Management of hypertension in acute strokeSudhir Kumar
Hypertension is an important and common risk factor for brain stroke- both ischemia and hemorrhagic subtypes. Appropriate management of blood pressure is crucial for good recovery rom acute stroke, and prevent recurrence of stroke. This presentation looks at the role played by hypertension in causing first ever and recurrent strokes. The current guidelines are also discussed.
newer drug combinations in management of hypertension,esp in presence of CAD, making them more potent anti-hypertensives, with lesser side effects especially pedal edema
Role of Blood Pressure in Recurrent StrokeSudhir Kumar
Hypertension is a major risk factor for the first stroke as well as recurrent stroke. Therefore, adequate control of BP is necessary to reduce the risk of stroke recurrence. This presentation looks at the ABCD 2 score to predict the exact risk of stroke recurrence after TIA. Target BP that needs to be achieved has been discussed. Various antihypertensive agents based on the scientific evidence have been discussed.
Management of hypertension in acute strokeSudhir Kumar
Hypertension is an important and common risk factor for brain stroke- both ischemia and hemorrhagic subtypes. Appropriate management of blood pressure is crucial for good recovery rom acute stroke, and prevent recurrence of stroke. This presentation looks at the role played by hypertension in causing first ever and recurrent strokes. The current guidelines are also discussed.
newer drug combinations in management of hypertension,esp in presence of CAD, making them more potent anti-hypertensives, with lesser side effects especially pedal edema
Role of Blood Pressure in Recurrent StrokeSudhir Kumar
Hypertension is a major risk factor for the first stroke as well as recurrent stroke. Therefore, adequate control of BP is necessary to reduce the risk of stroke recurrence. This presentation looks at the ABCD 2 score to predict the exact risk of stroke recurrence after TIA. Target BP that needs to be achieved has been discussed. Various antihypertensive agents based on the scientific evidence have been discussed.
Described the BP targets in Ischemic stroke with and without IV thrombolysis, with and without mechanic thrombectomy, Intra cerebral Heamorrhage, SAH and other Neurological emergencies with revised AHA/ ASA upated guidelines
ALSO showed different journal evidence of work on blood pressure management in acute ischemic and heamorrhagic stroke, BP tergets in SAH, PRES
Blood-Pressure Management in Patients with Acute Cerebral Hemorrhage
Kontroversi hasil studi ATACH-2 dan dampaknya dalam manajemen hipertensi pada stroke perdarahan intraserebral akut.
The presentation covers definitions, identification, Treatment goals, Special situations, Practice points, and cardinal pharmacotherapy. Session presented in NBE learning session
Described the BP targets in Ischemic stroke with and without IV thrombolysis, with and without mechanic thrombectomy, Intra cerebral Heamorrhage, SAH and other Neurological emergencies with revised AHA/ ASA upated guidelines
ALSO showed different journal evidence of work on blood pressure management in acute ischemic and heamorrhagic stroke, BP tergets in SAH, PRES
Blood-Pressure Management in Patients with Acute Cerebral Hemorrhage
Kontroversi hasil studi ATACH-2 dan dampaknya dalam manajemen hipertensi pada stroke perdarahan intraserebral akut.
The presentation covers definitions, identification, Treatment goals, Special situations, Practice points, and cardinal pharmacotherapy. Session presented in NBE learning session
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Artificial Intelligence to Optimize Cardiovascular Therapy
HTN & CVA.pptx
1. Hypertension and CVA
Dr PS Deb MD, DM
Director Neurology Guwahati Neurological
Research Center, Assam
Hypertension
CVA
Hypertension
2. Hypertension and Stroke (WHO 2013)
Hypertension causes 10%
death in India
• 51% death due to CVA
• 45% due to CAD
Stroke >25 years
• 34% men
• 32% women
Preventable by Rx
• 35-45% Stroke
• 25% CAD
3. Diastolic BP as Risk Factor of Stroke (< 1990)
Eastern Stroke and Coronary
Heart Disease Collaborative
Research Group
• Diastolic BP 110 mmHg had
13times risk of stroke as compared
to <79 mmHg
60
50
40
30
20
10
0
Stroke Prevention
MacMohan
Stroke
Prevention
4. Systolic BP as Risk factor for Stroke (>1990)
Systolic BP was more strongly correlated with 12-year risk of stroke
mortality than diastolic BP in Framingham Heart Study
Prospective population based Copenhagen City Heart study also
reported systolic BP is a better predictor of stroke than diastolic
Asia Pacific Cohort Studies Collaboration analyzing 37 cohort studies
reported a continuous, log-linear association between systolic BP and
risk of stroke down at least 115 mmHg.
After a 10 mmHg decrease in systolic BP was associated with a 41%
lower risk of stroke in Asia and a 30% inAustralia
5. Age and Stroke with Hypertension
Elevated BP and risk of stroke is weaker
in older age compared to middle age
The Asia Pacific Cohort Studies
Collaboration (APCSC)
Treating BP is still important due to
increased incidence of stroke with aging.
60
50
40
30
20
10
0
Stroke after 10mmHg
Decrease of Systolic BP
Stroke
Prevention
6. Pathogenesis of Stroke due to Hypertension
1. Large vesselAtherosclerosis
2. Medium vesselArteriosclerosis
3. Small Vessel Lipohyalanosis
4. Cardioembolic stroke
7. Cerebral Ischemic Stroke
Synaptic transmission
failure
Membrane pump failure
20
10
0
Time in hours
CBF
(ml/100g
brain)
Normal flow, normal function
Low flow, raised O2 extraction, normal
function
1 2 3 4 5
10. Blood Pressure in Acute IschemicStroke
Systolic blood pressure on arrival at Emergency
• >139 mm Hg in 77%
• >184 mm Hg in 15%.
The blood pressure is often higher in acute stroke patients with
a history of hypertension
Blood pressure decreases spontaneously within 90 minutes after
onset
11. BP control in Acute IschemicStroke
Is lowering of
BP harmful?
Y
es Is raising BP
beneficial?
Y
es
No
No What class of
drug?
CC Blocker
AB Blocker
Vasodilators
12. Is lowering BP is harmful? Yes
Autoregulation is defective in acute ischemia but it is time
dependent.
Oxygen extraction compensate to a point
BP control hamper perfusion of penumbra region
Lowering BP below >10-15% is potentially harmful
Hypertensive patient shows more significant decrease in MBP
after induced hypotension than hypertension
13. Oral Nimodipine in acute ischemic stroke
A placebo-controlled randomized trial tested oral Nimodipine
starting within 48 hours after ischemic stroke onset in 350
patients.
The systolic and diastolic blood pressures were both
significantly lower in the Nimodipine group.
Functional outcome at 3 months was similar in the 2 treatment
groups, but mortality was significantly higher in the
Nimodipine group
14. Intravenous Nimodipine West European Stroke
Trial (INWEST)
Nimodipine as cytoprotective therapy within 24 hours after ischemic
stroke onset and found complications related to blood pressure
lowering
Decrease in blood pressure was associated with intravenous
Nimodipine therapy and worse clinical outcome at 21 days.
A decrease in diastolic blood pressure >10 mm Hg, but not inthe
systolic pressure, was significantly associated with worse outcome
15. Candesartan in Acute Stroke
An efficacy trial (n=2004) of candesartan showed a
mean blood pressure reduction of 7/5 mm Hg at day 7
Favorable outcomes at 6 months, were less likely with
candesartan than with placebo.
16. The Continue or Stop Post-StrokeAntihypertensives
Collaborative Study (COSSACS)
Patients were enrolled within 48 hours of stroke
onset and the last dose of antihypertensive
medication and were maintained in the 2 treatment
arms for 2 weeks.
The study was terminated prematurely;
however, continuation of antihypertensive
medications did not reduce 2-week mortality or
morbidity and was not associated with 6-month
mortality or cardiovascular event rates.
17. Is lowering BP in AIS harmful? No
Defective autoregulation may not be present in all patients
Ischemic penumbra may not be present in all patients
Clinical experience indicates that many patients tolerates gentle
treatment of high BP
Natural history studies demonstrate no deleterious effects of
lowering BP
High BP at onset has poor prognosis
18. Hypertension during acute ischemic stroke
Extreme hypertension -> Encephalopathy, Cardiac
complication, renal insufficiency
Moderate arterial hypertension during acute ischemic stroke might
be advantageous by improving cerebral perfusion of the ischemic
tissue
It might be detrimental by exacerbating edema and hemorrhagic
transformation of the ischemic tissue
19. Candesartan in Acute Stroke
Starting an average of 30 hours after ischemic stroke onset
in 342 patients with elevated blood pressure.
Blood pressure and the Barthel index score at 3 months
were similar in the 2 study groups,
Patients who received the active drug had significantly
lower mortality and fewer vascular events at 12 months.
20. Is Raising Blood Pressure in Acute Ischemic
Stroke Beneficial? Yes
Small pilot trials have carefully
raised the blood pressure in acute
ischemic stroke patients without
apparent complications.
