Hypertension

hypertension summary

Arterial hypertension, or high blood pressure, is an asymptomatic disease that affects most people.
By definition, high blood pressure is characterized by a blood pressure greater than or equal to 140/90 mmHg, or 14 by 9. However, according to European guidelines published in October 2013, over 80 years old of hypertension when systolic pressure is greater than 150 mmHg and diastolic above 85 mmHg.

In about 90% of patients, the causes are known and derive from poor diet (intake of excess sodium, fat), obesity , age, use of medication, genetic factors, stress , sedentary lifestyle, etc. Due to the fact that many of these factors result from lifestyle habits in large cities, hypertension was more prevalent in developed countries for a long time. In 10% of cases, the disease has other causes, such as problems with the renin-angiotensin system, arteriosclerosis, kidney problems, etc. In August 2011 a Chinese study showed a possible link between the cytomegalovirus (CMV) virus and hypertension.

Complications are various and serious: stroke , kidney failure , myocardial infarction , impotence , visual problems, etc.

The pressure measurement must be repeated several times using a sphygmomanometer, the doctor can, for example, ask the patient to measure his pressure in the morning and in the evening for 7 days, using a self-measurement device. The diagnosis of hypertension can be made only after repeated measurements.

Treatment includes antihypertensive drugs, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARA), calcium channel blockers, diuretics, beta-blockers, etc.

It is also interesting to note that treatment of hypertension prolongs life expectancy in the long term, according to a clinical trial conducted in the United States in late December 2011.

Some medicinal plants include garlic and olive leaf .

Simple and effective measures can be adopted to control hypertension, such as a balanced diet, physical activity, avoiding everyday stress, reducing salt in food, avoiding cigarettes, reducing alcohol consumption, strictly following the medical instructions.

Definition

This abnormal rise in pressure is often permanent. Hypertension is a serious and frequent disease that can lead to serious problems ( heart attack , stroke , kidney problems…) when it is not correctly treated.
There is systolic hypertension, which is the maximum pressure in the arteries, when the heart (left ventricle) expels blood into the aorta, and there is diastolic hypertension, which is the minimum blood pressure, when blood is evacuated from the aorta. be measured thanks to devices that help to measure blood pressure, such as the automatic blood pressure gauge (can self-measure), or the sphygmomanometer connected to a stethoscope.

Tips

voltage measurement

1 – When measuring your blood pressure, try to rest 5 minutes beforehand and sit somewhere comfortable. Your pressure will be closer to reality and should theoretically go down.
2 – Try to measure your pressure if possible always at the same time , this will help to better analyze the results.

Caution : Hypertension is a disease that develops slowly and silently, and that is what makes it dangerous. It often does not show symptoms, even though the heart is already being damaged and that is why it is advisable to consult your doctor regularly (every year or every 6 months) to check your blood pressure. You can also measure your blood pressure yourself with the help of a personal tensiometer.

Epidemiology

– Worldwide, hypertension kills 9.4 million people a year from cardiovascular diseases such as stroke and myocardial infarction [Source: WHO, April 8, 2013].
It is important to remember that high blood pressure also increases the risk of developing other health problems, such as kidney failure and blindness.
According to WHO statements in April 2013, it is estimated that hypertension currently affects 1 in 3 people in the world, that is 2 billion people.

– In China, 200 million people (out of a population of about 1.3 billion people) suffer from hypertension. [Source: ATS, 15 August 2011]

– In Africa, about 46% of adults suffer from hypertension. [Source: WHO, April 7, 2013] This disease is responsible for nearly half of all deaths from stroke and heart disease. Most of these people are undiagnosed. [Source: ATS, May 17, 2012 and WHO]

– In the United States, about 79 million Americans or one in three suffer from hypertension. It is interesting to note that half of the patients treated in 2015 for hypertension continue to have a blood pressure greater than 140 mmHg, evidence that lowering blood pressure is not always easy, for several reasons.
In 2017, with a new hypertension guideline (hypertension when blood pressure is 130/80 mmHg or higher, also read Diagnosis below) from the American Heart Association , nearly half of the US adult population (46%) now suffers from hypertension, about 103 million Americans.

– In Brazil, according to data from the Ministry of Health, about 30 million Brazilians have hypertension and there are another 12 million who still do not know they have the disease.

Hypertension kills 7.6 million people a year worldwide, due to its complications such as  stroke ,  heart attack , among others. In Brazil, it is responsible for 300,000 deaths a year.

Causes

– 90% of cases of hypertension do not have their causes clearly defined, we are talking about essential or primary arterial hypertension .
However, some factors may influence this essential hypertension (highly fatty diet, genetics, stress , age, obesity , among others). Primary hypertension tends to develop with age.

Viruses and hypertension ?

According to a study carried out by Chinese doctors and published in August 2011, high blood pressure can be caused by a virus. The latter is cytomegalovirus (CMV), the virus causes infection in most humans at some point in their lives, showing no symptoms and therefore often goes unnoticed. The discovery could lead to the development of a vaccine that prevents the occurrence of hypertension. However, the investigation is at a preliminary stage and it is currently premature to predict a vaccine launch date.

– In about 10% of cases of hypertension the cause is known, in these cases we speak of secondary hypertension .
The causes of this hypertension can be, for example: a problem with the renin-angiotensin (hormonal) system, diabetes, kidney problems, other hormonal problems, arteriosclerosis, problems with the thyroid, the use of certain medicines, excessive consumption of alcohol or drugs ( some specialists also classify the hypertension caused by these excesses as primary hypertension), etc.

Among the causes of primary hypertension, a sedentary lifestyle and poor eating habits are one of the main reasons for developing high blood pressure. Excess consumption of salt in food, intake of fatty foods and lack of physical activity contribute to the onset of high blood pressure.

Groups of risk

Among young people, men are the most affected. After the age of 65, women suffer the most from hypertension. Blacks and Latinos are more likely to develop high blood pressure.

Among the risk factors we can highlight:

– Age: with increasing age, the risk of developing hypertension increases;

– Sex;

– Ethnicity;

– Socio-economic level: classes of lower socio-economic level are more likely to develop the disease;

– People with unhealthy eating habits: alcohol, excessive salt consumption, etc.

– Alcohol consumption: high consumption is associated with an increased risk of the disease, while moderate consumption has beneficial effects;

– Obesity ;
– Sedentarism: the low level of physical activity increases the risk of the disease.
– Women in menopause (the hormone estrogen exerts a protective effect and, as the concentration of this hormone decreases in menopause, hypertension is favored). It is estimated that about 27% of women are affected by hypertension, against 21% of men,

– People who suffer from other metabolic diseases.

– The black ones. In fact, blacks (Africans, Afro-descendants) suffer from hypertension more than whites.

Symptoms

Generally, high blood pressure is a disease that does not have alarming or clearly identifiable symptoms. This is what makes it dangerous and harmful. Many people ignore that they suffer from hypertension! It is estimated that this number reaches 1/3 of the people affected.
This is why a regular control to measure your blood pressure at the doctor or pharmacy is highly recommended. By the way, it is important to measure your pressure several times for better accuracy.
Sometimes in some people, such as those with severe hypertension, the symptoms may be easier to identify, for example headaches, eye problems, dizziness, fatigue, restlessness, ringing in the ears, nosebleeds, palpitations , …

Attention Always consult a doctor to diagnose any symptom, those listed here are only a basis and may also be symptoms of other diseases.

High blood pressure before age 55
A study published in 2017 showed that suffering from hypertension before age 55 increases the risk of cardiovascular death. This study, conducted by the Boston University School of Medicine (BUSM), was published in 2017 in the British Medical Journal .

When do we talk about hypertension?

We generally speak of hypertension when the diastolic pressure (minimum) is greater than 90mmHg (9cm of mercury) and when the systolic pressure is greater than 150mmHh (15cm of mercury). See table below.
We can summarize the values ​​in a table, note that with certain ages the values ​​can vary (the lower limits can increase).

**Note on blood pressureDiastolic pressure
(in *mmHg)
Systolic blood pressure
(in *mmHg)
°*pressure good to excellentbelow 80below 120
normal pressurebetween 80 and 85between 120 and 130
threshold before hypertensionbetween 85 and 90between 130 and 140
mild to moderate hypertensionbetween 90 and 100between 140 and 150
moderate to severe hypertensionbetween 100 and 110between 160 and 170
high to severe hypertension110 and more170 and more
° systolic hypertension (only)below 90140 and more

* sometimes we also use values ​​in centimeters of mercury, so, for example, 80 mmHg is equal to 8cmHg. The value is divided by 10. We say orally that the person has a pressure 9/13, that is, 90 mmHg as diastolic pressure and 130 mmHg as systolic pressure.

** Purely indicative values, please consult a doctor for any diagnosis
.
° Generally, systolic hypertension (only) is closely linked to emotions. In every case of ascertained hypertension, I wanted to see a doctor.

°* Below a certain pressure, we can also talk about hypotension. For any questions and treatment, ask your doctor for advice.

Sometimes, it is estimated that high diastolic pressure (above 80 mmHg) can mean stress (nervousness).

Hypertension and age (over 80 years)

According to European guidelines published in October 2013, over 80 years of age, hypertension is defined as systolic pressure above 150 mmHg and diastolic above 85 mmHg. Drug treatment is usually started when systolic pressure is greater than 160 mmHg. However, there may be differences between patients, your doctor will advise you.

