We’ve learned of new results from blood pressure research studies, that indicate people whose blood pressure fluctuates, are more at risk of developing a stroke than those who have steady raised blood pressure (or hypertension). Fluctuating blood pressure is known as episodic hypertension.
This is prompting a rethink of the advice given to doctors who may have previously overlooked occasional high blood pressure readings in their patients, and who now need to consider treatments, including prescribing high blood pressure medication, that produces the most even blood pressure readings over the long term.
The research is published in the UK Medical Journal – The Lancet, and was carried out by UK and Swedish researchers, led by Professor Peter Rothwell from the department of Clinical Neurology at the University of Oxford. It examined data associated with statistical variations in blood pressure readings, taken from doctors’ medical examination results. This confirmed that those with fluctuating high blood pressure readings taken across several different appointments, proved to be at the greatest risk of developing a future stroke, irrespective of what their average blood pressure reading was.
Doctors normally use average blood pressure reading
Usually doctors are advised to use an average value of a number of patient blood pressure measurements as the best way to warn of an increased stroke risk. This may now have to be updated with new advice not to ignore the occasional high blood pressure reading. Previously, they may have overlooked a single abnormal high blood pressure test result, and only commenced any form of treatment if repeated blood pressure readings were high.
The United Kingdom Stroke Association has now recommended that the national advice given to Doctors should be updated to reflect the results of this research, according to their their spokesperson Joe Korner. He said that many people who have occasional high blood pressure readings are not being diagnosed or treated.
Professor Rothwell’s explanation for the research findings is that rapid fluctuations in blood pressure can cause a turbulent flow of blood through the arteries that can cause stiffening and damage to the arterial walls. He said anyone diagnosed with high blood pressure who performs home blood pressure testing and monitoring should report any fluctuations in their readings to their doctor.
‘Clinical guidelines need to be reviewed’
The UK National Institute for Health and Clinical Excellence’s (NICE) guidelines on high blood pressure is in the process of being rewritten and these latest studies will apparently be taken into account. NICE have released the following statement :-
“With this new research it is now important that the clinical guidelines about treating high blood pressure are reviewed. “In the meantime we urge General Practitioners [Doctors] to read this research to help them prescribe the best treatment for people at risk of stroke.”
The British Heart Foundation have responded more cautiously, with their statement, issued by Professor Peter Weissberg;- medical director :-
“Current practice is not wrong, but this might add a new measure to help doctors make decisions on who to treat for hypertension and which drug to use.”
Strokes kill 200 people per day in the United Kingdom, and leave many more disabled or living with the debilitating after effects, or the threat of a second or third potentially fatal recurrence.
Now a new type of medical diagnostic device has been developed that could provide much earlier diagnosis of a stroke than ever before, and could help to save lives by allowing the correct form of treatment to be administered sooner by doctors.
There are two types of stroke – ischemic and hemorrhagic. The ischemic stroke accounts for nearly three quarters of strokes, and occurs when a blood clot forms inside one of the blood vessels in the brain, cutting off the supply of blood and oxygen. The hemorrhagic stroke is caused by a blood vessel that bursts and leaks blood into the surrounding brain tissue causing brain damage.
Depending on the type of stroke that you may suffer, vitally different treatment needs to given, as quickly as possible, by the attending doctor or surgeon. In order to do this it is critical to diagnose the exact nature of the stroke. For instance, it would be no use whatsoever to prescribe an anti clotting medication if the patient was suffering a hemorrhagic stroke, as this could make the hemorrhaging even worse, and possibly kill the patient. Hemorrhagic strokes almost always require emergency surgery to repair the damaged blood vessel and remove the blood from the surrounding brain tissue.
The new device is a type of helmet that is placed over the head, and connected to a computer. It uses advanced ultrasound techniques, and newly developed software to overcome previous problems associated with passing ultrasonic sound waves through the head. It can produce a complete and detailed video image of the inside of the brain to assist doctors to make a rapid and accurate diagnosis of the patient’s condition.
Developed by the scientists and engineers at Duke University, North Carolina, the high tech ‘stroke helmet’ could provide emergency paramedics with the advanced diagnosis of the patient’s condition, allowing instant treatment to take place inside the ambulance, or by transmitting a graphical image of the brain to the nearest hospital, and allowing the correct medical team to be assembled, and ready to perform the correct treatment on the arrival of the ambulance.
This could save vital hours compared to the present system where a CT scan is performed at the hospital after the patient has been admitted. Where clot busting drugs are required, these are only effective if they are administered within a few hours of the suspected stroke, so the time factor may be critical in determining the recovery prospects of the patient.
