A brain haemorrhage rarely comes out of nowhere. Years of high blood pressure is by far the most important cause, and you do not feel it. The same holds for the cerebral infarction, the other form of stroke, in which a vessel gets blocked instead.
Your blood vessels and your brain are not two subjects. They are one.
What is the difference between an infarction and a haemorrhage?
In a cerebral infarction a blood vessel gets blocked, so part of your brain stops receiving oxygen. In a brain haemorrhage a vessel bursts and blood leaks into the brain tissue. Both are called a stroke, and both mean calling the emergency number immediately.
| Cerebral infarction | Brain haemorrhage | |
|---|---|---|
| What happens | A vessel gets blocked | A vessel bursts |
| Most common? | Yes, roughly four in five | Less common |
| Biggest risk factor | High blood pressure | High blood pressure |
| Role of cholesterol | Large | Smaller |
| What you can measure now | Blood pressure, LDL, blood sugar | Blood pressure |
For both forms, the thing at the top of the list is what you can measure at home with a blood pressure monitor.
What are the first signs of a stroke?
A drooping mouth, an arm that sinks, and speech that suddenly becomes unclear. If you notice this in yourself or someone else, call the emergency services immediately. Do not wait to see whether it passes, because every minute counts for the tissue that can still be saved.
This is the one part of this article where you have nothing to weigh up yourself.
How does this connect to your memory?
Damaged blood vessels in your brain lead over time to vascular dementia. Often not through a single large stroke, but through dozens of tiny ones you never noticed. Added together, they slow your thinking.
That is why high blood pressure and high LDL cholesterol both sit on the list of fourteen dementia risk factors (Livingston et al., 2024). Cholesterol was only added in 2024.
A large meta-analysis on Alzheimer's also identified blood pressure as a modifiable factor (Xu et al., 2015). The full overview is in preventing dementia.
Does lowering your blood pressure really help?
For your brain, probably, though the evidence is nuanced. In the SPRINT MIND trial, more than 9,000 people were given either a strict or a standard target. Strict treatment clearly reduced the number of people with mild cognitive problems, but the difference in dementia itself was not statistically significant (SPRINT MIND Investigators, JAMA 2019).
For strokes, the evidence is far firmer. There, lowering blood pressure is one of the best-supported measures available.
I think that difference is worth naming. Lowering your blood pressure is not mainly a bet on your memory twenty years out. It is a gain for your vessels right now.
An example from practice
An example helps here. Picture a man of 67. He feels fine. His blood pressure is 158 over 96, his LDL cholesterol 4.2 mmol/l. He has no symptoms, and that is precisely the problem.
High blood pressure does not hurt. That is exactly why it gets to run unchecked for so long.
This man can start measuring today, and discuss with his GP what is needed. In fifteen years, that same conversation would be about damage already done.
What can you have measured?
You measure your blood pressure with a monitor, not in your blood. Your LDL cholesterol and your blood sugar do sit in your blood, and those two are the only factors from the list of fourteen you see there directly. The Hersenstichting and the RIVM name the same risk factors.
What counts as normal for your age is covered in blood pressure by age and cholesterol values by age. The wider picture is in preventing heart disease after 60.
The difference between Alzheimer's and vascular dementia is explained in preventing Alzheimer. If you want your cholesterol checked now, a lipid screening is the starting point.
References
- SPRINT MIND Investigators for the SPRINT Research Group (2019). Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia. JAMA. PMID 30688979.
- Livingston G, et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet. PMID 39096926.
- Xu W, et al. (2015). Meta-analysis of modifiable risk factors for Alzheimer's disease. J Neurol Neurosurg Psychiatry. PMID 26294005.
- Hersenstichting. Stroke: cerebral infarction and brain haemorrhage. hersenstichting.nl.
- RIVM. Figures on stroke and cardiovascular disease in the Netherlands. rivm.nl.
Would you like your cholesterol checked at a calm moment, without first booking an appointment with your GP? At Levenswijs Health you can. Every result is reviewed by a doctor registered in the Dutch BIG register. A blood test does not provide a diagnosis and does not predict a stroke. If you see a drooping mouth, a sinking arm or unclear speech, call the emergency services immediately.
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