Stroke – how to spot one, and how to lower your risk
A stroke is a medical emergency where minutes change the outcome. How to recognise one, what to do immediately, and what actually reduces the risk.
Recognising one: act FAST
A stroke happens when the blood supply to part of the brain is cut off, usually by a clot and sometimes by a bleed. Brain tissue starts dying within minutes, which is why this is the one situation where getting to hospital quickly changes the outcome more than almost anything a doctor does later.
- Face — ask them to smile. Has one side of the face drooped?
- Arms — ask them to raise both arms. Does one drift down or fail to lift?
- Speech — ask them to repeat a simple sentence. Is it slurred, jumbled or absent?
- Time — if any of these are present, call an ambulance immediately and note the time symptoms started.
Other ways a stroke shows up
- Sudden numbness or weakness on one side of the body, including the leg.
- Sudden loss or blurring of vision, particularly in one eye.
- Sudden severe dizziness, loss of balance or inability to walk.
- A sudden, extremely severe headache unlike any before, sometimes described as a blow to the head.
- Sudden confusion or difficulty understanding what people are saying.
What actually lowers the risk
Stroke is common in South Africa and it happens at younger ages here than in many countries. Most of that is driven by a small number of treatable things.
- Blood pressure. By some distance the biggest single factor, and the one most often undiagnosed. Treating it is the most effective stroke prevention there is.
- Stopping smoking, which roughly halves the excess risk within a few years.
- Controlling diabetes.
- Cutting down on salt and on heavy drinking.
- Physical activity — 150 minutes a week of moderate activity.
- Treating an irregular heartbeat. Atrial fibrillation greatly raises stroke risk, and blood-thinning treatment reduces it substantially.
- Cholesterol treatment where a doctor has assessed your overall risk as warranting it.
Medicines commonly used to reduce stroke risk, all prescribed and monitored rather than self-started:
Amlodipine — Amloc, Norvasc, Adco-Amlodipine, Pharmapress Amlo
Hypertension; stable angina
Enalapril — Pharmapress, Enap, Adco-Enalapril, Renitec
Hypertension; heart failure; diabetic nephropathy
Hydrochlorothiazide (HCT) — Ridaq, Adco-HCT, HCT Pharmacare
Hypertension; oedema
Atorvastatin — Lipitor, Aspavor, Adco-Atorvastatin, Zarator
Dyslipidaemia; cardiovascular risk reduction; high-risk patients
Aspirin (Low dose — Antiplatelet) — Ecotrin, Disprin CV, Myoprin
Secondary prevention of cardiovascular events; post-MI; post-stroke/TIA; unstable angina
Warfarin — Cipla-Warfarin, Marevan, Coumadin, Warfant
Prevention and treatment of VTE; atrial fibrillation; mechanical heart valves
After a stroke
Recovery continues for a long time, and rehabilitation is a large part of it — physiotherapy, occupational therapy and speech therapy all have evidence behind them. Progress is fastest in the first months but does not stop there.
The single most important thing afterwards is preventing the next one, which means taking the prevention medicines exactly as prescribed. A second stroke is far more likely than a first, and far more preventable.
Common questions
- Are strokes only a risk for old people?
- No. Stroke happens at younger ages in South Africa than in many countries, driven by untreated high blood pressure, and HIV is an additional risk factor for stroke in young adults.
- What should I do while waiting for the ambulance?
- Keep the person still and comfortable, lying on their side if drowsy or vomiting. Do not give food, drink or medication — including aspirin — because a stroke caused by a bleed would be made worse, and you cannot tell which type it is without a scan.
- My blood pressure is fine now on treatment. Can I stop?
- No. The number is normal because the medicine is working. Stopping returns it to where it was, usually within weeks, and this is one of the most common routes to a preventable stroke.
Sources
- South African hypertension practice guidelineSouth African Hypertension Society (SAHA)
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
Last reviewed 4 August 2026.