High Blood Pressure (HBP) is a chronic disease characterized by an increase in the normal values of blood pressure. It is caused by a permanent and sustained increase in the pressure force exerted by the blood on the arteries.
In adults, hypertension is more common in blacks (41%) than in whites (28%). Blood pressure increases with age. Sixty-six percent of persons > 65 years have hypertension, and individuals aged 55 years with normal blood pressure have a 90% risk of developing hypertension at some time in their lives.
Blood pressure classification
According to the European Society of Hypertension and the European Society of Cardiology, an optimal blood pressure is defined as SBP (systolic blood pressure) 120 mmHg and DBP (diastolic blood pressure) 80 mmHg. Normal blood pressure: SBP 120- 129 mmHg and DBP 80- 84 mmHg. High normal blood pressure: SBP 130- 139 mmHg and DBP 85-89 mmHg (normal blood pressure and high normal blood pressure are called prehypertension by the Americans.
Grades of Arterial Hypertension
There are 3 degrees of arterial hypertension, which are:
1. Arterial hypertension grade I. SBP 140-159 mmHg or DBP 90-99 mmHg.
2. Arterial hypertension grade II. SBP 160-179 mmHg or DBP 100-109 mmHg.
3. Arterial hypertension grade III. SBP equal or greater than 180 mHg or DBP equal or greater than 110 mmHg.
Isolated systolic arterial hypertension is defined as an SBP equal to or greater than 140 mmHg, which has clinical repercussions especially in the elderly.
In Ecuador, the incidence of arterial hypertension exceeds 9% of the population. In our country, the percentage of patients with hypertension is slightly higher in men than in women.
Consequences of HBP
The higher the blood pressure, the greater the risk of damage to the heart and blood vessels of major organs such as the brain and kidneys. Hypertension is the most important preventable cause of cardiovascular disease and stroke in the world. If not properly controlled, it can lead to myocardial infarction, enlargement of the heart and eventually heart failure.
Arteries can form bulges called aneurysms and weak areas that make them more susceptible to clogging and rupture. High blood pressure can cause blood to leak into the brain and cause a stroke. Other serious consequences that can result from HTN include kidney damage, blindness and cognitive impairment. Coronary heart disease is the most frequent cause of death in treated patients. Effective pressure control prevents most complications and prolongs patients’ lives.
High Blood Pressure can be divided into two groups or forms: Essential arterial hypertension, which is suffered by more than 90% of people and whose cause is unknown, is incurable but controllable, is related to hereditary factors (especially first-degree relatives who have the disease), environmental factors, stress and nutritional factors, especially related to an inadequate diet.
Secondary arterial hypertension, which is generally secondary to a disease that can trigger the elevation of blood pressure; this form of hypertension is more frequent in young people, usually under 30 years of age. Its importance lies in the fact that by treating the pre-existing disease, hypertension can disappear, i.e., this form of hypertension is curable.
Drugs, pharmaceuticals, toxins and hormones that can cause hypertension
There are some drugs, poisons and hormones that can cause hypertension, including:
-Nonsteroidal anti-inflammatory drugs (NSAIDs).
-Toxics: Alcohol, cocaine, nicotine.
-Toxic substances: lead, thallium, cadmium, arsenic.
-Exogenous hormones: growth hormone, thyroid hormones.
Factors related to Hypertension
There are some factors that are related to hypertension:
Ethnicity: black people have higher incidence (occurrence) or chances of developing this condition than white people, also hypertension is more severe and difficult to control with medication.
Age: Essential hypertension usually appears after 40 years of age, while secondary hypertension is more common in young people, usually under 30 years of age.
Sex: Hypertension is more frequent in men than in women; however, after menopause, women reach the same percentages as men of suffering from hypertension.
Overweight and obesity: Overweight and obese people are predisposed to have a higher than normal blood pressure since it has been determined that abdominal adipose tissue has cells capable of producing hormones and substances considered hypertensive that will predispose these people to develop conditions such as diabetes, hypertension and cardiovascular problems such as metabolic syndrome.
