How hypertension, heart disease, and stroke are related

  Hypertension is the medical term for high blood pressure and it can increase the risk of heart disease, stroke, and other cardiac conditions.

    High blood pressure causes your blood vessels to thicken and become stiff, which puts stress on the heart and can lead to heart disease.

    A stroke can occur as a result of failing to treat hypertension, so it is important to be aware of your risk factors and get your blood pressure checked regularly. 

    
Hypertension is the medical term for high blood pressure, or when blood vessels cannot relax enough and create higher resistance to blood pumping through the circulatory system. So, it plays an important role in heart health.

In fact, according to the Centers for Disease Control and Prevention about 70% of Americans who have chronic heart failure and 80% who have a stroke also have high blood pressure.

Here's what you need to know about how hypertension, heart disease, and stroke are related.
Hypertension and heart disease
When you have hypertension, your blood vessels thicken from the stress of blood forcefully rushing through them, says a cardiologist.

Over time, this can cause the vessels to grow stiff, which makes the heart work harder to continue pumping blood through them. Putting too much stress on your heart can lead to different types of heart disease:

    Coronary artery disease. The thicker, narrow blood vessels associated with high blood pressure make it easier for plaque to build up on your artery walls. If that plaque accumulation in the arteries leading to the heart, it can cause coronary artery disease, which can result in a heart attack or heart failure. A study in India found that hypertensive adults are 11 times more likely to develop coronary artery disease.

    Heart attack. When the arteries build up with plaque, a blood clot is more likely to form. A blood clot blocks blood flow to the heart and prevents it from getting the oxygen and nutrients it needs, which damages heart muscle and results in a heart attack. About 70% of Americans having their first heart attack will also have high blood pressure. 

    Heart failure. Over time, the stress of high blood pressure makes the heart larger and less efficient. This can lead to heart failure, or the condition when the heart can't provide enough blood to the body. A study in Massachusetts found that 91% of those who developed heart failure also had hypertension.

Hypertension and stroke

There are two main types of stroke: ischemic and hemorrhagic. Ischemic strokes are more common than hemorrhagic strokes (which only make up about 13% of stroke cases), but hypertension is strongly related to each type.

    Ischemic stroke. When blood clots form in arteries that lead to the brain, the result is an ischemic stroke. Without ample blood supply to brain cells, or neurons, they will stop working and heavily impair your body's most vital functions. Hypertension accounts for about 40% to 50% of ischemic strokes, says  a vascular neurologist. 

    Hemorrhagic stroke. In some cases, high blood pressure can cause blood vessels to burst. If a blood vessel bursts in the brain, it is called a hemorrhagic stroke, and blood may leak into the cranium and severely damage brain tissue. Research has found that hypertension increased the odds of hemorrhagic stroke by about 10 times.

Lowering blood pressure decreases the risk of heart disease and stroke

Despite the dangers of hypertension, the CDC estimates that 11 million US adults don't know they have it. You can't feel high blood pressure, which is why the American Heart Association calls it a "silent killer."

"Unless one has regular medical care and is getting checkups, you may not even be aware of having high blood pressure until unfortunately, you have had one of the unfortunate consequences," says  a cardiologist.

But there are common risk factors. According to a Dr., about 60% of people aged 60 or older have hypertension, and as you get older, it's a good idea to stay on top of your blood pressure.

Certain demographics are also prone to hypertension, Fergus says, such as African-Americans and second-generation immigrants, and you should be aware if it runs in your family.

If you do have hypertension, treating it can have a strong effect on your health. For example, research has found that reducing systolic blood pressure (the top number in your blood pressure reading) by 10 points is associated with a 50% to 60% lower risk of stroke death and a 40% to 50% lower risk of death resulting from coronary artery disease.

To treat hypertension and lower the chances of a stroke or heart disease, Fergus says you should exercise regularly, eat a low-salt and high-potassium diet, and stay away from cigarettes. For more detailed information, read our article, "How to lower blood pressure with a heart-healthy diet and exercise." 

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Window period for stroke intervention up from 6 hours to 24 hours suggest the latest trials

Incidence of stroke 
 
According to The World Stroke Organisation, one in six people globally will suffer a stroke in their lifetime, with someone succumbing to the disease every 6 seconds. Stroke or a brain attack is a major global public health problem and the second leading cause of death worldwide. The Global Burden of Diseases study indicates a 26 percent increase in global stroke deaths during the past two decades. The estimated incidence of stroke has increased more than 100% in low- and middle-income countries including India over the last five decades. A stroke can strike anyone, any time and nearly 1.54 million people are affected by it every year.

