The Enemy of the Heart and Brain: Hypertension

Two out of three people over the age of 65 are affected by hypertension. The specialists in Internal Medicine and Cardiology at Anadolu Health Center explain what can be done to combat this condition, which particularly threatens the heart and brain.

Hypertension, which affects two out of three people over the age of 65, becomes more prevalent as one gets older. According to statistics, a person who does not experience this issue by the age of 65 has a 90% risk of developing hypertension in the next 20 years. In other words, a person who lives until the age of 85 has a 90% chance of encountering hypertension. Hypertension, which increases the risk of both coronary heart diseases and stroke, is also considered one of the leading causes of chronic kidney disease. In Turkey, two-thirds of patients undergoing dialysis treatment suffer from kidney failure caused by either diabetes, hypertension, or a combination of both. Additionally, hypertension is a significant cause of heart failure and one of the most important reasons for arrhythmias in older individuals.

Hypertension Causes Stroke

One of the most dangerous outcomes of hypertension is stroke. The risk of having a stroke is 4-5 times higher in individuals with hypertension compared to those without it. Among individuals over the age of 65, the risk of having a stroke within two years is around 15-16% for those with hypertension, while it is only 3-4% for those in the same age group without hypertension.

Hypertension can cause stroke in three different ways:

1. By leading to small vessel disease in the brain and blocking small arterial vessels.
2. By creating weak spots and aneurysms in the brain's vessels over time, which rupture and cause bleeding.
3. By causing arterial stiffness in the vessels leading to the brain, leading to plaque formation and clotting on top of these plaques, which can either block the artery or send a clot to the brain.

Temporary Blockage Due to Hypertension Should Be Taken Seriously

Hypertension-related vascular blockages increase the risk of stroke depending on both age and the degree of blockage. Sometimes, temporary blockages occur, and although stroke symptoms are observed, these symptoms disappear within half an hour to an hour. Just because the blockage is temporary does not mean it is insignificant. It is considered just as serious as a full stroke. In some cases, the blockage may completely occur at a point further along the vessel. Such blockages may present themselves as subtle muscle contractions and numbness, in addition to typical symptoms such as arm weakness or facial drooping. Sometimes, these events can be mistaken for something else, and the person may not even realize they are experiencing a stroke. In more severe blockages, the complete loss of movement on the left or right side of the body may occur, potentially leading to dependence on a bed or even death. However, hypertension-related occlusive strokes generally do not result in death. Blockages in larger brain vessels increase the risk of fatal strokes. Even if death does not occur, most people who experience a stroke are unable to return to work and become socially isolated.

Effects of Hypertension

Hypertension causes damage to the vessels in the brain. The rupture of weak spots and micro-aneurysms leads to bleeding. Symptoms vary depending on the size of the bleed. These bleeds can sometimes be large enough to result in death. However, it is not always possible to establish a direct relationship between the severity of the bleeding and the level of hypertension.

Do Not Lower Blood Pressure During a Stroke

In strokes caused by hypertension, the risk is directly related to the duration of hypertension rather than the level. A sudden rise in blood pressure does not directly cause bleeding or occlusive strokes. Of course, the level of hypertension is important, but it is the damage to the vessels, not the high blood pressure, that leads to a stroke. In individuals who experience a stroke, blood pressure should never be lowered. Attempting to lower the blood pressure disrupts blood circulation in the brain, reduces the volume of blood passing through the brain, which results in further disruption of cell nourishment in the affected area, and enlarges the infarcted area. As a result, a stroke that could have been overcome with minor movement disorders or slight leg dragging could lead to dependency on a bed.

What to Do During a Stroke

It is a common misconception that giving garlic, lemon juice, or cold water on the head to someone having a stroke is helpful. Blood pressure medication should never be given, and efforts to lower blood pressure should not be made. The best thing you can do in such an emergency is to immediately take the patient to the nearest healthcare facility. So, is there anything else we can do? Of course, there is—stroke prevention. The first step in prevention is being aware of hypertension. In Turkey, one in three people with hypertension is unaware they have it. Among patients receiving treatment for hypertension in Turkey, 87% cannot reach their target blood pressure. In other words, only 13% of those undergoing treatment are successfully managing their hypertension.

Ways to Prevent Stroke

• Blood pressure should be kept below 14/9.
• If the person has diabetes or chronic kidney disease, blood pressure should be kept below 13/8.
• There is a direct relationship between salt consumption and stroke, so salt intake should be significantly limited.
• Regular physical exercise should be done. Research shows that regular physical exercise reduces the frequency of complications in individuals with hypertension.