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Blood Pressure dosing (Stroke)

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  • Blood Pressure dosing (Stroke)

    I have a family history of stroke and 20 years BP. I discovered that peak time for a stroke is 6.30 am.(ie when medication levels at lowest.) Dr has requested that I take a week of frequent recordings of BP. This morning I was 196/80 at 7.15 just before medication.
    So, should medication for stroke prevention be twice a day? Dr says at my age, ideal systolic should be < 150.
    johnep

  • #2
    It depends on the half life of the drug how often you need to take it. As for targets we go by NICE: -

    https://www.nice.org.uk/guidance/ng1...ecommendations

    1.4.20 For adults with hypertension aged under 80, reduce clinic blood pressure to below 140/90 mmHg and ensure that it is maintained below that level. [2019, amended 2022]

    1.4.21 For adults with hypertension aged 80 and over, reduce clinic blood pressure to below 150/90 mmHg and ensure that it is maintained below that level. Use clinical judgement for people with frailty or multimorbidity (see also NICE's guideline on multimorbidity). [2019, amended 2022]

    1.4.22 When using ABPM or HBPM to monitor the response to treatment in adults with hypertension, use the average blood pressure level taken during the person's usual waking hours (see recommendations 1.2.6 and 1.2.7). Reduce blood pressure and ensure that it is maintained:
    • below 135/85 mmHg for adults aged under 80
    • below 145/85 mmHg for adults aged 80 and over.

      Use clinical judgement for people with frailty or multimorbidity (see also NICE's guideline on multimorbidity). [2019, amended 2022]
    196/85 is too high, it shouldn’t be that high with medication. I’d advise do a week or so of readings, twice a day when you’re relaxed, and give them to the surgery.
    Lively debate is encouraged but please respect the opinions and feelings of others.
    Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
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    • #3
      I did suggest that I had an evening dose but no action was taken. My stroke experience started one early morning while preparing morning tea. I felt a "click" inside my head and then found myself pouring milk on the floor instead of the cup. I recovered and carried on as normal. I bed I was viewing a tablet reading the news. I tried to adjust the volume on a video and could not think how to do it. I thought, "I've had a mini stroke".
      Told my wife who simply replied "Hospital!". I agreed to rest and see how I progressed during the day. I took my Blood Pressure at intervals and it was fine until about 6pm when it started to rise. I repeated this at 11PM and it was 198. My wife phoned 111. When the paramedics arrived they took an ECG and my BP was 215/95. We left for Addenbrookes. I had a week in hospital and discharged on whole new set of medication. Doxasosin in the morning and and perindepril in the evening. ( just as I had suggested). However, although standard memories were intact I have lost all the passwords etc and my old get up and go.
      I had a haemorrhagic? stroke where I had a bleed in the brain which fortunately stopped quickly.
      Unlike a clot blocking a blood vessel, my blood still flowed meaning none of the usual left side paralysis etc. After two days back home I became incoherent and back in hospital for another week. Low sodium (hyponatraemia) this time.
      While I was in hospital I turned 88 and my son brought in some whisky which I enjoyed in tea.
      Only 34% survive the first year following this type of stroke, so I may see 89 or I might not.

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      • #4
        I think you’ll see 100 John!
        Lively debate is encouraged but please respect the opinions and feelings of others.
        Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
        Thank you for contributing to this site.

        Comment

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