Health & Wellness
High Blood Pressure and Stroke: Prevention is Possible

High Blood Pressure and Stroke: Prevention is Possible

By Alison Broderick

With almost five million people suffering from some form of stroke each year, according to the American Heart Association, 70% can be linked to existing high blood pressure.  This makes high blood pressure one of the most important controllable stroke risk factors out there. So, it’s no wonder that May is both High Blood Pressure Education Month and National Stroke Awareness Month.  Raising awareness is key to prevention and to early treatment.

High Blood Pressure: It Could Happen to You

As a child, you may have overheard your grandparents complaining of high blood pressure (HBP), but never thought it could happen to you. That is, until you got older. According to the Centers for Disease Control and Prevention (CDC), a staggering 74.5 million people in the United States suffer from high blood pressure. In other words, one out of three Americans aged 20 or older have HBP. High blood pressure is the gateway to more serious conditions like stroke, heart disease and kidney failure.

One of the best ways to observe High Blood Pressure Education Month is to go out and educate yourself and those you love about this ever-increasing problem. From basic facts, to prevention methods, to expert advice, it’s vital to learn all you can about the ways to keep your blood pressure under control and maintain an overall healthier lifestyle. Even if your blood pressure falls in the normal range, it is important to take preventive measures.

High Blood Pressure: What Is It?

Also known as hypertension, high blood pressure is a cardiovascular disease in which the blood vessels become tight and restricted.  “Elevated force pushes on the artery wall as blood flows throughout the body,” explains Kimberly Champney, MD, a cardiologist at Northside Hospital. “The raised pressure requires the heart to work harder to pump the blood throughout the body.”

According to Scott McKee, MD, FACC, a cardiologist with WellStar Cardiovascular Medicine, “High blood pressure creates stress on the blood vessels, leading to a rapid build-up of fat and cholesterol. Elevated blood pressure is the underlying cause of heart attack and stroke, but the high blood pressure itself often has no symptoms.” In addition to making lifestyle changes, McKee suggests taking appropriate medication(s) to move HBP into the normal range.

Prehypertension occurs when the blood pressure is higher than the normal range, yet not high enough to be considered hypertension. In this case, it is crucial to take preventive action and adopt a healthier way of life. Otherwise, you are at a greater risk for developing high blood pressure in the future.

Stroke1Understanding Blood Pressure Readings

There are two types of blood pressure readings: systolic and diastolic. The systolic number is measured when your heart contracts and sends a surge of pressure to keep the blood moving; the diastolic number is measured in between contractions, when the heart rests between beats. The systolic reading is taken when your blood pressure is at its highest point, and the diastolic reading is taken at its lowest.

Who’s At Risk?

High blood pressure can affect anyone, although certain traits, conditions and behaviors are known to increase a person’s risk. “Blood pressure tends to rise as a person ages. If you're a male older than 45 or a female above age 55, you are at a greater risk for developing high blood pressure,” says Kenneth Brigham, MD, director of the Center for Health Discovery and Well Being, a partnership between Emory University and the Georgia Institute of Technology. “However, it is more common in African-American adults than in Caucasian or Hispanic-American adults,” he says. Aside from advanced age, other risk factors for HBP include:
• Family history of high blood pressure, especially in a parent
• Lack of physical activity
• Gender (HBP is more common in males)
• Poor diet (especially a diet high in sodium)
• Overweight/obese (nearly two out of three adults are overweight or obese, and almost one out of three children between the ages of 2 and 19 are considered overweight)
• Excessive alcohol intake (more than one drink/day for women; more than two drinks/day for men)
• Smoking
• Sleep apnea
• Stress
• High blood cholesterol levels

“Individuals can prevent and control high blood pressure by getting regular exercise, quitting smoking, maintaining a healthy weight, limiting sodium intake and knowing their family medical history,” notes Amy Perez, RN, MSN, CNRN, the stroke program manager at Piedmont Hospital. “If a person is diagnosed with high blood pressure, he or she should work closely with a doctor to continue monitoring the blood pressure over time, and follow instructions regarding blood pressure medication,” she adds.

