Strokecast

Episode 047 — How High Blood Pressure Causes Stroke

'I think, overall, what we're going to end up finding is blood pressure is responsible for a lot diseases in a number of different ways that we probably didn't understand even until 2018.' -- @neuronirav #stroke #hypertension Click To Tweet

 

When I had my stroke at 46, it took a little while for the medical team to settle on the cause. I suppose that’s a good thing. We don’t want them to rush to a conclusion. Ultimately, they concluded the probable cause was a history of high blood pressure. It didn’t make sense to me at the time.

In 2015 I developed high blood pressure, AKA hypertension, but I didn’t know. That’s the thing about high blood pressure — it doesn’t hurt. There was no pain.

I only found out because during the last week of December, I began have massive 30 minute pouring nosebleeds every other day. I checked my blood pressure on a home blood pressure machine, and it registered more than 200 over 160. That and the random surprise bleeding got me into the doctor’s office. They measured my BP at 162/102. So it had dropped from apparently ER levels by that time.

'The pressure in the artery can create a sheer stress.' -- @neuronirav #stroke #hypertension Click To Tweet

Over the course of the next few months, we worked to get my BP under control through medication and some diet tweaks.

By March of 2016, my BP was coming in at 105/75.

Be February of 2017, it was down to 100/70.

And on June 3, 2017, I had my stroke.

Chart from heart.org showing levels of hypertension

'The bottom number, we call the diastolic number represents how flexible your arteries are, whereas the top number is how much pressure will go through.' -- @neuronirav #stroke #hypertension Click To Tweet

I had serious high blood pressure for maybe a year to a year and a half. I had it under control for a year before my stroke. So how could previous high blood pressure cause a stroke?

This week, Dr. Nirav Shah, a neurologist at Swedish Medical Center in Seattle and the founder and CEO of Sentinel Healthcare, returns to Strokecast to answer that very question as we talk about just how high blood pressure causes stroke.

'You certainly don't want the cumulative risk of blood pressure causing stroke, heart attack, kidney problems, eye problems, and so on.' @neuronirav #stroke #hypertension Click To Tweet

Bio

Dr. Nirav H Shah HeadshotDr. Nirav H. Shah is a fellowship trained neurologist and sub-specialist in cerebrovascular and stroke medicine with board certifications in: neurology, stroke medicine, carotid neurosonology, transcranial doppler ultrasound, and neuroimaging.

He is a practicing neurohospitalist and served as the stroke medical director at Swedish Medical Center in Seattle. Academically, he is interested in emergent and critical care neurology research and is an associate editor for The Neurohospitalist, a peer-reviewed journal. He enjoys mentoring trainees and collaborating on publications and conference presentations.

Outside of clinical care Dr Shah is collaborating with experts to develop scalable technologies capable of ameliorating healthcare’s challenges. He consults with startups and investors to develop technologies and devices so that one day they are available to his patients. He has worked with companies to meet FDA regulations for approval as well as to help them understand the provider perspective of product-market fit.

Dr. Shah is also the CEO and Founder of Sentinel Healthcare. He is also a passionate traveler and photographer.

Hack of the Week

After I lost the use of my left arm, eating became a challenge for some dishes. Sushi was easy. Steak was difficult because to cut a steak, you need to hold it still with your fork and slice with the steak with the knife in your other hand.

So how do you manage this out at a restaurant?

You’ve got a couple options. One, of course is to just skip cutting it, pick up the slab of meat with the one usable hand and start chowing down. Of course your dining companions may not prefer that choice.

The other option is incredibly simple. When you place your order, ask them to have the kitchen cut up the steak for you.

That’s it. It’s a simple request that will take them just seconds and it solves your problem.

Links

Lipohyalinosis

https://en.wikipedia.org/wiki/Lipohyalinosis

C. Miller Fisher on Wikipedia

https://en.wikipedia.org/wiki/C._Miller_Fisher

C. Miller Fisher On AHA Journals

https://www.ahajournals.org/doi/10.1161/STROKEAHA.112.661512

Atherosclerosis on WebMD

https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569

Arteriosclerosis / atherosclerosis on Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569

Lacunar Stroke on Wikipedia

https://en.wikipedia.org/wiki/Lacunar_stroke

Lacunar Infarction and Small Vessel Disease: Pathology and Pathophysiology

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325635/

Effect of reducing blood pressure with medications immediately following ischemic stroke

https://medicalxpress.com/news/2013-11-effect-blood-pressure-medications-immediately.html

Blood Pressure-Lowering Treatment After Subacute Stroke to Prevent Recurrent Stroke, Major Vascular Events, and Dementia

https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.118.023087?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Higher Blood Pressure May Be Linked to Brain Disease, Alzheimer’s

https://www.rush.edu/news/press-releases/higher-blood-pressure-may-be-linked-brain-disease-alzheimers

Nirav  on LinkedIn

https://www.linkedin.com/in/nirav-h-shah/

Nirav at Swedish

https://www.swedish.org/swedish-physicians/profile.aspx?name=nirav+h+shah&id=271893

Nirav on Twitter

http://twitter.com/NeuroNirav

The Neurohospitalist

http://journals.sagepub.com/home/nho

Nirav’s Photography

www.thoughtpotential.com

'Hypertension has been known to be a problem for generations -- potentially the way back to the Greek era.' -- @neuronirav #stroke #hypertension Click To Tweet

Where do we go from here?

'And this is going to be probably one of the biggest thing we'll find out about hypertension in the next few years -- there's other evidence suggesting lowering the blood pressure could prevent Alzheimer's.' -- @neuronirav #stroke… Click To Tweet

Strokecast is the stroke podcast where a Gen X stroke survivor explores rehab, recovery, the frontiers of neuroscience and one-handed banana peeling by helping stroke survivors, caregivers, medical providers and stroke industry affiliates connect and share their stories.

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