Despite the rising incidence of stroke which affects an individual’s quality of life forever or leads to death, there is low awareness about the disease, especially the fact that it is preventable. However recent demographic changes, limited awareness, sedentary lifestyle, smoking, obesity, and hypertension have challenged the prevention and treatment of stroke. Therefore, a comprehensive stroke care program that includes intensive stroke awareness and effective stroke rehabilitation is the need of the hour. 

What is a stroke?
A stroke happens when a blood vessel in the brain is obstructed or get gets ruptured. A blood clot usually develops in a narrowed artery caused by cholesterol plaque or could travel directly from the heart (if the heart is not pumping properly, beating irregularly or has a dysfunctional valve) to an artery that supplies to the brain. It affects the arteries which carry oxygen and other essential nutrients to the brain. Depriving oxygen and blood supply to the brain results in immediate cell microstructure change and stops functioning. Once the impacted part of the brain stops functioning normally, it affects the areas of the body it controls.
Stroke is of two kinds- ischemic stroke and hemorrhagic stroke. The more prevalent, ischemic stroke is an arterial blockage caused by a clot that restricts blood flow. Hemorrhagic stroke occurs when an artery in the brain leaks or bursts.
Symptoms
One of the primary concerns in stroke management is that most of the patients fail to reach the hospital in time. Thus, it becomes vital to know the symptoms for early detection. These are-
-Trouble in speaking or understanding with slurring of speech
-Paralysis
-Difficulty in vision, i.e., loss of vision, blackened or blurred vision
-Loss of balance or coordination
-Dizziness
-Severe, sudden headache with no reason
-Confusion
-Numbness or weakness in the face, arms, and legs, usually on one side

Time is brain in stroke
Since stroke affects other parts of the body apart from the brain, people experience symptoms such as the sudden onset of weakness in arm or leg, face deviation and speech difficulty. This is the reason why if identified early, the blood supply can be effectively restored within the limited time period, commonly called the window period. In stroke management, time is most crucial, and time is also the brain. This is because every passing minute following a stroke, millions of neurons die if the obstructed clot is not dissolved or removed and the lost neurons cannot be revived.
Therefore, most critical to a positive outcome for stroke treatment is the window period. The recommended window period for stroke intervention until recently was six hours. Latest trials have however extended this to 24 hours, in cases where the patient has salvageable brain tissue called penumbra. The American Heart Association and the American Stroke Association also endorse the expanded window period as the increased treatment window will consequently allow more lives to be saved and decrease suffering from life-altering disabilities.
Treatment of stroke
While traditionally, clots have been treated with clot-dissolving drugs, more recently neurointerventional and endovascular techniques using advanced devices are being utilized for treatment. Endovascular mechanical thrombectomy is one such process in which a clot is removed using a small catheter which is introduced in the body through a very small incision in the groin region within a short procedural time.
Untreated stroke has a long-term, often irreversible impact on normal body functions, daily activity, and social participation. Maintaining good health with regular exercise, optimal blood pressure, the balanced weight, and cholesterol offsets the risk of stroke considerably. Early identification of stroke symptoms and prompt treatment at a comprehensive stroke facility is crucial to treatment and cure. 

this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     
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How to spot someone having a stroke and what to do

A stroke is a serious life-threatening medical condition that affects the brain.

It is one of the leading causes of death around the world and urgent treatment is essential.

There are different types and recovery length depends on the severity of the attack, though roughly one in eight people will die within 30 days of having a stroke.

The sooner someone receives treatment, the less the brain will be damaged.

Read on for everything you need to know about strokes, from how to recognise the symptoms to what the different types are.
  
What is a stroke?
Described by the UK's Stroke Association as a “brain attack”, a stroke happens when the blood supply to the brain is cut off.

This prevents key nutrients and oxygen from getting to the brain, causing severe damage to the brain cells, which can impair a person’s speech and the way they move and think.

What are the different types of stroke?

There are three types of stroke.
Ischemic strokes, which are most common, occur when an artery that supplies blood to your brain becomes blocked by a blood clot.
The blood clots usually form in areas where the arteries have become narrowed over time due to a buildup of fatty deposits; this process is known as atherosclerosis.
Hemorrhagic strokes happen when there is bleeding in or around the brain caused by a blood vessel rupturing. This kills all of the surrounding brain cells.
The third type, according to the British Heart Foundation, is a mini-stroke, which is caused by a brief reduction in blood supply to part of the brain. These kinds of stokes, sometimes referred to as transient ischemic attacks, shouldn’t cause permanent damage to the brain, and most symptoms should pass within 24 hours.

What causes a stroke?

For ischemic strokes, which are caused by narrowing arteries, certain things such as smoking, obesity, diabetes, excessive alcohol consumption and high cholesterol can be triggers.
Arteries naturally narrow as you get older, so elderly people are also more at risk.
The main causes for hemorrhagic strokes, which are less common, are stress, lack of exercise, obesity and smoking.

How to spot someone is having a stroke

The symptoms for a stroke depend on the person and the type of stroke, though the NHS uses the F.A.S.T acronym to list the main signs as:

• Face – the face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have drooped.
• Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in one arm.
• Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake.
• Time – it's time to dial 999 immediately if you notice any of these signs or symptoms.

If you suspect you or someone else is having a stroke, the NHS advises phoning 999 immediately and asking for an ambulance.

What happens after someone has had a stroke?

Recovery from a stroke will vary depending on how much damage the brain has injured.
Some people will recover quickly, but others will need long-term support from a range of specialists, such as language therapists, dietitians, physiotherapists and psychologists.

After a stroke, a person's cognitive functions (communication, spatial awarenesses, memory and concentration) can be severely compromised, and in these instances, a rehabilitation plan will be created to help a person recover fully.

Strokes can also cause weakness in the body and, in some cases, paralysis. Physiotherapy will be prescribed if this is the case and a care worker may also be provided.

Other issues that may arise after a stroke include: vision problems, bladder issues, difficulty swallowing.

Mental health issues, such as depression and anxiety, may also arise after a stroke.

Some symptoms of stroke
 Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body.
Sudden CONFUSION, trouble speaking or understanding speech.
Sudden TROUBLE SEEING in one or both eyes.
Sudden TROUBLE WALKING, dizziness, loss of balance or coordination.
Sudden SEVERE HEADACHE with no known cause. 
Weakness or paralysis of any part of the body.
Gait disturbances (trouble walking) or loss of balance and coordination.
Confusion 
Memory loss
Behavioral changes
Muscle stiffness
Difficulty swallowing
Involuntary eye movements

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A stroke, also known as cerebrovascular accident (CVA), cerebrovascular insult(CVI), or brain attack, can occur when a part of the brain is deprived of blood flow. When brain cells are deprived of oxygen they begin to die, due to which the functions controlled by that part of the brain also stops, which results in different types of disabilities among stroke survivors.
There are two types of strokes

• Hemorrhagic
• Ischemic stroke

The first is caused when a brain aneurysm or a weak blood vessel bursts. Most of the time, this type of stroke leads to death. The second one happens when a clot blocks the flow of blood to the brain. Patients suffering from stroke suffer from various side-effects, the most common ones being paralysis or loss of feeling in a certain part of the body, problem in understanding or talking and loss of vision on one side. The side-effects start showing up immediately after a person has had a stroke.

In certain conditions, blood flow to a certain part of the brain stops for only some time and hence the body suffers stroke-like symptoms which only last a couple of hours before disappearing. This is known as a transient ischemic attack (TIA). Unfortunately, the effects of a stroke can be debilitating and also permanent. Hence, it's important to know the symptoms of a stroke and rush the patient to a doctor as soon as possible. Sometimes early treatment can save a lot of damage.

What are the warning signs or symptoms?
There may be no warning signs of a stroke until it actually occurs. You might be having symptoms that may warn you that you might be about to have a stroke.

