Emily Tumber
High blood pressure, or hypertension, is a major risk factor for strokes. Blood pressure is the force of blood against the walls of the arteries as it circulates through the body. Over time, high blood pressure can damage and weaken the blood vessels, making it easier for clots to form or arteries to rupture. This can lead to two types of strokes: ischemic strokes, which are caused by blocked blood flow, and hemorrhagic strokes, which are caused by bleeding in or around the brain. While the healthy blood pressure range is considered to be a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg, doctors recommend keeping blood pressure below 130/80 mm Hg to prevent a first-time stroke.
| Characteristics | Values |
|---|---|
| Healthy blood pressure range | Systolic pressure of less than 120 mm Hg and diastolic pressure of less than 80 mm Hg |
| Hypertension stage | Systolic: 130 mm Hg and above, Diastolic: 80 mm Hg and above |
| Hypertensive crisis | 180/120 mm Hg or greater |
| Risk factors | Age, family history, ethnicity (Black African or Black Caribbean), diet, stress, sleep, smoking, alcohol consumption, physical activity, weight, underlying health conditions |
What You'll Learn
High blood pressure weakens blood vessels
High blood pressure, or hypertension, is a major risk factor for strokes. It is also a leading cause of death and severe, long-term disability. Indeed, most people who have had a first stroke also had high blood pressure.
High blood pressure damages the arteries throughout the body, creating conditions that can make arteries burst or clog easily. Over time, high blood pressure can weaken and damage the walls of blood vessels, making them less flexible and more vulnerable to blood clot formation. This is because the turbulent blood flow weakens the blood vessels and increases the risk of clot formation in the arteries.
When a blood clot lodges in an artery that supplies blood to the brain, it can cause an ischemic stroke, the most common type of stroke. High blood pressure can also cause a hemorrhagic stroke, which occurs when an artery in the brain ruptures.
High blood pressure can also lead to other health complications, including peripheral vascular disease, erectile dysfunction, vision loss, and kidney failure.
To lower high blood pressure, doctors recommend a combination of lifestyle changes and medications. Lifestyle changes include eating a heart-healthy diet, exercising regularly, losing weight, reducing salt intake, quitting smoking, limiting alcohol consumption, and managing stress. If lifestyle changes are not enough to lower blood pressure, doctors may prescribe medications such as angiotensin II receptor blockers or calcium channel blockers.
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Clots and ruptures
High blood pressure, or hypertension, is a major risk factor for strokes. It is the biggest single risk factor, playing a part in about half of all strokes. Over time, high blood pressure can damage and weaken the blood vessels, making it easier for clots to form and arteries to rupture.
Clots
High blood pressure can cause the blood vessels to become narrower and stiffer, resulting in a build-up of fatty material, a process known as atherosclerosis. Clots can form on these areas of fatty material, and if a clot travels to the brain, it causes an ischemic stroke. This is the most common type of stroke. High blood pressure speeds up atherosclerosis, making arteries harder, narrower, and more likely to be clogged with fatty plaque. Hypertension also makes atrial fibrillation (AFib) more likely, a condition where blood collects in the heart and a clot can form. AFib increases the chances of a stroke by five times.
Ruptures
High blood pressure can also weaken blood vessels and make them more prone to rupture. When this happens in the brain, it is known as a hemorrhagic stroke. Hemorrhagic strokes are less common than ischemic strokes but tend to be more serious and deadly. A weak blood vessel breaks open, usually due to an aneurysm, a spot that has ballooned up from the pressure. High blood pressure damages arteries and makes them more likely to tear or burst.
Transient Ischemic Attacks (TIAs) or Mini-Strokes
Hypertension can also cause clots that lead to temporary "mini-strokes", known as transient ischemic attacks (TIAs). A TIA occurs when a clot dissolves or gets dislodged on its own. Most people fully recover from TIAs, but they are a warning sign that a full-blown stroke may occur.
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Ischaemic strokes
High blood pressure, or hypertension, is a major risk factor for strokes. It is the biggest single risk factor, playing a part in about half of all strokes. Over time, high blood pressure can damage and weaken the blood vessels, making it easier for clots to form or for arteries to rupture. This is why managing high blood pressure is critical to reducing your risk of stroke.
There are two types of stroke: ischemic and hemorrhagic. Ischaemic strokes are the most common type, accounting for about 87% of all strokes. An ischaemic stroke occurs when a vessel supplying blood to the brain is blocked by a clot. Within minutes, brain cells begin to die. This can happen due to atherosclerosis, a disease in which fatty deposits (plaques) build up inside your arteries. Atherosclerosis can cause two types of obstruction:
- Cerebral thrombosis: a thrombus (blood clot) that develops at the site of a fatty plaque within a blood vessel supplying blood to the brain.
- Cerebral embolism: a blood clot that forms in the heart or large arteries of the upper chest or neck, or elsewhere in the circulatory system. Part of the clot then breaks loose, enters the bloodstream, and travels to the brain. A main cause of embolism is an irregular heartbeat called atrial fibrillation.
Transient ischemic attacks (TIAs) are often called mini-strokes. They occur when the blood supply to the brain is interrupted briefly. Having a TIA can mean you are at risk of having a more serious stroke.
