High Blood Pressure or Hypertension (HBP) is a term that refers to the fact that blood travels through the arteries at a pressure higher than is desirable for health. In some cases, there may be dizziness, nosebleeds, or headaches, but not necessarily. Most of those affected have no symptoms. That does not mean that it is not dangerous: A large part of the deaths that occur each year are as a direct consequence of hypertension or its complications on the cardiovascular system or the kidney.
A typical normal Blood Pressure is 120/80 mm Hg. This means that the heart exerts a maximum pressure of 120 mm Hg during systole or pumping phase, and that the heart at rest, in the diastolic or filling phase, has a pressure of 80 mm Hg. (The pressure of the heart is the same as that of all the arteries of the body).
La Tensión Arterial viene determinada por dos factores principales entre muchos otros: La cantidad de sangre que circula, y el calibre de las arterias por las que circula. En general, cuanto más volumen de sangre circulante y cuanto menor es el diámetro por el que circula ese volumen, mayor es la Tensión Arterial. Los riñones controlan el volumen de agua circulante y la cantidad de sal que contiene el cuerpo. Estos dos hechos tienen efectos directos en la Tensión Arterial . Cuanta más sal en el cuerpo, más agua se retiene en la circulación, y más puede aumentar la Tensión Arterial , lo cual a su vez puede aumentar la tendencia de las arterias a hacerse más estrechas.
However, a person with a healthy kidney and without hypertension can tolerate a very wide range of salt intake with no effect on blood pressure. On the other hand, if the vessels become smaller, the heart has to work harder to pump the same amount of blood, and the pressure at which the blood is pumped increases. Other factors that influence Blood Pressure are the nervous system, the blood vessels themselves (in particular, the smaller arteries, called arterioles) and a number of hormones.
CAUSES OF HTA
HT is the increase in Blood Pressure to 140/90 mm Hg or more. This can occur without a known prior cause (essential HT) or as a result of some other disease (secondary HT). The most common causes of secondary HT are:
- Endocrine (gland) diseases: Cushing’s syndrome, Tumors of the adrenal glands.
- Kidney disease: Renal Artery Stenosis (narrowing), glomerulonephritis, or kidney failure.
Pregnancy and the use of oral contraceptives can also cause HT in some women
TREATMENT AND RECOMMENDATIONS
In most cases, the cause of HT is unknown. However, it can be treated effectively, lowering BP to manageable or normal levels and avoiding all serious consequences of HT, thereby maintaining a normal life expectancy. The treatment of arterial hypertension is based on the following points:
| DIET |
| Excessive salt in the diet causes fluid retention and increased Blood Pressure. To reduce Blood Pressure, the first step is to reduce your total salt intake (including that contained in bread, concentrated broths, prepared foods, etc.) to less than one teaspoon per day. The daily needs of salt are around half a gram a day (half a teaspoon), but in a normal Western diet eight times that amount is consumed, not only in salt shaker, but also in snacks, cheeses, sausages, condiments, soups of envelope. Sodium is not only in salt, but also in monosodium glutamate, yeast, etc., so read the labels of packaged products when following a strict low sodium diet.
On the other hand, excess weight contributes to increased cardiac work. Obesity is associated with high blood pressure to a great extent, in part because obese people have an increase in insulin that, through a lower flow of the renal circulation, produces a retention of salts (Sodium). A low calorie diet (1200 cal) with low fat intake can produce a 10 mm Hg decrease for every 10 kg of weight loss. In some people, losing weight is enough to control Blood Pressure. Tobacco and caffeinated beverages have a short-term effect of increasing blood pressure, but there is no clear evidence that their regular use can contribute to a sustained HT. However, the use of tobacco can accelerate the process of arteriosclerosis in people with HT. Likewise, habitual alcohol abuse can contribute to the development and maintenance of HTN. It should also be taken into account that certain drugs increase vascular resistance, including non-steroidal anti-inflammatory drugs, contraceptives, sympathomimetics and steroids. |
| MEDICATION |
| In general, treatment should be started when the mean diastolic pressure for three or four months is equal to or greater than 100 mm Hg. If it is less, to start treatment, there must be other risk factors at the same time, such as heart injury (ventricular hypertrophy, kidney failure, etc.) or other risk factors (diabetes, family history of cardiovascular disease). An attempt should be made to keep the diastolic pressure below 90 mm Hg, by means of a treatment that the patient tolerates well. We must take into account in the treatment of hypertensive disease that it is essential in the control of coronary heart disease, other factors that may be modified by these drugs:
· Diuretics (except indapamide), increase cholesterol and LDL with little change in HDL. · Beta-blockers (except celiprolol), lower HDL without modifying LDL or total cholesterol. The effect is greater the lower the intrinsic sympathomimetic activity of the drug. · Thiazide diuretics cause glucose intolerance and increased insulin resistance. The same occurs with beta-blockers, without sufficient data to establish differences between the drugs in the group. · Alpha-blockers (prazosin, doxazosin) have been receiving some attention lately because they favorably modify the HDL – LDL ratio and glycemic control. Neither the angiotensin-convertase inhibitors, the calcium antagonists, nor the majority of antihypertensives considered to be second-line influence the lipid fractions or the glycemia. These findings are important because the relative lack of efficacy of antihypertensive drugs to prevent coronary heart disease (14%) has been interpreted as proof that metabolic actions are sufficiently strong to partially counteract the beneficial effect of lowering blood pressure. · We must avoid diuretics and beta-blockers in diabetics, preferably using ACE inhibitors or calcium antagonists. · In dyslipidemia the same is done but sometimes diuretics or beta-blockers are used if this is going to mean an improvement in the control of HTN or if they are indicated for another reason. · If the aforementioned risk factors do not exist, the most experienced (old) medications should be used and, in general, avoid high doses of any of them and rush the possibilities of non-pharmacological therapies. · Try to substitute one of the triple therapy drugs for minoxidil. · Diuretic + beta-blocker + ACE inhibitor + hydralazine (or with alpha-blocker, calcium antagonist, replacing one of those mentioned). |
| EXERCISE |
| An aerobic exercise program helps to strengthen the heart, lose weight and control Blood Pressure. The exact mechanism by which it helps lower Blood Pressure is not known.
An appropriate exercise must be carried out for each age and for each person, therefore, half an hour of gentle exercise, preferably directed by a professional, 2 or 3 days a week is sufficient for most people. |