Learning About Stroke

According to the American Stroke Association (ASA), stroke is the third leading cause of death in the United States, behind heart disease and cancer. The underlying risk factors for stroke are hypertension, atrial fibrillation and diabetes. “High blood pressure has been called the ‘silent killer’ because it usually has no symptoms until damage to arteries is already advanced. Hypertension eventually causes an occlusion of the blood vessel or trapping of blood clots. Loss of blood flow due to an occlusion in the brain’s arteries can result in stroke,” says Michael Frankel, MD, a professor of vascular neurology at Emory University and director of the Marcus Stroke & Neuroscience Center at Grady Memorial Hospital.

Types of Stroke

While there are several types of stroke, ischemic and hemorrhagic are the most common. “Ischemic stroke occurs when an artery in the brain is blocked. The blockage deprives the brain of blood flow and causes permanent injury, known as a stroke,” says Frankel. Ischemic stroke accounts for approximately 87 percent of stroke cases.
“Hemorrhagic stroke occurs when a blood vessel ruptures in or near the brain, causing bleeding in the deep tissue. Chronic HBP or aging blood vessels are the main causes of this type of stroke,” Brigham says. A hemorrhagic stroke is typically caused by two types of weakened blood vessels: aneurysm and arteriovenous malformation (AVM).
Often referred to as a ‘mini-stroke’ or ‘warning stroke,’ a transient ischemic attack (TIA) should be taken seriously.  The usual TIA symptoms are the same as those of stroke, only temporary. Almost one out of three people who endure this type of stroke eventually suffer from a full-blown stroke. A TIA causes temporary blockage of a blood vessel that provides the brain with oxygen and blood. Different from a stroke, a TIA has no lasting brain damage and generally lasts five minutes or less.

Warning Signs of Stroke

Most Americans are unable to identify the warning signs of stroke, but recognition can mean the difference between life and death. “The signs of stroke are more difficult to recognize than a heart attack, as the brain is more complicated than the heart,” says Keith A. Sanders, MD, a board certified vascular neurologist  and medical director of the Primary Stroke Center at Saint Joseph's Hospital. As soon as you experience any stroke symptoms, call 9-1-1. Also, note the time when you encounter the first symptom. While there are warning signs of stroke, there is very little lead time, so you need to act fast.  “It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible,” explains Sunil Bhole, MD, Medical Director for Glancy Rehabilitation Center. “If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot. Most of the time, patients must reach a hospital within three hours after symptoms begin. Some people may be able to receive these drugs for up to four or five hours after symptoms begin.”

Here are a few of the warnings signs:
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

To determine if a person is experiencing a stroke, remember the first three letters of stroke:
S – Ask him or her to Smile
T – Ask him or her to Talk
R – Ask him or her to Raise both arms.
If the individual has difficulty with any of these tasks, call 9-1-1 immediately.

Stroke2

Post-Stroke Rehabilitation: The Road to Recovery

Stroke is not only the third leading cause of death in the United States, but also the leading cause of long-term disabilities and can affect anyone, at any age. While it occurs in the brain, stroke can affect the whole body. Common disabilities include paralysis or weakness on one side of the body, impaired thinking, attention, learning, awareness, memory and judgment and difficulty comprehending speech or constructing sentences.

The good news is there are amazing medical care centers here in Atlanta that are leading the way to help people recover.  Among them is the Atlanta Medical Center (AMC), which was recently the 2011 recipient of the Georgia Coverdell Champion Hospital of the Year Award from the Georgia Coverdell Stroke Registry. The award recognizes the hospital’s commitment to bettering stroke care across the state by sharing information and best practices with other Georgia hospitals.

Additionally, Grady Hospital is the first public hospital in the U.S. to be certified as a Primary Stroke Center by The Joint Commission of Accreditation of Healthcare Organizations. Their new Marcus Stroke & Neuroscience Center not only provides treatment for stroke patients, but also provides continuing research and training for neurologists of the future. The center is open and available to all who need stroke care, whether they are insured or not. The state-of-the-art center is Georgia’s first Neurocritical Care Unit with a neuroangiography suite and dedicated CT scanner, which helps minimize the transport time from a patient’s intensive care unit bed and back.

Post-stroke rehabilitation centers, such as the Glancy Rehabilitation Center, help individuals overcome disabilities caused by stroke. Services often include medical management, neuropsychological aid, physical and occupational therapy, and speech-language pathology. Glancy Rehabilitation Center also offers stroke support groups, education classes and a Stroke Peer Visitor Program, in which trained stroke survivors and caregivers visit with patients and family members to offer their support and hope.

