Normal Blood Pressure Still Risks Stroke If You Have These 5 Factors
People with normal blood pressure readings still face stroke risk if they have diabetes, arterial plaque, irregular heartbeat, smoking habits, or high cholesterol, warns a Thai hospital doctor.
Doctor Jedsada Bunyavongsirojn, deputy director of primary care at Maharat Nakhon Ratchasima Hospital, warns that normal blood pressure readings of 120/80 should not create a false sense of security about stroke risk. While normal blood pressure is good news, he emphasizes that stroke does not have only one pathway. Some people with normal blood pressure still face high risk if they have elevated blood sugar, plaque buildup in arteries, smoking habits, or undetected irregular heartbeat.
He recommends checking five additional factors:
1. High blood sugar or diabetes — Brain blood vessels are damaged by chronic high blood sugar just like the eyes and kidneys. Many people fear diabetes for its effects on kidneys and feet, but cerebral vessels suffer equally. Diabetes is a stroke risk factor on its own and often comes with abdominal fat and high cholesterol. Blood sugar control should not rely on fasting readings alone; post-meal spikes of 170-180 regularly signal vessel damage even when fasting glucose looks good. Those with abdominal weight gain, family diabetes history, or rising HbA1c levels must manage blood sugar alongside blood pressure.
2. High LDL and arterial plaque — Fat buildup narrows vessels independent of blood pressure. Blood pressure is the force hitting artery walls, but plaque gradually narrows the passage. High LDL and elevated fat particles can accumulate in vessel walls, including those feeding the brain. If plaque ruptures and causes a blood clot, ischemic stroke occurs. Arterial stiffness involves combined risk from high fat, diabetes, smoking, age, and family history. A blood pressure of 118/75 with years of high LDL is not a wash; they are separate risks. Those over 40 should know their total cholesterol, LDL, HDL, and triglycerides, and those with family history of early heart disease or stroke may need additional screening.
3. Atrial fibrillation (AF) — Blood clots may start in the heart, not brain vessels. AF is irregular heartbeat in the upper chambers, causing blood to pool and stall, creating clot risk. If a clot breaks loose and blocks a brain artery, stroke occurs even with normal blood pressure. AF is a major stroke risk factor, yet many feel no symptoms—only occasional heart flutter, skipped beats, unusual fatigue, dizziness, or nothing at all. Anyone over 50–60 with frequent irregular pulse should be tested properly, not just by manual pulse check, since AF can be intermittent.
4. Smoking or regular secondhand smoke exposure — Cigarettes damage blood vessels independent of blood pressure. Smoking affects far more than the lungs alone; chemicals in smoke harm vessels throughout the body.
