Beware of the leading cause of stroke: In-depth analysis of the pathological relationship of hypertension and screening of eight vulnerable groups.

Chapter 3 Sub-health is the Root Cause of Hypertension and Stroke Section 1 my country's Stroke Incidence and Mortality Rates Rank Highest in the World I. Hypertension is the Leading Cause of Stroke Due to inadequate prevention and treatment of hypertension, my country has the highest stroke incidence and mortality rates in the world. Data from the Chinese Medical Association shows that while the incidence and mortality rates of stroke have significantly decreased in developed countries worldwide, they are on the rise in my country. Hypertension is the most important risk factor for stroke. According to statistics from the Ministry of Health in 2002, there were 160 million people with hypertension in my country. However, most patients do not consider hypertension a serious health problem. On the physician side, as many as 30% of doctors are unaware that controlling blood pressure can prevent the vast majority of first-time strokes, and many physicians do not provide effective drug treatment to patients according to the standards recommended by medical organizations such as the International Hypertension Association or the content stipulated in the "Guidelines for the Prevention and Treatment of Hypertension in my country." Therefore, relevant departments convened 12 authoritative experts in the fields of cardiology and neurology in Beijing to reach a consensus on measures for treating hypertension and preventing stroke through evidence-based medicine. Professor Liu Lisheng, Department of Cardiovascular Medicine, Beijing Fuwai Cardiovascular Hospital, clearly points out that in my country, the most effective way to reduce the incidence of stroke is to control hypertension. This is also the most important and controllable factor in preventing stroke. Strokes often occur suddenly, and hypertensive patients should be aware of some early warning signs. These signs include: very high and difficult-to-control blood pressure; dizziness, headache, nausea, and vomiting; numbness in the hands and feet, and weakness in limb movement. If any of these symptoms occur, seek medical attention immediately. Professor Liu particularly emphasizes that all adults over 18 years of age should have their blood pressure measured 1-2 times a year to allow for timely intervention after a diagnosis of hypertension. This is because in my country, 70% of hypertensive patients are unaware of their condition.

II. Hypertension is a major culprit in stroke. Hypertension is closely related to stroke. Numerous studies have shown that hypertension can damage the arterial endothelium, causing arteriosclerosis and accelerating its progression. The most commonly affected blood vessels are the coronary arteries and cerebral arteries, leading to coronary atherosclerosis and cerebral arteriosclerosis, ultimately resulting in coronary heart disease and stroke. In my country, the main outcome of hypertension is stroke, with an incidence rate five times that of myocardial infarction. Hypertension is the most important risk factor for stroke. The occurrence of stroke is closely related to the degree and duration of hypertension. The higher the blood pressure and the longer it is not effectively controlled, the more likely it is to cause cerebral arteriosclerosis, narrowing or occlusion of the lumen. Therefore, hypertension is a major cause of cerebral infarction (ischemic stroke). Because hypertension can cause microaneurysms to rupture and bleed in certain weak areas of cerebral blood vessels, hypertension is also a major cause of cerebral hemorrhage. In my country, stroke is a major cause of disability and death, and hypertensive patients are three times more likely to develop stroke than those with normal blood pressure. A 1991 sample survey of 30 provinces and municipalities in my country showed that the prevalence of hypertension and the surviving stroke prevalence were almost parallel in all regions. The annual incidence rate was 120–180/100,000, and the mortality rate was 60–120/100,000. The lower the blood pressure, the lower the relative risk of stroke; there was no hypotension threshold that increased the risk of stroke. Even within the normal blood pressure range, blood pressure levels and the relative risk of stroke showed a linear positive correlation, and the degree of correlation was not significantly different from that in cases of hypertension. The relationship between blood pressure levels and the relative risk of stroke did not differ between men and women. In recent years, more attention has been paid to the role of systolic blood pressure and pulse pressure in the relationship between blood pressure levels and stroke. The Copenhagen Study, published in 1997, observed the risk of stroke at different blood pressure levels over a 10-12 year follow-up period. It found that systolic blood pressure and pulse pressure significantly determined stroke risk; the relative risk of stroke was 3-4 times higher in individuals with a pulse pressure >80 mmHg than in those with a pulse pressure <50 mmHg. The relative risk of stroke in individuals with isolated diastolic hypertension and normal systolic blood pressure was almost the same as in those with normal blood pressure. In patients who had already experienced a stroke, blood pressure levels showed a continuous positive correlation with the occurrence of recurrent stroke. Clinical trials have demonstrated that in individuals with isolated systolic hypertension, the incidence of cerebral infarction is significantly increased when blood pressure exceeds 160 mmHg. The incidence of cerebral infarction in hypertensive patients is twice that of those with normal blood pressure. In elderly individuals with isolated systolic hypertension (above 160 mmHg), effective blood pressure reduction resulted in a 25% reduction in the incidence of coronary heart disease, a 36% reduction in the incidence of stroke, and a 50% reduction in the incidence of heart failure. Coronary heart disease and heart failure are also risk factors for stroke. Effective antihypertensive treatment can reduce the incidence of all types of stroke by 38% and the stroke mortality rate by 58%. For every 10 mmHg increase in 24-hour average blood pressure, the risk of cerebrovascular events increases by 42%. Studies on hypertension in the elderly aged 65-74 years show that effective hypertension treatment reduces the overall incidence of cardiovascular and cerebrovascular diseases by 70%. It is estimated that in my country, a reduction of 9 mmHg in systolic blood pressure or 5 mmHg in diastolic blood pressure can prevent 450,000 stroke deaths annually. The reduction in stroke after antihypertensive treatment is mainly due to the reduction in blood pressure itself, and is unrelated to the type of antihypertensive medication used. In my country, the treatment rate and blood pressure control rate of hypertension are very low. The first priority should be to promote the use of inexpensive antihypertensive drugs to significantly increase the treatment rate, and then gradually improve the control rate, especially among high-risk patients prone to stroke. Health education and health promotion can improve lifestyle behaviors and lower the average blood pressure level of the entire population, including those with normal blood pressure.

III. Warning Signs of Stroke in Hypertensive Patients Before a stroke occurs, several abnormal signs often appear. These signs are generally referred to as "stroke warning symptoms." Common stroke warning symptoms include: (1) Dizziness, especially sudden vertigo; (2) Numbness in one limb or only in the upper limb, which may be accompanied by numbness in one side of the face or tongue; (3) Sudden worsening of headache, changing from intermittent to persistent; (4) Sudden, brief weakness, difficulty in movement, unsteady gait, or abnormal gait in one limb; (5) Brief slurred speech, unclear pronunciation, and sometimes drooling; (6) Brief loss of consciousness or sudden changes in personality and intelligence, such as taciturnity, talkativeness, irritability, or impaired judgment; (7) Sudden blurred vision or temporary blindness or double vision, which may recover within a short period; (8) Drowsiness, lethargy, and listlessness throughout the day. Hypertensive patients experiencing the above signs should seek medical attention promptly and receive proper diagnosis and treatment under the guidance of a doctor.

Section 2 The Relationship Between Hypertension and Stroke I. Stroke is the common name for cerebrovascular accident. Stroke is divided into two categories: ischemic and hemorrhagic. The former is further divided into cerebral infarction and cerebral embolism based on the different mechanisms of ischemia, while the latter is divided into cerebral hemorrhage and subarachnoid hemorrhage based on the different locations of hemorrhage. The clinical manifestations of stroke are diverse, commonly including unilateral limb paralysis, unexplained falls, diplopia, blurred vision in one eye, slurred speech, and sensory disturbances. In rare cases, these manifestations may not appear, only drowsiness and involuntary movement of one side of the body. Multiple small infarcts may only present with significant memory loss, getting lost, and dementia. There are often precipitating factors before the onset of stroke, such as overexertion, emotional excitement, irregular diet, excessive exertion, excessive exercise, climate change, changes in body position, and disease factors. These precipitating factors are almost all related to fluctuations in blood pressure and arteriosclerosis. Any cause that can affect blood pressure fluctuations or changes in cerebral blood supply can be a precipitating factor for stroke. Some patients may experience transient ischemic attacks (TIAs) before the onset of stroke, which is an important warning sign of cerebral infarction. It often manifests as transient unilateral or unilateral limb weakness or numbness, lasting from several minutes to several hours, but not exceeding 24 hours. Sometimes it may present as monocular blindness, aphasia, dizziness, and unsteadiness, or sudden weakness in both lower limbs leading to a fall, which recovers quickly. TIAs indicate the severity of systemic atherosclerosis; without treatment, one-third of patients will develop cerebral infarction within the next few years. Hypertension is the leading risk factor for stroke. Statistics show that 76.5% of stroke cases have a history of hypertension. Unlike coronary heart disease, the main complication of hypertension in most Western countries, in my country, the main complication of hypertension is stroke, which is five times more likely to occur than myocardial infarction. Hypertensive patients are six times more likely to experience stroke than those with normal blood pressure. The occurrence and prognosis of stroke are closely related to the degree and duration of hypertension. Studies have found that, except for subarachnoid hemorrhage, patients with cerebral hemorrhage almost always have hypertension, and their blood pressure levels are high, often above 180/110 mmHg. Patients with ischemic stroke often have cerebral arteriosclerosis, but not necessarily hypertension. Of course, the occurrence of arteriosclerosis is related to hypertension. Those with hypertension, especially those with predominantly systolic hypertension or isolated systolic hypertension, are more prone to ischemic stroke, particularly the elderly, whose stroke mortality rate is also higher than other types of hypertension.

II. The Relationship Between Hypertension and Stroke Numerous studies have shown that hypertension can damage the arterial endothelium, leading to arteriosclerosis and accelerating its progression. The most common harms caused by arteriosclerosis due to elevated blood pressure are coronary atherosclerosis and cerebral arteriosclerosis, resulting in coronary heart disease and stroke. In my country, the main outcome of hypertension is stroke, with an incidence rate five times that of myocardial infarction. The occurrence of stroke is closely related to the degree and duration of hypertension; that is, the higher the blood pressure and the longer it is not effectively controlled, the greater the risk of cerebral infarction. Clinical trials have demonstrated that in individuals with isolated systolic hypertension, the incidence of cerebral infarction significantly increases when blood pressure exceeds 160 mmHg. One group of men over 65 years of age with isolated systolic hypertension had a stroke incidence rate twice as high as those with normal blood pressure. Clinical experiments have also confirmed that for every 7.5 mmHg increase in diastolic blood pressure, the incidence of stroke doubles. Furthermore, numerous clinical trials have also confirmed that if blood pressure is effectively controlled, the incidence of stroke can be significantly reduced. In elderly patients with isolated systolic hypertension (above 160 mmHg), effective blood pressure reduction can decrease the incidence of coronary heart disease by 25%, stroke by 36%, and heart failure by 50%. Studies on hypertension in individuals aged 65-74 years have shown that effective hypertension treatment can reduce the overall incidence of cardiovascular and cerebrovascular diseases by 70%.

III. Which Hypertensive Patients Are Prone to Stroke? The risk of disability and death from stroke terrifies many patients. Stroke is cerebrovascular accident, including cerebral infarction and cerebral hemorrhage. Which hypertensive patients are prone to stroke? (1) Those with excessively high blood pressure. The stroke rate of hypertensive patients is 5 times that of non-hypertensive patients, and it is directly proportional to the degree of blood pressure. The higher the blood pressure, the higher the stroke rate. (2) Those with large pulse pressure. Pulse pressure is the difference between systolic and diastolic blood pressure. A large pulse pressure indicates that the patient's large blood vessels have poor elasticity, the vascular endothelial function is easily damaged, and the tolerance to high blood pressure indicators is poor. Such patients are more prone to cardiovascular and cerebrovascular diseases. Statistics show that those with a pulse pressure ≥6.0 kPa (45 mmHg) have a 5 times higher risk of stroke than those with a pulse pressure <6.0 kPa. (3) Those with excessively fluctuating blood pressure. Such as those whose blood pressure suddenly rises, or whose blood pressure fluctuates too much within a day due to short-acting antihypertensive drugs. The blood vessel wall is like a seawall. A rise in blood pressure is like the rising tide, and a fall in blood pressure is like the receding tide. The damage to the blood vessel wall caused by large fluctuations in blood pressure is like the damage caused by the impact of the rising and receding tides on the seawall. From a mechanical point of view, large fluctuations in blood pressure are more damaging to the blood vessel wall than high blood pressure with small fluctuations. (4) Hypertension at night and in the early morning. In recent years, experts from various countries have found through a large number of clinical studies that the incidence of stroke is twice as high in people with hypertension at night and in the early morning compared to those with hypertension only during the day. How do you know your blood pressure values ​​at night and in the early morning? Usually, the measurement methods we use can only be used during the day. To know the situation at night and in the early morning, we must use a 24-hour blood pressure monitor to dynamically monitor the patient's blood pressure, accurately record the values ​​and fluctuations of the examinee's blood pressure over 24 hours, as well as the heart rate and fluctuations, so as to judge the risk of stroke in the patient. (5) People with carotid artery atherosclerosis. Atherosclerosis of the carotid artery can reliably reflect the degree of hardening of the cardiovascular and cerebrovascular systems. Those with a carotid intima-media thickness ≥0.9 mm or atherosclerotic plaques in the carotid artery have an extremely high risk of stroke. Therefore, the examination of whether or not carotid artery atherosclerosis exists is of great significance. Through examination, once a hypertensive patient is found to have obvious carotid artery hardening, active and effective treatment can effectively prevent cerebrovascular stroke. (6) Those with a family history of early-onset stroke. Hypertensive patients whose father had a stroke before the age of 65 or whose mother had a stroke before the age of 55 are themselves high-risk individuals with a genetic predisposition to stroke. (7) Smokers. Hypertensive patients who smoke have a 4 times higher risk of stroke than non-smokers, so hypertensive patients must quit smoking. (8) Hypertensive patients with hyperglycemia. Hypertension and diabetes are both risk factors for stroke. For example, people with hypertension and diabetes have a 3 times higher risk of stroke than those with hypertension alone. Studies have found that the incidence of carotid atherosclerotic plaques in people with hypertension and diabetes is 6 times higher than in those with hypertension alone, and the incidence of stroke is 2.8 times higher. Therefore, people with hypertension should also be checked for diabetes. (9) People with hypertension and hyperlipidemia. Hypertension and hyperlipidemia are both risk factors for stroke. If a person has both hypertension and hyperlipidemia, the risk of stroke is greatly increased, especially the risk of cerebral infarction. Once a hypertensive patient finds that he or she is prone to stroke, he or she should not panic. As long as he or she seeks medical treatment actively and receives regular antihypertensive, hypoglycemic, and lipid-lowering treatments and effective drugs to protect the vascular endothelium, he or she can live as healthily and long-lived as other hypertensive patients.