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You can try your hand at Past Puzzlers, too!
The Scenario:
As a young man, Franz knew that his father took medications for high blood pressure. However, his father was not a very conscientious patient. He was an independent-minded person, ran his own business, and didn't like taking pills. Many days he just went without his pills, so that as a result, his blood pressure was never very well controlled.
That didn't seem to be such a big deal, until one day disaster struck. While working out in the garden one weekend, his father was struck down by a massive stroke, never to fully recover. The memory of that day haunted Franz for life.
As he grew older, Franz would occasionally have his blood pressure checked. It varied, of course, but tended to run slightly high: in the 150/95 range. His doctor talked to him about diet, exercise, and so forth, but didn't think he needed any medication.
Recently, Franz has begun to have headaches. They are located in the forehead region as well as the back of his head, and tend to get worse as the day wears on. One day, for no particular reason, his headache became quite severe. He called his doctor, but the doctor was out of the office that day. His big fear was that it might be his blood pressure, and that he might be about to have a stroke.
Questions:
Answer:
This puzzler gets at the question of how blood pressure, headaches, and stroke relate to one another.
First, as most people know, high blood pressure is a risk factor for stroke. It's easy to appreciate that if the pressure being contained within one's blood vessels is very high, then over time there is a chance one will burst. For some reason, the brain is particularly prone to this. That's not to say that blood vessels won't break or leak elsewhere in the body. But due to the nature and structure of the nervous system, a little bleeding in the brain often causes dramatic symptoms. If you recall your last physical exam, your doctor probably looked into your eyes with a light. This is done partly to look for evidence of tiny hemorrhages and other changes in the blood vessels in the back of the eye (the retina) that indicate a higher risk for complications from hypertension.
How high does the pressure have to be before the risk of a hemorrhage begins to increase? Without getting into lots of statistics, a simple way of answering this is to point out simply that the higher one's blood pressure, and the longer the period of time that the pressure is elevated, the higher the risk of stroke. Someone with a blood pressure of 230/130 (this really does happen) is at high risk of a hemorrhage right now and needs to be treated urgently to get the blood pressure down. On the other hand, someone with a pressure of 160/95 may have a slight increased risk of stroke over the next couple of decades, but in the absence of other medical problems, does not need urgent treatment. It is safe to watch this person while he or she tries to lower their pressure by losing weight if obese, reducing salt intake, exercising, reducing alcohol intake if they drink a lot, and possibly increasing dietary potassium and calcium. The goal for most people is to keep their average blood pressure below 140/90.
Are Franz's headaches related to high blood pressure, and might they be a warning he's about to have a stroke? I think not. First, contrary to popular belief, headaches are rarely caused by hypertension. For example, many people with quite severe hypertension do not have headaches. That is why it is called "the silent killer." Also, it is important to know that headaches, in most instances, are not a sign that you are about to have a stroke. When a stroke occurs, it is usually right out of the blue, with no warning. Even after the stroke has become evident, the person does not usually have a headache. Although not diagnostic by itself, the location of Franz's headaches is typical of a "tension headache." It is not likely to have any relationship to his blood pressure. There are, of course, other types of headaches, and other potentially serious problems that may cause headaches. Many people who answered the Puzzler were aware of these, suggesting the possibility of migraine headaches, a leaking brain aneurysm, or even a brain tumor.
On a practical level, I would suggest that Franz be seen by a doctor the same day, primarily because he has a new and changing headache that needs to be evaluated. His blood pressure can be followed up more routinely, but should definitely not be ignored or forgotten.
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