Rise In Strokes As Boomers Age: Single most important risk factor for stroke is high blood pressure

Greg Albers, MD, director of the Stanford Stroke Center, said lifestyle changes, such as exercise, diet and smoking cessation, can help reduce blood pressure -- and help minimize the risk of stroke.

Though new drugs and other strategies are helping to prevent strokes, the number of people who experience this potentially debilitating condition is likely to increase as the population ages, according to Greg Albers, MD, director of the Stanford Stroke Center, one of the country's first comprehensive stroke centers.

New medications, better control of high blood pressure and cholesterol, and the decline in smoking all have contributed to prevention of strokes, which occur when blood flow to the brain is interrupted, Albers said. At the same time, however, more than half of the people at risk for stroke still aren't being treated at all or not aggressively enough. Those factors, together with the aging of the population, are likely to contribute to a growing prevalence of the condition, he said.

"We're forecasting a dramatic increase in stroke over the next couple of decades because of the baby boomers aging," said Albers, professor of neurology and neurological sciences.

Stroke Facts

A stroke occurs when blood vessels carrying oxygen and other nutrients to a specific part of the brain suddenly burst or become blocked. When blood fails to get through, the oxygen supply to the affected part of the brain is cut off and brain cells begin to die.

More than 750,000 Americans have a stroke in any given year. Stroke is the No. 1 cause of adult disability.

Warning signs of stroke:

• Sudden weakness, numbness or paralysis of the face, arm or leg, especially on one side of the body
• Loss of speech, or trouble talking or understanding language
• Sudden loss of vision, particularly in only one eye
• Sudden, severe headache with no apparent cause
• Unexplained dizziness, loss of balance or coordination, especially if associated with any of the above symptoms

Figure: Pressure exerted by blood

If you or someone you know experiences any of the warning signs, seek emergency help right away. Call 911 immediately even if you think that you are getting better or if the symptoms seem to disappear. If the symptoms last for more than 10 to 15 minutes, appear frequently or seem to get worse, ask the emergency responders for urgent transportation to the nearest appropriate medical facility.

The single most important risk factor for stroke is high blood pressure. Fewer than half of people who have high blood pressure fail to control it adequately, Albers said. The most recent standards of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure call for intervention when an individual's blood pressure is greater than 120/80. Albers advises people with high blood pressure to use home monitors regularly to ensure that their pressure remains within this range.

"One blood pressure reading doesn't mean very much," he said. "And many people have higher blood pressure readings when they are in a doctor's office."

High blood pressure may be lowered through lifestyle changes such as exercise, diet and smoking cessation, but success is more likely through treatment with antihypertensive medications, according to Albers.

"High blood pressure can almost always be controlled by medications if they're used properly," he said. "They need to be monitored on a regular basis. I recommend that people taking these medications be checked by their doctors every three to six months if their blood pressure is stable, and more frequently if their blood pressure is not under control or if they're suffering from medication side effects."

Albers said the outlook is greatly improved for people who have strokes if they receive treatment with the clot-busting drug tPA (tissue plasminogen activator) within three hours after symptoms occur. Stanford researchers have found that the tPA "window" may extend up to six hours in some patients, but sophisticated images of the brain are needed to determine which patients are most likely to benefit. Stanford is one of the few places in the world that has the technology to generate sophisticated blood flow "maps" of the brain rapidly.

"Our biggest problem continues to be that most stroke patients do not arrive soon enough to be eligible for our emergency therapies," said Albers.

The stroke center brings together physicians from multiple specialties, including neurology, neurosurgery, neuroradiology, internal medicine and emergency medicine. The stroke center also has recently started a specialized clinic to treat people who have mini-strokes called transient ischemic attacks (TIAs), which are temporary interruptions in the brain's blood supply. The symptoms are the same as for stroke, but tend to disappear quickly and completely. They can be warning signs of pending stroke, so patients with TIA need to be evaluated in the emergency room. More than half of these patients are currently being managed without being admitted to the hospital.

For more information about Stanford's Stroke Center, please visit http://strokecenter.stanford.edu/ or call (650) 723-4448.