Illustration of a person holding their head in their hand with the brain highlighted in red and showing signs of ischemic stroke
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new study shows that though the risk of stroke varies significantly between Black adults and non-Black adults, intensive medical intervention can impact some of the risk factors that increase the risk of recurrence of this condition. With the intensive intervention, significant differences in important risk factors (physical activity and diastolic blood pressure) at baseline between Black and non-Black patients resolved at one year.

“Intense risk factor management has an important role in improving or eliminating these risk factor disparities in Black adults.” said study co-author Ashley Nelson, who at the time of this study, was a neurology resident at the Medical University of South Carolina in Charleston.

The research was published this week in Stroke. The lead author is Eyad Almailouhi, department of neurology, Medical University of South Carolina.

“Modifiable stroke risk factor differences between Black and non-Black adults were found at enrollment; however, our study found these disparities may be resolved by tailoring care to include lifestyle coaching, medication alterations or additions if appropriate, access to routine health care support and regular physician follow-up,” said Nelson.

There is evidence that more severe strokes in Black Americans may be due to specific gene variants.

These researchers examined health data from a study called SAMMPRIS (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis). They evaluated medication use and vascular risk factors, such as systolic blood pressure, diastolic blood pressure, low-density lipoprotein, blood glucose levels and physical activity of Black and non-Black adults with a recent stroke event. Physical activity was measured by the Physician-based Assessment and Counseling for Exercise (PACE) score.

The analysis found:

  • Significant differences for Black participants compared to their non-Black counterparts. Black participants had younger age (57 versus 61 years old); more high blood pressure at study enrollment (95.2% versus 87.5%); more Type 2 diabetes at enrollment (52.9% versus 39.7%); higher average diastolic blood pressure (82.4 versus 79.5 mm Hg); and low physical activity PACE score (2.7 versus 3.3). A PACE score of 4 or above is considered moderately active and within the target range.
  • After one year of intensive intervention, the disparity in diastolic blood pressure had disappeared – the average diastolic blood pressure in Black adults dropped to 74.7 mm Hg, compared to 75.5 mm Hg in all other participants.
  • After one year of the intervention program, the average PACE score increased among Black adults to 4.2 from 2.7; in comparison, the average PACE score among non-Black adults was 4.1.
  • During the one year of aggressive medical management, the percentage of diuretic medication use doubled in Black adults. Researchers speculate that the increased use of thiazide diuretics may explain the notable decrease in average diastolic blood pressure.

“We tend to focus on systolic blood pressure, yet diastolic blood pressure is also a good marker for cardiovascular health and the integrity of the blood vessels,” Nelson said. “Using a tailored approach resulted in better risk factor control for the participants.”

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