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Hypertension & Stroke




Sudden, severe headache. (Stroke symptoms usually come on suddenly.)

Weakness or paralysis on one or both sides of the face or body.

Numbness and tingling in one or both arms or legs.

Speech difficulty or loss; slurred speech.

Nausea and vomiting.

Total blindness or partial loss of vision, double vision, dilated pupils, or crossed eyes due to partial inability to move the eye.

Dizziness, mental confusion, or sudden loss of consciousness.

Memory loss.

Inability to walk or coordinate limbs.


When To Call Your Doctor

Call an ambulance immediately if you or someone in your presence exhibits stroke symptoms.

What Is It?

A stroke is a medical emergency caused either by obstruction of an artery carrying blood to the brain or by rupture of one of the cerebral arteries. Because brain cells cannot regenerate, lack of oxygen from blockage of the blood supply may quickly lead to cell death and permanent brain damage.

Strokes are more likely to occur when arteries have been substantially narrowed by atherosclerosis (a buildup of plaques in the walls of the arteries). Blood flow through narrow arteries is reduced, and blood clots are more likely to form along the uneven surface of the plaque. A clot formed in a carotid artery in the neck or a cerebral (brain) artery can block the artery at that site. Clots may also form elsewhere, become detached, and ultimately block a cerebral artery, causing a stroke.

About 80 percent of strokes are ischemic strokes due to blockage in either an artery in the brain or in one of the carotid arteries in the neck. The remaining 20 percent result from a rupture of a brain artery. This type of stroke called a hemorrhagic stroke is generally the most life-threatening, primarily because of the excessive pressure the bleeding exerts on brain tissue.

Although incidence is highest among those over age 65, a stroke may afflict anyone at any age. Symptoms often come on suddenly and vary depending on the portion of the brain affected. Some patients will have temporary stroke-like episodes known as transient ischemic attacks (TIAs) prior to a stroke, which resolve in minutes to a few hours. Strokes are the third leading cause of death in the United States, but the leading cause of disability. Prevention is key.

What Causes It?

Blood clots that obstruct a carotid or cerebral artery are the most common cause of stroke.

An embolus (a fragment of plaque, tissue, or blood clot) may develop in the heart and travel to the brain to cause a stroke. Emboli are most likely to develop in association with arrhythmias (especially atrial fibrillation), valvular heart disease, heart attacks, or cardiomyopathy (disease of the heart muscle).

An aneurysm (a balloon-like weak spot in an arterial wall) in a cerebral artery may burst or leak, resulting in a stroke.

Hypertension is the greatest risk factor for stroke.

Severely narrowed arteries due to atherosclerosis increase the risk of stroke.

Use of cocaine or amphetamines may boost blood pressure to dangerously high levels and cause a stroke.

Risk is high among those who have experienced one or more TIAs—a temporary blockage in an artery that lasts for less than 24 hours (usually only a few minutes) and causes no permanent brain damage.

A family history of stroke, early or premature heart attacks (before age 55 in men; age 65 in women), atherosclerosis, or high blood pressure increases the risk of stroke.

Smoking, alcohol abuse, high blood cholesterol levels, a diet high in fat (especially animal fat), obesity, lack of exercise, diabetes, and oral contraceptive use all may increase the risk of stroke.

Risk increases with age.


Don’t smoke.

Eat a diet low in fat, cholesterol, and salt.

Engage in moderate, regular exercise. Check with a doctor before beginning an exercise program.

Lose weight if you are more than 20 percent overweight.

Have no more than two alcoholic drinks a day.

Low daily doses of aspirin or other antiplatelet drugs (such as ticlopidine, clopidogrel, and dipyridamole) may be prescribed to reduce the chances of blood clot formation in those who have had a TIA or are otherwise at high risk for stroke.

Hypertension must be treated aggressively.

The anticoagulant warfarin may be prescribed for those with atrial fibrillation and some other conditions to prevent blood clot formation.

Patients who show evidence of substantial atherosclerotic narrowing in the carotid arteries (the two main blood vessels in the neck supplying blood to the brain) may be good candidates for carotid endarterectomy, a surgical procedure to clear away plaque deposits in these arteries.


Diagnosis is often made immediately upon examination by a doctor or emergency medical technician.

Blood tests are taken.

CT (computed tomography) scans or MRI (magnetic resonance imaging) may be used to locate an abnormal blood vessel or an area of brain damage.

Ultrasound scans of carotid arteries reveal narrowing due to atherosclerotic plaque.

Angiography may be performed to locate the arterial blockage or aneurysm. In this procedure a tiny catheter is inserted into an artery in the groin and threaded up to the carotid artery in the neck. A contrast material is injected to produce a clear x-ray image of the carotid and cerebral arteries.

An electrocardiogram (ECG) is performed to detect arrhythmias or heart damage from a heart attack.

A cardiac ultrasound (echocardiography) may locate a source of blood clots in the heart.

How To Treat It

Emergency treatment and immediate hospitalization is necessary. Life support measures may be required.

If a stroke is caused by arterial blockage due to a blood clot, thrombolytic (clot-dissolving) drugs, such as tPA, or anticoagulants, such as heparin or warfarin, should be initiated within three hours of the onset of symptoms.

If the stroke is the result of a brain hemorrhage, physicians will immediately take measures to reduce the blood pressure of hypertensive patients in order to minimize the flow of blood from the ruptured artery.

Long-term therapy following a stroke may include antiplatelet medications, such as aspirin, or anticoagulant medications, such as warfarin, to prevent future clots.

Special railings, braces, canes, wheelchairs, or other devices may be necessary to help increase mobility for those with partial paralysis.

Physical, speech, occupational, and emotional therapy helps patients and their families cope with major lifestyle changes.

Those with extensive disabilities may need a period of in-hospital rehabilitation or professional in-home medical care.


From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.


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Hypertension & Stroke

The Hypertension & Stroke White Paper from The Johns Hopkins White Papers series is an annual, in-depth report written by Hopkins physicians.

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Johns Hopkins Symptoms and Remedies
An easy-to-use reference work that can help you pinpoint the cause of hundreds of symptoms, from abdominal pain to skin rash to swollen glands.


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