What is that
Arterial hypertension is a disease characterized by the presence of higher than normal blood pressure .
Two values are distinguished: maximum pressure (systolic) and minimum pressure (diastolic) . The first represents the moment in which the heart contracts and pushes blood into the arteries through the aortic valve, the second coincides with the relaxation phase of the heart muscle, which fills with blood.
Blood pressure is recorded peripherally and is measured in millimeters of mercury (mmHg).
How widespread is it
Recent estimates state that 25-30 percent of the population suffers from hypertension . It mainly affects the elderly : over 65 years of age the proportion of hypertensives exceeds 80 per cent, under 30 years of age suffer from 5 per cent.
One of the biggest problems related to the spread of the disease concerns patient awareness: it is estimated that only half of those suffering from high blood pressure are aware of their problem. This greatly complicates prevention and treatment interventions.
Cause
In 95 percent of cases, the cause of hypertension is unknown . We then speak of primary, idiopathic or essential hypertension.
In the remaining 5 percent of cases hypertension is secondary to other pathologies . This is usually chronic renal failure , pheochromocytoma, or renal artery stenosis. Taking certain medications such as painkillers or birth control pills can also cause secondary hypertension.
There are also factors related to lifestyle that can favor the onset of hypertension such as cigarette smoking, alcohol abuse, a sedentary lifestyle and a diet rich in animal fats .
Symptoms and diagnosis
Arterial hypertension generally does not give definite and recognizable symptoms . For this reason it is often referred to as the “silent killer”.
However, palpitations, headache , dizziness, nervousness, tiredness, ringing in the ears or nosebleeds may occur . These symptoms occur in particular when the blood pressure registers a sharp rise (hypertensive crisis).
Diagnosis occurs by measuring the pressure with a special instrument, called a sphygmomanometer . However, the single measurement, which can be carried out in the pharmacy or at home, is not indicative. For a definitive diagnosis, you should contact your family doctor.
When the doctor evaluates a patient with suspected hypertension, he may carry out further tests in order to highlight the presence of risk factors (such as high cholesterol or diabetes ) , other diseases causing secondary hypertension or damage to other organs. Among the tests most commonly prescribed are the holter pressure or monitoring in clinics or, the echo Doppler , the electrocardiogram , tests of renal function , examination of the fundus of the eye .
Home blood pressure measurement is very useful , especially for those with a history of hypertension in the family. If measured correctly and consistently, it allows you to keep the values under control and diagnose the disease promptly.
Also, home measurements tend to be more regular than those obtained in a medical setting, which values tend to be higher due to “white coat” anxiety.
To measure blood pressure correctly, you need to be seated in a comfortable and relaxed position, with your forearm resting on a table. The sphygmomanometer cuff should be positioned above the bend of the elbow, without overtightening. The majority of instruments on the market today measure blood pressure automatically. The best times to take the measurement are when you wake up or in the evening.
With a classic sphygmomanometer, which also requires the use of a phonendoscope, some additional precautions are necessary. The cuff is inflated to a value of approximately 30 mmHg higher than that which corresponds to the disappearance of the heartbeat, with the stethoscope resting on the inside of the arm in correspondence with the brachial artery. It will then be necessary to let the air out of the cuff slowly (approximately 2 mmHg per second). During this procedure, a first “noise” will be clearly heard when the blood starts flowing back into the artery: the corresponding value will be that of systolic pressure (ie the maximum pressure). As the air continues to escape, the noises will first become louder, then gradually quieter:
The World Health Organization has classified hypertension into the following categories, based on systolic and diastolic blood pressure values, expressed in millimeters of mercury (mmHg).
| Diastolic (minimum) | Systolic (maximum) | |
|---|---|---|
| Optimal | < 80 | < 120 |
| Normal | < 85 | < 130 |
| Normal-high | 85-89 | 130-139 |
| Grade 1 hypertension – borderline | 90-94 | 140-149 |
| Grade 1 hypertension – mild | 95-99 | 150-159 |
| Grade 2 hypertension – moderate | 100-109 | 160-179 |
| Grade 3 hypertension – severe | ≥110 | ≥180 |
| Isolated borderline systolic hypertension | < 90 | 140-149 |
| Isolated systolic hypertension | < 90 | ≥150 |
Complications
The main and most dangerous consequences are heart attack and stroke . In fact, hypertension increases the cardiovascular risk, ie the probability of developing a thrombus inside a blood vessel with consequent obstruction of the same.
