Pre-Stroke Use of Antihypertensives, Antiplatelets, or Statins and Early Ischemic Stroke Outcomes

Yu, Amy Y.X.; Keezer, Mark R; Zhu, Bin; Wolfson, Christina; Côté, Robert

doi:10.1159/000207444

Cited by 29 publications

(20 citation statements)

References 65 publications

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“…Two other studies detected an association between the use of nonthiazide antihypertensives and an increased risk of first stroke and stroke severity. 30,31 We found ␤-blocker therapy and thiazide diuretic therapy to be associated with a higher risk of recurrent stroke events; furthermore, use of nonthiazide antihypertensives was associated with a higher risk of AMI in our study (Table). Interestingly, recent work from Rothwell and colleagues based on RCT data demonstrate that a high-dose calcium channel blocker reduces systolic blood pressure variability compared with other blood pressurelowering agents, in particular ␤-blockers, and that treatment with calcium channel blockers may therefore be particularly effective in the prevention of stroke.…”

Section: Discussionmentioning

confidence: 52%

Use of Secondary Medical Prophylaxis and Clinical Outcome Among Patients With Ischemic Stroke

Palnum

Mehnert²,

Andersen³

et al. 2012

Stroke

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Section: Discussionmentioning

confidence: 52%

Use of Secondary Medical Prophylaxis and Clinical Outcome Among Patients With Ischemic Stroke

Palnum

Mehnert²,

Andersen³

et al. 2012

Stroke

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“…Other preexisting CVDs are present in the majority of poststroke individuals: high rates of CAD, chronic hypertension, atrial fibrillation, hyperlipidemia, metabolic syndrome, and diabetes mellitus. 41,42 Although traditionally, stroke has not been considered a CVD, vascular health appears to have important implications for recovery from stroke, with low aortic stiffness being a biomarker of vascular integrity that is associated with favorable neurological outcomes at hospital discharge. 43 There is strong evidence for a clear inverse relation between physical activity and cardiovascular health.…”

Section: August 2014mentioning

confidence: 99%

Physical Activity and Exercise Recommendations for Stroke Survivors

Billinger¹,

Arena

Bernhardt³

et al. 2014

Stroke

1,072

623

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2532Purpose-This scientific statement provides an overview of the evidence on physical activity and exercise recommendations for stroke survivors. Evidence suggests that stroke survivors experience physical deconditioning and lead sedentary lifestyles. Therefore, this updated scientific statement serves as an overall guide for practitioners to gain a better understanding of the benefits of physical activity and recommendations for prescribing exercise for stroke survivors across all stages of recovery. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and indicate gaps in current knowledge. Results-Physical inactivity after stroke is highly prevalent. The assessed body of evidence clearly supports the use of exercise training (both aerobic and strength training) for stroke survivors. Exercise training improves functional capacity, the ability to perform activities of daily living, and quality of life, and it reduces the risk for subsequent cardiovascular events. Physical activity goals and exercise prescription for stroke survivors need to be customized for the individual to maximize long-term adherence. Conclusions-The recommendation from this writing group is that physical activity and exercise prescription should be incorporated into the management of stroke survivors. The promotion of physical activity in stroke survivors should emphasize low-to moderate-intensity aerobic activity, muscle-strengthening activity, reduction of sedentary behavior, and risk management for secondary prevention of stroke. (Stroke. 2014;45:2532-2553.)

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“…More recently Yu et al [44] showed that the combination of antihypertensives, antiplatelets, and statins were both associated with a favorable functional outcome at 10 days post-stroke. Angiotensin-II-decreasing agents were associated with increased initial stroke severity.…”

Section: Aspirinmentioning

confidence: 99%

Antiplatelet Treatment in Ischemic Stroke Treatment

Pinto

Raimondo²,

Tuttolomondo³

et al. 2009

CTMC

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Antiplatelets represent a diverse group of agents that share the ability to reduce platelet activity through a variety of mechanisms. Antithrombotic agents are effective in the secondary prevention of ischemic strokes. Most strokes are caused by a sudden blockage of an artery in the brain (called an ischaemic stroke) that is usually due to a blood clot. Immediate treatment with antiplatelet drugs such as aspirin may prevent new clots from forming and hence improve recovery after stroke. Several studies have evaluated the role of one antiplatelet agent, aspirin, in reducing stroke severity. The International Stroke Trial (IST) of 20,000 patients with acute stroke from other countries. In this study there was a significant 14% proportional reduction in mortality during the scheduled treatment period (343 [3.3%] deaths among aspirin-allocated patients vs 398 [3.9%] deaths among placebo-allocated patients; 2p = 0.04). There were significantly fewer recurrent ischaemic strokes in the aspirin-allocated than in the placebo-allocated group (167 [1.6%] vs 215 [2.1%]; 2p = 0.01) but slightly more haemorrhagic strokes (115 [1.1%] vs 93 [0.9%]. Few studies examined the role of ticlopidin in acute stroke setting the results showed treatment with ticlopidine improved the neurologic outcome. In the Examining the Safety of Loading of Aspirin and Clopidogrel in Acute Ischemic Stroke and TIA (LOAD) study, 40 consecutive ischemic stroke patients were treated with 325 mg of aspirin and 375 mg of clopidogrel within 36 hours of symptom onset. Overall, 37.5% (n = 15) of the patients had an improvement of 2 or more points on the NIHSS 24 hours after antiplatelet administration. The antiplatelet efficacy of aspirin in preventing secondary stroke was established by three studies conducted in the late 1980s and early 1990s: the Swedish Aspirin Low-dose Trial (SALT) trials have demonstrated that aspirin-even in doses as low as 30 mg/day-reduces secondary stroke, MI, or vascular death in patients with. Clopidogrel and aspirin have been used in combination in patients with diverse arterial vascular diseases However, combinations of antithrombotic agents do not necessarily improve clinical efficacy and are typically associated with increased toxicity.

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Pre-Stroke Use of Antihypertensives, Antiplatelets, or Statins and Early Ischemic Stroke Outcomes

Cited by 29 publications

References 65 publications

Use of Secondary Medical Prophylaxis and Clinical Outcome Among Patients With Ischemic Stroke

Use of Secondary Medical Prophylaxis and Clinical Outcome Among Patients With Ischemic Stroke

Physical Activity and Exercise Recommendations for Stroke Survivors

Antiplatelet Treatment in Ischemic Stroke Treatment

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