Hypertension means excessive pressure , or force, from the blood pumped from the heart into the arteries. A person can be said to be hypertensive if, by measuring the blood pressure with the sphygmomanometer , he always has values higher than normal.
The reliefs are 2, expressed in mm Hg (millimeters of mercury): the maximum pressure, or systolic , during the contraction of the heart; the minimum pressure , or diastolic , when the organ relaxes. The maximum acceptable values (but to be considered ‘limit’) are 140/90 mmHg , read as “140 out of 90″, so higher values (even slightly) indicate hypertension. Since hypertension does not cause disturbances until complications occur, it is referred to as the ” silent killer “.
But in the long run it damages internal organs and can cause serious accidents, such as heart attack and stroke. In addition, the state can generate brain disorders, such as dizziness and fainting, and lead to shock. But, habits that can positively affect blood pressure are diet, low in salt and fat and rich in vegetables , and movement. Hypertension can affect everyone and it does not spare children or pregnant women either, but is favored by particular factors, such as obesity.
As recommended by the World Health Organization ( WHO ) Guidelines , adequate antihypertensive behaviors are required. In fact, little salt and moderate animal fats at the table , no smoking and limited alcoholic drinks are the basis of the measures.
Hypertension: what it is
The term suggests effort, nervousness and stress, but in fact it is a state of high blood pressure in the arterial vessels.
In itself, hypertension is not a disease, but a condition that increases the risk of other diseases, particularly cardiovascular ones.
But, those who have high blood pressure values for a long time can be affected by:
- brain stroke
- heart attack
- kidney failure
Of course, the health hazard grows with increasing blood pressure.
Anatomy of the cardiovascular system
To understand the mechanisms involved in normal or not blood pressure, the cardiovascular system must be configured .
In the closed dynamic hydraulic system, the heart works like a pump and pushes the blood into the vessels to ensure its circulation. Located in the thoracic cavity, the muscular organ has 4 cavities , or chambers, of which 2 are superior, atria, and 2 inferior, ventricles.
The cavities communicate with the vascular system and atrium and ventricle with each other, via valves. The right side of the heart cannot communicate with the left, because they are separated by a septum.
Therefore the right heart and the left heart are distinguished , as 2 separate units working in parallel. The vessels carry arterial, oxygenated blood from the left heart to the periphery, for the exchange of nutrients and oxygen with the waste.
Instead, the venous blood, rich in toxic substances and devoid of oxygen , returns through the vessels to the right heart to be oxygenated. Hence, it is essential that the process runs perfectly , without obstacles, as on the contrary happens in the perturbed pressure.
Control and compensation of blood pressure
A healthy person’s body has several blood pressure control and compensation systems , among others:
- variation in the diameter of the veins and arterioles
- amount of blood pumped from the heart
- volume of the circulating one.
In addition, these mechanisms bring blood pressure back to normal after the increase or decrease due to physiological activities. Hence, the veins can dilate or narrow in order to change the volume of blood they can carry. Instead, in vasoconstriction, the “capacitance” is reduced, the ability to contain blood, which is pushed into the arterial district.
What makes the pressure rise
Consequently, blood pressure rises , while it decreases in case of dilation. In this latter state, the capacitance increases, pushing less blood into the arteries.
Arterioles can also dilate and shrink, reducing or increasing blood pressure.
The increase in blood pumped every minute, or cardiac output, raises the pressure until the resistance to flow is constant.
The organism can modify the blood quota pumped at each systole, slowing down or speeding up the frequency. Or, for the same result, the body can increase or decrease the contraction force of the heart. So if the volume of blood, or volume, increases, the pressure rises until the resistance to flow in the arteries is constant.
Organ involvement: what happens to the body
To encourage or reduce blood volume, the kidneys may vary the amount of fluid excreted in the urine. Hence, the compensation mechanisms are activated by specialized cells that function as sensors, or baroreceptors.
Located in the arteries , these sensors, including the most important ones in the neck and chest, continuously monitor pressure. But, if the baroreceptors detect a pressure change, a compensation mechanism is established, which maintains the pressure balance.
Then, to quickly correct the pressure, the heart is stimulated to change the speed and force of contraction , by varying the range. Then, the arterioles receive a signal that causes constriction or dilatation, changing the resistance of the vessels. The veins are given the order to shrink or dilate, with consequent changes in capacitance.
Kidneys and pressure regulation
In addition, the kidneys change the amount of liquid excreted , thereby changing the volume of blood in the vessels. But this operation is the slowest to control the pressure since it takes a long time to give results.
Pressure regulation depends on the renin-angiotensin-aldosterone system, which is made up of reactions that favor the process. But, when the pressure drops, for example systolic to 100 mm Hg, the kidneys release the renin enzyme into the blood .
This divides angiotensinogen, a large protein circulating in the blood, into some fragments, one of which is angiotensin I. The important fragment, relatively inactive, is divided into pieces, including angiotensin II, by the conversion enzyme angiotensin (ACE).
The angiotensin II hormone determines the constriction of the muscle walls of the arterioles, increasing blood pressure. In addition, angiotensin II, very active, causes the release of the hormone aldosterone from the adrenal glands. This hormone stimulates the kidneys to retain salt , or sodium, and expel potassium.
Hence, sodium in turn causes water to retain, which increases blood volume and thus blood pressure.
More susceptible to high blood pressure are smokers, diabetics and overweight people.
In fact, the incidence of the disease is 2 times higher in obese people than those of normal weight. In addition, sedentary subjects, with little physical activity, and those who abuse salt on the table can incur hypertension.
