“The Story of the Three Bears” was written by English writer Robert Southey who had an old woman stealing their porridge from the bears’ house. Twelve years after Southey’s story was published, writer Joseph Cundall changed the old woman into a little girl because there were many children’s books about old women at the time.
Once the little girl entered the story, she never left. She had many names, but ultimately, Goldilocks stuck. So Goldilocks, Papa, Mama, and Baby Bear became a story about an inquisitive, beautiful little girl and a family of bears.
In this story, the girl entered the bears’ house while they were gone, and Papa Bear’s porridge was too hot, Mama Bear’s porridge was too cold, but Baby Bear’s was “just right.” In the twentieth century, “Finding the Goldilocks Zone” was applied to a lot of things, like high and low blood pressure–not too high. not too low. but “just right” equals enough blood pressure to nourish the brain. We risk our lives by venturing too far outside the Goldilocks Zone.
Most stroke or traumatic brain injury (TBI) survivors do best with blood pressure in the range of: 110–140 systolic and 70–90 diastolic. (Systolic pressure is the maximum blood pressure during contraction of the ventricles; diastolic pressure is the minimum pressure recorded just prior to the next contraction. The blood pressure is usually written as the systolic pressure over the diastolic pressure).
The brain is reliant on stable blood flow to get the oxygen and supplements it needs. After a stroke or TBI:
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Blood vessels may be damaged
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The brain may lose its use to self-regulate blood flow
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Even small changes in pressure can cause fatigue, confusion, brain fog or worse symptoms
Also, the brain becomes more susceptible to blood pressure changes, and both high and low blood pressure can make things worse. High blood pressure (called hypertension) or low blood pressure (called hypotension) and the injured brain can be dangerous.
HIGH BLOOD PRESSURE (HYPERTENSION) AND BRAIN INJURY
Persistent high blood pressure injures blood vessels throughout the body, including the fragile vessels in the brain. This process can lead to several problems:
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Raises pressure inside the brain (especially calamitous after trauma)
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The brain’s small vessels are particularly vulnerable because they lack the muscular walls of larger arteries, making them prone to pressure-related damage
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Can worsen headaches, spasticity, or confusion
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Increases risk of another stroke by having sluggish vessels are more prone to rupture (hemorrhagic stroke) or blockage (ischemic stroke)
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May cause small vessel damage leading to cognitive decline
- Accelerated brain aging with small areas of brain tissue damage that accumulate over time and cognitive decline
You know it’s affecting you by:
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- Feeling flushed, dizzy, or ears pounding
- Trouble concentrating
- Headache behind the eyes
- Sudden Irritability
Maybe stop hypertension by:
- Low-sodium diet
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Consistent medication
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Gentle exercise
- Mindfulness or breathing exercises to reduce stress
LOW BLOOD PRESSURE (HYPOTENSION) AND BRAIN INJURY
The brain uses about 20% of the body’s total blood supply while being only 2% of body weight, making it inordinately sensitive to circulation changes. While less commonly discussed, chronically low blood pressure can also damage brain function:
- Not enough blood flow to meet the brain’s high metabolic demands
- Cognitive fog–difficulty concentrating, memory problems, fatigue
- Worsens memory, processing speed, attention
- Makes it hard for your brain to get oxygen
- Dizziness and falls, particularly when standing up quickly
- Depression and anxiety, possibly related to altered brain chemistry from poor circulation
You know it’s affecting you by:
- Dizziness, brain fog, or falls, especially when standing up quickly
- Perhaps related to altered brain chemistry from poor circulation
- Feeling slow or “off” for no reason
- Tired or weak after meals or hot showers
- Blurry vision, lightheadedness
Maybe stop hypotension by:
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Drink more water (8–10 cups daily)
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Saltier snacks (if approved by your doctor)
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Compression stockings (help push blood to the brain)
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Avoid long hot showers or standing too long
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A symptom journal that notes time of day, blood pressure reading, and cognitive symptoms like fog, confusion, dizziness
Most people start with their primary care doctor, or internist, who can effectively manage the majority of blood pressure cases. Specialists usually become involved when there are complications or when standard treatments aren’t working effectively.
Primary Care Physicians (PCP):
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First line for both high and low blood pressure
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Manages routine meds and referrals
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Family medicine doctors and internists are usually the first line of treatment
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Handle most usual hypertension and hypotension cases
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Prescribe medications, monitor progress, and manage lifestyle interventions
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Refer to specialists when neededCan monitor how blood pressure is affecting your overall health
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Prescribe medications, monitor progress, and manage lifestyle interventions
Cardiologists who deals with the heart and blood pressure:
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Best for high blood pressure (hypertension), especially if:
- Chest pain, heart problems, or family history of stroke/heart disease
- Heart specialists who treat blood pressure when it’s related to heart conditions
- Meds aren’t working
- Doesn’t respond to standard treatments
- Handle complex hypertension cases, especially with heart failure, coronary artery disease, or arrhythmias
Neurologists who deals with brain and nervous system:
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Treats blood pressure problems after stroke or TBI, especially if symptoms include:
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Brain fog
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Dizziness
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Autonomic nervous system issues
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History of stroke
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Neurovascular subspecialty of neurology focused on stroke prevention and recovery:
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Ideal if you’ve had a stroke, TIA, or vascular brain injury
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Can coordinate blood pressure management as part of stroke rehab
Endocrinologists who deals with hormone-related causes of blood pressure changes
(diabetes, thyroid, adrenal):
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Important if:
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Blood pressure is linked to diabetes
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Unexplained drops or spikes
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Hormonal imbalances are suspected
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Manage secondary hypertension from hormonal imbalance
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Hormone specialists who treat blood pressure related to endocrine disorders
- Address conditions like diabetes, thyroid disease, adrenal disorders affecting blood pressure
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Nephrologists who deals with the kidneys:
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Nephrologists treat kidneys to regulate blood pressure:
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Resistant hypertension
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Blood pressure problems related to kidney disease
- Handle cases where blood pressure medications affect kidney function
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Pulmonologists:
- Lung specialists who may address blood pressure related to sleep apnea or pulmonary hypertension
Emergency Medicine Physicians:
- Handle hypertensive crises or severe hypotensive episodes requiring immediate intervention
Autonomic Specialists / Dysautonomia Clinics:
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Rare but critical for people with autonomic nervous system dysfunction (postural orthostatic tachycardia syndrome [POTS], neurogenic hypotension after TBI)
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Manage blood pressure that spikes or crashes due to nerve issues
Geriatricians (if over age 65) in older adult care:
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Helps manage blood pressure with a focus on brain safety, fall risk, and medication sensitivity
As Channing Frye, an American former professional basketball player, says, “I’m a 120-over-78 blood pressure guy.”
Perfect! Keep doing whatever you’re doing!
