Target Stroke Risk Factors
Until relatively recently, stroke was known as “a blow from an unseen hand”; a condition associated with helplessness and virtually no medical treatment. Today stroke is not only a medical emergency, but a condition that can be largely prevented by familiarity with, and modification of, known risk factors.
Because risk factors for stroke are both known and modifiable, the identification and education of at-risk populations are essential for prevention.
Stroke Prevention: Blood Pressure Management Programs
An intensive real blood pressure management program, either through technology, therapies or education, is an example of a targeted intervention with a powerful impact. Although hypertension is the most significant risk factor for stroke, only a small percentage of persons with the condition achieve adequate control. It is recommended that 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. In patients with hypertension with diabetes or renal disease, the BP goal is <130/ 80 mm Hg.
“Hypertension remains the most important well-documented, modifiable risk factor for stroke, and treatment of hypertension is among the most effective strategies for preventing both ischemic and hemorrhagic stroke. Across the spectrum of age groups, including adults > 80 years of age, the benefit of hypertension treatment in preventing stroke is clear. Reduction in BP is generally more important than the specific agents used to achieve this goal. Hypertension remains undertreated in the community, and additional programs to improve treatment compliance need to be developed, tested, and implemented.” (Stroke, 2010)
Because high blood pressure is the single most powerful stroke risk factor, JTSSF considers meticulous blood pressure management an important preventive tool and supports research that directly relates to compliance in reducing blood pressure, especially in secondary stroke patients.
Computer Technology Applied to Stroke Risk Populations
Similarly, computer technology can be used to analyze stroke risk data and as a management tool for populations at risk for stroke. Such management, exemplified and enhanced by electronic medical records, is likely to be increasingly web-based, and lends itself to the analysis of populations. Since stroke risk factors are well defined, these populations can be identified and targeted for large-scale interventions to prevent stroke. Such scalable interventions may also be implemented to reduce morbidity and increase the likelihood of good outcome in patients having a stroke. This type of intervention is likely to be especially important in the future, because even though the incidence of stroke has actually been falling over the last decade because of better primary prevention measures, we can expect that the aging of the population and the massive rise in obesity and diabetes will reverse these recent gains made (Ovbiagele, 2013); such intervention is also well-aligned with national objectives like reduction of heart disease, diabetes and childhood obesity. It is also remarkable that as many as one-third of all strokes occur in people who have already had a stroke, which unequivocally identifies a population that benefits from increased vigilance and medical control of risk factors like hypertension and diabetes. Research targeting these scalable, web-based interventions and the digital technologies that make them possible is a major interest of JTSSF, as it aims ultimately to eliminate the disease.