Managing diabetes? It’s essential to keep your blood sugar level consistent to avoid the big “ups and downs” that can be dangerous. A registered dietitian (RD) or certified diabetes educator (CDE) can help you make a plan for healthy eating and active living, along with medications,
if needed.
When it comes to eating, there’s no single prescription for blood sugar control. What matters is managing your intake of carbohydrate, protein, fat and calories and controlling your weight. Overweight and obesity increase risk for diabetes and its complications. That said, you don’t have to give up favorite foods; instead keep track of the types of foods you eat and learn how to fit them into your daily meal plan.
Whether you use carbohydrate counting or the Exchange System, match your eating plan for diabetes management to your food preferences and lifestyle. If you’re overweight, plan for weight loss, too.
Make Carbohydrates Count
Want flexibility or simplicity? Carbohydrate counting lets you map your intake of food and insulin (if you take it) more precisely and adjust, depending on your blood sugar level. This system is like a budget; you get a certain number of carbohydrates per meal and per day and when that number is used up, you’re done. That’s because carbohydrates affect your blood sugar level more than protein or fat does.
Work out a plan. With your RD, CDE or other health care provider, target carbohydrate amounts for each meal and snack. Track your carbohydrate intake, try to stay consistent and check your blood sugar levels.
Make nutrient-rich carbohydrate choices. Select starchy vegetables, legumes, fruit, juice, milk products and whole-grain and enriched breads and cereals, without too much fat or added sugars.
Know carbohydrate facts. Nutrition Facts on food labels give carbohydrate amounts for labeled serving sizes.
Get carbohydrate savvy with unpackaged foods. In general, a small piece of fresh fruit (apple, banana, orange) counts as 15 grams of carbohydrate; one cup of low-fat milk counts as 12 grams; one-half cup of cooked or one cup of raw veggies (broccoli, carrots, spinach) counts as 5 grams.
Find a book or website with carbohydrate facts. Figuring carbohydrates in mixed foods, such as lasagna and burritos, takes practice.
Plan the “Exchange” Way
For many, the Exchange System is the “full-service” meal plan approach for managing diabetes. This system puts foods and beverages into 3 main groups and “free foods.” These are subdivided into exchange lists, with measured amounts of food supplying similar amounts of nutrients and calories. It’s like a “mix-and-match” system for selecting foods.
You and your health care provider make a daily meal and snack plan, specifying the number of servings per exchange list. Then you choose enough food variety, spreading energy-producing foods and drinks throughout your day. With this system, paying attention to portion sizes is a must.
Carbohydrate (Starch, Fruit, Milk, Other Carbohydrates, Vegetables). Go for variety so you aren’t short-changed on nutrients. Choose mostly fat-free or low-fat options, as well as those without added sugars. Go easy on Other Carbohydrates (rich desserts, sweets, higher-fat snacks) with few nutrients.
Meat and Meat Substitutes (Very Lean, Lean, Medium-Fat, High-Fat). Choose fish, legumes (beans) and mostly lean or very lean meat and poultry. Fat (monounsaturated, polyunsaturated, saturated, trans fat). Choose mostly vegetable oils, such as olive and canola oils and soft margarine, as well as nuts. Limit intake of saturated and trans fats.
Free Foods. Add flavor with very low-calorie or calorie-free foods, as recommended by your health care provider.
Useful Tools
Learn to figure your portions. Misjudging affects not only the carbohydrate, calories and amounts you eat, it also impacts your blood sugar level.
Weigh and measure. Until you are skilled at visual estimates,
use measuring cups, spoons and a kitchen scale to determine
meal and snack portions. Check yourself every month or so to
make sure your estimates stay accurate.
Become food label savvy. Check the number of servings
and serving size on the Nutrition Facts label. Since many
containers provide more than one serving, do some math.
Eating more than one label serving means more carbohydrate,
calories and exchanges.
