Arterial hypertension

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

Summary

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  • 1 Description
  • 2 Risk factors
  • 3 Causes
    • Causes of secondary hypertension
      • 1.1 Renal
      • 1.2 Vascular
      • 1.3 Endocrines
        • 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. The moving blood pushes against the walls of the arteries and this force is measured as blood pressure. Hypertension is a term used to describe chronic high blood pressure. Blood pressure is said to be high when it exceeds 140/90 mmHg in three consecutive intakes with 6 hours of difference between them.

High blood pressure is the main cardiovascular risk factor. It is known as ‘the silent killer’, because in most cases it has no symptoms, so you can develop heart or kidney problems without being aware of hypertension. Without treatment, high blood pressure appreciably increases the risk of a heart attack or stroke .

Risk factor’s

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

  • Family history of hypertension.
  • African-American raceAfrican- Americans have a higher incidence of high blood pressure than whites, and the disease usually appears younger and is more severe.
  • Male sex: The man is more prone to HT. In women the risk is higher after 55 years.
  • 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: Cigarette damages blood vessels.
  • Oral Contraceptive Use: Women who smoke and use oral contraceptives greatly 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 drink is defined as 1.5 fluid ounces (44 ml) of spirits with an alcoholic strength of 40 ° (80 proof) (eg, American or Scottish whiskey, vodka, gin, etc.), 1 fluid ounce ( 30 ml) of spirits with an alcoholic strength of 50 ° (100 proof), 4 fluid ounces (118 ml) of wine, or 12 fluid ounces (355 ml) of beer.
  • Sedentary lifestyle: It is physically inactive.
  • Mellitus diabetes

Causes

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

Causes of secondary hypertension

Kidney

Kidney causes (2.5-6%) of hypertension include kidney parenchymal diseases and kidney vascular diseases, such as the following:

  • Polycystic kidney disease
  • Chronic kidney disease
  • Renin-producing tumors
  • Liddle syndrome
  • Renal artery stenosis
  • Renovascular hypertension produces 1.2-4 percent of cases, which has been increasingly recognized as a major cause of clinically atypical hypertension and as chronic kidney disease.

Vascular

  • Coarctation of aorta
  • Vasculitis
  • Vascular diseases of collagen.

Endocrine

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

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

Neurogenic

  • Brain tumors
  • Bulbar poliomyelitis
  • Intracranial hypertension

Drugs and toxins

  • Alcohol
  • Cocaine
  • Cyclosporine, 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. In 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 can 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 or 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.

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

Make sure you get a good-quality, good-fit home blood pressure monitor. It must have the appropriately sized cuff and a digital reader.

Practice with the doctor or nurse to verify that you are taking your blood pressure correctly.

Bring the home blood pressure monitor to your doctor appointments so he can verify 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 evaluating the function of the heart from the electrical point of view, as well as determining if there is any heart disease.
  • Echocardiogram: it allows to know the functioning of the heart from the mechanical point of view. It also allows defining if there is a heart disease.
  • Kidney function tests: they allow to know if there is any impairment of kidney function.
  • Renal ultrasound: allows to know the morphological characteristics of the kidney to determine if there are any abnormalities in them.

Treatment

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

The first action plan generally involves a lifestyle modification:

  • Reduce body weight if you are overweight.
  • Reduce your salt intake to 4-6 grams a day; eat fewer prepared and preserved products, and don’t use too much salt in food preparation. However, there are patients who do not respond to salt restriction.
  • Reduces alcohol intake, which in women should be less than 140 grams a week and in 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.
  • Give up smoking.
  • Follow a diet rich in polyunsaturated fatty acids and low in saturated fat.

In addition to the recommended measures, the hypertensive has a wide variety of drugs that allow him to control the disease. The treatment should be always individualized. For the choice of 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 levels), the side effects and the cost of the drugs and the tests necessary to monitor your safety. The drugs are usually well tolerated by patients, but any antihypertensive drug can cause side effects, so if these occur, the doctor should be informed to adjust the dose or change the treatment.

Complications

The fatal or non-fatal complications of HT are 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 medication and lifestyle changes. When blood pressure is not well controlled, you are at risk of:

  • Bleeding from the aorta, the large blood vessel supplying the abdomen, pelvis, and legs
  • Chronic kidney disease
  • Heart attack and heart failure
  • Poor blood supply to the legs
  • Vision problems
  • Stroke

 

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