A certain familiarity appears connected to the onset of the disease, above all understood as predisposition. In the elderly, from 65-70 years of age , an increase in pressure occurs due to the arteries becoming rigid.
Even children can develop hypertension, especially in preschool , while infants are excluded. However, hypertension mainly affects 3/4 of women and 2/3 of men aged 75 or over.
In the other age groups, both sexes are equally subject to the pathology, but with an early onset in young males.
Diffusion in the world
Regarding ethnicities, hypertension appears to be more frequent in the black population, with 32% of adults affected . Instead whites, but also South Americans, with high blood pressure would be 23%.
Worldwide, it is believed that 35-45% of the population suffers from hypertension, mainly in developing countries.
However, in nearly 50 years, the amount of hypertensive people has doubled , reaching a total of over 1 billion. Furthermore, particularly relevant is the fact that the rise in hypertension has occurred in low-income countries.
23% of hypertensives, or 258 million, live in southern Asia and 21%, 235 million, in eastern Asia. In these countries, hypertension is estimated to affect 1 in 6 men and 1 in 10 women.
In the United States, it has been calculated that over 50 million people are affected by the morbid condition . But only 2 out of 3 Americans with hypertension are diagnosed and 75% of them are actually treated.
Blood pressure: what it is and how to measure it
The arterial pressure is the force exerted by the blood pumped from the heart, on artery walls, which distribute the body. But this force, for various reasons, can become too intense and persistent and cause damage and disease. Hypertension is full-blown if the blood pressure, measured with the sphygmomanometer, is always at rest above the set limits.
For the reading of the measurement, usually on the arm, 2 values are recorded :
- systolic (maximum)
- diastolic (minimum value).
Physical activity affects pressure as exercise temporarily increases it and then balances it. Normally, the values vary according to the time of day : they rise in the morning and decrease at rest and at night. So you should know your blood pressure, even measuring it at home , in order to be able to intervene if it changes.
The sphygmomanometer consists of a rubber cuff, connected to a pump, to inflate it, and a meter. Blood pressure readings are reported on the dial of the meter, which records the pressure of the cuff.
Take blood pressure at home and at the doctor
For the survey at home, simplified devices are available, quite reliable, with a bracelet to wrap around the wrist or fingers. Certainly with home measurement the hypertensive effect given by the presence of the “white coat” is avoided.
However, it is preferable, for the diagnosis, to rely on the more precise findings of the doctor, even for occasional checks. However, before the measurement, the subject must remain calm and at rest for at least 5 minutes .
Seated, the person concerned must rest an uncovered arm on a table, tilting it so that it is at heart level.
The operator puts the cuff on the arm and inflates it with the pump until it compresses the artery and blocks the flow of blood.
With a phonendoscope on the artery, under the cuff, and feeling the pulse, the doctor no longer hears noises generated by the passage of blood. Then, after pumping more air , the operator begins to deflate the cuff until he feels a pulse, the systolic.
Instead, the dystolic is established when the noise of the bloodstream stops, while the cuff deflates again.
But, the home instrument measures the pressure automatically, without the need for a pump and a phonendoscope.
For people over 50, the blood pressure measurement measured on the arm is the most accurate and avoids false results.
Similarly, in order not to have uncertain results, the bracelet must be proportional to the size of the arm. In fact, if it were too small, the values would be higher and, conversely, if large, the reading would be lower.
But, for a certain evaluation, 2 measurements are needed within a few minutes of each other.
The second is done after the subject has stood up, especially in case of diabetes or old age. But the diagnosis cannot be based on a single double measurement, even in the face of values above 140/90 mmHg.
How to interpret blood pressure values
The higher figure indicates the highest, or maximum, pressure present in the arteries, reached during the contraction of the heart, or systole. The other evaluation, or minimum, indicates the lowest pressure in the arteries, when the heart relaxes, between contractions, or diastoles.
The measurements are expressed in mm Hg, millimeters of mercury, because the first instrument for the measurement was a mercury column.
Throughout life, the pressure naturally varies with the years and that of young children is much lower.
Normal values and high values
A normotension must have systolic blood pressure between 90 and 119 MMHG and diastolic blood pressure between 60-79 MMHG.
In adults, hypertension occurs if the values, at rest, exceed the threshold considered acceptable, around 140/90 mmHg . Instead, with measurements equal to or higher than these levels and with the coexistence of both altered, we can define ourselves as hypertensive.
Hypertension and hypotension
But, too low values, below 90/60 mmHg, are universally considered anomalous and cause of problems. In fact, hypotension can cause brain ailments such as:
- respiratory difficulties
- chest pain.
Find out all about low blood pressure : what it is and how to fight it.
Hypertension due to unknown medical causes is called “primitive” or “essential ” and affects approximately 90-95% of subjects.
There is primary , or essential, hypertension which tends to develop gradually over several years (therefore age is among the risk factors): in this case, no cause can be identified. And then there is secondary hypertension , when high blood pressure is caused by an underlying pathology: in this case the disease tends to appear suddenly and leads to an increase in pressure greater than primary hypertension.
This state seems to depend on many factors, also related to the environment, but the origin is unknown of many.
Certainly the development of high blood pressure values is linked to unhealthy behaviors, such as sedentary lifestyle and being overweight.
Also, reasons for primary hypertension can be advanced age and psychological imbalances, such as depression . In some cases, there may be a hereditary anomaly of vasoconstriction of the arterioles at the base, between the pressure controllers.
However, the phenomenon has not yet been well understood, but some variations occur as a result of this family status. All changes are borne by the heart and vessels, such as an increase in cardiac output or volume.
