intake of monounsaturated or saturated fat (not polyunsaturated oils) also had the lowest risk for stroke. Studies on Asian men have reported similar results. Consuming fish two or three times a week helps the heart and may also reduce the risk of stroke. Foods such as apples and tea, which are high in flavonoids, may also be protective. Vitamin supplements may be helpful in prevention. Results from a recent animal study suggest that high levels of vitamin E in the diet may reduce the amount of brain tissue injured by a stroke. A 1995 study found that people whose diets are low in vitamin C have the same high risk for stroke as those with hypertension. The B vitamins B6, B12 and, particularly, folate protect against high levels of homocysteine in people who may be deficient in these vitamins. A recent study reported that high-potassium diets significantly lower their risk for stroke. Low potassium levels also increase the risk for high blood pressure, stroke, and death in patients who develop stroke. Magnesium is also important; deficiencies may increase the risk for atrial fibrillation.

Hormone Replacement Therapy

The effect of hormone replacement therapy (HRT) on stroke has been controversial. There have been many contradictory studies, some showing a reduction in risk, some an increase, and many showing no effect. If major studies finally prove that HRT has any effect on stroke one way or the other, most likely it will be small.

Treatment of Atrial Fibrillation

The object of treatment for atrial fibrillation is to prevent blood clots from forming by first restoring and then maintaining normal heart rhythm and function. To initially restore heart rhythm, arrhythmic drugs are usually used first. If drugs fail to restore normal rhythm, mild electric shock therapy known as cardioversion may be effective. Even if a steady rhythm is restored by drugs or cardioversion, however, often it cannot be sustained for prolonged periods, so long-term maintainance therapy using anti-arrhythmic drugs may be required. A series of cardioversions may succeed, however, in maintaining normal rhythm in young healthy patients without the need for any medications

After a diagnosis of atrial fibrillation, patients usually need to take drugs to reduce blood clotting, usually warfarin or aspirin. Warfarin (Coumadin, Panwarfin) is very effective and experts estimate that it could prevent 40,000 strokes a year. It carries a risk for bleeding, however, and requires careful monitoring. Aspirin is less effective but also has a lower risk for bleeding; it is currently the preferred treatment for younger patients and those with no other medical risk factors for stroke.

Treatment after TIAs and in People at High Risk for Stroke

Aspirin

Because blood clots are responsible for TIAs, medications that prevent blood from coagulating, or clotting, have been used for years in people at risk for stroke. Aspirin prevents blood platelets from sticking together and is commonly recommended for patients with TIAs who have no other serious complications.

Other Drugs

Other drugs used for stroke prevention include the antiplatelet drugs ticlopidine (Ticlid) and clopidogrel (Plavix). Ticlopidine may be up to 20% more effective than aspirin and may be particularly beneficial for women. It is expensive however and diarrhea is common. A rare side effect -- a drop in white blood cells -- can be serious, although reversible when treatment has stopped.

Screening Tests

High levels in the blood of a factor called C-reactive protein is an indicator of inflammation and may predict a higher risk of stroke and heart attack. Elevated levels of a substance called lipoprotein (a) may reveal the possibility of an unruptured aneurysm, which can be confirmed with an MRI (magnetic resonance imaging). Whether such tests should become part of a regular screening process will be determined with more research.