Stroke caused by high blood pressure
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Stroke Caused by High Blood Pressure: An Overview
Introduction to Stroke and High Blood Pressure
High blood pressure (HBP), or hypertension, is a significant risk factor for stroke, which is the second leading cause of death and a major cause of disability worldwide . Hypertension damages blood vessels, making them more susceptible to blockages that can lead to strokes . This article synthesizes research findings on the relationship between high blood pressure and stroke, focusing on outcomes, prevention, and management.
High Blood Pressure and Stroke Outcomes
Acute Stroke and Blood Pressure
High blood pressure is common in acute stroke patients and is associated with poor outcomes. Elevated mean arterial blood pressure (MABP) and diastolic blood pressure (DBP) are significantly linked to increased mortality. Specifically, high systolic blood pressure (SBP) and DBP are associated with death or dependency in both ischemic stroke and primary intracerebral hemorrhage (PICH). Additionally, high SBP is linked to death or deterioration in PICH patients.
Long-term Impact
The global burden of stroke attributable to high systolic blood pressure remains significant despite a decrease in mortality and disability-adjusted life years (DALY) over recent decades. However, the years lived with disability (YLD) have increased, indicating that while fewer people are dying from strokes, more are living with long-term disabilities.
Prevention of Stroke through Blood Pressure Control
Primary Prevention
Controlling blood pressure is crucial for the primary prevention of stroke. Antihypertensive therapy has been shown to significantly reduce the risk of stroke, stroke-related death, and disability. The risk of stroke increases with blood pressure levels above 115/75 mm Hg, and features like nocturnal hypertension and morning surge further elevate this risk.
Secondary Prevention
For those who have already experienced a stroke, managing blood pressure is essential to prevent recurrence. Guidelines recommend using diuretics and calcium channel blockers to lower blood pressure in elderly patients, who are most affected by stroke .
Management of Blood Pressure in Acute Stroke
Acute Phase Considerations
Managing blood pressure in the acute phase of stroke is complex due to the heterogeneous nature of stroke causes and hemodynamic consequences. High blood pressure in the acute phase can lead to cerebral edema, hematoma expansion, or hemorrhagic transformation, while low blood pressure can result in increased cerebral infarction or perihematomal ischemia .
Treatment Approaches
Several studies have explored the effects of different antihypertensive agents in acute stroke patients. Calcium channel blockers (CCBs) did not significantly alter outcomes in ischemic stroke, while angiotensin receptor antagonists (ARAs) like candesartan showed promise in reducing combined cerebral and cardiac vascular events. Ongoing trials are expected to provide more definitive evidence on the best approaches for blood pressure management in acute stroke .
Conclusion
High blood pressure is a critical modifiable risk factor for stroke, significantly impacting both the occurrence and outcomes of stroke. Effective management of blood pressure through antihypertensive therapy can reduce the risk of stroke and improve outcomes for stroke patients. Ongoing research and clinical trials will continue to refine the strategies for managing blood pressure in both the acute and long-term phases of stroke care.
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