Get Moving ... Another Important Strategy
Active living offers many benefits: 1) as active muscles use
glucose, blood sugar levels go down; 2) since regular physical
activity helps you manage weight, it also helps with blood
sugar control and 3) regular aerobic exercise promotes heart
health (important because diabetes significantly increases
cardiovascular risk).
Devise a physical activity plan with your health care provider.
This includes blood sugar level checks, snack plans and
beverage choices, as well as the amount, type and timing
of exercise.
Check your blood sugar level before exercising. If it’s low, snack
first. If it’s high, wait until it comes down. At 100 to 150 mg/
dL, you can start moving, but snack lightly first, if you’ll stay
active for 30 minutes or more.
Carry a carbohydrate-rich snack or beverage from your meal plan.
Stop to eat it if you feel light-headed. Likely your blood sugar
has dropped. Fruit juice, regular soft drinks and sports drinks
are fast-acting carbohydrate sources.
Take precautions. Wear diabetes identification, carry a cell
phone and get a workout partner who can help if you need it.
Managing your diabetes with prescribed medication, diet and
exercise is essential for your good health.
Healthy eating and physical activity can benefit everyone in your family, so get
them on board, too.
Tuesday, November 29, 2011
Make-Ahead Ham & Egg Enchiladas
What You Need
2 tsp. oil
4.5 oz. (1/2 of 9-oz. pkg.) OSCAR MAYER Deli Fresh Smoked Ham, chopped
8 eggs, beaten
8 corn tortillas (6 inch)
1-1/2 cups KRAFT Shredded Low-Moisture Part-Skim Mozzarella Cheese, divided
1 jar (16.7 oz.) green salsa
1/2 cup PHILADELPHIA Original Cooking Creme
2 Tbsp. chopped fresh cilantro
Make It
HEAT oil in large skillet on medium heat. Add ham; cook and stir 1 min. Stir in eggs; cook 2 min. or until set.
SPOON egg mixture down centers of tortillas. Top each with 1 Tbsp. cheese; roll up. Place, seam-sides down, in 13x9-inch baking dish sprayed with cooking spray. Refrigerate overnight.
HEAT oven to 350°F. Mix salsa and cooking creme until well blended; pour over enchiladas. Cover. Bake 25 min. Top with remaining cheese; bake, uncovered, 5 min. or until melted. Sprinkle with cilantro.
Kitchens Tips
Serving Suggestion
Serve with fresh fruit to round out the meal.
Filling Corn Tortillas
If tortillas are not pliable, microwave on HIGH 1 min. to avoid any cracks when filling.
Variation
Assemble enchiladas as directed. (Do not refrigerate.) Top with salsa mixture; cover. Bake 20 min. Top with cheese; bake, uncovered, 5 min. or until melted.
alternatives to medicine
As an integrative health care practitioner, using the BodyTalk modality, I have been witness to improvements in client health ranging from the mild to astounding. Anyone in touch with the most recent science of quantum physics, and writers of the quality of Deepak Chopra (“Quantum Healing”), Dr. Amit Goswami PhD (“The Quantum Doctor”) and Dr. Bruce Lipton PhD (“Biology of Belief”) will recognize that your opinions expressed are outdated.
Kudos to the Ontario College of Physicians and Surgeons for moving with the times, or even in some cases, recognizing that 2000-year-old modalities like accupuncture, massage and yoga are still around because they work.
Dr. Oz who writes a column in your paper and has a TV show is famous for his alternative views. The fact that so many are resorting to other health-care modalities sends a huge message to the health-care sector, which is all ready overburdened with so many patients that our hospitals are overflowing.
Acute diseases usually respond best to medical tools, however the overwhelming rise in chronic diseases can more effectively be managed with various alternatives. The belief that “there is a pill for everything” is truly the outdated concept.
Let’s all agree to take an integrative approach that uses the best tools for the job, and begin learning as much as possible about all the other modalities that are out there that have been “muzzled” too long.