The urgent treatment for ischaemic stroke is clot removal. Doctors can accomplish this with medication and mechanical treatments. Medication with alteplase IV r-tPA, also known as tissue plasminogen activator, is approved by the Food and Drug Administration to treat ischemic stroke. Doctors administer it through an IV in the arm, dissolving the clot and improving blood flow to the part of the brain that is deprived of oxygen. Mechanical treatments include thrombectomy, where doctors use a wire-cage device called a stent retriever to remove the clot.
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Haemorrhagic strokes
The signs and symptoms of a haemorrhagic stroke can vary depending on the location and extent of the bleeding. However, common symptoms include a sudden, severe headache, vomiting, neck stiffness, increased blood pressure, and rapidly developing neurological signs. Seizures, aphasia, and hemianopia may also be present, especially in lobar haemorrhage. In the case of thalamic haemorrhage, patients may experience a loss of all sensory modalities.
Prompt diagnosis and treatment are crucial in haemorrhagic stroke to prevent life-threatening complications and minimise brain damage. Imaging tests such as computed tomography (CT) scans, magnetic resonance imaging (MRI), and angiography are used to confirm the diagnosis and determine the location and extent of the bleeding. Treatment options may include interventional radiology or neurosurgical procedures, such as surgical clipping or coil embolisation, to stop the bleeding and reduce intracranial pressure. Medical management focuses on reducing blood pressure, controlling intracranial pressure, and preventing seizures.
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Lifestyle changes to reduce risk
High blood pressure is a serious condition that can lead to a stroke. It is the biggest single risk factor for stroke and plays a part in about half of all strokes. While high blood pressure is a severe condition, the good news is that there are things you can do to reduce your risk of a stroke. Here are some detailed and focused lifestyle changes to help you do that:
Monitor your blood pressure: Get your blood pressure checked regularly, especially if you know it tends to run high. Keeping your blood pressure within a healthy range is one of the best ways to lower your risk of stroke. A healthy blood pressure reading is a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg.
Reduce salt intake: Eating too much salt can increase your blood pressure. Limit your salt intake to no more than 1,500 milligrams (about half a teaspoon) to 6 grams (about one teaspoon) per day.
Eat a healthy diet: A healthy diet can help lower your blood pressure and cholesterol levels, reducing your risk of a stroke. Aim for a low-fat, high-fibre diet rich in fruits, vegetables, whole grains, and lean proteins. The Mediterranean diet, which emphasizes fish and fruits, has been linked to a reduced risk of stroke. Avoid high-cholesterol foods such as burgers, cheese, and ice cream.
Exercise regularly: Exercise helps to keep your blood flowing and your heart strong, and it can also help lower your blood pressure and cholesterol levels. Aim for at least 30 minutes of moderate-intensity exercise, five days a week. Even if you can't manage 30 minutes at once, shorter sessions of 10-15 minutes can also be beneficial.
Lose weight if overweight: Being overweight contributes to high blood pressure, cholesterol, and diabetes, all of which increase the risk of stroke. Losing weight can significantly reduce your risk. Work with your doctor to create a weight loss plan that's right for you.
Quit smoking: Smoking increases your risk of stroke by narrowing your arteries and making your blood more likely to clot. Quitting smoking immediately reduces your risk of stroke and improves your overall health.
Limit alcohol consumption: Excessive alcohol consumption can lead to high blood pressure and trigger an irregular heartbeat, increasing the risk of stroke. Limit alcohol intake to one drink per day for women and two drinks per day for men. Red wine is thought to be a better choice, as it contains resveratrol, which may offer some protection for the heart and brain.
Manage stress: While stress is not a direct cause of high blood pressure, it can lead to unhealthy habits that contribute to it. Reducing stress can be a part of a healthy lifestyle. Try positive self-talk and healthy stress management techniques.
Treat underlying conditions: If you have underlying conditions such as atrial fibrillation, high cholesterol, diabetes, or transient ischaemic attacks (TIA), work with your doctor to manage and treat these conditions. This can help reduce your risk of stroke.
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Frequently asked questions
A stroke occurs when a blood vessel to the brain is blocked or bursts, resulting in brain cell death within minutes. Symptoms include sudden numbness or weakness on one side of the face or body, confusion, difficulty speaking or understanding speech, vision problems, dizziness, severe headache, and difficulty walking.
High blood pressure, or hypertension, is the biggest single risk factor for stroke, contributing to about 50% of cases. Over time, it damages and weakens blood vessels, making it easier for clots to form or arteries to rupture, leading to ischemic or hemorrhagic strokes.
A healthy blood pressure range is considered to be a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg. Doctors recommend keeping your blood pressure below 130/80 mm Hg to prevent a first-time stroke.
Warning signs of a stroke can be identified using the acronym F.A.S.T.: face drooping, arm weakness, speech difficulty, and time to call emergency services.
Managing blood pressure is critical to reducing the risk of a stroke. Lifestyle changes such as a healthy diet, regular exercise, weight loss, reducing salt and alcohol intake, quitting smoking, adequate sleep, and stress management can help. Medication may also be prescribed by a doctor if needed.
