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The Silent Link Between Blood Pressure & Stroke

High blood pressure, also known as hypertension, is a common health condition affecting nearly half of adults in the U.S. If left untreated, it can lead to serious health problems such as stroke, cardiovascular conditions and kidney problems.

As a top risk factor for stroke, high blood pressure is often called the ‘silent killer’ because it often has no symptoms and can go undetected for years if not routinely monitored. According to the CDC, more than 795,000 strokes occur each year in the U.S., leading to the greatest cause of serious long-term disability.

How Can High Blood Pressure Lead to Stroke?

High blood pressure is the force of blood running through your arteries that is consistently high, which ultimately increases the workload on your heart and damages the interior lining of the blood vessels.

High blood pressure can lead to stroke in two different ways. When high blood pressure impacts the delicate lining of the arteries, atherosclerosis or the buildup of plaque (cholesterol) on the artery walls, can occur. This leads to narrowing of the arteries, and even clots, that block the flow of blood, which can cause an ischemic stroke, the most common type of stroke (87 percent of all strokes). On the other hand, a hemorrhagic stroke occurs when a weakened artery in the brain ruptures and bleeds out into the brain, which accounts for the other 13 percent of all strokes.

When is it Considered High Blood Pressure?

Generally, if your blood pressure levels are 120/80 mm Hg or below, you’re considered in the ‘normal’ range. From there, it gets tricky, which is why knowing your numbers and talking with your physician is important.

Guidelines published in 2017 by the American College of Cardiology (ACC) and the American Heart Association differentiate between elevated and high blood pressure, eliminating a category previously known as ‘pre-hypertension.’ Anything between 120-129/80-89 is considered an elevated blood pressure that should be addressed with lifestyle modifications. Beginning with 130/80, there are three defined stages of high blood pressure — Stage 1, 2 or Hypertensive Crisis as outlined in the chart below.

“Before the guidelines were changed, we focused most of our efforts on patients who were 140/90 or higher, but the evidence has shown us that addressing blood pressure control more aggressively and much earlier can lead to much better outcomes,” explains WakeMed Primary Care Physician Vickie Fowler, MD.

When it Comes to Blood Pressure, Early Intervention is Key.

Too often, patients ignore high blood pressure in its early stages. Because it’s so common, there’s a misconception that it doesn’t need to be taken seriously until it “gets really bad.” This couldn’t be further from the truth, Dr. Fowler tells us.

“The irreversible damage to arteries that’s caused by high blood pressure occurs gradually over time, which is why it’s so important to treat it early. The stiffer your arteries get, the harder it is to control your blood pressure — so addressing it as soon as it’s detected can prevent so many other conditions that can have serious and long-term effects on your overall health.”

Dr. Fowler explains that in its early stages, high blood pressure can often be addressed with lifestyle changes alone. She highlights modifications such as getting more physical activity, reducing stress and eating a healthy diet that’s lower in sodium. Eliminating or reducing tobacco and alcohol use can also have a significant impact on reducing your blood pressure. While these changes aren’t easy to make, she suggests starting small by setting realistic goals.

“I always ask my patients what small goals they can work towards in between their appointments. For some, that’s incorporating physical activity a few days a week, for others it may mean adhering to a low-sodium diet. As primary care doctors, we have tools such as medications, but for those patients who really commit to lifestyle changes, we often see improvements that are equal or even better to what they’d see with medication alone. I like to tell my patients that while it’s important to check in with us regularly, the real work happens at home.”

 Consider Creative Tools for Blood Pressure Management.

Dr. Fowler highlights her passion for helping patients control high blood pressure, which she says requires a partnership between the patient and provider.

“As physicians, we are so invested in helping our patients control their blood pressure because we know the significant lifelong impact doing so can have on overall health, wellness and even longevity.”

Since it’s such a common issue, Dr. Fowler says the WakeMed Primary Care team continuously evaluates how to help our patients better understand and manage their blood pressure.

“We’re constantly monitoring how we’re helping our patients keep their blood pressure under control. We are currently developing new protocols and tools throughout our practices focusing on improved blood pressure management. We’ve learned that goal setting with patients really can have an impact. And by using digital tools through MyChart allows patients to take their blood pressure readings at home and send to us, so we can adjust our recommendations as needed in between visits.

“All of this is to say, we really want to help our patients control this important risk factor. In most cases with the appropriate management of risk factors, stroke is preventable. Our role as physicians is to help our patients to be as healthy as they can be.”