Nearly half of American adults have high blood pressure, or hypertension. About Stroke. Stroke Symptoms. Stroke Symptoms Act F. Types of Stroke and Treatment. Effects of Stroke. Recursos en español. Stroke in Children. Stroke Risk Factors. Stroke Connection e-news.

Home About Stroke Stroke Risk Factors High Blood Pressure and Stroke. How do you reduce blood pressure? Whether your blood pressure is high or normal, you should: Eat a healthy diet , including reducing salt intake. The development of hypertension to stroke needs a process, and the length of the process depends on the patient's own body condition and so on.

The risk occurred probability of stroke in hypertension patients was not fixed during the whole hypertension years, but fluctuates. There were 4 onset peaks, which were in 8 years peak value 0. Why did the risk probability of stroke in hypertension patients show four different peaks instead of one-way change, this might be that the blood pressure was not effectively improved, and other risk factors accumulate, resulting in vascular damage to a certain extent, leading to the outbreak of stroke.

Other factors might be superimposed. The highest risk probability of male patients was in 26 years peak value 0. The highest risk of female patients was in 15 years peak value 0. Although the time point of outbreak was the same for male and female, the occurrence probability of both was significantly higher in male than in female.

This might be a more risk factor for male exposure than female exposure, there might also be other unknown factors related to gender. In addition, if hypertensive patients did not receive antihypertensive treatment, the risk probability of stroke might be higher, and the peak time point might be more advanced.

Stroke is a group of cerebrovascular circulation disorders caused by various reasons, manifested as focal neurological deficit, and even accompanied by disturbance of consciousness.

Because of its sudden onset, it is also called cerebrovascular accident. There were many risk factors for stroke, such as age, heredity, hypertension, heart disease, arrhythmia, diabetes, hyperlipidemia, smoking, drinking, obesity, high salt, high animal oil diet, excessive physical activity, etc.

The risk of stroke was higher in the hypertension and diabetes population. By further classifying levels of age, blood pressure and body mass index, the results showed that different blood pressure grades, age groups and body mass index had different effects on the occurrence of stroke.

The higher blood pressure, the older age and the higher body mass index was, the higher risk of stroke was in hypertension patients.

These results were consistent with the above risk occurred probability of stroke in hypertension patients and literature reports. The influence of sex, smoking habit, drinking habit and physical activity on stroke complications was statistically significant, the lower limit value of RR of were less than 1.

This also means that the direction of action of these factors was protective factors or opposite effect. The reason might be affected by the assignment of data classification, for example, male was assigned as 1 and female was assigned as 2 in sex classification, but the risk of male was actually high than that of female.

It might also be caused by other factors. This needs further study, but it is undeniable that sex, smoking habit, drinking habit and physical activity are the influencing factors of stroke, which must be paid attention to in community prevention and control.

Atrial fibrillation AF is the most common arrhythmia and has significant morbidity. Morphological voltage P wave duration MVP ECG score is of great significance in predicting ischemic stroke hospitalization and long-term atrial fibrillation [ 31 ].

A score composed of easily measured electrocardiographic variables to identify patients at risk of AF would be of great value in order to stratify patients for increased monitoring and surveillance. It has been reported that abnormal P-wave index is related to the occurrence of atrial fibrillation and ischemic stroke.

It has also been reported that atrial fibrillation AF can increase the risk of ischemic stroke by about 5 times. We pay attention to this information, but it is a great pity that China's primary medical institutions did not have the ability to carry out these testing services and these data could not be collected in the past hypertension followed-up.

The calculation of these indexes requires special analysis software and digital ECG, these analysis results can't be presented in this study. In short, hypertension patients were prone to stroke, and the total cumulative occurred probability of stroke in followed-up HTN patients was 0.

The risk probability of stroke among hypertension patients was high and would continue to increasing disproportionately during period of hypertension, outcome of stroke in HTN patients would have four different onset peaks. Male, blood pressure level stage 3 BP , abnormal weight underweight and overweight and blood pressure control level could increase the risk probability of stroke.

The results of multivariate Cox regression analysis showed that male patients, patients with high blood pressure, abnormal body mass index and positive family history were high-risk objects of stroke.

Paying attention to blood pressure, weight and male are important and effective measure to prevent stroke in community. The data that support the findings of this study are available from the Hypertension Follow-up Management System database in Jiading district in Shanghai, but restrictions apply regarding the availability of these data, which were used under license for the current study and thus are not publicly available.

The data are, however, available from the authors upon reasonable request and with permission of the Jiading district health committee in Shanghai. Lin Ma, Baohua C, Lei C, et al. Epidemic trend and characteristics of stroke in China from to Chin J Cerebrovasc Diseases Electron Edn.

Google Scholar. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from causes of death for 20 age groups in and a systematic analysis for the Global Burden of Disease Study Article Google Scholar.

Longde W, Jianmin L, Yi Y, et al. The prevention and treatment of stroke in China still faces great challenges—Summary of China stroke prevention and treatment report Chin J Circul. Huo Y, Li J, Qin X, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial.

Article CAS Google Scholar. Hu L, Huang X, Zhou W, et al. Associations between resting heart rate, hypertension, and stroke: a population based cross-sectional study. J Clin Hypertens. Meschia JF, Bushnell C, Boden-Albala B, et al.

Li A-l, Zhu S, Zhi-Hao Hu, et al. The distribution and epidemic characteristics of cerebrovascular disease in followed-up hypertension patients.

Sci Rep. Article CAS PubMed PubMed Central Google Scholar. Chinese Guidelines for the Management of Hypertension. Chinese Guidelines for the Management of Hypertension Cin J Cardiol.

China hypertension prevention and treatment guidelines revision committee. Guidelines for the prevention and treatment of hypertension in China revised in Prevent Treat Cardiovasc Cerebrovasc Diseases.

Neurology branch of Chinese Medical Association, Cerebrovascular Disease Group of Neurology branch of Chinese Medical Association.

Chinese guideline for primary prevention of cerebrovascular disease Chin J Neurol. Cerebrovascular Disease Group, Neurology Branch, Chinese Medical Association. Chinese guideline for diagnosis and treatment of acute ischemic stroke General Pract China.

Peng B, Wu B. Liu LS. Chinese guidelines for prevention and treatment of hypertension Chin J Hypertens. China Association of Hypertension, Cardiovascular Branch of Chinese Medical Association, etc.

China hypertension prevention and control guide revised version Chinese Journal of cardiovascular disease. Montori VM, Erwin PJ, Lopez Jimenez F, et al. Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis. Int J Obesity.

Li AL, Shao YQ, Yuan H, Zhang YY. Incidence spectrum of hypertension in Jiading District of Shanghai. Prevent Control Chron Diseases China. Qi W, Ma J, Guan T, Zhao D, Abu-Hanna A, Schut M, Chao B, et al. Risk factors for incident stroke and its subtypes in China: A Prospective Study.

J Am Heart Assoc. Article PubMed PubMed Central Google Scholar. Jiang HM. The value of Framingham stroke risk score combined with RDW in predicting the long-term stroke risk of patients with H-type hypertension. Sichuan Med Univ. Tang X, Zhang DD, Liu XF, Liu QP, et al.

Application of China par stroke model in predicting stroke risk in northern rural population. J Peking Univ Med Edn. CAS Google Scholar. Zeng J, Liu Q, Lin AH. Analysis of influencing factors and risk prediction of ischemic stroke among middle-aged and elderly people in Guangzhou community.

J Sun Yat sen Univ: Med Sci Edn. Fu Q, Huang YJ, Jiang SZ, Li XD. Ten year risk probability analysis of stroke in hypertension patients.

Wang CY, Cao LM, Shi J, Li X, Hu FL, Ma JP, et al. A prospective cohort study on blood pressure control and risk of ischemic stroke in patients with hypertension. Zhonghua Yu Fang Yi Xue Za Zhi. Article CAS PubMed Google Scholar.

Li A-l, Peng Q, Shao Y-Q, Fang X, Zhang Y-Y. The interaction on hypertension between family history and diabetes and other risk factors. Zhou F, Hou D, Wang Y, Yu D.

Evaluation of H-type hypertension prevalence and its influence on the risk of increased carotid intima-media thickness among a high-risk stroke population in Hainan Province, China. Medicine Baltimore. Li AL, Peng Q, Shao YQ, Fang X, Zhang YY.

The effect of body mass index and its interaction with family history on hypertension: a case-control study. Clin Hypertens.

Dai J, Wang X, Zhu XY, Yang YJ, Zheng KW. A study on the influencing factors of stroke in China based on multi-layer Logit model.

Chin Health Stat. Du QM, Cao SH, Su M, et al. Risk factors and prognosis of stroke patients of different ages and genders. Chin J Gerontol. The onset of symptoms usually occurs over 24—48 hours with neurological progression. The examination can show retinopathy haemorrhages, exudates and papilledema , transient and migratory neurological nonfocal deficits ranging from nystagmus to weakness and an altered mental state ranging from confusion to coma.

Focal neurological lesions are rare and should raise the suspicion of stroke. Symptoms are usually reversible with prompt initiation of therapy. Agents that affect the central nervous system, such as clonidine, reserpine and methyldopa, and diuretics should be avoided.

Posterior reversible encephalopathy syndrome PRES has been increasingly recognised as a complication of hypertensive encephalopathy. Hypertension with failed autoregulation, dysfunction of the blood brain barrier, arteriolar dilatation and hyperperfusion leading to vasogenic oedema have all been implicated in its pathophysiology.

The clinical presentation can be very similar to a hypertensive encephalopathy including headache, nausea, hemiparesis, hemianopsia, seizures and coma. Findings from brain MRI are typical and show symmetric hyperintensities in the subcortical white matter of the posterior temporal and occipital lobes in the fluid-attenuated inversion recovery sequences.

Some patients can also present with string-of-beads and focal vasodilatation-vasoconstriction areas in the cerebral angiogram, a finding compatible with reversible cerebral vasoconstriction syndrome.

However, PRES can also occur in patients without elevated BP levels, including those using immunosuppressive drugs, after organ and bone marrow transplantation and in patients with sepsis and multiorgan failure.

Acute ischaemic strokes occur due to an occlusion of an intracranial or cervical artery with consequent deprivation of blood and oxygen to a brain territory. A few minutes after an arterial occlusion in the brain, a core ischaemic lesion is established, however a larger area at risk of hypoperfusion can be salvageable if recanalisation therapies are administered.

The salvageable area or ischaemic penumbra is largely dependent on collateral blood flow and acute reductions of BP can threaten perfusion in critical areas. In the acute phase of ischaemic stroke, early initiation or resumption of antihypertensive treatment is indicated only in patients treated with recombinant tissue-type plasminogen activator or if hypertension is extreme.

The benefit of acute BP lowering in patients with acute ischaemic stroke who do not receive thrombolysis is uncertain. Rapid reduction of BP, even to lower levels in the hypertensive range, can be detrimental. Restarting BP control is reasonable after the first 24 hours for hypertensive patients who are stable.

Spontaneous, non-traumatic intracerebral haemorrhage is the second most common cause of stroke after ischaemic stroke. The most common causes are hypertension, bleeding diatheses, amyloid angiopathy, drug misuse and vascular malformations.

Subarachnoid haemorrhage is another subtype of haemorrhagic stroke. The two major causes of subarachnoid haemorrhage are rupture of arterial aneurysms that lie at the base of the brain and bleeding from vascular malformations that lie near the pial surface.

In patients with intracerebral haemorrhage, BP is often elevated and hypertension is linked to greater haematoma expansion, neurological deterioration and worse prognosis. However, the management of hypertension is complicated by competing risks reducing cerebral perfusion pressure in patients with intracranial hypotension and potential benefits reducing further bleeding.

A favourable trend was also seen toward a reduction in the conventional clinical end point of death and major disability. Intracranial pressure is another important parameter to be considered in patients with intracerebral haemorrhage.

If the systolic BP is higher than mmHg and there is evidence or suspicion of elevated intracranial pressure, it is recommended to keep cerebral perfusion pressure at 61—80 mmHg.

If the systolic BP is — mmHg, acute lowering to mmHg is probably safe. The management of BP in the acute phase of subarachnoid haemorrhage is based on even less clinical evidence.

Observational studies suggest that aggressive treatment of BP may reduce the risk of aneurysmal rebleeding, but with an increased risk of secondary ischaemia. Guidelines from different clinical societies agree that is reasonable to treat BP if the aneurysm is not yet secured, although the levels recommended in the guidelines differ.

The risk is also high after a transient ischaemic attack TIA or a minor ischaemic stroke. Data from a registry of TIA clinics in 21 countries that enrolled 4, patients showed that at 1-year follow-up, the rate of cardiovascular events including stroke was 6. There are gaps in the evidence for the management of BP for secondary prevention of stroke and there is a need for further studies.

BP-lowering therapy should be considered in patients with stable neurological status, 72 hours after onset of neurologic symptoms, or immediately after TIA, for previously treated or untreated patients with hypertension, except in patient with large vessel occlusion and fluctuating clinical symptoms.

A Cochrane review of randomised controlled trials investigating BP-lowering treatment for the prevention of recurrent stroke, major vascular events and dementia in patients with a history of stroke or TIA. The BP-lowering drugs started at least 48 hours after stroke or TIA.

The authors concluded that the results support the use of BP-lowering drugs in people with stroke or TIA for reducing the risk of recurrent stroke and that the current evidence is primarily derived from trials studying an ACE inhibitor or a diuretic and that no definite conclusions can be drawn from current evidence regarding an optimal systolic BP target after stroke or TIA.

Reducing BP appears to be more important than the choice of agents and the effectiveness of the BP reduction diminishes as initial baseline BP declines. Angiotensin inhibitors, calcium channel blockers and diuretics are reasonable options for initial antihypertensive monotherapy and may be used in such patients.

Beta-blockers should not be given unless there is a compelling indication for their use, particularly as the most common recurrent event after stroke is a further stroke rather than MI.

Projections show that by , an additional 3. Evidence of the benefits are weaker for lower BP targets obtained with intensive BP lowering, especially in older patients. The management of BP in adults with stroke is complex and challenging because of its heterogeneous causes and haemodynamic consequences.

Future studies should focus on optimal timing and targets for BP reduction, as well as ideal antihypertensive agent therapeutic class by patient type and event type. New strategies to identify and reduce stroke risk and improve management of acute stroke are necessary.

Markers for increased risk may improve prevention. Achieving control of behavioural and metabolic risk factors could avert more than three-quarters of the global stroke burden.

Health promotion strategies for positive cardiovascular health should be emphasised, in addition to the treatment of established CVD. Unfortunately, the number of people — even young people — who have far from ideal cardiovascular health is still high.

Healthcare providers should have tools for quality improvement interventions on adherence to evidence-based therapies. Primordial prevention strategies that prevent the emergence of stroke risk factors should be the ultimate goal. Measures such as salt reduction and dietary interventions, implementation of tobacco control and support to the development of healthy environment are crucial for reducing the burden of cardiovascular diseases.

This endeavour needs close collaboration between healthcare professionals, institutions and governments. ICR 3. ECR is the official journal of the. About ECR. Editorial Board. For Authors. Special Collections. Submit Article. Mauricio Wajngarten ,. Gisele Sampaio Silva ,. Register or Login to View PDF Permissions Permissions × For commercial reprint enquiries please contact Springer Healthcare: ReprintsWarehouse springernature.

For permissions and non-commercial reprint enquiries, please visit Copyright. com to start a request. For author reprints, please email rob. barclay radcliffe-group. Average ratings No ratings. Your rating Sign in to rate. Abstract Stroke is the second most common cause of mortality worldwide and the third most common cause of disability.

Keywords Hypertension , stroke , treatment , prevention , emergency , public health ,. Citation ×. Select format. ris Mendeley, Papers, Zotero. enw EndNote. bibtex BibTex. txt Medlars, RefWorks. Open Access: This work is open access under the CC-BY-NC 4. Hypertensive Encephalopathy The diagnosis of hypertensive encephalopathy is based on the presence of vague neurologic symptoms, headache, confusion, visual disturbances, seizures, nausea and vomiting.

Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from causes of death for 20 age groups in and a systematic analysis for the Global Burden of Disease Study Lancet ; — Crossref PubMed Feigin VL, Norrving B, Mensah GA.

Global burden of stroke.

A high intraluminal pressure will lead to extensive alteration in endothelium and smooth muscle function in intracerebral arteries. The increased stress on the endothelium can increase permeability over the blood-brain barrier and local or multifocal brain oedema.

Endothelial damage and altered blood cell-endothelium interaction can lead to local thrombi formation and ischaemic lesions.

Fibrinoid necrosis can cause lacunar infarcts through focal stenosis and occlusions. Degenerative changes in smooth muscle cells and endothelium predisposes for intracerebral haemorrhages. Furthermore, hypertension accelerates the arteriosclerotic process, thus increasing the likelihood for cerebral lesions related to stenosis and embolism originating from large extracranial vessels, the aortic arch and from the heart.

But they can still be an option for other people. They are more effective if you eat less salt. Using potassium-based salt substitutes can raise blood potassium levels, so check with your GP or pharmacist before using them.

The most common side effect is a persistent dry cough. Other side effects include dizziness, tiredness, weakness, rash, headaches and changes to your sense of taste. Like ACE inhibitors, these work on the hormone angiotensin-2 by blocking its effects. Examples include candesartan, irbesartan, losartan, valsartan and olmesartan.

These drugs are usually used instead of an ACE inhibitor if you are not able to tolerate one. The two types of medication should not be used together. They are mainly used with people under 55, who are not of black African or black Caribbean origin.

They stop calcium from entering the muscle cells in your heart and blood vessels. This relaxes your arteries and lowers your blood pressure. Examples of calcium channel blockers include amlodipine, felodipine and nifedipine, as well as the less commonly used diltiazem and verapamil.

These medications are particularly effective in people aged over 55, or in black African and black Caribbean people of any age. Avoid drinking grapefruit juice while taking some types of calcium channel blockers as it can increase the amount of medication in your bloodstream.

This can make your blood pressure drop suddenly and increase your risk of side effects. Ask your GP or pharmacist for advice. Possible side effects include swollen ankles, ankle or foot pain, constipation, skin rashes, a flushed face, headaches, dizziness and tiredness.

Diuretics are often used with people over 55, and people of black African and black Caribbean origins. They can also be an option for other people, and they may be used if calcium channel blockers cause side-effects. They are usually taken as a tablet once a day.

It can be helpful to take them in the morning, as taking them in the evening can mean you need a wee during the night. You may need to have regular blood tests after you start treatment to check potassium levels and blood sugar.

You should have a blood test every year. Possible side effects include needing to wee more often, thirst, dizziness, weakness, feeling lethargic or sick, muscle cramps and skin rash.

Beta-blockers work by making your heart beat more slowly and with less force, which reduces your blood pressure. It is important that you do not suddenly stop taking this type of medication without seeking medical advice first. Possible side effects include slowing of the heart rate, cold fingers and toes, nausea, diarrhoea, tiredness and sleep problems.

It can make asthma worse, or affect your breathing if you have heart failure. Other medications that may be used to control blood pressure include doxazosin and terazosin which belong to a group called alpha-blockers , and clonidine and methyldopa which belong to a group called centrally acting drugs.

Another type of diuretic called spironolactone can also be used at low doses. These medications are only usually recommended if other treatments have not worked. Blood Pressure UK. Your Blood Pressure , [Cited: November 17, Causes High blood pressure , October 23, Blood pressure test: introduction , July 23, Blood pressure and you: the basics.

Pharmaceutical Services Negotiating Committee. Essential facts, stats and quotes relating to hypertension. NICE National Institute for Health and Care Institute. CVD prevention: detecting and treating hypertension.

May Stroke: causes. August 15, Pre-eclampsia Overview. September 28, What is white coat syndrome. Practical Matters. High blood pressure. April Diagnosis High Blood Pressure Hypertension.

October 23, Type 2 diabetes in adults: management. December Blood pressure, the meopause and HRT. February 8, Monitoring your blood pressure at home. Hypertension in adults: diagnosis and management.

August 28, Treatment High blood pressure hypertension. Royal College of Physicians. Royal College of Physicians National clinical guideline for stroke. National clinical guideline for stroke. Hypertension in pregnancy: diagnosis and management.

June 25, Treatment pre-eclampsia. August, 28, Medications for high blood pressure. Diuretics Overview. Medicine for high blood pressure.

May, 26, Breadcrumb Home What is a stroke? Are you at risk of stroke? The information on this page can be accessed in the following formats: Download this information as a pdf or large print document. Order a printed copy from our shop To request a braille copy, email helpline stroke. uk On this page: Staying healthy and reducing high blood pressure What is high blood pressure?

What is high blood pressure? Strokes due to a clot ischaemic stroke High blood pressure damages your blood vessels by making them become narrower and stiffer, and causing a build-up of fatty material. Stroke and cognitive problems due to small vessel disease Small vessel diseases means having damage to the tiny blood vessels deep inside the brain.

Stroke due to bleeding in or around the brain haemorrhagic stroke High blood pressure can damage blood vessels inside the brain, causing bleeding in the brain. Tailoring your treatment There are several different types of medication for high blood pressure, and we know that age, ethnicity and family history affect how they work.

Getting started with your medication It can sometimes take a while to adjust to taking a long-term medication. Pharmacy-based support service England only In England, you can join the New Medicines Service NMS by asking your local pharmacist. How long will I be on medication?

Side effects and drug interactions Like all medications, blood pressure medications can cause side effects. Lifestyle changes quick guide On top of medication, healthy lifestyle changes can often help to lower your blood pressure even more.

Reduce your salt intake. Have a look at our guide to healthy eating after stroke for some ideas on how to do this. Get help with quitting smoking. Eat plenty of fruit and vegetables. Lose weight if you need to.

Reduce your alcohol intake and avoid binge drinking. Be more active. Reduce your stress levels and take time to relax. Try to get at least six hours sleep a night. How is high blood pressure diagnosed?

How is blood pressure measured? Understanding your blood pressure reading Your blood pressure reading is recorded as two numbers. Systolic: the pressure when your heart beats. Diastolic: the pressure in between heartbeats.

What do the numbers mean? Why is the target level lower for home blood pressure testing? Monitoring your blood pressure How often should I get checked? If you have been diagnosed with high blood pressure, you should be monitored until you reach your target blood pressure.

Afterwards you should have an annual check. All adults should have their blood pressure checked at least every five years.

Who can get high blood pressure? Some things that put you at greater risk of high blood pressure include: Eating too much salt. Being inactive. Being overweight. Drinking more than the safe limits for alcohol.

Some health conditions can cause high blood pressure, including: Kidney disease. Obstructive sleep apnoea interrupted breathing during sleep. Lupus immune disorder. High blood pressure in pregnancy If you have high blood pressure during pregnancy, your blood pressure will be monitored during pregnancy, labour and after the birth.

Quick guide to blood pressure medication This guide can only give general information. The main groups of blood pressure medication are: ACE inhibitors. Abbreviated from angiotensin-converting enzyme. Angiotensin-2 receptor blockers ARB.