According to the World Health Organization, homeopathy is the second most widely used medical system in the world. It is not considered alternative in many parts of the world, such as India, Cuba, France, Germany and England. Homeopathy is covered under the national health care system in England and in some European countries.
Homeopathic treatment has existed throughout time: its principles—like cures like, and use the smallest dose possible—were recorded by Hippocrates, Socrates and Plato. They are mentioned in the Jewish Bible, and were practiced throughout history by such great practitioners such as Paracelsus.
In the late 1700’s, Samuel Hahnemann, a doctor and chemist, devised a systematic methodology to produce medicine which was not toxic to the patient. He incorporated the historical philosophy of homeopathy into a text which is still studied and followed today. It was in the same year that Hahnemenn published his work that Edward Jenner published his findings on the use of vaccination in smallpox. Vaccination is the use of the same substance which causes the disease to prevent the disease, and that principle is commonly used in homeopathic treatment. Conventional medicine today uses the principle of “like cures like” in treatments such as amphetamines like Ritalin for ADD, or minute doses of heroin in withdrawal treatment for heroin addicts.
Homeopathy is nano-medicine. The same remedies have been used for over 200 years. The reason homeopathy is so popular and has survived alongside conventional medicine is because it works and people want it. Homeopathy is safe for everyone, including pregnant women, babies, and the elderly. Homeopathic products are regulated by Health Canada. Homeopathy is currently being regulated as in Ontario and the establishment of a College is underway.
Kudos to the Ontario College of Physicians and Surgeons for moving with the times, or even in some cases, recognizing that 2000-year-old modalities like accupuncture, massage and yoga are still around because they work.
Dr. Oz who writes a column in your paper and has a TV show is famous for his alternative views. The fact that so many are resorting to other health-care modalities sends a huge message to the health-care sector, which is all ready overburdened with so many patients that our hospitals are overflowing.
Acute diseases usually respond best to medical tools, however the overwhelming rise in chronic diseases can more effectively be managed with various alternatives. The belief that “there is a pill for everything” is truly the outdated concept.
Let’s all agree to take an integrative approach that uses the best tools for the job, and begin learning as much as possible about all the other modalities that are out there that have been “muzzled” too long.
According to the World Health Organization, homeopathy is the second most widely used medical system in the world. It is not considered alternative in many parts of the world, such as India, Cuba, France, Germany and England. Homeopathy is covered under the national health care system in England and in some European countries.
Homeopathic treatment has existed throughout time: its principles—like cures like, and use the smallest dose possible—were recorded by Hippocrates, Socrates and Plato. They are mentioned in the Jewish Bible, and were practiced throughout history by such great practitioners such as Paracelsus.
In the late 1700’s, Samuel Hahnemann, a doctor and chemist, devised a systematic methodology to produce medicine which was not toxic to the patient. He incorporated the historical philosophy of homeopathy into a text which is still studied and followed today. It was in the same year that Hahnemenn published his work that Edward Jenner published his findings on the use of vaccination in smallpox. Vaccination is the use of the same substance which causes the disease to prevent the disease, and that principle is commonly used in homeopathic treatment. Conventional medicine today uses the principle of “like cures like” in treatments such as amphetamines like Ritalin for ADD, or minute doses of heroin in withdrawal treatment for heroin addicts.
Homeopathy is nano-medicine. The same remedies have been used for over 200 years. The reason homeopathy is so popular and has survived alongside conventional medicine is because it works and people want it. Homeopathy is safe for everyone, including pregnant women, babies, and the elderly. Homeopathic products are regulated by Health Canada. Homeopathy is currently being regulated as in Ontario and the establishment of a College is underway.
