From the Guidelines
Blood pressure levels of 130/80 mmHg or higher significantly increase the risk of stroke, and maintaining blood pressure below this threshold is crucial for prevention. Consistently elevated blood pressure damages blood vessels over time, making them more prone to rupture or blockage, which can lead to both hemorrhagic and ischemic strokes. The risk increases progressively with higher blood pressure readings, with severe hypertension posing the greatest danger. According to the 2020 International Society of Hypertension global hypertension practice guidelines 1, hypertension is the most important risk factor for ischemic or hemorrhagic stroke, and blood pressure should be lowered if ≥140/90 mm Hg and treated to a target <130/80 mm Hg.
Some key points to consider in managing blood pressure to reduce stroke risk include:
- Lifestyle modifications such as reducing sodium intake, regular exercise, limiting alcohol, maintaining a healthy weight, and quitting smoking can help lower blood pressure 1.
- Medications such as RAS blockers, CCBs, and diuretics are first-line drugs for treating hypertension 1.
- Regular blood pressure monitoring is essential, especially for those with hypertension, diabetes, heart disease, or a family history of stroke.
- Even moderately elevated blood pressure can double or triple stroke risk when sustained over years, making consistent management crucial for prevention 1.
It's also important to note that the relationship between blood pressure and stroke risk is continuous, graded, and consistent, and that the higher the blood pressure, the greater the risk of stroke 1. Therefore, maintaining blood pressure below 130/80 mmHg is a critical component of stroke prevention, and individuals with elevated blood pressure should work with their healthcare provider to develop a plan to manage their blood pressure and reduce their risk of stroke.
From the FDA Drug Label
Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit The FDA drug label does not answer the question.
From the Research
Blood Pressure and Stroke Risk
The relationship between blood pressure and stroke risk is well-established, with higher blood pressure levels increasing the risk of stroke.
- A blood pressure of 115/75 mmHg is associated with minimal vascular mortality and is considered optimal 2.
- The risk of stroke increases continuously with blood pressure levels above 115/75 mmHg 3.
- Patients with prehypertensive blood pressure levels (120-139/80-89 mmHg) also have a higher incidence of stroke compared to those with normotensive blood pressure levels 4.
Blood Pressure Targets for Stroke Prevention
- A blood pressure target of under 140/90 mmHg is generally recommended for primary and secondary prevention of stroke 3.
- Lowering systolic blood pressure to less than 120 mmHg may be beneficial for patients with high cardiovascular risk, including those with diabetes or previous stroke, as it can prevent major vascular events 5.
- However, it is essential to consider the potential risks and benefits of aggressive blood pressure lowering, as it may increase the risk of adverse events such as syncope 5.
Risk Factors for Stroke at Normal Blood Pressure Levels
- Even at normal blood pressure levels, certain risk factors can increase the incidence of stroke, including: