High Blood Pressure and Stroke-by Dr Harold Gunatillake

High Blood Pressure and Stroke-by Dr Harold Gunatillake

Harold Gunatillake



Yes, most strokes are preventable.

Unchecked high blood pressure is the most common and important known risk factor for stroke, heart attacks and kidney failure, loss of eyesight and even Alzheimer’s disease.

You can effectively and successfully lower your blood pressure and prevent the above episodes by checking your blood pressure at home.

Increase blood pressure due to extra forceful pumping of the heart, really the left ventricle, cause intense pressure on the walls of your arteries. This high blood pressure causes damage or injury to the inner lining of the arteries, which progresses to a condition called atherosclerotic plaques.

Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery.

There are three serious diseases caused by atherosclerosis. Each has its own warning signs:

Heart disease, Cerebrovascular disease, the present topic of discussion. Peripheral arterial disease, causing poor circulation in your legs first.

In addition to high blood pressure, high cholesterol, high triglycerides, smoking, insulin resistance, obesity, diabetes, inflammation from diseases, such as arthritis, lupus, or infections- all cause hardening and damage of the vessels that can lead to a stroke.

Patchy inflammation of the inner lining of the arteries at certain locations, especially at bifurcations is the earliest change in the atherosclerotic plaque formations.

This endothelial dysfunction allows entry of lipoproteins and migration of inflammatory cells into the inner layer of the artery.

Inside the plaque the cells are activated by cytokines. These are proteins secreted by specific cells of the immune system produced by lymphocytes. They signal and regulate immunity, inflammation, among other changes

Following inflammation in the inner lining of arteries, fatty streaks are formed. Then leucocytes and smooth muscle cells migrate into the plaque and foam cells are formed.

Macrophages are scavenging cells that eat the low-density lipoproteins i.e., bad cholesterol, become and gives a foamy appearance.

So, these macrophages at these sites are called the foam cells.

So, atherosclerotic plaques are formed due to chronic inflammatory and immune disease involving multiple cell types, including monocytes, macrophages, T-lymphocytes, smooth muscles cells-all form the bulk of the plaque.

These plaques grow gradually and can obstruct to the flow of blood and starve tissues without oxygen.

This is exactly what happens in TIA. The underlying cause of a TIA is a buildup of cholesterol-containing fatty deposits called plaques in the carotid arteries of the neck, or one of its branches that supplies oxygen and nutrients to your brain.

The blockage by a clot is only for a short time.

In most situations the plaque ulcerates, or ruptures into tiny pieces of plaque and clotted blood can travel in the blood stream to the brain.

The symptoms are like a stroke but do not last long and does not cause permanent damage to the brain.

It is also called a ministroke, being a warning sign to have a real stroke unless immediate remedial measures are taken after hospitalization.

About 1 in 3 people who has a TIA attack will eventually have a stroke within a year.

Immediately after hospitalization antiplatelet drugs are given. Anticoagulants like heparin drips are started to dissolve the clots. Medicines may include aspirin, clopidogrel, dipyridamole or warfarin medications are given long term.

If the plaque obstructs over 60 percent of the blood flow an operation to sleeve the plaque called endarterectomy is done and a stent is inserted to prevent rebuild of plaque.

Stents alone when they are inserted, may cause intracranial hemorrhages which in turn also cause a stroke.

Most vascular surgeons prefer to perform carotid endarterectomy without stents and is a well proven treatment for carotid artery disease. It has been performed successfully for over 50 years, in preventing a first or recurrent stroke.

The other types of strokes that are more severe are the ischemic stroke when the blood clots keep flowing into the brain and cause brain cell death.

There are two major types of ischemic stroke:

Ischemic Stroke (Clots)

Occurs when a blood vessel supplying blood to the brain is obstructed. It accounts for 87 percent of all strokes.

The thrombotic or ischemic strokes are caused when clots are formed in the arteries supplying the brain.

The underlying condition for this type of obstruction is the development of fatty deposits lining the vessel walls. This condition is called atherosclerosis, as previously described.

Embolic strokes begin with a clot in a distant site as the heart in auricular or ventricular fibrillation, or any irregular erratic movements of the heart.

Blood seems to clot in the chambers of the heart, and they travel through the carotid arteries to the brain.

They could arise from a plaque in the neck carotid arteries due to ulceration of the plaques.

Together they are the most common type of stroke.

The early symptoms are numbness or weakness on one side of the body or face, trouble speaking and difficulty with vision or balance.

You need prompt treatment in the closest hospital outpatients.

In hospital, they are given tPA stands for tissue plasminogen activator.

Larger clots in the brain may require a minimally invasive procedure known as a thrombectomy.

The other common type of stroke especially in old people is the hemorrhagic stroke. This happens when a weak blood vessel like the congenital berry aneurysm bursts and bleeds into the brain. Uncontrolled high blood pressure alone can cause this.

In hemorrhagic stroke there are warning signs like a headache or head pain. In ischemic strokes there may not be any warning signs.

Hemorrhagic strokes are less common, but they are deadlier.

Bleeding could be from a weak blood vessel breaking on the surface of the brain.

The other site of a bleed is the subarachnoid hemorrhage which occurs on the surface of the brain.

In minor ruptures from an aneurysm, a surgical clip is place at the base of the brain aneurysm to remove blood flow and stop the bleeding.

Unfortunately, not everyone survives – around one in eight people die within 30 days of having a stroke. That is why it is so important to be able to recognize the symptoms and get medical help as quickly as possible.

Hello viewers, over 40,000 globally, this is my humble plea to you. According to the World Health Organization, 15 million suffer stroke worldwide each year. Of these 5 million dice and another 5 million are permanently disabled.

High blood pressure contributes to more than 12,7 million strokes worldwide.

The incidence of stroke in Sri Lanka is remarkably high.

Stroke has been ranked the second most common cause of death and the third most common cause of disability-adjusted life years lost worldwide

This is a preventable disability, and my message for 2021 is, please change your lifestyle for a healthier one: eating less foods with added sugar, less fats, eating lots of veggies, pulses, and nuts.

Keep your blood cholesterol level and your weight within the normal range, check your blood pressure with your own apparatus at home frequently and keep your systolic 120 and diastolic between 60- 70 mm. of Hg.

Most of all the best medicine for the prevention of chronic diseases, including cancer, is daily exercise.

Most of you are by now retired, and you should spend at least 2-3 hours walking intermittently, daily.

If you walk 25,000 steps daily, your plaques in your artery will dissolve, your blood pressure may come within the normal range without medication or with minimum.

If you are a diabetic, you could reduce your insulin resistance and you may be able to control your blood sugar with low sugar diets and exercise with extraordinarily little anti-diabetic medication.

Your reserve strength of your heart increases to perform your daily routines much more efficiently.

Take my word, I have done this routine for years and at ninety-one, I feel so fit.

Do not wait until the conditions are perfect to begin. Beginning makes the conditions perfect.

Take care and goodbye for now.



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