Kidney disorders can also occur , which depend mainly on the reduced ability of the organs to filter the blood properly, causing kidney failure.
There is also a certain margin of risk for the eyes. The most common complication in this case is hypertensive retinopathy , an eye disease that damages the blood vessels in the retina. In severe cases, the condition can cause blurring of vision and distorted images.
Particular attention should be paid to pregnant women. Pregnancy hypertension , which may be pre-existing or emerge during pregnancy, can give rise to even serious complications such as preeclampsia or eclampsia .
Cure
There are many drugs for the treatment of hypertension and they should be taken only if prescribed by a doctor, who will evaluate any individual risk factors and the presence of other pathologies or damage to other organs.
The main categories are: diuretics, beta blockers, ACE inhibitors, angiotensin inhibitors, calcium channel blockers, alpha blockers, vasodilators.
We speak of resistant hypertension when drug therapy is unable to bring blood pressure back to normal, even excluding any causes of secondary hypertension.
The main objective of hypertension therapy is not only to bring the values back to normal, but also to protect the organs that could possibly be affected by the damage that high blood pressure can cause, or to remedy it if it has already occurred, as in the case of left ventricular hypertrophy.
Lifestyle and nutrition can also be of great help in reducing blood pressure, especially when the values are slightly higher than normal . It is believed that lowering blood pressure by just 5 mmHg significantly reduces the risk of strokes (34%) and heart attacks (21%). The risk of developing other conditions such as vascular dementia or atrial fibrillation is also reduced .
When to see your doctor
Pressure is considered normal when the minimum is less than 80 mmHg and the maximum is less than 120 mmHg. When the values are consistently higher than these parameters, it is advisable to contact the family doctor.
According to the parameters adopted in medicine, one is considered hypertensive when the values exceed the minimum 90 mmHg and the maximum 140 mmHg . When only the maximum value is higher than normal, the diagnosis is isolated systolic hypertension.
Prevention
The prevention of hypertension mainly involves adopting a correct lifestyle.
As far as nutrition is concerned , a diet rich in fiber and low in saturated fat (especially if of animal origin) helps keep blood pressure under control. Fruits and vegetables are also particularly important as they are rich in elements such as potassium , which counteracts the action of sodium at the cellular level, and can prevent the onset of alterations in the nerves, endocrine system and blood vessels.
Furthermore, it is essential to reduce the intake of salt . The recommended daily amount of salt is 5 grams, which is about a teaspoon. This quantity does not only concern the salt added to foods, but also the salt already present in foods such as preserves, cheeses, cured meats and sausages. Ideally, the intake of a food rich in salt should be compensated for by another low content.
From there also the consumption of alcoholic beverages should be imitated : no more than two glasses of wine a day for men, no more than one for women.
Constant and regular physical activity , especially if agreed with your doctor, can have many benefits for cardiovascular health. Aerobic activity (or cardiofitness) can significantly improve the functionality of the cardiovascular system and the body’s ability to transport oxygen, factors that have obvious positive effects on blood pressure regulation.
In general, it is estimated that at least 30 minutes of brisk walking or the practice of sports such as swimming or cycling at least five times a week can reduce blood pressure by about 4-9 mmHg . To produce clear and lasting positive effects, physical activity should last for at least six months.
Even reducing or otherwise learning to manage stress can have a decisive influence on hypertension. It is known that anxiety disorders and panic attacks affect the cardiovascular system and can cause symptoms of transient hypertension. For this reason it can be useful to use relaxation techniques or meditation to remove the original cause of stress.
In any case, it should be remembered that real hypertension is not considered a transient syndrome and is not the result of stressful events. The pharmacological therapy agreed with your doctor must be followed in any case.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.