On the other hand , hypertension from a known or “secondary” cause is traced back to certain circumstances and diseases. These hypertensives, 5-10% of the total, can be affected by renal changes, which compromise the elimination of sodium and water .
Others have kidney disease, such as a narrowing of the kidney artery or inflammation or injury.
Some people with secondary hypertension have other disorders, including drug dysfunction, such as oral contraceptives . The condition can be triggered by heart problems or hormonal changes, which include Cushing’s syndrome .
Secondary hypertension is related to arteriosclerosis , which makes the arteries rigid, and to the abuse of licorice, drugs or alcohol.
Hypertension in pregnancy
High blood pressure in pregnancy is a condition to be kept under control. It comes in two forms:
chronic hypertension (when blood pressure is high before pregnancy or before the 20th week)
gestational hypertension or preeclampsia (when it develops after the 20th week). Generally this tends to disappear after pregnancy.
Degrees of hypertension
In addition to the optimal (below 120/80 mmHg) and normal (below 130/85 mm Hg) pressure, there is pre-hypertension, at 130-139 / 85-89 mm Hg.
Not yet a morbid condition, this normal / high blood pressure is already a risk if it persists over the years without control.
Those who manifest these values should measure the pressure every year and carry out tests to detect their evolution, with any deterioration.
If the pressure reliefs are 140-149 / 90-94 mmHg, hypertension is called Grade 1.
This borderline stage, especially with values tending to the maximum set, can already lead to organ damage . In fact, cardiovascular risk, although not serious, may be present in Grade 1 hypertension.
When blood pressure reaches 150-159 / 95-99 mmHg , there is mild Grade 1 hypertension.
In this intermediate situation, if there is damage to an organ, the risk of pathologies increases exponentially.
Second degree hypertension: values
Those who reach pressure levels of 160-179 / 100-109 mmHg have moderate Grade 2 hypertension.
The stage should be monitored to find out the likely kidney and heart problems that are frequently related.
Third degree hypertension
Hypertension becomes severe, Grade 3, and therefore ascertained, with pressure values equal to or greater than 180/110 mmHg.
Furthermore, when the systolic and diastolic pressure of a subject are placed in different categories, the greater one must be taken into consideration.
Finally, borderline isolated systolic hypertension also exists, characterized by values of 140-149 on less than 90 mmHg.
Particular forms of hypertension
With a systolic equal to or greater than 150 mmHg and a diastolic less than 90 mm Hg, isolated systolic hypertension occurs.
These last 2 stages are common in the elderly , probably as a result of rigid or plaque vessel walls. In particular, in people with very rigid arteries, especially in old age, pseudohypertension can be identified .
The high values found are due to the arm artery too rigid to be compressed by the measuring sleeve. As a result we are not faced with a true hypertension but with the fact that the pressure cannot be measured accurately.
Instead, a serious form of hypertension , from emergencies, is malignant, with values of at least 210/120 mmHg. However, the dangerous phenomenon occurs rarely, only in 1 in 200 hypertensives , and affects more men, of lower social class.
Malignant hypertension can cause numerous serious symptoms and, if left untreated, often leads to death within 3-6 months.
Other forms of hypertension
Another dangerous situation is given by the hypertensive urgency, with measurements greater than 180/110 mmHg . Usually this pressure apex gives no symptoms, but often requires rapid medical intervention, sometimes in the hospital.
A particular variant of hypertension is nocturnal , in an individual who is normally normal during the day. In fact, normally the blood pressure at night drops , due to the lower production of catecholamines, while in this patient the opposite occurs.
Hypertension: causes and risk factors
Substances and drugs responsible for hypertension
Substances, among many:
- nonsteroidal anti-inflammatory drugs
- oral contraceptives
- corticosteroids and nasal sprays with cortisone
- excess of alcoholic drinks and licorice.
By evaluating the patient, an attempt is made to trace the origin of hypertension, which can also depend on physical and emotional stress.
In an Italian study, the cloistered nuns, compared to the others, showed optimal blood pressure values , thanks to the quiet life. Typically, stress causes a temporary increase in blood pressure , which returns to normal after the moment.
An example is given by the transient “white coat” hypertension, or by stress of the medical examination that raises the pressure.
The same mechanism occurs on working days when a person has higher blood pressure than on vacation. Therefore, the hypothesis is that, in predisposed subjects, short blood pressure increases can damage and eventually give stable hypertension.
Regarding the familiarity of hypertension, i.e. predisposition, latest studies indicate a polygenic transmission. So the pathogenesis of the condition would be linked to multiple inherited genes, rather than just one.
But, a current hypothesis on hypertension is the “mosaic theory” , according to which several factors intervene in the genesis.
An important element is the overweight, so every 5-10 kg taken there would be a pressure increase of 3-4 mm Hg.
In fact, obese individuals, with BMI over 30, are more at risk and to be monitored.
Instead, numerous factors have been identified that put a person at risk for the onset of hypertension. First of all, the consumption of salt higher than the acceptable 4 grams per day can lead to hypertension.
In fact, with excess sodium, the vessels stiffen and vasoconstriction occurs, so it is good to limit yourself to 2-3 g of salt daily.
A diet too rich in salt or low in potassium produces imbalances that contribute to hypertension.
Hypertension and smoking
Cigarette smoke, especially in the acute phase, that is, while smoking, induces vasoconstriction, which increases blood pressure.
After having smoked even a single cigarette, the blood pressure remains higher for at least half an hour.
