Episode 047 -- How High Blood Pressure Causes Stroke


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.

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

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.



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.




C. Miller Fisher on Wikipedia


C. Miller Fisher On AHA Journals


Atherosclerosis on WebMD


Arteriosclerosis / atherosclerosis on Mayo Clinic


Lacunar Stroke on Wikipedia


Lacunar Infarction and Small Vessel Disease: Pathology and Pathophysiology


Effect of reducing blood pressure with medications immediately following ischemic stroke


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


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


Nirav  on LinkedIn


Nirav at Swedish


Nirav on Twitter


The Neurohospitalist


Nirav’s Photography


Where do we go from here?


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.

Here is the latest episode of The Strokecast

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