The research team are working on a version of the helmet that will allow clinical trials to take place, although it may be some time yet before your local paramedics are able to offer the new device to their suspected stroke patients.
Until recently, little was understood regarding the psychological effects of suffering a stroke. According to a recent study, the first of it’s kind, carried out by Newcastle and Durham Universities from The United Kingdom, the psychological side-effects are so devastating that they are considered to be as traumatic as those that soldiers have suffered in war-torn zones, commonly know as ‘post traumatic stress disorder’.
The study which was funded by the Clark Lister Brain Haemorrhage Foundation concluded that post-traumatic stress disorder in stroke sufferers was more prevalent in people who had suffered a ‘subarachnoid haemorrhage’ – a life threatening condition where blood seeps from arteries that run beneath the arachnoid membrane of the brain.
Approximately 8.000 people a year in the UK have a subarachnoid haemorrhage, and it is more likely to affect middle-age people; women being more susceptible than men. This type of stroke is particularly devastating; as fifty per cent of people struck down with it will be left either seriously incapacitated or will die.
One sufferer describing his experience said “It was like being struck by a bus”, and Professor/Neurosurgeon David Mendelow from Newcastle University refers to this type of stroke as a ‘brain attack’. He is delighted that the study has given more insight into a sufferers need for more psychological help in coping with acute and distressing symptoms, as well as support for their carers.
If you have suffered a subarachnoid haemorrhage and are concerned regarding your eligibility to drive, you can check out the possible implications on the NHS website by clicking on the ‘complications’ section.
By learning to understand what causes stroke, and recognise stroke signs and symptoms you could save the life of a loved one or family member.
This follows the recent death of a 48 year old British man – Jeffrey Wingrove, a former marathon athlete, who died from the stroke injury and the complications resulting from the delays by a United Kingdom healthcare provider’s out-of-hours on-call doctors. Despite repeated requests for assistance from the man’s wife, they failed to correctly diagnose the symptoms of stroke on three separate occasions.
What happened ?
This is a brief summary of the key events in this medical emergency. Not all details have been included for the sake of brevity :-
- Jeffery Wingrove collapsed after suffering from severe headaches, sweating and vomiting
- He managed to crawl to his bedroom, but was unable to move his right side easily – showing symptoms of a right stroke
- His wife called the doctor, but was referred to an alternative doctors office who were handling local requests for advice during the the night time
- Mrs Wingrove requested a home visit as her husband was too unwell to get out of bed, and he was too heavy for her to move
- On two occasions, doctors from the company declined to visit the patient at his home
- They advised her to collect a prescription for pain killing medication from a local pharmacy
- Eventually Mrs Wingrove called paramedics, who took the patient to Broomfield hospital in Braintree, United Kingdom, then transferred him to neurosurgical ward at Queen’s Hospital in Romford
- Despite having emergency surgery at the hospital he died from the stroke damage to his brain
- The total elapsed time from the man starting to feel unwell to his death was less than 48 hours
What lessons can be learned from this tragedy ?
We at Lower Blood Pressure sympathise whole heartedly with the Wingrove family, however we exist to educate, inform and hopefully help you – our readers – to avoid any repeat of this unfortunate, and we believe, avoidable episode in your own lives and families. So what what can we learn from this sad story ?
We must educate ourselves to know how to quickly recognise the stroke signs and symptoms. This is the most important factor in helping to save the life of a husband or a wife or an elderly relative. Because Mrs Wingrove did not know that her husband was displaying signs of a stroke, she attempted to contact the family’s doctor, rather than the emergency services.
We have a feature article all about Stroke, and how you can recognise the symptoms – you can find it here – it explains all about the FAST (Face – Arm – Speech ) test, which is the most effective way to diagnose the early signs of the onset of stroke.
We must act quickly if we suspect that any ONE of the FAST symptoms described above is present in the patient. It is absolutely essential to CALL 911 IMMEDIATELY, as this may save vital time in getting the proper treatment to the patient, which is best given at a hospital or ER Center.
Stroke symptoms awareness and fast treatment are key to stroke survival
Although the family have taken out and won a law suit, and received substantial compensation in an out-of-court settlement over Mr Wingrove’s treatment, the fact remains that he could possibly have survived this stroke damage. If everyone involved in the management of this man’s illness had had a greater awareness of this devastating life threatening condition, he may have been diagnosed and treated more quickly, and may have been alive today.