Those at particular risk for bleeding are patients with a history of alcohol abuse, chronic kidney disease, or previous gastrointestinal bleeding. A pacemaker may be implanted just under the skin with electrodes leading to the ventricles to boost heart rates in people whose rhythm is too slow. A more aggressive procedure uses open chest surgery, in which a maze of cuts is made in the atria. As they heal, the scar tissue prevents the heart circuitry from misfiring. A new procedure is similar but less invasive.
Treatment of hypertension is most effective if instituted early.
Drug therapy is generally recommended if even mild hypertension does not respond to changes in diet and lifestyle within three to six months. Patients with hypertension who discontinue drug therapy greatly increase their risk of hemorrhagic stroke. According to one 1999 study, lovastatin was very effective in slowing progression of atherosclerosis in the carotid artery in both women and men. Disease regression in women was greatest when they took a combination of warfarin and lovastatin while men achieved the best protection from lovastatin alone. If an unruptured aneurysm is detected, patients should discuss all options with their physician, including surgical repair.