And now let's turn to one of the most dreaded consequences of high blood pressure: strokes. You may think of strokes as affecting the elderly, but the problem is increasing among people in their 50s, their 40s and even younger. Without proper treatment, young stroke survivors face the risk of a shorter life.

NPR's Richard Knox reports.

RICHARD KNOX, BYLINE: Most days you can find Melissa McCann in a helicopter, accompanying sick and injured patients to a distant hospital.

MELISSA MCCANN: I'm a flight nurse with Life-Flight of Maine. And I was actually working when it happened.

KNOX: When she had a stroke at the age of 37. It began with a weird feeling.

MCCANN: I had a very euphoric feeling. It's hard to explain but everything felt very cartoonish to me. It felt very bizarre.

KNOX: She'd just gotten a page about a patient who needed to be transported. But when she tried to respond, she couldn't.

MCCANN: The number you dial is 2-3-4-5. I went to go dial it with my left hand and I could not coordinate my hand to dial the number.

KNOX: Then other strange things began to happen. The light began to hurt her eyes. She couldn't speak.

MCCANN: I could not coordinate my hand to dial the number.

KNOX: Then other strange things began to happen. The light began to hurt her eyes. She couldn't speak. And, nurse that she is, she realized she was having a stroke.

MCCANN: It was very scary. Really, even being in the medical field, I think it was scarier for me because I know what could possibly happen.

KNOX: She could die, as her father-in-law did, or be permanently disabled.

One in five young adults who survives a stroke is likely to die over the next 20 years, according to new research from the Netherlands. That's four times higher than others their age.

The study appeared in the Journal of the American Medical Association. Author Frank-Erik de Leeuw says the increased death rate was unexpected.

FRANK-ERIK DE LEEUW: We had the impression that they were doing quite well. But now that we followed all of them - and also the patients who didn't show up in our outpatient clinic anymore - it turns out that their prognosis was poor. To me it was a true surprise.

KNOX: It means that doctors should pay a lot more attention to these patients. Make sure their blood pressure and cholesterol are under control. Work harder to get them to lose weight and stop smoking.

DE LEEUW: We can't just send them back to their homes and say, well, we see you now one or two times after your stroke. Take care. I think that's not possible any more.

KNOX: And the warning applies to this side of the Atlantic as well.

DR. LEE SCHWAMM: It's extremely alarming.

KNOX: Dr. Lee Schwamm is a stroke specialist at Massachusetts General Hospital.

SCHWAMM: These data suggest to me that we still have a sort of cavalier attitude toward secondary prevention - particularly in younger patients.

KNOX: Secondary prevention means preventing another stroke, heart attack or other catastrophe in someone who's survived a first one.

SCHWAMM: We just don't take secondary prevention seriously enough.

KNOX: More doctors also need to realize that young adults can suffer strokes. The new study shows that even a minor stroke can increase the later chance of an early death.

SCHWAMM: Many of the young patients that end up in my office, when they sought emergency medical care, were told that it was likely not a stroke and had only a CAT scan, which didn't show any injury, and were sent home. So stroke is still underdiagnosed in young patients.

KNOX: In Melissa McCann's case, it was clear she suffered a stroke. And fortunately, the symptoms cleared pretty quickly without treatment. But doctors couldn't find any reason why she had a stroke at 37.

MCCANN: I wasn't satisfied with that response. Take one aspirin a day and hope it doesn't happen again is not an acceptable answer for me.

KNOX: So she sought out Dr. Schwamm in Boston for a second opinion.

SCHWAMM: She came to me with a list of questions. She knew what the right questions were to ask.

KNOX: Sort of your ideal patient.

SCHWAMM: Very much so. She really wanted to understand was there a treatable, preventable cause here that could be modified, so that her risk in the future would be lower.

KNOX: An ultrasound scan of her heart revealed an abnormal hole between the two upper chambers. She'd had it her entire life. Doctors think that eventually, it allowed a blood clot to move to her brain, causing the stroke.

A surgeon repaired the hole, and she went back to work six weeks later. That was almost three years ago.

MCCANN: I'm working full time. I have a grandson that's three years old. I'm watching my youngest go through college. Yeah, you might have to take some medications, but you can get yourself back to your normal life.

KNOX: And now that she's addressed the probable cause of her stroke, she hopes that life will be a long one.

Richard Knox, NPR News, Boston.

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