General symptoms of a stroke, according to Dr.
- Face: Does the face droop on one side when the person tries to smile?
- Arms: Is one arm lower when the person tries to raise both arms?
- Speech: Can the person repeat a simple sentence? Is speech slurred or hard to understand?
- Time: During a stroke every minute counts. If you observe any of these signs, call your local emergency number immediately.
Other symptoms of a stroke include:
All strokes involve symptoms that relate to impairment of nerve function. A patient might complain of a few of the following or all of the following symptoms:
- Confusion
- changes in the level of consciousness
- trouble speaking
- trouble understanding speech
- vertigo
- balance problems
- headache
- nausea
- vomiting
Nausea, sometimes accompanies a stroke, particularly when the stroke involves bleeding inside the brain. The symptoms typically arise suddenly and most commonly occur on one side of the body as the brain controls the ipsilateral part of the body, i.e. brain lobes control opposite parts of the body. Example, a right brain stroke would make the left side of the body weak.

Depending on the part of the brain where the stroke has occurred, be it ischemic or hemorrhagic the effect would be seen in the body. The brain controls different functions of the body like speaking, hearing, listening other than the motor functions.

For example, most people's speech center is located in the left half of the brain so a stroke affecting the left side of the brain would affect speech and comprehension. It also would be associated with weakness of the right side of the body.

Who is at a higher risk of stroke?
Many factors can increase your risk of a stroke. Some factors can also increase your chances of having a heart attack. Potentially treatable stroke risk factors include:
Lifestyle risk factors
- Being overweight or obese
- Physical inactivity
- Heavy or binge drinking
- Use of illicit drugs such as cocaine and methamphetamines
Medical risk factors
- High blood pressure
- Cigarette smoking or exposure to secondhand smoke
- High cholesterol
- Diabetes
- Obstructive sleep
- Cardiovascular disease
Other factors associated with a higher risk of stroke include:
- Personal or family history of stroke, heart attack or transient ischemic attack.
- Being age 55 or older.
- Men have a higher risk of stroke than women

What to do if you feel FAST with a patient?
Time is the key to recovery in a stroke patient. If you feel someone around you has symptoms of stroke, the patient should be rushed to a hospital in emergency services. If during the initial phase of the attack the treatment is given, maximum number of brain cells could be prevented from dying as death of brain cell is an irreversible process. The damage which has been caused by the death of brain cells cannot be recovered.
The following things can be done other than taking him to the hospital
- Make the patient lie on one side with their head slightly raised and supported in case they vomit.
- Check to see if they're breathing. If they're not breathing at all, perform Cardio Pulmonary Resuscitation. If they're having difficulty breathing, loosen any constrictive clothing.
- Do not give them anything to eat or drink.
- If the person is showing any weakness in a limb, avoid moving them.
- You yourself need to be calm and patient to tell and brief the doctor about the event.

Diagnosis
On physical examination a doctor in the emergency would be able to confirm if it is a Stoke. To confirm it clinically a CT Scan or MRI of the brain would be done which would confirm on the type of stroke i.e. ischemic or hemorrhagic, and the lobe of the brain where it has occurred.
PS: There is an urgency to make the diagnosis and determine whether treatment clot-busting drugs to "reverse" the stroke is a possibility. The time frame to intervene is narrow and may be as short as 3 to 4 ½ hours after onset of symptoms.

The specialist, a Neuro physician or Neuro surgeon would further decide on the treatment and keep the patient in the Intensive Care Unit for further care.

Treatment
Depending on the type of stroke the treatment is planned. For an ischemic stroke, the treatment is generally through medications by a Neuro physician. If the stroke is hemorrhagic then the intervention of a Neuro surgeon may be required to remove the blood clot depending on the site of clot. If the clot is deep inside the brain it is generally not operated upon. If the clot is in the outer coverings or near the coverings of the brain the Neuro surgeon might take a call.

Recover from a Stroke
After first aid and treatment, the stroke recovery process varies. It depends on many factors, such as how fast treatment was received or if the person has other medical conditions. The first stage of recovery is known as acute care. It takes place in a hospital where your condition is assessed, stabilized, and treated. Rehabilitation is usually the next stage or the main of stroke recovery. The goals of rehabilitation are:
- strengthen motor skills
- improve mobility
- limit use of the unaffected limb to encourage mobility in the affected limb
- use range-of-motion therapy to ease muscle tension

Preventing a stroke
The best way to prevent a stroke is to address the underlying causes. This is best done by living healthfully, which means:
- Eating a healthy diet.
- Maintaining a healthy weight.
- Exercise regularly.
- Don't smoke.
- Avoiding alcohol or drink moderately.

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