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Improving the Management of Acute Stroke Patients

Stroke is a huge burden on our society. The NHS reports that around 110,000 people in England suffer from a stroke every year, making this the third biggest cause of death following heart disease and cancer and a leading cause of long-term severe disability¹.

What actions are taken post-stroke are critical for a patient’s outcome. For acute stroke, however, less data have been collected as to what the most beneficial actions are, meaning for some time uncertainty has prevailed.

Hypertension (high blood pressure) is the commonest treatable cause for developing a stroke. Researchers have known that following an acute stroke, blood pressure levels however can often be abnormal, both hypotension (a low blood pressure) and hypertension, which is more common, being associated with poor outcomes.

Opinions have differed on the effectiveness of taking anti-hypersensitive drugs immediately after a stroke. Should they be used? Concerns have been raised over whether they could in fact be extending the stroke and many have doubted their role in reducing mortality rates.

Professor John Potter from the UEA, however, has been looking into the potential effects of using anti-hypersensitive drugs for stroke patients. Our work has since gone on to impact guidelines both in the UK and the US and has been cited by both the American Heart Association and the Royal College of Physicians.

Prof Potter’s work has helped to fill in the gaps on what we should be doing to improve patient outcomes after experiencing a stroke, providing a platform from which to draw evidence.

UEA research has highlighted that anti-hypertensive drugs given immediately following acute stroke to those who were not previously on treatment does not alter initial outcomes but in some patients’ long-term prognosis may be improved with a 50% reduction in mortality at the 3 months. In a further large UK based trial, continuing to take pre-existing anti-hypersensitive drugs for a 2 week period after the acute stroke has proven to be ineffective in terms of reducing death or disability.

After a stroke, clinicians say that one third of patients will recover, one third will improve after rehabilitation and one third will die within the days or weeks following a stroke. Prof Potter’s work has enabled clinicians worldwide to better understand the best ways of managing acute stroke patients.

Now Prof Potter is working in conjunction with Professor Philip Bath at Nottingham University after gaining a 1.5 million pound grant from the British Heart Foundation to measure whether rapid ambulance responses to help reduce blood pressure can improve overall outcomes in stroke sufferers. Furthermore, since the publication of these ground breaking trials Professor Potter has received a Programme grant from both the British Heart Foundation (BHF) and The Stroke Association (TSA), working with the Universities of Leicester and Oxford on blood pressure variability and the effects of different antihypertensive regimes on outcomes following acute stroke.’

Currently 2 years into this 5 year program, this work is set to continue improving the chances of survival for those who’ve had a stroke, as well as making sure professionals are given guidelines which will ultimately make a difference to their patients’ lives.

¹ www.nhs.uk/conditions/stroke/pages/introduction.aspx

 

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Prof John Potter

Clinical Professor, Norwich Medical School

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