AHA/ASA guideline recommendations for prevention of stroke in women risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]


Sex-Specific Risk Factors

Risk Factors Commoner in Women

2014 AHA/ASA Guideline Recommendations for Prevention of Stroke in Women (DO NOT EDIT)

Prevention of Preeclampsia

Class I
"1. Women with chronic primary or secondary hypertension or previous pregnancy-related hypertension should take low-dose aspirin from the 12th week of gestation until delivery. (Level of Evidence: A). "
"2. Calcium supplementation (of ≥1 g/d, orally) should be considered for women with low dietary intake of calcium (<600 mg/d) to prevent preeclampsia. (Level of Evidence: A). "

Treatment of Hypertension in Pregnancy and Post Partum

Class I
" Severe hypertension in pregnancy should be treated with safe and effective antihypertensive medications, such as methyldopa, labetalol, and nifedipine, with consideration of maternal and fetal side effects. (Level of Evidence: A). "
Class III (Harm)
" Atenolol, angiotensin receptor blockers, and direct renin inhibitors are contraindicated in pregnancy and should not be used. (Level of Evidence: C) "
Class IIa
"1. Consideration may be given to treatment of moderate hypertension in pregnancy with safe and effective antihypertensive medications, given the evidence for possibly increased stroke risk at currently defined systolic and diastolic BP cutoffs, as well as evidence for decreased risk for the development of severe hypertension with treatment (although maternal-fetal risk-benefit ratios have not been established)(Level of Evidence: B)"
"2. After giving birth, women with chronic hypertension should be continued on their antihypertensive regimen, with dosage adjustments to reflect the decrease in volume of distribution and glomerular filtration rate that occurs after delivery. They should also be monitored carefully for the development of postpartum preeclampsia. (Level of Evidence: C)"

Prevention of Stroke in a Woman with a History of Preeclampsia

Class IIa
" Because of the increased risk of future hypertension and stroke 1 to 30 years after delivery in women with a history of preeclampsia (Level of Evidence: B), it is reasonable to:"
"1. Consider evaluating all women starting 6 months to 1 year post partum, as well as those who are past childbearing age, for a history of preeclampsia/eclampsia and document their history of preeclampsia/eclampsia as a risk factor, and

2. Evaluate and treat for cardiovascular risk factors including hypertension, obesity, smoking, and dyslipidemia (Level of Evidence: C)"