Furthermore, nicotine dependence harms the vessels , causing loss of elasticity, injury to the walls and the formation of atherosclerotic plaques.
Finally, the study is the sleep apnea syndrome , of neurological origin but of cardiological interest and hypertension factor. More common in obese people, prolonged sleep apnea is associated with severe heart rhythm difficulties, such as ventricular fibrillation.
Diseases and hypertension: links
In most cases, it is not possible to highlight the disease responsible for hypertension with diagnostic tests. In fact, in such patients, the pressure rise would be due to the defective functioning of the mechanisms that maintain the pressure balance.
This is the case of essential or primary hypertension , also called idiopathic because it would fall within the constitution of the individual.
Clinical data associate hypertension with metabolic syndrome , characterized by insulin resistance and high levels of triglycerides and cholesterol.
Of course, diabetes often accompanies elevated blood pressure and increases its cardiovascular risk .
Arteriosclerosis interferes with the blood pressure control system, promoting its increase. The resulting stiffness of the arteries prevents vasodilatazone which would otherwise bring the pressure back to normal values.
However, only in 1 in 20 hypertensive patients, about 5%, is it possible to identify a specific cause of the condition.
Secondary diseases and hypertension
In secondary hypertension it is possible to demonstrate an organic link, especially with a disease. The detectable causes are many; among the most frequent are:
- kidney disease, including renal artery stenosis
- kidney cancers
- polycystic kidney
- organ trauma
- radiation therapy in the area
- hormonal disorders, such as hyperthyroidism
- Cushing’s syndrome
Other pathologies, such as:
- aortic coarctation
- preeclampsia (complication of pregnancy)
- lead poisoning
- acute intermittent porphyria.
In most people, hypertension is asymptomatic , although it can give some random signs. In a widespread but incorrect way, numerous signs are attributed to the condition:
- nosebleeds (nose bleeds)
- redness of the face
In fact, hypertensive people experience these symptoms as often as those who are normotensive. In fact, many hypertensive subjects do not know they are because they do not complain about particular symptoms. On the contrary, long-term or untreated hypertension, especially malignant hypertension, causes disturbances.
In fact, high blood pressure can damage the brain, eyes, heart and kidneys.
As a result, late symptoms occur, such as:
- He retched
- breathing difficulties
- impaired vision.
A hypertensive person, after years in this condition, may experience a black vision or bright spots in front of his eyes . But, even a morning headache can be a wake-up call as well as ringing in the ears, or tinnitus.
Furthermore, a hypertensive person, after a long time , can suffer from:
- sense of fatigue
Above all, the subject has difficulty climbing stairs , is hungry for air and feels exhausted for no reason.
Importance of not underestimating the symptoms
Often the signals are not received or are underestimated as they are attributed to other physical conditions.
Non-peculiar symptoms of hypertension can be associated with others specific to the underlying disease . In fact, in the worst cases, cerebral edema occurs from which:
- marked nausea
- intense vomiting
- heavy headache
This hypertensive encephalopathy can lead to seizures and coma and requires immediate treatment. But, if hypertension depends on a tumor of the adrenal gland, pheochromocytoma, related symptoms occur.
In this case, the high levels of adrenaline and norepinephrine , secreted by the tumor, cause tachycardia or heart rate, i.e. arrhythmia. In addition, pheochromocytoma hypertension is revealed with profuse sweating, or diaphoresis, tremor, pallor, intense headache and anxiety.
Hypertension and heart damage
When the blood pressure values exceed 140/90 mm Hg , the heart expands and the walls become thicker. The phenomenon is due to the fact that the organ must stimulate the contractile force to pump blood.
Therefore, as these walls are more rigid, the heart cavities do not dilate normally and fill with greater difficulty. The consequent increase in cardiac work can lead to changes in rhythm and heart failure, or failure.
Arrhythmias can be life-threatening, even without producing manifest symptoms.
Heart failure is revealed by edema, dyspnoea and asthma and can lead to embolism or thrombi, the basis of a stroke .
How pathology evolves
The high blood pressure condition is potentially dangerous for the body and is a significant cardiovascular risk factor. Given that for years hypertension gives no symptoms, but ultimately causes serious complications, she is nicknamed the “silent killer”. In fact, until complications occur, the condition does not cause disturbances, being asymptomatic.
Silent killer: health risks
However, the abnormal blood pressure, not recognized or treated, deteriorates the body silently, slowly but steadily.
In fact, the consequences are usually not immediate but appear years after the onset.
Therefore, without early diagnosis and treatment, the hypertensive goes through damage whose severity is proportional to the extent of the pressure increases.
Damage to the blood vessels
First of all, the vessels are affected by the morbid situation, which leads to dissection of the aorta and atheromatous plaques. Hypertension causes micro-lesions on the internal walls of the vessels , in which:
- fat storage.
Furthermore, as the pressure-damaging action continues, atheromas, plaques composed of lipids, fibers and proteins are formed on the walls. Thus the lumen of the arteries narrows, impeding the flow of blood, with the danger of inflammation and rupture of atheromas.
Mobile bodies, derived from plaque fragmentation, can cause occlusion of the smaller and distal arteries. The vascular suffering, characteristic of atherosclerosis, affects in particular the aorta, carotids and coronaries, with harmful consequences. In particular, the vessels become less elastic , thicker in the muscular part, semi-closed and more fragile, predisposed to break.
Particularly relevant is the fact that hypertension leads to atherosclerosis and vice versa , so that atherosclerosis worsens hypertension. Also, due to the poor state of the vessels, the internal organs are not sufficiently sprayed with blood.
