From the Guidelines
Stress is a significant contributor to the risk of having a stroke, and managing stress is crucial to prevent stroke, as emphasized in the 2024 guideline for the primary prevention of stroke by the American Heart Association/American Stroke Association 1. The relationship between stress and stroke is complex, involving multiple pathways. Chronic stress can lead to elevated blood pressure, inflammation, and increased blood clotting, all of which are risk factors for stroke. During periods of intense stress, the body releases hormones like cortisol and adrenaline that raise blood pressure and heart rate, potentially triggering a stroke in vulnerable individuals. Key factors to manage stress and reduce stroke risk include:
- Practicing regular relaxation techniques like deep breathing, meditation, or yoga
- Maintaining physical activity with at least 150 minutes of moderate exercise weekly
- Ensuring adequate sleep of 7-8 hours nightly
- Eating a balanced diet rich in fruits, vegetables, and whole grains
- Limiting alcohol consumption
- Avoiding smoking As highlighted in the guideline, controlling blood pressure, cholesterol, and diabetes is also essential for stroke prevention 1. The importance of addressing stress as part of a comprehensive approach to stroke prevention cannot be overstated, given that more than half of stroke events could be prevented with better implementation of known strategies for risk factor control, including stress management 1.
From the Research
Relationship Between Stress and Stroke
- Stress can increase the risk of stroke by modulating sympatheticomimetic activity, affecting blood pressure reactivity, cerebral endothelium, coagulation, or heart rhythm 2.
- The relationship between emotional stress and stroke risk is complex, and several potential mechanisms are discussed as the cause, including the impact of stress on blood pressure and the cerebrovascular system 2, 3.
Impact of Stress on the Cerebrovasculature
- Psychological stress is known to be an important risk factor for essential hypertension, and acute stress can induce transient elevations of blood pressure in the context of the fight-or-flight response 3.
- Chronic stress may lead to impaired auto-regulation, regional vascular remodeling, and breakdown of the blood-brain barrier (BBB), which can increase the risk of stroke 3.
Prevention and Treatment of Stroke
- Antihypertensive therapy, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and beta-blockers, can help reduce the risk of stroke by lowering blood pressure and providing cardioprotective effects 4, 5, 6.
- The selection of antihypertensive therapies should be based on the presence of concomitant cardiovascular and metabolic conditions, as well as patient-specific factors such as race 6.