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Arterial hypertension

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Arterial hypertension

High blood pressure , also known by its acronym: HTA , is the disease caused by the chronic elevation of blood pressure values ​​above what is established as normal.

Summary

[ disguise ]

  • 1 Description
  • 2 Risk factors
  • 3 Causes
    • 1 Causes of secondary hypertension
      • 1.1 Renal
      • 1.2 Vascular
      • 1.3 Endocrine
        • 1.3.1 Exogenous Imbalances
        • 1.3.2 Endogenous Imbalances
      • 1.4 Neurogenic
      • 1.5 Drugs and toxins
      • 1.6 Other causes
    • 4 Symptoms
    • 5 Diagnosis
    • 6 Treatment
    • 7 Complications
    • 8 Forecast
    • 9 Sources

Description

The heart pumps blood through a network of arteries, veins and capillaries. Moving blood pushes against the walls of the arteries and this force is measured as blood pressure. Hypertension is a term used to describe chronically high blood pressure. The ideal blood pressure for an adult is less than 120/80. Blood pressure is said to be high when it exceeds 140/90 mmHg in three consecutive doses 6 hours apart.

High blood pressure is the main cardiovascular risk factor. It is known as ‘the silent killer’, because in most cases it does not present symptoms, so you can develop heart or kidney problems without being aware of having hypertension. Without treatment, high blood pressure significantly increases the risk of a heart attack or stroke .

Blood pressure is determined by both the amount of blood the heart pumps and the degree of resistance to blood flow in the arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure will be. The blood pressure reading is determined in millimeters of mercury (mm Hg). It has two numbers.

  • Upper value ( systolic pressure ). The first, or higher, measures the pressure in the arteries when the heart beats.
  • Lower value ( diastolic pressure ). The second, or lower, measures the pressure in the arteries between heartbeats.

You can have high blood pressure for years without experiencing any symptoms. Uncontrolled high blood pressure increases the risk of serious health problems, such as heart attack and stroke. Fortunately, high blood pressure can be easily detected. And, once you know you have high blood pressure, you can work with your doctor to control it.

 

Risk factor’s

It is known that there are conditions that increase the probability of developing high blood pressure, such as:

  • Family history of hypertension.
  • African American race: African Americans have a higher incidence of high blood pressure than whites, and the disease usually appears at a younger age and is more severe.
  • Male sex: Men are more prone to HTN. In women, the risk is higher after age 55.
  • Age over 60 years: Blood vessels weaken with age and lose their elasticity.
  • Stress: According to some studies, stress, anger, hostility, and other personality characteristics contribute to hypertension, but the results have not always been consistent. Emotional factors most likely contribute to the risk of certain people who have other risk factors for hypertension.
  • Overweight or obesity.
  • Smoking habit: Smoking damages blood vessels.
  • Use of oral contraceptives: Women who smoke and use oral contraceptives considerably increase their risk.
  • Diet: high in saturated fat and sodium.
  • Alcohol consumption: According to experts, moderate consumption is an average of one or two drinks per day for men and one drink per day for women. A beverage is defined as 1.5 fluid ounces (44 ml) of 80 proof spirits (e.g. American or Scotch whiskey, vodka, gin, etc.), 1 fluid ounce ( 30 ml) of 50° alcohol (100 proof) spirits, 4 fluid ounces (118 ml) of wine or 12 fluid ounces (355 ml) of beer.
  • Sedentary lifestyle: She is physically inactive.
  • Mellitus diabetes

Causes

Most of the time there is no specific cause that triggers hypertension, which is why it is called primary or essential hypertension . 90% of hypertensives would be in this group. However, there are a large number of disorders associated with the development of hypertension, which is why, in these cases, it is called secondary hypertension .

Causes of secondary hypertension

Kidney

Renal causes (2.5-6%) of hypertension include renal parenchymal diseases and renal vascular diseases, such as:

  • Polycystic kidney disease
  • Chronic kidney disease
  • Renin-producing tumors
  • Liddle’s syndrome
  • Renal artery stenosis
  • Renovascular hypertension occurs in 1.2-4 percent of cases. This has been increasingly recognized as an important cause of clinically atypical hypertension and as a chronic kidney disease.

Vascular

  • Coarctation of aorta
  • Vasculitis
  • Collagen vascular diseases.

Endocrine

They represent 1-2 percent. They are determined by exogenous or endogenous hormonal imbalances.