In this way, in turn, the organs with a lower blood flow are damaged.
The target organs most affected by high blood pressure are:
Cardio-vascular disease risk
After about ten years of hypertension, the cardiovascular system is more deteriorated . Brain structures are also affected by the harmful action of the condition, but about 20 years have passed since its inception .
Long-standing hypertension may experience transient attacks of cerebral ischemia, or TIA, and peripheral arterial disease.
The subject easily develops diseases of the kidneys and heart, such as heart attack, heart failure and sudden death. In fact, the thickening of the walls of the heart can generate cardiac ischemia from which the event of the heart attack. At the level of the cardiovascular system, the altered pressure produces:
- left ventricular hypertrophy
- heart failure
Furthermore, hypertension is the main risk factor for stroke, even at an early age, and among the 3 most important for cardiac infarction.
Impaired kidney function
Since kidney functions are compromised by high blood pressure , there is accumulation or loss of substances useful in the body with the urine. So, bad kidneys, revealed by morning swellings in the legs and eyes , can lead to kidney failure or nephrosclerosis.
But until there is a 70-80% reduction in kidney function , no symptoms develop, such as lethargy and fatigue.
As a result of the lasting high blood pressure values, the brain may suffer:
- lacunar infarction
The lesions can be linked to the reduction of oxygen to the organ , with a slow and gradual brain dysfunction. Instead the stroke , the worst damage that leads to permanent disability or fatal outcome, occurs following the breaking of a vessel .
Hypertension can cause eye retina problems , such as:
- papilla edema
- subconjunctival and exudate hemorrhages.
The first sign is the alteration of the permeability of the capillaries , with subsequent occlusion of the same and the formation of aneurysms. But, slightly high blood pressure values can already give thickening of the walls of the vessels and reduction of their caliber and blood supply.
Subsequently, the blood spreads into the retina and there is gradual loss of vision , especially in the central part, macula.
Even the reproductive system can be attacked by hypertension which deteriorates the vessels responsible for spraying the pelvic area. In men, elevated blood pressure leads to erectile dysfunction, while in women there is a drop in libido.
Diagnosis in adults
The first rule for evaluating blood pressure is its measurement, with rapid and not annoying instruments such as the sphygmomanometer. The blood pressure test must be repeated at least for another 2 consecutive days , to ensure effective hypertension. However, if the doubt persists, it is necessary to resort to 24-hour pressure monitoring , with the “pressure holter “.
Blood pressure holter
The small, portable instrument, tied at the waist, is connected with a rubber cable to a sphygmomanometer sleeve, placed on the forearm. The device runs on batteries and measures the pressure every 30 minutes during a day , even at night.
The readings, recorded on an internal memory, allow to verify the presence of hypertension and its extent. Fluctuations in values may be physiological, perhaps due to anxiety , but persistent changes are indicative of hypertension.
Even those with very stiff arteries , which are difficult to compress in the cuff, can exhibit erroneously high blood pressure values. And, in uncertainty but also to confirm the diagnosis, the target organs of hypertension are usually evaluated.
Therefore, standard practice includes, in addition to the anamnesis, physical examination and a series of analyzes on vessels , heart, kidneys and brain.
Visit to the doctor
During the visit, we proceed with palpation of the side, abdominal area corresponding to the kidneys, to seek pain. With a phonendoscope on the side, the doctor can detect a murmur , due to the blood flowing turbulently in the renal artery.
Kidney problems can be discovered with blood and urine tests.
Especially in the urine the previous damages suffered by the kidneys are found early. The signal of this state is the presence in the urine of red blood cells and albumin, the most abundant protein in the blood.
Still using the phonendoscope, the doctor can intercept the heart tones to find out if they are altered. The so-called “fourth tone” is one of the first variations of the heart to be attributed to hypertension.
The condition appears because the left atrium must contract more strongly to fill the left ventricle, rigid and dilated.
Hypertension and electrocardiogram
The ECG-electrocardiogram can highlight cardiac changes, especially dilatation.
However, especially in the early stages, the echocardiogram is more suitable for having details on cardiac anomalies. The high frequency waves, ultrasound, reflected at the level of the heart, provide excellent images to establish the state of the apparatus.
The retina, which is the photosensitive membrane of the inner surface of the back of the eye, is checked with an ophthalmoscope. Only in this area, the specialist can directly observe the harmful effects of hypertension on arterioles.
In fact, the modification of the retinal arterioles is thought to be comparable to that of the other vessels in the body. Therefore by establishing the degree of retinal deterioration, or retinopathy, it is possible to evaluate the severity of hypertension.
In addition, additional risk factors should be evaluated in patients with hypertension and cardiovascular disease familiarity .
Among the variants to consider, there are:
- heart rate
- increase in body weight
- habit of smoking.
Hypertension: blood test
In addition, always appropriate, to calculate the cardiovascular risk , are the dosages of:
A broader analysis may include radiography, ultrasound and scintigraphy of the kidneys and kidney vessels.
In addition, the subject can undergo chest x – rays and blood and urine tests to measure some hormones:
However, the cause of hypertension can be suspected of having some symptoms. For example, an arterial murmur above the kidney may indicate renal artery stenosis .
Other special tests may suggest rare causes of high blood pressure :
- measurement of potassium can reveal hyperaldosteronism
- hormonal catabolites in the urine lay for pheochromocytoma, a tumor that produces a lot of adrenaline and norepinephrine.
The higher the blood pressure values and the younger the age of the subject, the wider the search for a cause of the condition must be.
However, the origin of the rise in blood pressure is identified only in 10% of cases.
Diagnosis in children
In pediatric age, hypertension is very often even more unknown, sometimes found by chance. In children, for the diagnosis of high blood pressure, the reference to the ” growth percentile “, which determines normality by age , is appropriate . This factor serves above all to control the growth of children , which is not always the same for everyone. So, for guidance, the weight and height of thousands of children of different ages are checked.
In the first year of life, weight is considered first, with a weight loss after birth of 10%. Then the index of good health is the stature, which must increase twice in 4 years and triple in 12 years.
On this basis, the reference “normograms” have been devised to evaluate infantile blood pressure.
By statistical criterion, pediatric hypertension is defined by establishing the 95th percentile of the distribution of blood pressure values. Therefore maximum and minimum must be evaluated in relation to the sex, age, weight and height of the subject.
With values equal to or greater than the 90th percentile and lower than the 95th, you are faced with pre-hypertension or normal high blood pressure.
The blood pressure must be measured in small during the annual checkups and reliefs interpreted according to the nomograms. The measurement methods are the same as those for adults, with the use of a bracelet of the right size.
Therefore, for children, repeated readings of values in the clinic are valid for diagnosis, as opposed to self-monitoring and holter.
Children at risk of hypertension
The peaks most exposed to essential hypertension are those in excess weight, born with low weight or with familiarity with the condition. Therefore, for them, the presence of secondary forms, which are inversely proportional to age, must be excluded.
Secondary hypertension, directly proportional to blood pressure values, emerges from amnestic data and instrumental and blood tests. In fact, according to studies, a child with high blood pressure may already have organ changes and become a hypertensive adult.
Hence, in early childhood, secondary and later primary hypertension prevails , with blood pressure rises up to 17 years. In addition, increases in blood pressure, to be carefully evaluated, are more frequent in puberty.
But, childhood cardiac changes are poorly indexed, due to the complex relationship between body and heart growth.
Furthermore, hypertensive children and adolescents do not develop clinically evident renal abnormalities. With direct ophthalmoscopy, 51% of hypertensive children were found to have retinal changes.
In summary, in order to intercept the condition, the pediatrician should carry out an accurate family history of hypertension.
From the third year of age, the specialist has the task of measuring the pressure at each visit and relating it to the tables. In case of abnormal values, the detection of blood pressure values is required on at least 3 different occasions.
Having made a distinctive diagnosis between the 2 forms , the pediatrician must send the children with secondary hypertension to the reference centers. Instead for the primary one, the doctor can refer the child to diet-behavioral therapy .
Those who fail the treatment or have a demanding secondary form, are entrusted to second-level, multidisciplinary centers for further treatment.
Self-monitoring of pressure at home
Self-monitoring of home pressure is also recommended to motivate hypertensives to adhere to treatments.
But, when the doctor’s indications for a healthy lifestyle do not affect the pressure enough, we switch to hypertensives.
The International Society of Hypertension recently published its new guidelines in Hypertension and the Journal of Hypertension . For clinical practice, recommendations for the management of hypertension in adults aged 18 years and over are presented.
In fact, researchers say that a person’s blood pressure should be at least 140/90 mmHg for diagnosis. Furthermore, the measurement must take place in hospital or outpatient clinic and be repeated several times.
According to the document, individuals with higher than normal limits (130-139 / 85-89 mmHg) could benefit from lifestyle interventions. Only in some cases, these should take medicines, while confirmed hypertensives must receive adequate drug treatment.
The researchers point out that lifestyle modification is the first anti-hypertensive line , also useful for improving the effect of medicines.
How to lower blood pressure with medicines
Drug therapy should reduce blood pressure by at least 20/10 mmHg, ideally reaching 140/90 mmHg in 3 months. The drop in blood pressure, however, must occur gradually, in order not to induce weakness in the first few days.
In addition, too rapid a reduction could adversely affect the perfusion of organs, including the brain, heart and kidneys. However, primary hypertension cannot be resolved, but controlled to prevent aggravations and complications.
Since the morbid condition is asymptomatic, drugs with side effects and quality of life are avoided as much as possible. So, before prescribing medicines, alternative remedies are usually offered.
These drugs are available in a wide range so tailored therapy is possible for each subject. The European Guidelines recommend starting already with the combination of 2 compounds, at a low dosage, to limit harmful effects.
The goal of pharmacotherapy varies according to other diseases that may be present.
The diastolic can drop to 70 mmHg , but in case of coronary artery disease and angina not below 80 mmHg. Instead, in diabetes, it is necessary to reach values lower than 130/80 mmHg and, in the elderly, to 140/90 mm Hg.
The various types of drugs lower the pressure with different mechanisms for which the possible therapeutic plans are numerous.
When choosing antihypertensives , the following should be kept in mind:
- other pathologies
- severity of hypertension
- consequences and costs.
If unwanted drug disorders arise, therapy can be reduced or changed , but not suppressed. In fact, the treatment of hypertension must be continued throughout life, with regularity and constancy.
Typically, the first drug administered is a thiazide diuretic which dilates the vessels and helps the kidneys eliminate sodium.
If potassium is lost too much with urine , mineral-sparing diuretics are used, in combination with other drugs. Diuretics are especially indicated for:
- Senior citizens
- those suffering from chronic heart or kidney failure.
Alpha-blockers, beta-blockers, alpha-beta-blockers and peripheral adrenolytics are part of the antiadrenergics, also called adrenergic blockers.
Their action is to reduce the circulatory response to stimuli of the sympathetic nervous system which rapidly increases pressure.
