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Stroke

Any recommendations?

03/24/2006

Question:

First, I am a 731/2 y.o. female with a hx of asthma(now gone),psorasis (also now in remission)recently dx`d with hypertension. My physician ordered a brain scan, blood tests, stress test, etc. based on my fear of a stroke (no hx of this). The brain MRI report showed cerebral atrophy with small vessel periventricular ischemic changes evident. Focal area of Lacunar infaction left-sided basal ganglia and extending to the left periventricular white matter tract anteriorly. The blood report showed: All within normal limits except: vit D, 25 hydroxy, low at 14 out of normal 20-100 ng/ml TSH high at 7.08 whth normal limits of 0.40-5.50 MIU/L My cholesterol test showed HDL 66 LDL at 124 coronary risk factor 33.3 My physician told me I had had a stroke, and recommended, in addition to my HCTZ and baby aspirin that I take lisinopril 10 mg tab./day.

I am more of a natural bent and, although I am following his advise, would prefer a more functional, environmental approach. Do you concur with my physician? Is there any more natural action I can take? (I already follow the recommendations with the dash diet).

Answer:

There are several previously answered questions pertaining to white matter disease.  Please refer to these answers.  Having white matter disease on MRI does not necessarily mean that you have had a stroke.

Even if you have never had a clinical stroke, high blood pressure is the single biggest risk factor for developing a stroke.  I agree with your doctor that controlling your BP is very important for your long term health.  Only he/she knows your whole medical history and can thus know what medicines are most likely to help you.  However, for most people, HCTZ is the first drug to try and medicines in the same class as lisinopril (including lisinopril) are usually used as the second drug added.

There is sound medical evidence that these medicines control BP well, and that good BP control reduces the risk of stroke or heart attack, as well as preventing other health problems.  I am not aware of any non-medicine alternative strategies that would provide this same protective effect.  The low salt diet is important even if you are taking the meds, and would not substitute for them.

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Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati