Lower Your Blood Pressure - Preventing Stroke: Stroke
Content provided by the Faculty of the Harvard Medical School
Lower your blood pressure
Untreated hypertension is the leading cause of all types of stroke in the United States, and controlling blood pressure is probably the most powerful weapon in the preventive arsenal. High blood pressure damages vessel walls, and this damage sets in motion a domino effect of problems that can culminate in a stroke. It encourages scarring, which in turn leads to plaque buildup and, eventually, atherosclerosis.
Blood pressure measurements are written as a pair of numbers: The systolic pressure (the top number) is a measure of the pressure the blood exerts against the arterial walls when the heart contracts. Diastolic pressure (the bottom number) is the pressure between contractions. Normal blood pressure is considered to be less than 120/80 mm Hg (see Table 2).
Table 2: Blood pressure guidelines | |||
| Category | Systolic BP (mm Hg) | Diastolic BP (mm Hg) | Treatment recommendations |
| Normal | Less than 120 | Less than 80 | Lifestyle changes encouraged |
| Prehypertension | 120–139 | 80–89 | Lifestyle changes necessary Drugs for compelling indications* |
| Stage 1 hypertension | 140–159 | 90–99 | Lifestyle changes necessary Thiazide diuretic for most people May also consider other blood pressure drugs alone or in combination Drugs for compelling indications* |
| Stage 2 hypertension | 160 or higher | 100 or higher | Lifestyle changes necessary Two or more blood pressure drugs for most people Drugs for compelling indications* |
| *Compelling indications: diabetes, chronic kidney disease, previous heart attack, congestive heart failure, previous stroke, high cardiac risk Note: When systolic and diastolic pressures fall into different categories, physicians rate overall blood pressure by the higher category. For example, 150/85 mm Hg is classified as stage 1 hypertension, not prehypertension. Source: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, December 2003. | |||
A person with a blood pressure of 160/95 mm Hg is about 4 times more likely to have a stroke than someone with normal blood pressure. Even if just one of the blood pressure numbers is elevated, your risk of stroke rises. In a review of 9 studies that involved 420,000 people, those with the highest diastolic blood pressure (105 mm Hg) were 10 times more likely to have a stroke than those with the lowest (76 mm Hg). Elevated systolic blood pressure also increases the risk of stroke. Many elderly people, especially women, have isolated systolic hypertension, a condition in which only the first of the two blood pressure numbers is elevated.
High blood pressure is often called "the silent killer" because it rarely causes symptoms. The only sure way for you to know if you have hypertension is to have your blood pressure checked regularly.
Hypertension can sometimes be lowered by lifestyle changes alone, such as eating a diet rich in fruits, vegetables, fish, and low-fat dairy products; reducing salt intake; exercising regularly; and losing weight. Diets high in potassium may help reduce stroke risk through an association with lower blood pressure.
Often, to effectively control blood pressure, these modifications need to be combined with blood pressure medications, such as diuretics, ACE inhibitors, angiotensin-receptor blockers, or alpha blockers. Many studies have demonstrated that lowering blood pressure is well worth the trouble. Treating hypertension reduces the incidence of stroke by 35%–40%.
| Last updated: | September 05, 2008 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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