Health

Does blood pressure affect stroke recovery?


Mistry says one of the key aspects of treating patients is monitoring and controlling their blood pressure.

“We didn’t really have any data to guide us,” said Mistry, an assistant professor in the UC School of Medicine’s Department of Neurology and Rehabilitation Medicine and a UC Medical Practitioner. said. “That’s when the question that popped into my mind was the relationship of blood pressure in the ICU to the outcomes of stroke patients treated with thrombolysis.” In 2017, Mistry and her colleagues performed the first observational study to show a relationship between high blood pressure and worse patient outcomes after thrombectomy.

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When Mistry came to UC to be a stroke fellowship, she helped lead a more extensive observational study to determine which exact blood pressure goals were associated with better or worse outcomes after procedures. thrombectomy. That study identified a systolic blood pressure of 160 mm of mercury as a dividing line, with lower blood pressure associated with better outcomes and higher blood pressure associated with worse outcomes.

research design

Study BEST-II was a randomized trial to find out if lowering blood pressure is safe for patients. In the trial, 120 patients who had undergone thrombectomy for acute stroke were assigned to one of three treatment groups. Using blood pressure medications, one group had a systolic blood pressure of less than 140 mm, another group had a systolic blood pressure of less than 160 mm, and a third group had a systolic blood pressure of less than or equal to by 180 mm.

“BEST-II is the second trial in this particular space, so it is a very new clinical question, but also a very new trial design,” said Mistry.

Mistry said if lower blood pressure targets are found to be unsafe, it is important to share that data immediately because there are a number of different targets currently being used by stroke doctors across the country. fabricate.

“On the other hand, if they are safe, then we would recommend a large study to see if they are effective in improving the long-term functional outcomes of stroke patients,” Mistry said.

BEST-II is the first time Mistry has acted as the national principal investigator (PI) for a randomized clinical trial. Under her leadership, it completed enrollment in February, ahead of the expected completion time. Mistry said her work as a national PI in the previous BEST-I observational study prepared her to take on the leadership role of a multisite randomized trial.

“It would be great to be able to translate that into a more rigorous and randomized clinical trial, which has more regulatory and contractual complications,” she said. “Our entire UC stroke team, the study coordinators and of course the patients and families have all been fantastic at driving this forward and helping future patient outcomes be better. as much as possible.”

Pooja Khatri, MD, Mistry’s colleague and professor of neurology at UC School of Medicine, says Mistry has always been dedicated to improving stroke care and is constantly striving to think creatively and collaboratively to improve stroke care. help patients. Khatri said: Early completion of enrollment while the pandemic slows or stops trials and with a limited budget shows Mistry’s “innovative and industrious approach” to clinical trials. in her career.

“It’s a testament to her leadership and team-building skills and her ability to create a realistic and viable experiment,” Khatri said. “It’s especially remarkable that Mistry has achieved all of these accomplishments, while raising a beautiful young family and being a kind and generous co-worker.”

Emerging Leaders

In addition to leading BEST-II, Mistry was recently invited to attend the National Academy of Medicine (NAM) Emerging Leaders Forum in Washington, DC Invited attendees must be a NAM member nominated to attend the prestigious forum and Mistry was nominated by Roger Lewis, MD, her mentor at UCLA.

The Leadership Development Program provides a platform for young professionals in all medical and medical fields to work together to identify new and innovative ways to solve difficult problems. challenges in this area and bring about transformative change.

“It was eye-opening to meet people in a profession that I never thought would have such a big impact on people’s lives,” says Mistry. “I’ve met social scientists, economists, lawyers, anthropologists, people of all walks of life and professions with the common goal of improving human health.” The forum also connects young professionals with NAM members, mentors and other established professionals. Mistry says she especially enjoys meeting and hearing from mentors who are immigrants and have similar career paths to her.

“As an immigrant, when I was in medical school, I wasn’t exposed to research and the fact that I didn’t know how to read and interpret a clinical trial paper,” she said. “People from similar backgrounds have attended, and are now principals of, public health schools, and seeing people on similar paths to mine makes important contributions to the care of others. Health is very important to me.”

Mistry says attending the forum has broadened her horizons to see how her research fits into the bigger picture of work improving people’s health.

“What I do is a very small part of a very big goal,” she said. “So it made my work small and important at the same time, which opened my eyes.”

Forum draw

Another major topic that Mistry drew from the forum was the topic of research equity, which involves working to ensure that patient populations participating in clinical research are representative of the population as a whole. .

“The PI for example says, ‘I want to exclude people of a certain race’, but we only designed the studies in such a way that it is possible that the inclusion/exclusion criteria unintentionally excluded minorities. numbers and marginalized,” she said. “We have many examples to demonstrate that the populations we enrolled in our studies do not match the epidemiology we see in communities where the burden of disease is.”

Mistry said she recently applied for funding with the desire to bring more equity to acute stroke research prior to the forum, so this is confirmation that this is important research needed. follow.

The forum also includes discussions about putting research into practice, so that as researchers discover, knowledge is shared with the community and used to improve care. core.

“In stroke research, we have seen some therapies take years to be implemented at the community level, either by clinician hesitation or patient hesitation,” she said. “If I produce results, but if the changed practice never returns to the community, then it will be a waste of time and resources. I am very eye-opening knowing that the real phase is real. Clinical research is now very important.”

Source: Eurekalert



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