The Double Whammy of High Blood Pressure and Afib for Stroke

When we discuss potential consequences of cardiovascular issues, the risk of stroke is high on the list. Stroke occurs when small blood clots from the cardiovascular system, or pieces of plaque from the arteries, enter the brain and block its tiny blood vessels. The part of the brain fed by the blocked blood vessel rapidly begins to die.

In my electrophysiology practice, one of the most important parts of treating cardiac arrhythmias especially atrial fibrillation or Afib is the prevention of stroke. Patients with Afib have a five times greater risk of stroke, not to mention a higher risk of heart attack and heart failure as well. We use technologies such as radiofrequency catheter ablation and cryoablation to address many treatable arrhythmias. We also use left atrial appendage occlusion devices such as the Watchman to seal blood clots in the heart, minimizing the risk that they travel to the brain.

High blood pressure, however, adds to this overall risk. A recent study from early 2021 in the European Journal of Preventive Cardiology added even more credence to what we know – high blood pressure can cause Afib. However, high blood pressure creates the colloquial “double whammy” because the condition itself, independent of Afib, can also increase the risk of stroke as well as other cardiovascular problems.

What is high blood pressure and why does it matter?

High blood pressure represents not only how hard the heart needs to pump to push blood through the body, but also the pressure on the arterial walls as the blood circulates. We measure blood pressure using a simple non-invasive cuff on the arm – you’ve probably had your blood pressure checked at every medical appointment in recent memory. The upper number or systolic blood pressure refers to the amount of pressure in the arteries during a heartbeat, while the lower number or diastolic reading measures the pressure between beats when the heart is at rest.

High blood pressure can weaken the arteries and make it easier for disease to take hold. One of the most common arterial issues is known as atherosclerosis, when arteries narrow due to plaque formation on their walls. As the arteries narrow, the heart must pump harder to get blood through the body, leading to a weakening of the muscle and ultimately heart failure. However, if the artery becomes mostly or completely occluded, warning signs such as chest pain, dizziness and other cardiovascular issues may start to appear and the risk for a devastating heart attack increases dramatically. If a piece of plaque breaks off and travels to the brain, a stroke can occur.

What does this mean for me?

Treating heart disease requires a holistic approach. We start with lifestyle management, including improved diet and exercise. We then move on to medications when appropriate. However, with the double whammy of high blood pressure and Afib, some patients may require greater intervention. Most importantly, you need to advocate for yourself. Visit your cardiologist and electrophysiologist so they may coordinate your care and address both risks of stroke appropriately.

To learn more, please schedule a consultation with Dr. Tordini. She will work with your medical team to approach these dual risk factors in a comprehensive manner.

Dr. Tordini is a part of Florida Medical Clinic Orlando Health