The beta-blockers, the most common, are suitable for young people, with previous heart attack, tachycardia, angina pectoris or migraine.
Instead with these substances, the risk of unwanted consequences, such as dyspnea and heart failure, is higher in the elderly.
Centrally acting alpha agonists behave similarly to adrenergic blockers, but are rarely used.
How do they work?
Angiotensin converting enzyme inhibitors, or ACEs, by dilating arterioles, prevent the formation of angiotensin II.
By blocking the angiotensin converting enzyme, which converts angiotensin I to II, the compounds hinder shrinkage of the arterioles. These inhibitors are recommended for coronary artery disease, heart failure and for those who lose protein in the urine by nephropathy.
Angiotensin II blockers act like inhibitors, stopping the action of angiotensin, but with fewer side effects.
Calcium channel blockers block the entry of calcium into the muscle cells of the arterioles.
By reducing arteriolar constriction, for a short or long time, these drugs are suitable for the elderly, suffering from angina pectoris and tachycardia.
However, short-acting ones have been associated with an increased risk of death from a heart attack.
Direct vasodilators also dilate the arterioles but are not used alone but with another ineffective antihypertensive.
Cure secondary hypertension
The treatment of secondary hypertension corresponds to that of related pathology. Treatment of kidney disease or angioplasty, balloon dilation of a stenotic renal artery, resolve or reduce pressure.
Surgical removal of tumors that alter blood pressure values, such as pheochromocytoma, normalizes blood pressure. In general, the hypertensive urgency is treated with an adrenergic blocker, clonidine, taken orally.
Furthermore, in hypertensive emergencies, including encephalopathy and the malignant form , drugs, such as labetalol, are administered intravenously.
When a subject does not respond to drug therapy, different interventions are proposed in selected cases.
Resistant hypertension: carotid baroreceptors and renal denervation
In resistant hypertension, the carotid baroreceptors can be stimulated, an old method recovered. The technique is based on a pulse generator that is implanted to stimulate these points in the carotid sinus region. The electrical activation of the natural sensors of cardiovascular regulation acts by relaxing the vessels, with a decrease in blood pressure.
However, although the system is valid, it is somewhat invasive and therefore difficult to carry and often unwelcome.
After 30 years of studies, renal denervation is carried out today to stop the hypertensive stimuli of the Sympathetic Nervous System in the kidneys. The minimally invasive operation deactivates the nerve fibers by ultrasound through a catheter in the bilateral renal artery.
However, renal denervation is expensive and there is no certainty about its real efficacy in all subjects.
Diet and lifestyle
In addition, weight loss is recommended for overweight hypertensives, as the loss of only 5 kilos can reduce pressure. In fact, those with diabetes, obesity and high cholesterol levels should follow a low calorie, low fat and sugar diet.
To decrease cardiovascular risk, smokers must abolish smoking and reduce alcohol abusers.
Daily alcoholic drinks should correspond to a maximum of 2 glasses of wine for men and 1 for women.
Medicines may not be needed if salt is decreased and proper intake of magnesium, potassium and calcium is maintained.
The salt intake should remain below 5 grams per day, better if it amounts to 2 grams.
Aerobic exercise , such as walking and cycling, is beneficial, especially if moderate and constant. In fact, if hypertension is under control , there is no point in limiting activity, which reduces weight and improves heart function and health.
The first antihypertensive strategy is to keep your blood pressure under control.
Everyone, aged 18 to 40 , should measure blood pressure every 2 years and then once a year.
If you are predisposed to hypertension for familiarity , you must often monitor the pressure to identify abnormalities early. In fact, since it is not possible to intervene on the genes, it is necessary to correct the environmental factors that facilitate high blood pressure.
However, a correct lifestyle is recommended for everyone as unhealthy habits can affect the rise in blood pressure. Therefore healthy subjects must abandon wrong behaviors , also to avoid the development of damage to organs from hypertension.
The importance of diet and hypertension
In the specific WHO- World Health Organization Guidelines , a relevant part is dedicated to indications of life.
Especially individuals who do not exhibit additional risk factors, can benefit from simple antihypertension rules.
First of all, body weight should be controlled, avoiding getting too fat , and limiting stress conditions.
Moderating calories can make you lose weight and, for every pound of weight lost, blood pressure drops by 1 mm Hg.
Decrease salt and fat
At the table, it is good to decrease the salt and foods that are rich in it , such as sausages and broth nuts. Furthermore, elaborate products, such as hamburgers, salty snacks and preserved vegetables, should be eliminated, if the pressure is within the safety limits.
On the contrary, the diet must be rich in magnesium and potassium , contained in cereals, fruit, vegetables and citrus fruits. Plants are a source of substances that help eliminate free radicals, waste that causes damage to blood vessels.
In addition, the consumption of animal fats , which bring cholesterol, and that of alcoholic drinks must be contained .
Hypertension and alcohol
While small amounts of alcohol can protect the heart, excess contributes to high and harmful blood triglyceride levels .
In fact, the association between alcohol and hypertension is demonstrated if you exceed 20 grams of alcohol daily:
- 2 glasses of wine
- or 4 glasses of beer or 2 glasses of hard alcohol.
Furthermore, in the intoxication, the pressure can increase in an exaggerated way, with the risk of rupture of a blood vessel and cerebral hemorrhage.
Hypertension and smoking
Other dictates require not to abuse licorice, which in excess causes pressure to rise, and to stop smoking . Smoking increases not only the possibility of high blood pressure but also of incurring a cardiovascular accident .
