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媒体 2008年12月23日 佚名
 

“In my horrible voice, I said, ‘Yes, I want the tPA,’ ” Dr. Fite said.

Within 10 to 15 minutes, the drug started to dissolve the clot.

“I had weird spasms as nerves started to work again,” Dr. Fite said. “An arm would draw up real quick, a leg

would tighten up. It hurt so bad I was crying because of the pain. But it was movement, and I knew

something was going on.”

Now, she looks back with dismay on her cavalier attitude toward high blood pressure. She knew very well

how to prevent a stroke but, like many patients and despite her medical training , she found it all too easy to

deny her own risk.

Researchers have known for years the conditions that predispose a person to stroke — smoking, diabetes,

high cholesterol and an irregular heartbeat known as atrial fibrillation. But the major one is high blood

pressure.

“Of all the modifiable risk factors, high blood pressure leads the list,” Dr. Sacco said. “With heart disease, you

think more of cholesterol; with stroke you think of high blood pressure.”

The reason, Dr. Sacco said, is that with high blood pressure, the tiny blood vessels in the brain clamp down so

much and so hard to protect the brain that they can become rigid. Then they get blocked. The result is a

stroke.

Often, people decide they do not need their blood pressure medication or simply forget to take it because they

feel well. But, Dr. Sacco said, patients are not solely to blame. Doctors may not have time to work with

patients, monitoring blood pressure, telling them about changes in their diet and exercise that might help, or

trying different drugs and combining them if necessary.

And it is not so simple for people to keep track of their blood pressure. Machines in drugstores and

supermarkets are not always accurate. Doctors may require appointments to check blood pressure.

Even when people do try to control their pressure, doctors may not prescribe enough drugs or high enough

doses.

“They’re on a couple of drugs, and the doctor doesn’t want to push it,” said Dr. Jeffrey A. Cutler, a consultant

to the National Heart, Lung and Blood Institute and its retired director of the clinical applications and

prevention program.

The result is that no more than half the people with high blood pressure have it under control, Dr. Cutler

said. He estimated that half of all strokes could be prevented if people got their blood pressure within the

recommended range.

Another lost opportunity to prevent strokes is the undertreatment of atrial fibrillation, in which the two

upper chambers of the heart quiver. Blood can pool in the heart and clot, and those clots can be swept into

the brain, lodge in a small blood vessel and cause a stroke.

Strokes from atrial fibrillation can largely be prevented with anticlotting drugs like warfarin. Yet many who

have the condition do not know it and many who know they have it were never given or do not take an

anticlotting drug.

Some strokes can also be prevented by procedures to open obstructed arteries in the neck that supply blood

to the brain.

As for Dr. Fite, she completely recovered. And she has changed her ways.

She was sobered by the cost of her treatment and brief hospital stay — $96,000, most of which was paid by

her insurance company. But she was even more sobered by how close she came to catastrophe.

Now, Dr. Fite takes three blood pressure pills, a drug to prevent blood clots and a cholesterol-lowering drug.

She plans to take those drugs every day for the rest of her life.

“I was so stupid,” she said. “Boy, when you go through this, you never want to go through it again.”

“I have been given that precious second chance,” she said. “I was so blessed.”

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