The Roles of Hypertension and Cholesterol in Stroke

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The Roles of Hypertension and Cholesterol in
Stroke

• 06/05/03
• Craig Douglas
• Nadine MacCowan
• Lina Jumat

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Stroke

• Rapidly developing signs of focal or global
  disturbance lasting 24 hours or longer, or
  leading to death with no apparent cause other
  than of vascular origin
• 3rd highest cause of death worldwide
• 1 in 10 deaths in England, 1994
• Demands 4.4 of NHS expenditure

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Hypertension

• Defined as the level of blood pressure where the
  benefits of treatment outweigh the side effects
• 140/90 is recognised as mild hypertension
• It is a target for primary and secondary
  prevention of stroke

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Hypertension

• Systolic and diastolic pressures independently
  predict stroke
• The risk rises sharply and continuously, without
  threshold!
• Relative risk increases 2x for increase of 10
  mmHg
• Treatment of SBP 10-12 mmHg
• DBP 5-6 mmHg
• decreases stroke risk 33-50

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Anti-Hypertensive Therapy

• Primary Prevention
• ACE inhibitors, B-blockers, Ca channel
  antagonists and thiazide diuretics are all used.
• There are many guidelines such as the
  Cambridge AB/CD rule as to the best therapy.
• Ramipril is the first line therapy in
  diabetic patients (microHOPE study)

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Anti-Hypertensive Therapy

• PROGRESS
• To determine the benefits and risks of
  Perindopril as a BP lowering agent in patients
  with a history of cerebrovascular disease
• Stroke 28 risk reduction
• MVE 26 risk reduction
• Beneficial as therapy, even in normotensive
  patients

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Anti-Hypertensive Therapy

• HOPE
• Study the effects of ramipril or vit E vs a
  placebo with regards to CV death, MI and stroke
• RR of stroke on ramipril 0.68
• RR of stroke on ramipril 0.67 if the patient is
  also diabetic (33 RRR)

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Hypertension and Lifestyle

• NEVER FORGET!!
• Decrease salt, saturated fats
• Alcohol ( remember the J curve )
• Lose weight
• Regular cardiovascular exercise
• STOP SMOKING!

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Relationship Between Cholesterol And Stroke

• There is a strong relationship between
  cholesterol and stroke
• As cholesterol levels increase the risk of stroke
  increases
• One recent government white paper suggested 70
  of people in the UK have high cholesterol levels

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How Cholesterol Causes Stroke

• An accumulation of lipoproteins causes atheroma
  by
• lipoproteins taken up by macrophages and form
  foam cells
• progresses to plaque formation
• occludes vessel or emboli break off, causing
  stroke

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HDL and LDL

• HDL
• Protective
• Low levels have a strong association with atheroma

• LDL
• LDL particles can deposit lipids in walls of
  vessels
• High levels have a strong association with
  atheroma

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Diet

• Poor diet is one of main causes of high
  cholesterol
• Large amounts of fats (especially saturated) and
  sugars in diet lead to high cholesterol levels
• Reducing intake of cholesterol can decrease the
  risk of stroke and therefore it is a partly
  modifiable risk factor

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