Research: Knowledge is Power

Exciting new developments have been made in stroke research and treatment. The National Institute of Neurological Disorders and Stroke (NINDS) is currently conducting research on the mechanisms of stroke risk factors and the process of brain damage that results from stroke. It is through continuous research that scientists are working to develop improved methods of helping the brain restore itself after suffering a stroke.  “Recognize the risk factors for stroke, and take steps to reduce those risk factors,” advises James H. Hipkens, MD, PhD, FACP with Kaiser Permanente of Georgia. “Exercise, maintain a healthy weight and if you smoke, quit. Make an appointment with your doctor for a complete physical exam, including blood work. Have your vitals measured and ask your physician to check for signs of heart and vascular disease. Then, schedule a time to have your physician review the results of your exam and lab work with you.”

Community Awareness and Involvement

“Both national and local programs that focus on health and wellness are making strides in reaching individuals to help them learn more about high blood pressure and its threats,” says Brigham. Americans are becoming more proactive in lowering their blood pressure and thus, reducing their risk of stroke.

Below are just a few of the advancements that have been made to improve the overall health of Americans.
• The National Salt Reduction Initiative is a public and private partnership that is aimed at reducing Americans’ salt intake in packaged and restaurant foods by 20 percent over five years.
• New USDA dietary guidelines and the new USDA Food Pyramid call for reduced sodium, fat and sugars in the American diet. “The new dietary guideline recommends 1,500 milligrams (about 1/2 teaspoon) of salt per day for people over the age of 51, African Americans and individuals with diabetes, HTN or kidney disease. This encompasses about 50 percent of the population,” Champney says.
• First Lady Michelle Obama recently celebrated the first anniversary of Let’s Move—a national campaign that encourages children to eat healthy and get active.
• The Healthy, Hunger-Free Kids Act of 2010 was passed last December, which brings healthier, more nutritious foods into school cafeterias.


The Use of Aspirin

As stroke often results from the arteries becoming blocked and unable to send blood to parts of the brain and heart, often an anti-inflammatory drug such as aspirin is recommended as a stroke preventative. Aspirin has been seen to prevent these blockages by reducing the production of a chemical called thromboxane, which promotes clotting.

It is important to find the correct balance in the dosage of aspirin and in 2009, the United States Preventative Services Task Force offered new guidelines. These recommendations were published in the March 17, 2009 issue of the Annals of Internal Medicine, which outlined the risk factors for individuals.  Since the risk varies per individual, it is important to consult with a physician before taking aspirin.

“Baby aspirin has been shown to be beneficial in primary prevention of heart attack,” explains Edward A Espinosa, MD of Buckhead Concierge Internal Medicine. “The jury is still out on the benefits of aspirin in primary prevention of stroke. Aspirin has been shown to be beneficial in secondary prevention of stroke.”  (Primary prevention: Never had a stroke and want to prevent a stroke from ever happening. Secondary prevention: Had a stroke in the past and want to prevent another stroke.)
Risk factors to consider before deciding to use aspirin to prevent stroke include:
• Age
• Sex
• Diabetes
• Blood pressure
• Cholesterol levels
• Smoking
• Risk of gastrointestinal bleeding
• Risk of bleed in the brain


Editorial Resources

American Stroke Association (ASA), www.strokeassociation.org
Atlanta Medical Center, www.atlantamedcenter.com
Centers for Disease Control and Prevention (CDC), www.cdc.gov
Center for Health Discovery and Well Being, www.predictivehealth.emory.edu/chd
Glancy Rehabilitation Center, Duluth, www.gwinnettmedicalcenter.org
Kaiser Permanente of Georgia, www.kaiserpermanente.org
Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, www.gradystroke.org
National Institute of Neurological Disorders and Stroke (NINDS), www.ninds.nih.gov
National Stroke Association, www.stroke.org
Northside Hospital, www.northside.com
Piedmont Hospital, www.piedmonthospital.org
Saint Joseph’s Hospital of Atlanta, www.stjosephsatlanta.org
WellStar Cardiovascular Medicine, www.wellstar.org