Strokes and Hypertension

I just finished my neurology rotation last week. For those of you who don’t know what that means, medical students spend their third and fourth years working in various specialities before choosing their specialty. The neurology rotation is one of the core specialities that I’m exploring during my third year. During this time, I saw patients with many different ailments: seizures, headaches, dementia, peripheral neuropathies, vertigo. But what really struck me was the number of patients that came in with strokes, and how many could have been prevented.

About 80% of strokes are due to ischemic causes, which means that a part of the brain isn’t getting adequate oxygen and nutrition.(2) The other 20% are due to hemorrhagic causes. It’s a little counter-intuitive but hypertension is a major risk factor for ischemic stroke. When blood pressure is chronically high, the arteries have to adapt to be able to transport the blood without bursting from the pressure. To do so, they undergo a change known as lipohyalinosis, which causes the arteries to become narrower. Eventually, they become completely occluded, leading to stroke.

Hypertension is tricky to manage, but there are a number of things that can be done. For those who are willing and able to use antihypertensive medications, it works pretty well.(1) But I know people don’t always like to take medications. We want to be able to manage our problems naturally. We don’t want the side effects. I get it. I hate taking medications, too. But when the medication is life saving…well, I’m sure you can tell where I’m going with this.

But let me talk now about what you can do in terms of lifestyle to manage high blood pressure. Because there is a lot that can be done. In obese and overweight individuals, a 1 pound weight reduction corresponds to about 1 mmHg reduction in systolic blood pressure.(5) For example, in someone 20 pounds overweight with a systolic blood pressure is 150 mmHg, losing that weight could drop the systolic blood pressure to 130 mmHg. Suddenly, this person is no longer hypertensive. Pretty amazing, right??

I mentioned a while ago that I would be making a post about the Dietary Approaches to Stop Hypertension (DASH). So here it finally is. The DASH diet consists of fruits, vegetables, legumes, low-fat dairy products, and less than 25% fats.(3) The study found that this diet correlated to a reduction of about 11 mmHg in patients with hypertension, and these effects were seen in just 2 weeks! It’s also been shown to reduce the risk of strokes by 19%.(4)

You may have noticed that I don’t add a lot of salt in my recipes. This is because the low-sodium DASH diet (less than 1200mg sodium daily) is shown to reduce blood pressure even more effectively than the original DASH diet. Neither I nor the people I regularly cook for have hypertension, but I firmly believe in stopping problems before they happen. So this is me being proactive about my health. And I hope that you will be, as well.

 

References:
  1. Basile, J., & Bloch, M. (2016, March 2). Overview of hypertension in adults. Retrieved March 26, 2016, from http://www.uptodate.com/contents/overview-of-hypertension-in-adults?source=search_result&search=Overview of hypertension in adults&selectedTitle=1~150
  2. Caplan, L. (2016, February 2). Etiology, classification, and epidemiology of stroke. Retrieved March 26, 2016, from http://www.uptodate.com/contents/etiology-classification-and-epidemiology-of-stroke?source=search_result&search=stroke&selectedTitle=3~150
  3. Kaplan, N., & Forman, J. (2015, September 30). Diet in the treatment and prevention of hypertension. Retrieved March 26, 2016, from http://www.uptodate.com/contents/diet-in-the-treatment-and-prevention-of-hypertension?source=search_result&search=Diet in the treatment and prevention of hypertension&selectedTitle=1~150
  4. Salehi-Abargouei, A., Maghsoudi, Z., Shirani, F., & Azadbakht, L. (2013). Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseasesdIncidence: A systematic review and meta-analysis on observational prospective studies. Nutrition, 29, 611-618. Retrieved March 26, 2016.

  5. Stevens, V., Corrigan, S., Obarzanek, E., Bernauer, E., Cook, N., Hebert, P., . . . Dalcin, A. (n.d.). Weight loss intervention in phase 1 of the Trials of Hypertension Prevention. Arch Int Med, 153(7), 849. Retrieved March 26, 2016.
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