A report looking at 1,086 black men and women who had been out of the hospital for only about six weeks after having strokes found that even those people were not effectively treating the risk factors for stroke, particularly high blood pressure.
"They had seen doctors in the hospital and had one or two follow-up visits afterwards, yet even despite this, a lot of the patients were unaware of the risk factors in their profile, particularly high blood pressure," says study author Sean Ruland, a neurologist at the Rush Medical College in Chicago.
"This study is particularly distressing because these are men and women who have been treated, and they are already under scrutiny. Further, they have significant risks of having another stroke. One quarter of all strokes are recurrent strokes," says Dr. Stanley Tuhrim, director of the stroke program at New York City's Mount Sinai Hospital.
Yet, he adds, the results are "probably typical of the general African-American population."
The study, funded in part by the National Institutes of Health, appears in tomorrow's issue of Neurology.
Ruland's findings were culled from another study comparing the effectiveness of an anti-clotting agent to aspirin in stroke and heart attacks. For this study, Ruland looked at rates of awareness, treatment and control of risk factors for stroke, including hypertension, diabetes and cholesterol levels among the men and women stroke victims whose average age was 62.
Of the three, high blood pressure was the most common risk among these patients.
Eighty-seven percent of the stroke patients in the study had high blood pressure, Ruland and his colleagues found, yet a fourth of those patients took no hypertension medicine. And, he says, even among those who did take hypertension medicine, 70 percent still had elevated blood pressure. Further, of the 143 patients with no reported hypertension or use of medications, more than half had elevated blood pressure, above 130/85.
Blood pressure is a measurement of how the blood travels through the arteries. The top number, called systolic, represents the blood pressure when the heart is beating, and the bottom number, called diastolic, represents the pressure when the heart is resting between beats. The higher the blood pressure, the harder the heart has to pump and the more strain there is to arteries that have to carry blood moving under greater pressure. Over time, the increased wear on the body can lead to health problems, particularly stroke and heart attacks.
"Clearly, African-Americans have a higher prevalence of hypertension than do white Americans. It seems to be the only explanation why they are at increased risk of stroke," Tuhrim says.
About 40 percent of the stroke victims had diabetes, and about 85 percent were taking medication for their illness. A history of high cholesterol or use of cholesterol-lowering medicine was reported by 39 percent of the study participants.
Ruland says underuse of proven effective therapies is a serious problem for blacks and points to several possible reasons: physician attitudes, problems with patient access to care, unawareness of the importance of routine screening, and compliance with treatment.
"Physicians may not have the time for necessary care and follow-ups or aren't aware of the current guidelines for hypertension treatment," Ruland says.
Last year, the Joint National Committee of the National Heart, Lung, and Blood Institute lowered to 130/85 the threshold for treating hypertension. Previously it had been 140/90, Ruland says.
Other problems are that hypertension has few if any symptoms, so unless people are vigilant about taking their blood pressure they might not know they have it.
Lastly, Ruland says, people whose blood pressure readings are high in his office are often in denial that they have high blood pressure.
"They tell me they just sat in traffic for an hour or walked up a hill," he says when he reports that they have high blood pressure. "I've heard everything in the book."
He recommends that people with a reading above 130/85 should monitor their own blood pressure regularly, several times a week until it reaches the recommended level. He tells patients to buy a blood pressure cuff from the pharmacy or have it checked at one of the many public places that offer blood pressure readings.