Severe intracranial atherosclerosis
or stenosis may require BP
elevation to maintain IC
circulation
21. Is Raising Blood Pressure in Acute Ischemic
Stroke Beneficial? No
U shaped relation between
admission BP and outcome
Elevated in-hospital blood pressure
during acute ischemic stroke has
been associated with worse clinical
outcomes in a more linear fashion.
22. Other problem of raising BP
Increase risk of ICH after lytic therapy
May increase amount and formation of cerebral edema
A 12% increase in terms of size of infarction.
May adversely affect cardiac function
23. Optimal BP during acute ischemic stroke
Extreme arterial hypotension is clearly detrimental, because
it decreases perfusion to multiple organs, especially the
ischemic brain, exacerbating the ischemic injury.
An ideal blood pressure range has not yet been scientifically
determined for individual patient.
An ideal blood pressure range during acute ischemic stroke
will depend on the stroke subtype and other patient specific
co-morbidities.
24. Recommendation (AHA 2013)
1. Not for thrombolysis > 220/120 mmHg,
2. For Thrombolysis >185/100 mmHg
3.Severe cardiac failure, Aortic dissection, Hypertensive
encephalopathy
4. Cautious blood pressure lowering when (IV
Labetalol, IV Enalepril, Nitrendepine) avoid venodilators
25. When to Temporary discontinuation ofAHT?
Because swallowing is often impaired, and
responses to the medications may be less
predictable during the acute stress.
26. When to Re-start AntihypertensiveTherapy
After the initial 24 hours from stroke onset in
most patients.
Individualize such therapy based on relevant co-
morbidities, ability to swallow.
30. Hematoma volume and outcome
Type ICH Vol. mL Coma Prognosis
I < 30 - Good
II 30-60 - Fair
III 30-60 + Poor
>60 +
(Joseph P.Broderick et al Stroke 1993;24:987-993)
32. How to treat Hypertension in ICH?
When should we treat Hypertension
What is the target mean arterial pressure for patients with
intracerebral hemorrhage (ICH)?
Do we want to be aggressive or conservative?
What should first-line therapy be: beta blockers or calcium-
channel blockers?
What should the duration of intravenous (IV) therapy be: 24
hours or 72 hours?
33. Primary aim
1. Early intensive blood pressure (BP) lowering (target of
<140 mmHg systolic) as compared to the
2.Guideline-recommended ‘standard’ control of BP
(target of <180 mmHg systolic) improves
3.Survival free of major disability in acute spontaneous
intracerebral haemorrhage (ICH)
Standardised treatment protocols – locally available
intravenous (IV) BP lowering agents of physician’s choice
33
34. Protocol schema: from INTERACT1 (Lancet Neurol 2008)
and (Int J Stroke 2010)
Acute spontaneous ICH confirmed by CT/MRI
Definite time of onset within 6hours
Systolic BP 150 to 220mmHg
No indication/contraindication to treatment
In-hospital vital signs, NIHSS, GCS and BP over 7 days
Intensive BPlowering
SBP <140 mmHg
Standard BPmanagement
Guidelines SBP <180 mmHg)
R
34
Independent 90 day outcome with
modified Rankin scale (mRS)
N=2800 gives 90% power for
7% absolute (14% relative)
decrease (50% standard vs 43%
intensive) in outcome
35. Patient Flow – 2839 patients
recruited October 2008 to August
2012
1382 (98.5%) for
primary
outcom
e
1412 (98.3%) for
primary
outcom
e
2839
Randomised
28,829 Total estimated
screened
3 no consent
1 missing baselinedata
2lost to follow-up
3 withdrew consent
12 alive without mRSdata
Reasons for exclusion
(n=3572)
39%Outside timewindow
16% Judgedunlikely to benefit
11% BPoutsidecriteria
8% Plannedearly surgery
5% Refused
21% Other reasons
6411 Screening logs
completed
1403 Intensive BP lowering 1436 Standard BP lowering
5 no consent
1 missingbaselinedata
5 lost to follow-up
4 withdrew consent
9 alive without mRSdata
36. Systolic BP time trends
1 hour - Δ14mmHg(P<0.0001)
6 hour - Δ14mmHg(P<0.0001)
Systolic BP control
Median (iqr) time to treatment, hr - intensive 4 (3-5), standard 5 (3-7)
Intensive group to target
(<140mmHg)
462 (33%)at 1hour
731 (53%)at 6hours
Mean
Systolic
Blood
Pressure
(mm
Hg)
0
110
130
120
140
150
160
180
170
190
200
Standard
Intensive
//
//
Days / Time
164
153
150
139
am pm am pm am pm am pm
2 3 4 5
am pm am pm
6 7
P<0.0001
beyond 15mins
R 15 30 45 60 6 12 18 24
Minutes Hours
Targetlevel
36
37. safe - no increase in death or harms
effective – borderline significant effect on the primary
endpoint
• secondary analyses - improved recovery of physical functioning and
health-related quality of life in survivors
Early intensive BP lowering treatment is
37
38. Treatment effect smaller (4%) than expected 7% absolute,
but:
• active-comparison study on background therapies, some with BP
lowering properties (i.e. mannitol)
• equates to NNT 25 (greater than aspirin and near late use of rtPAin
ischaemic stroke)
No clear time-dependent relationship of treatment
• potential mechanisms beyond haematoma growth
• benefits of BP control may take several hours tomanifest
• effects on haematoma growth and other results outlined in Symposium
this afternoon
INTERACT2 - issues
38
39. INTERACT2 resolves longstanding uncertainty over the management of
elevated BP in acute ICH
Provides evidence regarding safety and efficacy in a broad range of patients
with ICH
Defines for the first time a medical therapy for the management of acute
ICH
As BP lowering treatment is low cost, simple to implement, and widely
applicable, the treatment should become standard of care to patients with
ICH in hospitals all over the world
Conclusions
39
41. Recommendation AHA2010
Hypertension is common during early
states of ICH -> Expansion, Peri-
hematoma edema and re-bleeding
A systolic BP above 140 to 150 mm
Hg within 12 hours of ICH is
associated with more than double the
risk of subsequent death or
dependency.
