Stroke is both a leading cause of disability and pre-COVID-19, was the fifth most
frequent cause of death, and according to the American Stroke Association, Americans
paid about $73.7 billion in 2010 for stroke-related medical costs and
The CDC and the American Stroke Association summarize the scope of the problem:
• Stroke kills more than 130,000 Americans each year—one out of every 19
• Every year, more than 795,000 people in the United States have a stroke.
• About 185,000 strokes—nearly one of four—are in people who have had a
• The lifetime risk of stroke in North America is 22.4%.
• About 87% of all strokes are ischemic strokes when blood flow to the brain is
The disabilities caused by a stroke can be devastating. A stroke can cause one or
several of five types of disabilities: paralysis or problems controlling movement,
sensory disturbances including pain, problems using or understanding language,
problems with thinking and memory, and emotional disturbances. Brain damage
caused by a stroke can include cognitive and sensory impairments, epilepsy, speech
or communication disorders, visual disturbances, poor attention, behavioral problems,
and poor quality of life.
High blood pressure also causes brain damage that is subtler than a stroke. A study
in the journal Lancet Neurology found that even among individuals in their 40s,
those with any degree of increased blood pressure had damage to the structural
integrity of the brain’s white matter and decreases in the volume of its gray matter,
injuries associated with cognitive decline. The study found that the amount of
brain injury worsened as blood pressure increased. Even the modestly increased
blood pressure of prehypertension causes brain damage that is likely to contribute
to cognitive decline and possibly eventually to dementia.
Because vascular brain injury develops insidiously over time, by knowing and treating their high blood
pressure at a young age, people can improve their late-life brain health. Because
high blood pressure causes cumulative damage over long periods of time, time-averaged
or “cumulative” BP is powerful predictors of coronary heart disease, heart
failure, stroke, and vascular dementia.
Several studies provide good evidence that elevated blood pressure in middle-life is
associated with reduced cognitive function at older ages. In one study,
participants, who were on average, 56 years old, were followed for 20 years. Prehypertension
or hypertension was present at baseline in 58% of white and 76% of
Black American study participants. Death was a major outcome related to having
hypertension at the first evaluation, with fewer than 50% of individuals with systolic
blood pressure (SBP) greater than 160 mm Hg surviving to an average age of
76 years. Of those who survived, there was a modest but significant association
between baseline SBP and the rate of cognitive decline. The higher the middle-life
SBP, the greater the rate of decline. Individuals receiving hypertension treatment
had substantially slower rates of cognitive decline compared with those who were
A source of brain damage made likely by chronic hypertension is a series of small
strokes that may not be easily recognized when they occur, but the resulting cumulative
brain damage can cause multi-infarct or vascular dementia, the second most
common cause of dementia after Alzheimer disease, and vascular damage to the brain may lead
to Alzheimer disease.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel