Arterial hypertension

The blood pressure is chronically elevated blood pressure above limits or values that are set by convention and from which, detection and treatment improves quality of life for people who suffer.

The joint American National Committee for the prevention, detection, evaluation and treatment of arterial hypertension (JNC) and experts of the WHO (1997), have established that the normal values ​​of blood pressure for adults majors of 18 years are:

Hypertension is considered to be above 140 mmHg systolic and / or 90 mmHg diastolic.

Causes of high blood pressure

Blood pressure is the force that allows blood to adequately reach all parts of the human body. It varies throughout the day, and is usually lower at night.

Blood pressure is the result of the balance of many factors including:

• Heart rate
• The contractility of the heart.
• Blood volume
• Blood viscosity.
• The elasticity of the artery wall.
• A series of mechanisms that contract or relax blood vessels.

All these factors are in balance. When this balance is disturbed, the blood pressure figures are also altered. If these figures are higher than those considered normal, and are maintained constantly, there are alterations in the vascular system that give rise to arterial hypertension and the complications that derive from it.

The factors that influence the appearance of arterial hypertension are:

• Age.
• Sex.
• Genetic factors.
• Race.
• Excessive alcohol consumption.
• Excessive consumption of salt.
• Sedentary life.
• Drugs and drugs.
• Overweight / Obesity.
• Cholesterol.
• Impaired glucose tolerance.
• Electrolytes ( Potassium , Calcium and Magnesium).
• Stress .
• Tobacco.
• Caffeine.

Symptoms of high blood pressure

High blood pressure does not initially have specific symptoms unless target organs (heart, kidney, eye, central nervous system ) are affected, although it is possible to find high blood pressure figures in people who do not have any type of repercussion.

The most common symptoms in hypertensive people are headache and dizziness.

Any person diagnosed with hypertension should be evaluated to look for signs of target organ involvement.

As for secondary hypertension, the symptoms that it presents are usually related to the disease that causes it and these orient towards the diagnosis of it.

Complications of high blood pressure

The increase in mortality caused by arterial hypertension is mainly due to its cardiovascular complications. These include acute myocardial infarction and congestive heart failure, conditions that can take a long time to show symptoms.

Complications derived from the arterial hypertension itself: malignant hypertension, hypertrophy of the left ventricle, congestive heart failure, cerebral hemorrhage, hypertensive encephalopathy, kidney failure, etc.

Complications of high blood pressure related to arteriosclerosis: angina pectoris, myocardial infarction , cerebral thrombosis and others.

How is it diagnosed?

Blood pressure is measured in millimeters of mercury (mmHg).

Correct blood pressure measurement can be done using a mercury sphygmomanometer, an aneroid manometer, or an electronic device. It is convenient that all the devices are correctly calibrated.

The most suitable for determining blood pressure is the mercury sphygmomanometer.

Treatment of hypertension

In general, hypertension should be treated in the following cases:

When the systolic blood pressure is greater than 180 mmHg.
When the diastolic blood pressure is greater than 100 mmHg.
When the diastolic blood pressure is between 95-99 mmHg. and there are other cardiovascular risk factors.
When the diastolic blood pressure is between 90-94 mmHg. and there is target organ involvement.

Pharmacotherapy

The objective of the treatment and control of arterial hypertension is to reduce the blood pressure levels to values ​​that are considered within normality, and also to reduce the cases of ischemic heart disease and cerebrovascular accidents and other complications directly related to hypertension arterial.

Currently there are a number of effective and reasonably well tolerated antihypertensive drugs, which can be included in several pharmacological groups:

• Diuretics: are drugs that cause a loss of water and sodium from the body through urine, and act directly on the kidney.
• Beta-adrenergic blockers: they act through different mechanisms (reducing cardiac output, acting on the central nervous system …).
• Postsynaptic alpha-1 adrenergic blockers: they act by dilation of the arteries and veins, thereby reducing peripheral vascular resistance and blood pressure.
• Alpha-beta adrenergic blockers: they also act by dilation of blood vessels but by acting on other types of receptors (alpha-1 adrenergic).
• Other antihypertensive drugs: Clonidine, Methyl-dopa, Guanfacine, Hydralazine, Minoxidil …
• Angiotensin converting enzyme inhibitors (ACEI): lower blood pressure in both normal and hypertensive people. They increase blood circulation in the vessels of the heart, kidney and brain and decrease left ventricular hypertrophy.
• Angiotensin II receptor antagonists: have similar efficacy to ACE inhibitors and with few side effects.
• Calcium channel blockers: calcium channel blockers or calcium channel blockers are a very broad group of drugs that act by preventing the entry of calcium into the smooth muscle fiber of the blood vessels.

Non-pharmacological treatment

This treatment consists of a series of general measures to aid drug treatment. These general measures are based on changing lifestyle and eliminating a series of factors that are detrimental when it comes to controlling high blood pressure, these factors are:

• Tobacco cessation.
• Decrease in overweight.
• Abandonment of alcohol.
• Reduction of salt consumption.
• Moderate and aerobic physical exercise.
• Cholesterol reduction.

How can I avoid it?

Lifestyle modifications are essential in the prevention of hypertension, since they have been shown to be effective in reducing not only blood pressure, but other cardiovascular risk factors.

The most important preventive measures are:

• Overweight / Obesity: when overweight, weight reduction should be attempted gradually and sustained in the medium-long term. The diet must be individualized.
• Alcohol consumption: should be aimed at total abandonment of alcohol consumption.
• Salt intake: reducing salt intake in meals not only helps to control high blood pressure, but also, in cases where drug treatment is required, increases the antihypertensive effect of some medications. At the same time, diets with an adequate supply of potassium, calcium and magnesium should be eaten.
• Physical exercise: it is advisable to carry out aerobic physical exercise (running, swimming, walking, cycling…) on a regular basis, 3-4 days a week. Competitive sport or isometric exercise (weightlifting, rowing …) is not recommended.
• Cholesterol: saturated fat and cholesterol should be reduced.
• Tobacco: people with hypertension should stop smoking, since its association leads to an increased cardiovascular risk. «
• Caffeine: coffee can be consumed moderately, since a direct relationship between its consumption and an increase in blood pressure has not been demonstrated.

Following the appropriate norms (see diagnosis of arterial hypertension), in some cases, blood pressure can be measured by the hypertensive itself.

Blood pressure considered normal with self-monitoring is:

1. SBP less than 135 mmHg.
2. DBP less than 85 mmHg.

It is advisable to go to the doctor from time to time to check your blood pressure, because this pathology does not present symptoms, except when blood pressure levels rise sharply.