Doctors consider hypertension to be a silent killer, since it generally does not cause discomfort, or when it is present, the affected person does not give it much importance. There may be a slight headache (cephalea), especially in the back (occipital region), mainly in the mornings.
Other symptoms that may occur are those caused by complications of hypertension; shortness of breath (dyspnea) on exertion due to abnormal heart growth (cardiac hypertrophy), chest pain due to angina or heart attack. Many people do not know they are hypertensive (one in three people who are hypertensive do not know they have this condition).
Organs affected by hypertension
The main organs affected by BHP are:
Retina and Brain: Hypertension damages the retina, a condition called hypertensive retinopathy that can only be detected by means of an eye fundus study. At the level of the brain it can trigger a cerebrovascular accident (stroke).
Heart and cardiovascular system: enlargement of the heart, especially the left ventricle (concentric hypertrophy), a disorder with a very poor prognosis that can lead to congestive heart failure and sudden cardiac death. Alteration of the peripheral circulation which is called peripheral arterial disease that affects mainly the lower limbs. Decreased oxygenated blood supply to the heart which can trigger angina pectoris or infarction, which if it covers more than 40% of the surface of the heart can be fatal (massive or fulminant infarction).
Kidneys: Untreated or poorly controlled high blood pressure can severely injure the kidneys leading the patient to chronic or end-stage renal failure that will require the need for life-sustaining dialysis or the practice of kidney transplantation.
Complications of hypertension
Untreated or poorly controlled arterial hypertension can trigger some complications that in certain cases can be very serious and potentially fatal:
1. Myocardial infarction.
4. Aortic dissection (very serious complication and high mortality).
5. Metabolic syndrome.
7. Heart failure.
Blood pressure control
It is very important to monitor blood pressure values, as they guide medical treatment. The World Health Organization currently establishes that the pressure should be controlled with an electronic sphygmomanometer cuff because they are more accurate in the measurement than the manual ones both at hospital and ambulatory level (office, home).two measurements (morning and afternoon) three to four times a week is ideal, the person should remain seated for at least 15 minutes before taking the pressure, should not have eaten food or have made any kind of effort.
The treatment should include some general measures such as: weight loss and exercise; smoking cessation, and as regards diet, the consumption of fruits and vegetables should be increased, as well as a decrease in salt intake and limitation of alcohol consumption.
Hypertension is controlled with medication, which must be taken every day for the rest of the affected patient’s life. In general, medication, a healthy diet and adequate physical activity are sufficient for adequate blood pressure control.
If, after three months or more, the blood pressure has not leveled off, two or three more medications can be added to the treatment schedule, until an acceptable blood pressure value is achieved that avoids or delays the appearance of the complications of the disease, which are those that lead to the patient’s death. Despite the effectiveness of pharmacological treatment, blood pressure drops to the desired level in only one third of hypertensive patients.
Some preventive measures are recommended to prevent or delay the onset of long-term complications in arterial hypertension:
-It is highly recommended to lead a quiet life and avoid stress as much as possible.
-A healthy diet is highly recommended. High-fat food should be avoided, and salt consumption should be reduced. Avoid or limit the consumption of condiments and pickles that have high levels of salt, canned food, sausages.
-Coffee consumption is very controversial, previous studies indicated that its excessive consumption, that is, three or more cups a day could raise blood pressure. However, in a recent study published this year in the journal of the American Medical Association, it was revealed that the consumption of three or more cups of coffee per day was not related to an increase in blood pressure, although as coffee is a stimulant of heart rate and blood pressure, it is not recommended for people with difficult or poorly controlled hypertension.
-The consumption of fresh fruits and vegetables is highly recommended, due to the antioxidant benefits of their components.
-Perform adequate physical activity within a regular exercise program, supervised by the physician, since exercise and physical activity are natural regulators of blood pressure.
-Maintaining an ideal weight is the most appropriate, since overweight and obesity overload the work of the heart, and treatment is more difficult in this type of patient, as is blood pressure control.
-It is very important to reduce or eliminate alcohol consumption; in fact, alcohol can trigger a condition called alcoholic heart disease.
-Eliminating tobacco, since nicotine has been shown to be toxic to the heart and arteries.
-Treatment and control of diabetes.