When Jatin Sanghvi (60) was rushed to the hospital after developing weakness on the right side of his body and difficulty in speaking, his family believed it be an unexpected emergency. However, doctors found out that the problem had been building up silently for years.
Jatin had poorly controlled hypertension/high BP since over a decade. He had also stopped taking his medications several weeks before the incident. His BP on admission was critically high. Tests confirmed brain haemorrhage, leading to a stroke. He required intensive care, and later physio and speech therapy.
One of the hidden risks of high BP is that most people experience no symptoms until an emergency occurs, and remain unaware of the damage to the body and brain.
High BP’s impact on brain
Under sustained pressure, brain’s blood vessels begin to change, causing the arterial walls to become thicker over time. As a result, the brain receives less oxygen and glucose-rich blood due to less arterial flexibility.
The structural damage caused to these vessels generates microscopic bleeds in brain, leading to tiny patches of dead or dying tissue, where blood supply was cut off entirely. This damage, called silent brain infarcts, can lead to cognitive decline. These infarcts are five times more frequent than stroke and increase significantly with advancing age and high BP.
Cognitive erosion and its impact
The cognitive consequences of this accumulating damage are alarming. Various studies provide strong evidence that structural and functional changes in the brain over time lead to lowered cognitive functioning when BP control is poor or lacking. When high BP damages the tissue connecting the frontal lobe to the rest of the brain, the ‘manager’ of the mind begins to falter.
Symptoms of untreated high BP
People living with untreated hypertension often experience a ‘slowing down’ of mental processing. Some notable and common symptoms cause people to forget words mid-sentence and lose focus during conversations, easily switch between tasks, or making them feel mentally slower than earlier.
People remain unaware of the toll of hypertension and usually attribute these symptoms to stress, ageing, and/or a lack of sleep. This condition, called vascular cognitive impairment, can be a precursor to severe dementia. Unlike Alzheimer’s disease, which begins with memory loss, hypertensive brain damage typically starts with these executive deficits. Hypertension is one of the leading risk factors for the progression of cognitive impairment and the brain is the target organ of hypertension.
The micro-bleed phenomenon
Beyond structural narrowing of blood vessels, hypertension also creates ‘leaky’ vessels. Chronic high BP weakens the walls of the vessels to the point where microscopic amounts of blood escape into the surrounding brain tissue. These microbleeds are too small to cause a clinical emergency, but they act as toxins to the brain cells. The presence of iron from the blood triggers an inflammatory response, further damaging the brain.
Over years, these microbleeds accumulate deep inside the brain and the resulting damage disrupts the motor circuits, leading to subtle changes in gait or balance. A person might find themselves shuffling or feeling less steady on their feet. Often, many blame it on footwear or joints, unaware that hypertension is causing this damage.
A preventable problem
Early detection and management of high BP can help reduce its harmful impact on the brain. However, it cannot undo the damage already done, as dead brain tissue cannot regenerate. That is why early detection and consistent management are very important.
Hypertension is very much a treatable problem. Dietary and lifestyle changes, limiting salt intake and quitting alcohol and tobacco consumption can help control BP. Research suggests that reducing systolic blood pressure by just 10 mmHg cuts stroke risk by 27-40 per cent. What makes the difference, however, is not any single intervention, but being consistent — regular monitoring and following a healthy lifestyle. And if detected, by taking your medication regularly and following precautions recommended by the doctor.
— The writer is Senior Neurologist, Fortis, Mohali