Stroke: People at Risk and its Consequences

"Stroke" is a the common term for an "acute cerebral infarction", which means injury with loss of neurons of the brain tissue. There are 2 main causes for stroke: the obstruction of one of the arteries that feeds blood to the brain and bleeding from blood vessels in the brain. Both situations are very serious and can lead to loss of brain cells, loss of physical or intellectual function and death.

The people who are at risk for stroke are diabetics, people with high blood pressure, smokers, obese and patients with high cholesterol. If someone already has had a stroke he or she has a higher risk to have another one. In addition, for an individual who has coronary artery disease or peripheral artery disease, there is an increased risk of stroke. Atrial fibrillation (AF; an irregular heart beat) increases the chances of stroke, that is the reason why many persons with AF have to take an anticoagulant (blood thinner). Finally, there are genetic conditions that can increase the risk of stroke. Examples of this are sickle cell disease and increased coagulation disorders such as Factor V Leyden.

Stroke can be a devastating condition for the individual and it is definitely a major public health problem¹ due to the immense cost it represents. It accounts for approximately 320 billion dollars every year in healthcare direct and indirect expenditures². The patient has to deal with loss of function, which could be physical  (paralysis of arms, legs and/or face), and intellectual deficits like the loss memory and inability to speak. The recovery from stroke is usually slow and involves the use different levels of rehabilitation services.

References

1. Hankey GJ. StrokeHow Large a Public Health Problem, and How Can the Neurologist Help?. Arch Neurol. 1999;56(6):748-754. 

2. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133:e38-e360.

Marco A. Ramos MD

5 Possible Consequences of Uncontrolled High Blood Pressure

Uncontrolled high blood pressure (hypertension) is associated with several health conditions. Hypertension is treatable, so this means that the following diseases can be prevented or delayed. 

1. Heart attacks. Elevated blood pressure is related to atherosclerosis, which, by narrowing the coronary arteries, can lead to heart attacks. Heart attacks can cause congestive heart failure and sudden death. 

2. Impaired vision. Hypertension can cause something called hypertensive retinopathy. This means that the retina (where the images are formed in the eye) can get damaged by chronic high blood pressure and can lead to impaired vision and blindness.

3. Amputation of limbs. High blood pressure can lead to the amputations of limbs, specially feet and legs. The problem starts with the atherosclerosis in the arteries of the limbs which eventually leads to obstruction and lack of blood supply to the feet and legs, especially. Hypertension is related to the atherosclerosis of the limb arteries, just as with the heart.

4. Stroke. The brain can also be the victim of atherosclerosis, which is related with hypertension (as we have just seen). In addition to this, if the blood pressure becomes too high, it can lead to bleeding inside the brain, by rupture of the arteries.

5. Kidney disease. The kidneys are very sensitive. Elevated blood pressure for a long time can cause scarring of the kidney tissue to the point that it cannot perform its functions anymore. The kidneys are important for sodium and potassium control, blood pressure control, generation of red blood cells, vitamin D and calcium metabolism and acid-base balance.

Marco A. Ramos MD