Stroke: The Silent Killer

Last Editorial Review: 1/30/2005

Too many people die from it. Here's how to reduce the risk.

WebMD Feature

April 17, 2000 (Great Falls, Mont.) -- The numbers are startling: Every 53 seconds someone in the United States suffers a stroke, and someone dies from one every 3.3 minutes. Strokes afflict a half million people each year, killing about a third of them and disabling another 200,000, according to the American Stroke Association, a division of the American Heart Association.

Right now, three million survivors are living with the life-altering consequences of strokes, including Connie Bentley of Portland, Ore. A cardiologist prescribed medication for her high blood pressure 10 years ago, but because the pills made her sleepy, she stopped taking them. After all, Bentley, now aged 49, was in peak shape at the time: She lifted weights three days a week and ran four miles on alternate days.

"I didn't think I needed medication because I was staying healthy by exercising," says Bentley. So she told herself she could quit the medicine, at least for now, and perhaps resume it in her 50s or 60s when she might not be able to exercise as intensely. Then, two years ago, she suffered a stroke that paralyzed her left arm and leg. Since then, she has learned to walk again, and now lifts light weights.

The Costs of High Blood Pressure

Would Bentley have avoided a stroke if she'd stayed on her medication? Perhaps. A study published in the February 2000 issue of the journal Stroke reports that many strokes could be prevented if closer attention were paid to those with hypertension (elevated blood pressure). Hypertension is considered the most common and controllable of stroke risks, so when blood pressure increases to a consistent reading of more than 140/90, doctors usually begin to treat it with medication. For some people, however, the medications don't always lower their pressure enough, and they need to be switched to other medicines or a different dose. And some people, like Bentley, stop taking the medication and don't bother to tell their doctors.

The price of uncontrolled blood pressure is great, according to internal medicine physician Bruce Psaty, MD, PhD, and his colleagues at the University of Washington in Seattle, who conducted the study. They monitored 555 patients who had strokes despite taking blood pressure-lowering drugs. The researchers also evaluated nearly 3,000 control patients who were also treated for high blood pressure but did not have strokes. Their findings were striking. Blood pressure was found to be inadequately controlled in 78% of those who had ischemic strokes (in which a lack of oxygen damages brain tissue), in 85% of those with hemorrhagic strokes (in which blood vessels in the brain burst), and in 65% of the controls.

Psaty and his team concluded that uncontrolled high blood pressure raised the odds for ischemic stroke 1.5 times and for hemorrhagic stroke 3.0 times, compared to controls. And the higher the blood pressure, the greater the stroke risk in both men and women, regardless of age. Overall, they estimate that a third of strokes could have been avoided by better control of blood pressure.

Keeping It Down

Patients who are prescribed drugs for high blood pressure may fail to lower their blood pressure for several reasons. Some people have pressure that is hard to bring under control even with drugs. Others don't take their medication regularly because of side effects, so their pressure may increase rapidly if they skip a dose. Lastly, because high blood pressure shows no obvious symptoms, patients may think that they don't need the drugs any longer, especially if they begin to feel better.

To make sure their blood pressure is under control, Psaty encourages his patients to have additional blood pressure readings between doctor visits -- at health fairs, fire stations, and drug stores, if the pharmacist can assure them that the in-store device is accurate. Or, patients might want to invest in a home monitor, usually available at drug stores, and occasionally ask their doctor to check it for accuracy.

Taking readings two to three times a week is extremely helpful, Psaty says. For one thing, some patients get nervous and their blood pressure shoots up just from coming to a doctor's office. Outside readings give physicians a better sense of blood pressure control.

Patients and their doctors need to work together to find a medication that works and has minimal side effects. There are a host of blood pressure medications, and if one causes you problems, the best thing is to tell your doctor so the medication can be switched or the dose adjusted.

"I wish I had gone back to the doctor and asked for a different medication without side effects, but I didn't know you could do that," says Bentley, who now takes a new medication "religiously."

Other ways to lower blood pressure and stroke risk include getting regular exercise, losing weight, quitting smoking, and limiting alcohol. Psaty says his team found that even modest improvement in blood pressure control can potentially reduce the risk of the devastating complications of stroke.

Carol Potera is a journalist from Great Falls, Mont., who writes for WebMD, Shape magazine, and other publications.

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