Preventing a Second Stroke: Blood Pressure, Medicines and Habits

Why a second stroke happens

A stroke is a symptom of an underlying problem, and if that problem remains, another stroke can follow. Common causes:

• High blood pressure: the single most important risk factor; it damages vessels and raises the risk of both clot and bleed.
• Atrial fibrillation (AF): an irregular heartbeat that allows clots to form in the heart and travel to the brain; see atrial fibrillation and blood thinners.
• Narrowing of the neck or brain arteries: by fatty deposits.
• Diabetes: damages vessels and raises clotting risk; see diabetes at home after 60.
• High cholesterol.
• Smoking and tobacco in any form, including bidi and chewing tobacco.
• Heavy alcohol use.
• Obesity, inactivity and unhealthy diet.
• Sleep apnoea; see sleep apnoea in older adults.
• Heart disease and heart failure; see heart failure at home guide.
• Kidney disease; see chronic kidney disease home care.
• Air pollution and stress contribute.

A first stroke or mini-stroke should prompt a full review: scans, heart tests, blood tests and a plan from the doctor.

Blood pressure: the first priority

• Know the target. The doctor sets a blood pressure goal for your parent, depending on age and conditions. Do not assume a number; ask, and write it down.
• Measure properly at home, with a validated upper-arm monitor, at the same times each day, sitting, after five minutes' rest, with the arm supported. Take two readings and record them. See how to measure blood pressure at home, bp monitor buying guide and cuff size and bp accuracy. For those with poor eyesight, see voice bp monitor for low vision.
• Keep a log and take it to each visit; see bp log and what to tell the doctor.
• Report readings that are persistently above or below the agreed range, or if your parent feels dizzy or faint, since too-low blood pressure also needs attention; see dizziness and low blood pressure when standing.
• Never adjust blood pressure medicines yourself.

For full guidance, see hypertension home care guide.

Medicines: taking them reliably

After a stroke, doctors commonly prescribe medicines to reduce clotting, lower blood pressure, lower cholesterol and control diabetes and heart rhythm. The details depend on the person; this guide names none. What families should know:

• Take every prescribed medicine every day, as directed. Stopping because the person "feels fine" or because of cost, fear of side effects or confusion is a leading cause of second strokes.
• Never stop, skip, halve or change doses without asking the doctor, even if there is a side effect: call first.
• Use a pill organiser, a written schedule and phone alarms; see pill organiser guide, setting up a weekly medicine box and medicine reminders for forgetful parents.
• Keep a current list and show it to every doctor, dentist and pharmacist; see keeping a health record at home.
• Watch for side effects, such as bleeding or bruising on blood thinners, dizziness, swelling or cough, and tell the doctor promptly; see medicine side effects families should watch.
• Do not add over-the-counter painkillers, herbal products or supplements without asking, since some interact or raise bleeding risk; see supplements and medicine interactions and painkillers and older adults.
• Plan for refills so supplies never run out, including during travel and festivals.
• Tell the doctor about money worries, since there may be options.
• For forgetfulness or confusion, have a carer give medicines; see dementia and medicines at home.

Heart rhythm and other conditions

If the heart rhythm is irregular, the doctor may advise treatment to prevent clots, which needs careful monitoring; see atrial fibrillation and blood thinners. Diabetes needs regular sugar checks and good control, with attention to low sugar episodes; see diabetes and low-sugar emergencies. Cholesterol is checked with blood tests. Narrowed neck arteries may need a scan and sometimes a procedure. Sleep apnoea, if suspected, needs testing. Keep all follow-up appointments, tests and scans.

Food

A heart-healthy, Indian-style diet helps blood pressure, cholesterol and weight.

• Reduce salt. Excess salt raises blood pressure. Most salt in Indian diets comes from added salt, pickles, papad, chutneys, namkeen, processed foods and restaurant food. Cook with less salt, gradually reduce, use lemon, herbs and spices for flavour, and read labels. Avoid salt substitutes containing potassium unless the doctor agrees, especially with kidney disease or certain medicines.
• Eat more vegetables, fruit, whole grains and pulses.
• Choose healthier fats: limit ghee, vanaspati and deep-fried foods; use small amounts of oil; see nutrition for heart health after 60.
• Include fish, nuts and seeds as suits your diet; see omega-3 guide for seniors.
• Limit sugar and refined carbohydrates, especially with diabetes; see nutrition for diabetes after 60.
• Keep to a healthy weight where appropriate, and avoid crash diets. Check weight regularly; see weighing scale and weight loss in seniors.
• Stay hydrated unless fluids are restricted; see hydration for older adults.
• Be consistent with foods that interact with some blood thinners, as advised by the doctor.
• If swallowing is affected, follow the speech therapist's advice; see swallowing problems and dysphagia.

Activity

Regular, gentle activity lowers blood pressure and improves vessel health. After a stroke, activity must follow the rehabilitation team's advice. Build up gradually; see exercise after a stroke at home, walking programme for older adults and chair exercises for seniors. Break up long sitting; see sitting for long hours. Avoid sudden heavy exertion and extreme heat; see exercising indoors in Indian summer and monsoon.

Tobacco, alcohol and other habits

• Stop all tobacco, including smoking and chewing. Ask the doctor about support; stopping reduces risk quickly. Avoid second-hand smoke.
• Limit alcohol, or avoid it, as the doctor advises; see substance and alcohol use in older adults.
• Sleep: aim for regular sleep; treat snoring and apnoea; see sleep problems in older adults.
• Stress and mood: low mood after a stroke is common and treatable; see depression in older adults.
• Pollution: reduce exposure on bad air days; see pollution season plan for seniors.
• Vaccines: discuss with the doctor; infections raise vascular risk; see vaccines for older adults in India.

Know the signs and act

Teach the whole family the FAST signs and act at once: face drooping, arm weakness, speech difficulty, time to call 112; see stroke warning signs and the first hour. A TIA is an emergency too. Keep a medical summary at hand; see emergency contact card and medical summary.

Follow-up and records

• Attend scheduled visits and tests, bringing the blood pressure log, medicine list and questions; see preparing for a doctor's visit with a parent.
• Keep reports together.
• Ask: What caused the stroke? What are our targets for blood pressure, sugar and cholesterol? Which medicines are essential, and what side effects should we report? What activity is safe? When is the next review?
• Telemedicine can help with repeat visits; see teleconsultation and home readings and chronic disease management with teleconsults.

Family support

Encourage, do not nag; make healthy food for everyone; walk together; handle medicines calmly; look after the carer too; see caregiver burnout signs and prevention and caring for a parent after stroke.

When to ask a professional

A doctor manages blood pressure, sugar, cholesterol and medicines. A cardiologist or neurologist advises on heart rhythm, arteries and prevention. A dietician adapts meals. A pharmacist answers medicine questions. A physiotherapist guides activity. For senior services, call Elderline 14567. For stroke signs or any emergency, call 112.