A delicate balance: Control high blood pressure to reduce stroke risk

by Richard T. Benson, MD, Associate Medical Director, Comprehensive Stroke Center
November 6, 2018

High blood pressure is a major risk factor for heart disease. But many patients don’t realize that high blood pressure (hypertension) also can increase the risk of ischemic strokes. This type of stroke is caused by blood clots that form in the arteries leading to the brain, blocking blood flow. Ischemic strokes account for approximately 87 percent of strokes.

Your blood pressure is measured by the pressure within your vascular system when the heart is contracting or relaxing. I like to think of a closed loop system with a pump. The heart is the pump, and when it contracts, it creates the maximum pressure within that system. When the heart relaxes, the pressure decreases. All the organs receive blood from the heart before it goes back to the lungs, then back to the heart again, closing the loop. When this delicate cycle is disrupted, the risk for stroke increases.

Having high blood pressure puts extra strain on the heart, brain, and kidney. The brain is most sensitive to this pressure. A stroke can occur when the high blood pressure affects the brain’s arteries causing problems, such as:

  • Changes to the walls of the lining of the arteries of the brain
  • Hemorrhages, or when blood leaks from a ruptured blood vessel
  • Narrowing of the arteries in the brain

LISTEN: Dr. Richard T. Benson, MD, PhD, discusses how high blood pressure can affect stroke risk in the Medical Intel podcast.

Americans with high blood pressure (almost one in every two adults) have many steps they can take to control their blood pressure, and in return reduce the risk of stroke. The first is finding out whether you have or are at risk for hypertension.

Can you tell if your blood pressure is high?

Most people can’t tell if their blood pressure is high or not without measuring it. However, if people do experience symptoms, they can include blurred vision, headaches, and nosebleeds.

Since symptoms are rare, it’s important that patients and doctors take the time to check the blood pressure regularly at home and at check-ups. There are even phone apps patients can use to log their blood pressures, or they can simply jot them down in a journal. Studies have shown that people who check their blood pressure at home with a monitor for just three months increase their chance of reducing their high blood pressure.

Once you and your doctor determine your blood pressure and risk, it’s important to maintain a healthy blood pressure by actively pursuing a healthy lifestyle. There are many relatively easy changes patients can make at home that don’t cost anything and don’t require extra doctor visits.

3 ways to maintain a healthy blood pressure at home

1. Exercise

One of the major reasons for high blood pressure is the obesity epidemic in America. Unfortunately, we’re even seeing high obesity rates in young kids. We need to change this trend, and one way we can do so is by exercising more as a family.

The Northern Manhattan Stroke Study, which is the first stroke study that looked at a tri-ethnic community—African-Americans, Hispanics, and whites— found that people who exercise 20 to 30 minutes a day, three times a week, have a lower rate of stroke compared to those that don’t exercise at all. My advice? Do 30 minutes three days a week, minimum.

It doesn’t have to be a long run or heavy weightlifting session. Gather your family, friends, or neighbors and take a walk together, or even march in place in the living room to your favorite TV show or movie. Every bit of activity is beneficial to your health.

2. Eat a low-sodium diet

Let’s not sugar-coat it: Americans eat too much salt and fast-food, which hurts blood pressure because it’s less nutritious and high in sodium. The American Heart Association (AHA) suggests choosing foods with less sodium and preparing foods with little or no added salt. Aim to eat no more than 1,500 milligrams a day.

An easy way to achieve this is to follow the tasty and heart-healthy Mediterranean diet. This plan reduces processed foods and red meats in favor of fruits, vegetables, whole grains, olive-oil, beans and legumes, and lean meats, such as fish.

Related reading: 29 Things You Should Do for a Healthy Heart

3. Manage stress

Stress can exacerbate high blood pressure, and while we can’t take stress out of our lives completely, we can change how we respond to it. Consider these tips to relieve stress in a healthy way:

  • Exercise
  • Get enough sleep
  • Surround yourself with a good social support network of people who care about you
  • Meditate or pray if you are religious or spiritual

If lifestyle changes aren’t enough to reduce your stroke risk, it’s important to take blood pressure medication. The AHA has an algorithm that suggests which medication to start with based on differences in patient demographics, such as gender and ethnicity. This can include an ace inhibitor, which allows your blood vessels to relax and widen, making it easier for blood to flow through. Another option is a diuretic, which removes excess salt and water from the body. Another option is a beta blocker, which helps your heart beat more slowly and with less force. It’s important to discuss the suggestions with your doctor because each person reacts differently to medications.

Having #highbloodpressure can increase your #stroke risk. Dr. Richard T. Benson says lifestyle changes such as exercising, eating well, and managing stress, along with medication, can reduce stroke risk. via @MedStarWHC

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How doctors can help patients

Uncontrolled blood pressure is also a doctor problem, and there are provider-level interventions that doctors should use to improve their patients’ blood pressure. Doctors should adhere to an agreed-upon protocol or algorithm to know when they should change a medication and when to refer a patient to a hypertension specialist.

Another method we use is an incentive program called Target BP, which is promoted by the AHA. The program encourages doctors to check their patients’ blood pressure control rates and provide non-patient-specific data to the AHA.

The AHA then gives providers national recognition if they show that 70 percent or more of their patients’ blood pressures are below target. This type of incentive is a win-win for patients and providers. It encourages more doctors to take an active role in their patients’ blood pressure management, which results in better patient care.

Education is another important role of doctors in reducing stroke risk. Beyond discussing the link between blood pressure and stroke, all patients should know the signs of a stroke and what to do if they or a loved one show symptoms. To detect the immediate signs of a stroke, a patient or doctor can use the FAST acronym:

  • F: face or facial weakness
  • A: arm weakness
  • S: speech problems
  • T: time, meaning call 911 immediately

Seek treatment at the first sign of a stroke

As many as 70 percent of all strokes have at least one FAST symptom. Unfortunately, too many patients try to wait to see if some of the symptoms of a stroke go away, or to save themselves from paying a hospital bill, so they choose to wait. But we know that time is brain. The longer a patient waits, the longer it takes to get treatment that could restore blood flow to the brain, which increases the risk of long-term brain damage and death.

MedStar Washington Hospital Center is a Comprehensive Stroke Center, which means we provide advanced techniques to treat patients with even the most complex strokes. Among the latest techniques is embolectomy, which is an incredibly effective intervention for clot-related strokes. For example, embolectomy, or mechanical thrombectomy, is a clot-retrieval procedure that can restore blood flow to the brains of patients who suffer in strokes, even up to 24 hours after the stroke began.

If you or your doctor is concerned about your blood pressure, seek the care of a hypertension specialist. You can get coordinated care from all different specialties here at the Comprehensive Stroke Center, rather than just from cardiovascular specialists. When you come here, you have the best experts in all types of care at your fingertips.

Call 855-546-1974 or click below to make an appointment with a doctor.

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Category: Medical Intel     Tags: heart diseasehigh-blood-pressurestroke