Thursday, November 24, 2011
Patients benefit from LDL-C lowering strategies long-term
Longer-term LDL-cholesterol lowering statin therapies can greatly reduce vascular events, according to the results of the Heart Protection Study (HPS) published Nov. 23 in The Lancet. Additionally, researchers found that even after the study treatments were stopped, the benefits lasted for at least five years without any emerging dangers.
“Collectively, findings of HPS and other major trials of statins provide compelling evidence that lowering LDL cholesterol by about 1 mmol/L reduces vascular mortality and morbidity by about a quarter in a wide range of patients (including elderly people and those with low cholesterol concentrations), without increasing the risk of non-vascular mortality or morbidity (apart from a small myopathy excess) during about five years of treatment,” according to background information from the study.
Previous studies have eluded to the fact that lower blood cholesterol concentrations have been linked to an increased risk of cancer and non-vascular morbidity and mortality. “It has been suggested, therefore, that lowering LDL cholesterol (particularly to low levels) might produce increases in the rates of cancers and other types of adverse events that take longer than five years to emerge,” the authors wrote.
During the Heart Protection Study (HPS) study, conducted by the HPS Collaborative Group, 20,536 patients who were at a high risk of vascular and nonvascular outcomes were enrolled and randomized to receive either 40 mg of simvastatin or placebo. Mean in-trial follow-up was 5.3 years and post-trial follow-up yielded a mean total duration of 11 years.
Between July 1994 and May 1997, of the 17,519 patients who were alive at the start of the post-trial follow-up period, 8,863 received simvastatin (Zocor, Merck) and 8,656 patients were randomized to receive placebo.
The study used first post-randomization major vascular event as the primary endpoint.
The researchers found that self-reported statin use was similar in both groups, rising from about 59 percent at the end of the first year to 84 percent by the end of the fifth year.
Additionally, the researchers reported that 2,153 major vascular events were reported in the 10,269 patients administered simvastatin vs. 2,712 events in 10,267 who were administered placebo. This related to a 23 percent reduction.
While no significant differences were noted in the first year, the authors did report reductions of about a quarter during the subsequent in-trial year. Among those who were event-free at the start of the post-trial period, 1,636 first events arose in patients previously administered simvastatin vs. 1,566 patients who were previously administered placebo.
The researchers reported a 14 percent additional decrease that was recorded in the first post-trial year in patients who were originally administered simvastatin. However, thereafter, little difference was seen between the two groups. Meanwhile, a 27 percent reduction for major coronary events was noted during the in-trial period. A 24 percent reduction in stroke risk was also found during the in-trial period.
Lastly, vascular mortality was linked to 826 deaths in those administered simvastatin and 998 in those administered placebo, an 18 percent proportional reduction. Vascular mortality rates were similar in both treatment groups during the post-trial period, 1,019 vs. 1,007, respectively.
Non-vascular mortality during the in-trial period was responsible for 580 deaths in those administered simvastatin compared with 613 administered placebo. However, death from cancer or other non-vascular reasons did not statistically differ. During the post-trial period, the rates of non-vascular mortality were similar.
“Similarly, the large numbers of other types of outcome recorded during prolonged follow-up provide compelling evidence that five years of statin therapy is not associated with excesses of any particular type of non-vascular death, site specific cancer, or other major non-vascular morbidity,” the authors noted. “Moreover, although 11 years might still not be long enough for deleterious effects on cancer to emerge fully, no adverse trend was noted, even during the later years of post-trial follow-up.
“As well as providing reliable evidence about the long-term benefits of statin therapy, the large numbers of other major health outcomes recorded during prolonged follow-up in HPS provide considerable reassurance—both to prescribers and to patients—about the long-term safety of lowering LDL cholesterol substantially for about five years,” the authors concluded.
“Statins have revolutionized modern cardiovascular treatment by producing a striking reduction in coronary risk,” Payal Kohli, MD, and Christopher P. Cannon, MD, both of the TIMI Study Group and Brigham and Women’s Hospital in Boston, wrote in an accompanying editorial.