Association of low BP and
deterioration is not consistent like
ischemic stroke.
In patients
presenting with a
systolic BP of 150
to 220 mm Hg,
acute lowering of
systolic BP to 140
mm Hg is probably
safe
• Class IIa; Level of
Evidence: B
42. When to initiate oral antihypertensive
medication?
After first 24-48 hours
43. Subarachnoid Hemorrhage
Asia Pacific Cohort Studies Collaboration demonstrated thathypertension was
an independent risk of SAH increased sharply with increase in systolicBP
SAH incr ICP & decr cerebral perfusion causing global ischemia
Induces intense vasospasm in neighbouring vessels (4- 12 days) after
initial bleed.
Goal-dec 20-25% of MAP over 6-12hrs but not <160/100.
If vasospasm occurs later-inc BP with 3H(notproven)
Preffred - lobet
Avoid- nitrodilators
44. Hypertensive Encephalopathy
When high perfusion pressure overwhelms cerebral
autoregulation.
Can lead to blindness, seizures, coma, gradually worsening
headache.
Pathologically-cerebral edema, petechial hemorrhg,
microinfarcts.
Immediate Neuroimagng - to rule out ischemic
stroke/hemorrhage
Hallmark is improvement in 12-24 hrs of BP redn.
45. HTN ENCEPH… DIFFN POINTS
Focal neurological deficit is unusual without
cerebral bleed
Papilledema is almost always assoc with Htn
enceph
Mental staus improves by 24-48hrs-delayed in CNS
bleed
Brain dysfunction develops by 12-24 hrs in Htn but
more acutely with ischemic stroke/bleed.
48. Prevention of Stroke - Trials
Diuretics CCBs ACE-I ARBs
ALLHAT ALLHAT HOPE ( ACCESS (Stroke 2003)
(JAMA (JAMA 2002)
2002)
ASCOT (Lancet PROGRESS MOSES (Stroke 2006)
2005) (Lancet 2002)
Long term control of Hypertension following stroke
reduces recurrence of stroke
49. BP Control as Primary Prevention of Stroke
Both lifestyle modification and pharmacological therapy, are
recommended (Class I; Level of Evidence A)
Systolic BP should be treated to a goal of <140 mm Hg and
diastolic BP to <90 mm Hg because these levels are associated
with a lower risk of stroke and cardiovascular events (Class I;
Level of Evidence A).
In patients with hypertension with diabetes or renal disease, the
BP goal is <130/ 80 mm Hg (also see section on diabetes) (Class
I; Level of Evidence A).
50. Cerebral Small Vessel Disease (SVCD)
n Incidence: 20-25% of Small vessel Infarcts (SVI) lacunarinfarcts
n Short term better prognosis but not longterm
51. Cerebral Microbleeds (CMBs)
n MRI – 4.7% - 24.4% in community
n Ischemic stroke 19.4%
n Hemorrhagic stroke: 68.5%
n Lobar distribution in Amyloid Angiopathy
n Basal and Infratentorial in Hypertensive Vasculopathy
n Hypertension, Diabetes and Low serum Cholesterol as predisposition
A gradient-recalled echo
and
B susceptibility weighted
imaging maps.
Susceptibility-weighted
imaging is more sensitive
than gradient-recalled
echo to venous structures.