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Being dead would not be so bad. Some say it will be a bright light guiding. Some think it will be all darkness. Some believe in a heaven filled with glory and loved ones. Some believe in a hell filled with fire and brimstone. Some believe there is nothingness, no psyche, no soul. Whatever it is, it would have to be better than this. To be trapped in a non-responsive body, fully aware, seeing and hearing everything, yet unable to respond; this must be worse than death.
No one really knows how long it has been called the “silent-killer.” It is known to be more of a problem now than ever in recorded history. Maybe it is because people are aging longer. Maybe it is because people tend more to obesity. Maybe we just know more about it. Maybe people tend to brush off the symptoms because they just seem like normal health issues.

The American Society of Hypertension, Inc. (ASH) is a government sanctioned not-for-profit organization dedicated to the public knowledge of this insidious disease. They produce a pamphlet that defines blood pressure as “the force of blood moving through arteries.” Hypertension, also known as high blood pressure, is compared to driving on a tire with too much air in it. The tire itself wears out faster than with normal pressure. In the human body, not only the arteries will feel the pressure, but the eyes, brain, heart, and kidneys.

One of the most prevalent concerns for the person with high blood pressure is the increased risk of stroke. Some strokes are caused by tiny weak spots in blood vessels in the brain or clots blocking small blood vessels (ASH). These mini-strokes are more formally called Transient Ischemic Attacks (TIA). A report conducted by the School of Medicine at Mount Sinai Hospital in New York details the concerns about these mini-strokes as harbingers for severe strokes. “A transient ischemic attack is a reversible neurologic deficit that occurs when an area of the brain is temporarily denied adequate perfusion” is the formal definition of this event. While hypertension is a factor in all TIAs, there are underlying factors that cause the hypertension and those must be addressed. If the carotid artery is clogged or overly stiffened (stenosis), then the artery must be cleaned, repaired, or replaced. If the patient has a tendency toward Atrial Fibrillation (A-Fib), the anti-coagulants will be needed.

The hypertension must be treated nonetheless. Some patients may not have any symptoms, hence the name “silent killer.” Others have headaches, blurred vision, dizziness upon standing, or a reaction to certain food types. A good example of this is salt. Some people are more sensitive to salt, particularly as they age, and blood pressure may rise markedly whenever salt is consumed. For some people, a few sips of a caffeinated beverage are all it takes to get the heart racing, and the blood pressure stirring. For other people, stress is the factor. While it is idiomatic to say that getting angry raises the pressure, like most idioms, there is an element of truth. Other factors are age, weight, smoking, diabetes, ethnicity, and familial heritage. That is to say that some people simply inherit the tendency along with blue eyes or brown hair.

Stroke has many meanings. The generalized meanings are those related to the comforting movement of the hand, or word (OED). However, Medline, which is a defining online publication of the National Institute of Health Medical Library defines hemorrhagic stroke as “a blood vessel that breaks and leaks into the brain” (NIH). The most important thing about a stroke is to recognize the symptoms for early treatment that will lead to early response.

Since the National Institute of Health (NIH) has oversight for the issue, their list of symptoms is the foundational one. The symptoms of stroke are distinct because they happen quickly:

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause (NIH)

The National Stroke Association suggests the acronym FAST be applied for a quick symptom check. Ask the person to smile and see if one side of the Face drops. Ask the person to raise both Arms and see if one drifts downward. Ask the person to Speak some simple sentence and hear is speech is slurred. Check and not the time—tell someone immediately.

The consequences of stroke can be mild, but they can be severe. After a TIA, the patient will have to address the causes, but may not have any ongoing issues. After a stroke, there are likely to be problems. The problems and the severity of them depend on the area of the stroke, the severity of the stroke, and the time delay until treatment of the stroke. Some of the issues may be communication related—stroke victims may have trouble speaking clearly or at all. They may not be able to read or write as they could before the stroke. Stroke victims may have issues with mobility—they may be off balance, or unable to grasp and hold things. Some stroke victims deal with depression or sexuality issues (NIH). The sudden disability of a previously healthy person is traumatic to the whole family. The best way to not have this trauma is to reduce the risk of stroke.

The number one way to reduce the risk of stroke is to lower blood pressure. Quick after that are guidelines of general health—manage diabetes and quit smoking, exercise daily and eat properly (NIH). Of course, because high blood pressure frequently has no symptoms, the first step is awareness, with education a quick second step, and action a quick third. This means that everyone should get a blood pressure check.

A blood pressure check is easy and painless. There are machines at every health clinic and fire department, and in many grocery stores and pharmacies. The reading will come in three pieces. The top number is the systolic pressure, when blood is being pushed out along the artery—generally, that number should be around or below 120. The bottom number is diastolic pressure, when the blood is flowing into the space in the artery. That number should be around or below 80. When the numbers start creeping up around and over 140/90, it is time to start taking action (NIH). The third number generally given is pulse. How many times per minute the heart beats, or pulses, varies widely from person to person and is also dependent of the actions of the person.

When taking a blood pressure reading, wait at least two hours after extended rest. Sit quietly for five minutes or so before taking the reading. Do not eat, talk, or drink while taking the reading. Sit up straight with both feet flat on the floor. If the reading seems particularly high or low, wait five minutes and adjust the cuff before taking another reading (NIH).

A Human Press medical school textbook series on Clinical Hypertension and Vascular Diseases has a book called Hypertension in the Elderly by Dr. L. Michael Prisant. Chapter 14 of that text details information about “Cerebrovascular Disease in the Elderly Hypertensive.” The book was published in 2005, and in it Dr. Prisant presents that in 1997, stroke was the number three cause of death in the United States, behind heart disease and cancer. The National Center for Health Statistics (NCHS) provides that data for 2007 as unchanged.

Dr. Prisant also explains that the risks for stroke doubles every ten years after age 55. Smoking doubles the risk, and those with diabetes and high blood pressure are three to six times as likely to have a stoke. The point he makes most clearly is that Hypertension is a major risk factor for all types of stroke and is the single most modifiable variable for stroke prevention”. Further evidence he provides shows that not only are these groups more likely to have strokes, the strokes are more likely to be severe. Probably the most remarkable thing in Dr. Prisant’s book is where every section defining the variety of stroke patterns leads with “hypertension is the most common cause of …”

The awareness of one’s own blood pressure lets one know if it is comfortably and routinely below 120/80 or, if above, that it is time to start watching it more regularly. The education of the consequence should be enough to spur one on to that third step, action.

Lifestyles are not easy things to change. People, as a general rule, seem to like their ruts. For good or for ill, people fear the unknown, and experience stress with every change. Even knowing change is for the positive, it is still hard. “Lifestyle change may involve the discontinuation of unhealthy behaviors (eg, stopping smoking), the modification of unhealthy behaviors (e.g., reducing dietary fat intake or decreasing sedentary behavior), or the initiation of healthy behaviors (e.g., beginning an exercise regimen)”.

“Research has demonstrated that lifestyle change is multi-determined and related to a variety of factors, including social, psychological, cultural, and environmental factors, but some of the most powerful predictors of health behavior are individual factors”. Their research also details interesting facts, like women are more likely to eat better, while men are more likely to increase exercise toward the same goal of better fitness. The fundamental key seems to be a reinforcement of the desired behavior. If the patient does not feel reinforced in the new behavior, where comfort is not as likely, slipping into former, more comfortable behavior is a huge risk, and it has huge consequences.

Change in life is accepted better when accessed gradually. It is startling to see how much a friend’s child has grown, when not routinely visited. It is troubling to visit a dear friend after a long time and see how much the friend has aged. The daily changes of life are accepted and adapted to with a certain element of ease. Still, with monitoring, hypertension can be caught early enough that gradual and minor changes can bring pressures back into the normal range. Medications vary greatly in usage and costs, but can be extremely effective. After the sudden onset of a stroke, and all the repercussions, drastic change may be required.

Stroke patients, like many patients of critical illness, will often feel betrayed by their own body. Here is part of the challenge of the “silent killer.” Lack of symptoms may make patients unaware. The realities of aging have been known to creep up on many people. It takes a little longer to do things. Arms reach a little farther to see things. More items are lost. Bending and lifting are harder. These are all natural parts of aging. For patients with high blood pressure, these minor changes will be overwhelmed should a hemorrhagic stroke occur. Instead of having to pause a moment on rising from sitting that stroke patient may not be able to rise or walk. Instead of carrying a little less that stroke patient may not be able to grasp hold of anything. Instead of having to consider words and speak a little louder the stroke patient may not be able to speak. Probably the most common comment about the stroke patient is, “She was fine earlier in the week!” That is because her blood pressure was not a known problem.

Once aware of the risks, and of one’s own pressure, one can be educated about the consequences of not treating hypertension. Also, one can learn about the methods of care and treatment to control hypertension and prevent stroke. Then, one must act! With every bite, every sip, every opportunity, comes a choice. Laze around, drinking high calorie caffeinated beverages or alcohol and eating high fat salty foods, or get up and move. Food is choice. Action is choice. Life is a choice.

For someone who has had a stroke, action may not be an option. To lie in bed, awaiting care, unable to talk, unable to move is not choice. To be trapped in a non-responsive body, fully aware, seeing and hearing everything, yet unable to respond, this must be worse than death.

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