Harvard Men's Health Watch

Your stroke prevention action plan

You get the most bang for your buck from keeping blood pressure in the normal range, but don't skip the other things.

Many tasks are required to run a household. There are groceries to shop for, broken things to fix, and windows to wash. But you need to prioritize: it makes no sense to worry about the weeds in the garden if the mortgage payment is overdue.

The same goes for preventing stroke, which is a top concern for men—and with good reason. After a major stroke, survivors may face extended rehabilitation and permanent disability. The best medicine for stroke is prevention.

The first item on your stroke prevention checklist should be keeping blood pressure in the normal range. "There's no question that out of all the risk factors, high blood pressure is the biggest perpetrator," says Dr. Vasileios-Arsenios.

Lioutas, a neurologist at Harvard-affiliated Beth Israel Deaconess Medical Center. "It's the one that causes the most illness and death from strokes, and so you get the greatest return on your investment by controlling it."

Stroke and blood pressure

High blood pressure (hypertension) is called the silent killer because you don't feel its effects directly. But over the years, the "silent" effects of persistent high blood pressure grow louder. Eventually, hypertension damages not just the blood vessels themselves, but also the heart, brain, kidneys, and eyes.

In the brain, arteries weakened by hypertension may rupture and cause bleeding (a hemorrhagic stroke). Or, fatty deposits in the arteries may break open, triggering a clot that blocks blood flow (an ischemic stroke). Brain cells then die from lack of oxygen.

Priority one in a stroke prevention strategy is knowing your blood pressure and taking steps to keep it under control. It takes multiple blood pressure measurements over time to really be sure you have high blood pressure, and home monitoring can help.

A pressure above 140/90 millimeters of mercury (mm Hg) is considered high and in need of treatment. The target pressure depends on individual factors, but in general the lower the better.

Medication plays a central role in maintaining healthy blood pressure, though how much you need and at what pressure to begin taking it is an individualized decision. Inadequate drug therapy—because you either are not being prescribed enough medication or are not taking it as directed—is often at the root of uncontrolled hypertension.

See the big picture

"Start with blood pressure" doesn't mean "forget the rest." It's important to take a 360-degree view of cardiovascular health and keep the many and varied risk factors for stroke in perspective.

Men often hear that stress, working long hours, lack of restful sleep, and not getting enough of this or that nutrient is associated with greater risk of stroke. All true. But which factors should you pay attention to?

Focus on the basics. Besides blood pressure, getting regular exercise should be high on your stroke prevention plan. Recent studies show that just taking a moderately intense daily walk can measurably lower the risk of stroke. "Exercise is like a medication in many ways," Dr. Lioutas says. "It helps your blood vessels to function better and, as a result, it helps your brain."

Eating a heart-healthy diet counts, too. There is good evidence that a plant-based diet, with minimal amounts of red meat and sweets and moderate amounts of dairy foods, helps prevent strokes. This includes capping daily sodium intake at 2,300 milligrams or lower.

Stroke prevention steps also lower the risk of heart attacks. The major difference is the consequences, because stroke can have particularly devastating effects. "Once a stroke happens, it's a very loud bell that has been rung," Dr. Lioutas says. Don't wait for the bell to toll before taking action on high blood pressure.

6-point stroke prevention plan

  1. Keep your blood pressure under control. The ideal for healthy adults is 120/80 millimeters of mercury. If you have high blood pressure, work with your doctor to reach your treatment goal.
  2. Exercise moderately for at least 150 minutes a week (ideally 30 minutes a day, five days per week). Leisure activities and chores count, too.
  3. Eat a nutritious plant-based diet. You can include occasional lean red meat, fish at least two times a week, and skinless poultry.
  4. Keep your cholesterol within norms. Take a cholesterol-lowering statin drug if your doctor recommends it.
  5. Don't consume more than two standard alcoholic drinks per day. A standard drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80-proof liquor.
  6. Don't smoke—or quit if you do.

Learn more about our
health content.