The authors noted that the results of the current study show the long-term benefits of statin use, despite the previous concerns of adverse event risk. Cannon and Kohli concluded that "[C]oncerns should be put to rest and doctors should feel reassured about the long-term safety of this life-saving treatment for patients at increased cardiovascular risk.”
“Collectively, findings of HPS and other major trials of statins provide compelling evidence that lowering LDL cholesterol by about 1 mmol/L reduces vascular mortality and morbidity by about a quarter in a wide range of patients (including elderly people and those with low cholesterol concentrations), without increasing the risk of non-vascular mortality or morbidity (apart from a small myopathy excess) during about five years of treatment,” according to background information from the study.
Previous studies have eluded to the fact that lower blood cholesterol concentrations have been linked to an increased risk of cancer and non-vascular morbidity and mortality. “It has been suggested, therefore, that lowering LDL cholesterol (particularly to low levels) might produce increases in the rates of cancers and other types of adverse events that take longer than five years to emerge,” the authors wrote.
During the Heart Protection Study (HPS) study, conducted by the HPS Collaborative Group, 20,536 patients who were at a high risk of vascular and nonvascular outcomes were enrolled and randomized to receive either 40 mg of simvastatin or placebo. Mean in-trial follow-up was 5.3 years and post-trial follow-up yielded a mean total duration of 11 years.
Between July 1994 and May 1997, of the 17,519 patients who were alive at the start of the post-trial follow-up period, 8,863 received simvastatin (Zocor, Merck) and 8,656 patients were randomized to receive placebo.
The study used first post-randomization major vascular event as the primary endpoint.
The researchers found that self-reported statin use was similar in both groups, rising from about 59 percent at the end of the first year to 84 percent by the end of the fifth year.
Additionally, the researchers reported that 2,153 major vascular events were reported in the 10,269 patients administered simvastatin vs. 2,712 events in 10,267 who were administered placebo. This related to a 23 percent reduction.
While no significant differences were noted in the first year, the authors did report reductions of about a quarter during the subsequent in-trial year. Among those who were event-free at the start of the post-trial period, 1,636 first events arose in patients previously administered simvastatin vs. 1,566 patients who were previously administered placebo.
The researchers reported a 14 percent additional decrease that was recorded in the first post-trial year in patients who were originally administered simvastatin. However, thereafter, little difference was seen between the two groups. Meanwhile, a 27 percent reduction for major coronary events was noted during the in-trial period. A 24 percent reduction in stroke risk was also found during the in-trial period.
Lastly, vascular mortality was linked to 826 deaths in those administered simvastatin and 998 in those administered placebo, an 18 percent proportional reduction. Vascular mortality rates were similar in both treatment groups during the post-trial period, 1,019 vs. 1,007, respectively.
Non-vascular mortality during the in-trial period was responsible for 580 deaths in those administered simvastatin compared with 613 administered placebo. However, death from cancer or other non-vascular reasons did not statistically differ. During the post-trial period, the rates of non-vascular mortality were similar.
“Similarly, the large numbers of other types of outcome recorded during prolonged follow-up provide compelling evidence that five years of statin therapy is not associated with excesses of any particular type of non-vascular death, site specific cancer, or other major non-vascular morbidity,” the authors noted. “Moreover, although 11 years might still not be long enough for deleterious effects on cancer to emerge fully, no adverse trend was noted, even during the later years of post-trial follow-up.
“As well as providing reliable evidence about the long-term benefits of statin therapy, the large numbers of other major health outcomes recorded during prolonged follow-up in HPS provide considerable reassurance—both to prescribers and to patients—about the long-term safety of lowering LDL cholesterol substantially for about five years,” the authors concluded.
“Statins have revolutionized modern cardiovascular treatment by producing a striking reduction in coronary risk,” Payal Kohli, MD, and Christopher P. Cannon, MD, both of the TIMI Study Group and Brigham and Women’s Hospital in Boston, wrote in an accompanying editorial.
The authors noted that the results of the current study show the long-term benefits of statin use, despite the previous concerns of adverse event risk. Cannon and Kohli concluded that "[C]oncerns should be put to rest and doctors should feel reassured about the long-term safety of this life-saving treatment for patients at increased cardiovascular risk.”
Diets That Help Improve Cholesterol
If you've been diagnosed with high cholesterol, your doctor has probably told you to change your diet in order to bring your numbers down. Fortunately, there are several options when it comes to a cholesterol-smart diet. Which foods belong in your kitchen?
Your Cholesterol-Friendly Shopping List
*Choose these all-star foods in each section for extra cholesterol control.
Vegetables
Tip: Vegetables provide cholesterol-lowering fiber and phytosterols.
o Artichokes
o Asparagus
o Beets
o Bell peppers
o Broccoli
o Brussels sprouts
o Cauliflower
o Carrots
o Celery
o Corn
o Cucumber
o Eggplant
o Green beans
o Green peas
o Jicama
o Leafy greens
o Leeks, onions, shallots
o Mushrooms
o Okra
o Parsnips
o Potatoes
o Squash (summer and winter)
o Tomatoes
o Zucchini
Fruit
Tip: Check with your doctor about potential medication interactions with citrus.
o Apples
o Apricots
o Avocados*
Go Mediterranean
Many studies indicate that the traditional Mediterranean diet is one of the most effective for improving unhealthy cholesterol numbers. Why? It replaces saturated fats with heart-healthy monounsaturated and polyunsaturated fats (such as olive oil, nuts, and seeds), which can help lower your "bad" LDL-cholesterol and may even raise your beneficial HDL levels. The Mediterranean diet also includes a wide variety of other cholesterol-improving foods, such as fruits, vegetables, whole grains, legumes, and fish.
Try a Little TLC
The TLC (Therapeutic Lifestyle Changes) Diet, created by the National Institutes of Health, is similar to the Mediterranean diet in many ways. For example, it emphasizes lots of produce, whole grains, low-fat or nonfat dairy, and fish. In addition, it also advocates keeping saturated fat to less than 7% of your daily calories, eating less than 200 milligrams of cholesterol a day, and limiting your total daily fat consumption to less than 35%.
Invest in This Healthy Portfolio
A recent study found that a diet with a rich "portfolio" of cholesterol-lowering foods reduces cholesterol even better than a diet low in saturated fat. Which cholesterol-smart foods should you "invest" in? Consider these:
Your Cholesterol-Friendly Shopping List
*Choose these all-star foods in each section for extra cholesterol control.
Vegetables
Tip: Vegetables provide cholesterol-lowering fiber and phytosterols.
o Artichokes
o Asparagus
o Beets
o Bell peppers
o Broccoli
o Brussels sprouts
o Cauliflower
o Carrots
o Celery
o Corn
o Cucumber
o Eggplant
o Green beans
o Green peas
o Jicama
o Leafy greens
o Leeks, onions, shallots
o Mushrooms
o Okra
o Parsnips
o Potatoes
o Squash (summer and winter)
o Tomatoes
o Zucchini
Fruit
Tip: Check with your doctor about potential medication interactions with citrus.
o Apples
o Apricots
o Avocados*
Go Mediterranean
Many studies indicate that the traditional Mediterranean diet is one of the most effective for improving unhealthy cholesterol numbers. Why? It replaces saturated fats with heart-healthy monounsaturated and polyunsaturated fats (such as olive oil, nuts, and seeds), which can help lower your "bad" LDL-cholesterol and may even raise your beneficial HDL levels. The Mediterranean diet also includes a wide variety of other cholesterol-improving foods, such as fruits, vegetables, whole grains, legumes, and fish.
