Yes, we're back at blood pressure. After dozens of Stroke-Proof tips I think we've reached the point where any new tips we can come up with would be so minor in their importance that we'd be diluting the key messages. So, back to the start and the most important of all.... There are lots of things we can do to reduce our risk of stroke. But one stands above almost everything else: Getting blood pressure under control. It is not glamorous. It will not generate the same excitement as a full-body scan, a biological-age test or a new supplement. But the size of the prize is enormous. The INTERSTROKE study compared 13,447 people who had experienced a first stroke with a similar number who had not, across 32 countries. Having hypertension—or a measured blood pressure of at least 140/90 mmHg—was associated with almost three times the odds of stroke. At a population level, high blood pressure accounted for an estimated 47.9% of stroke risk. Its contribution was even greater for bleeding within the brain. The Global Burden of Disease study reached a remarkably similar conclusion using a very different method. It estimated that high systolic blood pressure contributed to around 55.5% of all healthy years lost to stroke worldwide in 2019—more than any other risk factor. These figures do not mean that lowering blood pressure would instantly prevent exactly half of all strokes. Population-attributable estimates are not the same as the benefit of an individual treatment. But they tell us something hugely important: Blood pressure sits at the centre of the stroke-prevention opportunity. Does lowering it genuinely prevent stroke? Yes. And this is not based only on association. It has been tested in large randomised trials. An individual-participant meta-analysis (combination of trials) combining around 350,000 people from 48 trials found that every 5 mmHg reduction in systolic blood pressure reduced the relative risk of stroke by about 13%. The greater the blood-pressure reduction, the greater the average benefit.

Many stroke risk factors, such as smoking, high blood pressure and diet, can be modified. However, factors in our environment also matter. Air pollution is one of the most important environmental factors that can increase the risk of stroke. Around 20 years ago, the American Heart Association published its first scientific statement highlighting the association between exposure to air pollution and cardiovascular disease, including stroke. More recently, the Global Burden of Disease study identified air pollution as one of the important risk factors for stroke worldwide. It estimated that 16.6% of stroke-related disability and premature death was linked to ambient particulate air pollution (1). Scientists are still learning exactly how air pollution affects the heart and brain. Tiny particles in polluted air can be breathed deep into the lungs, where they trigger harmful changes in the body. These changes can damage blood vessels, raise blood pressure, increase inflammation, and make the blood more likely to clot. Over time, this can increase the risk of stroke (2). Fine particulate matter (PM2.5) In recent years, research has focused on PM2.5, which are tiny particles measuring 2.5 micrometres or less in diameter. PM2.5 particles come from many sources, including: - Road traffic pollution - Factories and industrial emissions - Burning coal, wood, or oil - Wildfires - Commercial cooking - Dust from roads and soil Most studies have examined the relationship between the overall amount of PM2.5 in the air and cardiovascular risk. However, the health effects may also depend on what the particles are made of and where they come from. Research suggests that pollution from traffic, industry, burning coal, oil or wood, and dust is associated with a higher risk of heart disease and stroke (3). Why does this matter? People who live near busy roads or areas with higher levels of air pollution may be exposed to greater health risks over time. Air pollution may also contribute to conditions such as high blood pressure and diabetes, which further increase stroke risk.

Good evening, I've just added a stroke prevention checklist to the Classroom section. It's only a first draft and so will need some tweaking. Please have a look and let me know what you think.

Good morning, just a quick reminder that we have our stroke proof community meeting today at 7:00 p.m. you can join by clicking the link in the calendar section of this app/website this is a chance for us all to catch up and talk about what we're doing to reduce our stroke risk and any challenges we have. I hope see you there!