Exogenous Imbalances
  • Use of oral contraceptives: Activation of the renin-angiotensin-aldosterone system is the likely mechanism, because hepatic synthesis of angiotensinogen is induced by the estrogen component of oral contraceptives. About 5 percent of women taking oral contraceptives may develop hypertension.
  • Use of non-steroidal anti-inflammatory drugs (NSAIDs): They may have adverse effects on blood pressure. These drugs block both cyclooxygenase-1 (COX-1) and COX-2 enzymes. Inhibition of COX-2 may inhibit its natriuretic effect which, in turn, increases sodium retention. Non-steroidal anti-inflammatories also inhibit the vasodilatory effects of prostaglandins and the production of vasoconstrictive factors, i.e. endothelin-1. These effects may contribute to the induction of hypertension in a patient with controlled hypertension or normotension.
Endogenous Imbalances
  • Primary hyperaldosteronism
  • Cushing’s syndrome
  • Pheochromocytoma
  • Congenital adrenal hyperplasia

Neurogenic

  • Brain tumors
  • Bulbar poliomyelitis
  • intracranial hypertension

Drugs and toxins

  • Alcohol
  • Cocaine
  • Ciclosporin, tacrolimus
  • Erythropoietin
  • Adrenergic medications
  • Decongestants containing ephedrine
  • Herbal Remedies Containing Licorice
  • Nicotine

Other causes

  • Hyperthyroidism and hypothyroidism
  • Hypercalcemia
  • Hyperparathyroidism
  • Acromegaly
  • Obstructive sleep apnea
  • Pregnancy-induced hypertension

Symptoms

The most of time, there are not symptoms. For most people, high blood pressure is detected when they go to the doctor or have it measured elsewhere.

Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure.

If you have a severe headache, nausea or vomiting, confusion, vision changes, or nosebleeds, you may have a serious and dangerous form of high blood pressure called malignant hypertension .

Diagnosis

The doctor will measure your blood pressure several times before diagnosing you with high blood pressure. It is normal for your blood pressure to be different depending on the time of day.

All adults should have their blood pressure checked every 1 to 2 years if it was less than 120/80 mmHg in the most recent reading.

If you have high blood pressure, diabetes, heart disease, kidney problems, or some other conditions, have your blood pressure checked more often, at least once a year.

Blood pressure readings you take at home may be a better measure of your usual blood pressure than those taken at the doctor’s office.

Make sure you get a good-quality, well-fitting home blood pressure monitor. You should have the appropriate size cuff and a digital reader.

Practice with your doctor or nurse to make sure you are taking your blood pressure correctly.

Bring your home blood pressure monitor to your doctor’s appointments so your doctor can check that it is working properly.

The doctor will perform a physical exam to look for signs of heart disease, eye damage, and other changes in the body.

Complementary Exams

  • Lipidogram: looking for high cholesterol levels.
  • Electrocardiogram: allows you to evaluate the function of the heart from an electrical point of view, as well as determine if there is any heart disease.
  • Echocardiogram: allows us to know the functioning of the heart from a mechanical point of view. It also allows you to define if there is heart disease.
  • Kidney function tests: allow us to know if there is any impairment of kidney function.
  • Renal ultrasound: allows us to know the morphological characteristics of the kidney to determine if there is any abnormality in them.

Treatment

Hypertension cannot be cured in most cases, but it can be controlled. In general, regular treatment must be followed throughout life to lower the pressure and keep it stable.

The first action plan usually involves a lifestyle modification:

  • Reduce body weight if you are overweight.
  • Reduce salt consumption to 4-6 grams per day; consume less prepared and preserved products, and do not use too much salt in food preparation. However, there are patients who do not respond to salt restriction.
  • Reduce alcohol intake, which for women should be less than 140 grams per week and for men less than 210 grams.
  • Do physical exercise, preferably walking, moderate running, swimming or cycling, for 30 to 45 minutes, a minimum of 3 times a week.
  • Reduce coffee consumption and do not consume more than 2-3 coffees a day.
  • Eat foods rich in potassium, such as legumes, fruits and vegetables.
  • Quit the habit of smoking.
  • Follow a diet rich in polyunsaturated fatty acids and low in saturated fats.

In addition to the recommended measures, hypertensive patients have a wide variety of drugs that allow them to control the disease. The treatment should be always individualized. When choosing the drug, factors such as the age and sex of the patient, the degree of hypertension, the presence of other disorders (such as diabetes or high cholesterol values), the side effects and cost of the drugs and the tests necessary to monitor its safety. Patients usually tolerate the drugs well, but any antihypertensive drug can cause side effects, so if these appear, the doctor should be informed so that the dose can be adjusted or the treatment changed.

Complications

The fatal or non-fatal complications of HTN are very directly related to the amount of increase in blood pressure and the time of evolution. For this reason, the best way to prevent them is to establish an early diagnosis of hypertension.

Forecast

Most of the time, high blood pressure can be controlled with medications and lifestyle changes. When blood pressure is not well controlled, you are at risk of:

  • Bleeding from the aorta, the large blood vessel that supplies the abdomen, pelvis, and legs
  • Chronic kidney disease
  • Heart attack and heart failure
  • Poor blood flow to the legs
  • Vision problems
  • stroke

 

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