A smoker has a double chance of suffering a stroke and a 5 times greater risk of heart problems than others . Luckily, if you quit nicotine, the risks diminish regardless of how long you have smoked.
Finally, it is good practice to regularly exercise light physical activity, which helps prevent cardiovascular disease. Even a brisk 30-minute walk a day decreases the chance of developing high blood pressure by 30% .
In addition, swimming, jogging or cycling stimulate the cardiovascular system significantly, at any age. In fact, following motor exercise, a liquid loss comparable to that obtained with diuretics occurs .
On the move, the activity of the Sympathetic Nervous System decreases, with a decrease in catecholamines in the plasma. The plasma rate of some hormones is also affected by physical practice so that beneficial ones, such as prostaglandins and endorphins, increase.
In addition, the movement makes you lose weight and relax , resulting in a reduction in alcohol consumption.
What sport to do and how often
A truly effective exercise program against blood pressure rise must involve at least 3 weekly workouts.
Between one session and another, lasting at least 30 minutes, you can take a day off. Work on the lower limbs should be preferred to the effort of the arms, for example with a moderate gear or bicycle.
In contrast, power exercises, including weight lifting and bodybuilding, increase pressure.
Example of training to prevent hypertension
Each training is divided into 3 phases:
- first, with 10 minutes of warm-up and stretching
- second, for 20 minutes, with aerobic work, characterized by an effort not exceeding 50% of the subject’s maximum heart rate, a value that varies according to age and is calculated with the formula “maximum frequency = 220-age
- third, about 10 minutes, for recovery and relaxation.
Hypertension: history and medical studies
In the past, the altered pressure has been related to some pathologies, but only by hypothesis, without evidence.
Hard pulse disease
The “hard pulse disease” was already known by Hippocrates, around 400 BC, and treated with bloodletting, blood sampling.
In 1600, William Harvey illustrated blood circulation and in 1700 Stephen Hales a primitive measurement of pressure . Subsequently, in London, in 1827, thanks to an autopsy, Queen Victoria’s doctor, Richard Bright, made a discovery about it.
In the deceased, who had many proteins in his urine while alive, evident left ventricular hypertrophy was noted. This heart pain gave rise to “Bright’s riddle”, because for years nobody knew how to explain it. But, at the time, the means were scarce, so many assumptions were made in this regard, all incorrect.
In 1879, in London, the Pakistani doctor Akbar Mahomed had an intuition, linking blood pressure to heart damage.
Invention of the sphygmomanometer
But tests on pressure were only possible in 1896, when Scipione Riva Rocci invented the sphygmomanometer . Therefore, the mercury device, to measure pressure, has allowed studies and research on the complications of the pathology.
In 1899, the pathophysiologist Carlo Forlanini of Pavia described hypertension as “an arterio-constriction”. In addition, in the early 1900s the American surgeon Harvey W. Cushing helped spread the sphygmomanometer around the world. While, his compatriot Theodore Janway, in 1913, associated high blood pressure with early mortality .
The studies of the time were based on arbitrary pressure levels, deduced from observation, not yet scientific.
However, for years, it was not possible to cure hypertension , so patients died, like American President Franklin Roosevelt in 1945.
But, important results, in particular on secondary hypertension , are derived from studies undertaken between the 2 world wars. In the 1950s, the first epidemiological investigations of the condition were made by George Pickering.
Definition of blood pressure values
Following these analyzes, it was possible to define normal blood pressure values and high ones , especially according to age.
In 1967, a clinical study of 143 hypertensives laid the foundations for the link between:
- high pressure
- cardiac mortality
In 30 years, 14 clinical studies have shown that hypertension therapy compared to placebo reduces fatal outcomes. But recently it has been seen that the treatment intervenes to prevent cerebrovascular complications , not so much coronary complications .
Until 1997, numerous medications have been made against hypertension , such as diuretics and sartans, which are still prescribed.
Since then, the pharmaceutical industry has not given new products, because the effects of those developed are not well understood and controlled. Instead, some specialists are dealing with treatments other than pharmacological ones, such as neurostimulation.
Today, research is focused on genetics as the possible gene responsible for hypertension has not yet been found. Numerous current studies are aimed at the early characterization of organ damage, in order to avoid it.
The recent study “Pamela” in Lombardy has found the effective connection between dysmetabolism and high blood pressure values.
In fact, 45% of the hypertensive involved :
- metabolic and blood sugar changes.
Furthermore, it has been estimated that 50% of the subjects suffer from metabolic complications. However, there are ongoing investigations to establish guidelines on hypertension values and strategies that are continuously renewed.
Social and economic impact of hypertension
But hypertension not only damages the body with serious consequences but can lead to disability and death . A long and authoritative study has calculated that in one year 18% of global deaths are linked to hypertension .
In the active age, when high blood pressure disorders occur, it affects the profession and life. Therefore, absences from work, even just to carry out assessments, ailments and related pathologies affect the performance of the person concerned.
Furthermore, the tendency towards nervousness and short temper, due to the situation, compromises the social relationships of the hypertensive.
In addition to sudden death, from heart attack or other cardiovascular problems, the hypertensive can face a stroke of the brain . This event, if not fatal, leaves serious results in the patient who can remain injured, with difficulty moving and talking.
Therefore, unknown and untreated hypertension are dangerous from the point of view of health and quality of life. Furthermore, the lack of work and healthcare costs , also incurred to treat emergencies, weigh on the family and society.
Every year, there is the worldwide awareness campaign for the fight against high blood pressure , promoted worldwide by the World Hypertension League .