Try a Little TLC
The TLC (Therapeutic Lifestyle Changes) Diet, created by the National Institutes of Health, is similar to the Mediterranean diet in many ways. For example, it emphasizes lots of produce, whole grains, low-fat or nonfat dairy, and fish. In addition, it also advocates keeping saturated fat to less than 7% of your daily calories, eating less than 200 milligrams of cholesterol a day, and limiting your total daily fat consumption to less than 35%.
Invest in This Healthy Portfolio
A recent study found that a diet with a rich "portfolio" of cholesterol-lowering foods reduces cholesterol even better than a diet low in saturated fat. Which cholesterol-smart foods should you "invest" in? Consider these:
- Plant sterols from sterol-fortified foods, such as margarine and orange juice
- Soluble-fiber-rich oats
- Barley
- Psyllium
- Beans and other legumes
- Soy (from tofu, soymilk, and soy "meat")
- Nuts and seeds
Saturday, November 19, 2011
Blood Pressure and Stroke Risk Become Complex
| | |
 Usual treatment suggested to patients who’ve had ischemic stroke is to keep subsequent blood pressure levels as low as possible to reduce the risk of subsequent stroke. The traditional treatment has been challenged by international study and considered probably not that helpful. In fact it could actually increase recurrent stroke risk - at least in the first few months after the first event. The findings, from a team of scientists led by Bruce Ovbiagele, MD, professor of neurosciences at the University of California, San Diego School of Medicine, are published in the November 16 issue of JAMA, the Journal of the American Medical Association. The 5-year study examined the cases of 20,330 patients (age 50 years and older) at 695 centers in 35 countries who had suffered a recent non-cardioembolic ischemic stroke, which is caused by drifting blood clots formed outside of the heart. Patients were categorized by their average Systolic blood pressure (SBP) level: very low-normal (less than 120 mmHg), low-normal (120 to less than 130 mm Hg), high-normal (130 to less than 140 mm Hg), high (140 to less than 150 mm Hg) and very high (150 mm Hg or greater). The occurrence rate for the primary or first stroke was highest in patients with a very high SBP (14.1 percent), followed by patients with high SBP (8.7 percent). Next came patients with very low-normal SBP at 8 percent, low-normal SBP at 7.2 percent and then high-normal SBP at 6.8 percent. The occurrence rate for a second stroke or other vascular event followed the same pattern. SBP is the maximum pressure applied to arterial walls as blood is pumped through the body. Diastolic blood pressure (DBP) is the minimum. Typically, normal blood pressure is defined as less than 120 mm Hg for SBP and less than 80 mm Hg for DBP. "For most patients at high vascular risk, including diabetics, the general approach has been that much lower is much better," said Ovbiagele. "For stroke patients, whose condition is most strongly related to elevated blood pressure, it has been believed that much, much lower is much, much better, and that the relationship of SBP with stroke was likely a linear one." The new findings indicate the association between blood pressure and stroke risk is more complicated than previously suspected. While the researchers said it was not surprising to find that higher-than-normal SBP levels boosted recurrent stroke risk, it was somewhat unexpected to discover the same effect among patients with very low SBP levels. The apparent narrowing of what constitutes a "healthy" SBP for stroke patients may not be the only relevant factor. Ovbiagele said timing also appears to be important because the effects were most pronounced in the first six months after the primary stroke. "It''s conceivable that the brain may still require a certain threshold of blood perfusion early-on after the index vascular brain injury and so is susceptible to more strokes if SBP dips below that threshold. This is just a theory, but there are a couple of other clinical studies that suggest early BP reduction after an acute stroke may be associated with some harm." Ovbiagele said the message to patients and clinicians is that "it increasingly appears there is no one-size-fits-all approach with regard to treating blood pressure to prevent stroke. This study and other recent data now suggest that there are several factors to take into consideration when lowering blood pressure to prevent stroke, including the age of the patient, level of blood pressure, any history of prior stroke, type of prior stroke and timing of prior stroke." |
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