New recommendations (guideline) to assist people over 50 years of age
A preliminary study, which had to be stopped more than a year before the scheduled end because of exceptional results that could save the lives of many people, showed that the decrease in systolic pressure by 12 or 120 mmHg in patients over the age of 50 , can reduce the risk of heart attack, heart problems and stroke by about a third, as well as decrease the risk of mortality associated with these diseases by approximately 25%, compared to the target of a systolic pressure of 14 in this age group and in 15 patients aged over 60 years. Diastolic pressure should be reduced to 8 or 80 mmHg, versus 90 mmHg often recommended prior to the release of this preliminary work. These results come from a study released on September 11, 2015, funded by theNational Institutes of Health (NIH) e nomeado como Systolic Blood Pressure Intervention Trial (SPRINT).

Pressure decrease with age
Blood pressure in older people begins progressively to decrease approximately 14 years or more before death, according to a study published December 4, 2017 in the journal Journal of the American Medical Association  (DOI: 10, 1001/jamainternmed.2017.7023). It is normal for blood pressure to tend to decrease in the elderly, but this heralds the end of life. To reach these conclusions, researchers at UConn Healthand the University of Exeter School of Medicine in the United Kingdom examined the electronic medical records of 46,634 British citizens who died aged 60 years or older. The large sample of people included healthy people as well as people with heart disease or dementia (eg Alzheimer’s). UConn Health scientist George Kuchel , one of the study’s authors, cautioned in a study release to avoid misinterpreting the results: “I would be very concerned if anyone interpreted our paper as suggesting that hypertension should not be treated at the end of life. or that these patients should discontinue their hypertension medications.”

Diagnosis

The diagnosis of high blood pressure is performed using a device, the sphygmomanometer. The health professional wraps the patient’s arm with the device that has a wide strap and inflates an air pump. When inflating, this pump causes pressure on the patient’s arm, which is monitored by a meter.
Diagnosis of hypertension is based on repeated pressure measurements, for example, by measuring pressure in the morning and evening for 7 consecutive days.
It is preferable to take a pressure measurement at arm or wrist level.

It is also advisable to measure the pressure in both arms, a difference of 15 mmHg or more between the results of each of the arms indicates an increased risk of suffering from certain cardiovascular diseases. According to a study published in 2012 in the medical journal “Lancet”, the risk of death from heart disease, such as myocardial infarction, was 70% higher in people with a pressure measurement difference between the 2 arms greater than 15mmHg, compared to to people with a difference of less than 15 mmHg.

American Heart Association  2017 Recommendations
In the United States, the guideline that suggests starting treatment for high blood pressure has been reduced. Instead of 140/90 mmHg, a person is already considered to have hypertension when the pressure is 130/80 mmHg or more. This means that we are talking about hypertension with systolic pressure of 130 mmHg or more and diastolic pressure of 80 mmHg or more. This is the first official review of the diagnosis of hypertension since 2003. This guideline comes from the American Heart Association , which published a study with this new guideline in the journal Hypertension(DOI: 10.1161 / HYP.0000000000000065) on November 13, 2017, at a convention held in the Los Angeles area. With this new guideline, nearly half of the American adult population (46%) suffers from hypertension, about 103 million people. Previously, that number was 32% or 72 million Americans.

Complications

Hypertension can cause serious health hazards, they are:

–  Stroke ( Cerebral Vascular Accident ), also known as a Cerebral Attack or Stroke

– Heart attack ( myocardial infarction )

– Heart failure

– Kidney problems (kidney failure )

– Impotence
– Eye problems
– Arteriosclerosis
– etc.
– That is, it is very important to treat this disease.

Treatments

In case of essential hypertension (see under Causes), the doctor may particularly encourage the patient to change his lifestyle or prescribe medication. In the case of secondary hypertension, the treatment of the disease or problem in question may consequently lead to a decrease in pressure.

To treat essential hypertension, we will adopt as a first measure a change in lifestyle:
 reduction of tobacco, practice of exercises, reduction in salt consumption,…

Then a drug treatment may be indicated, depending on your blood pressure.
That said, depending on each patient (gender, age, risks), the doctor will determine the target pressure to be achieved, both for systolic and diastolic pressure. Lifestyle changes and/or drug therapy will aim to achieve these pressure values. A very important factor for success is the good use of medication and regular monitoring of blood pressure.

* Medications commonly used to treat high blood pressure

Different classes of drugs available (prescription drugs)

1. Interaction with the renin-angiotensin system: Angiotensin-

converting enzyme inhibitor (ACE): these drugs block the conversion of angiotensin I to angiotensin II, the latter being a hormone responsible for increasing blood pressure. Attention, some remedies in this class can cause a dry cough as a side effect.

Angiotensin receptor antagonists (ARA): block the effect of angiotensin II (responsible for an increase in blood pressure), thus acting as an antagonist. These drugs are increasingly being sold around the world, certainly due to their effectiveness. Certain drugs are already major blockbusters (over a billion dollars in sales).

2. Calcium channel blockers (calcium antagonists): This class of drugs acts as an antagonist on calcium, the latter responsible for activating smooth muscles in cardiac blood vessels. With the help of Calcium Channel Blockers, smooth muscles become more relaxed and blood pressure decreases. Watch out for possible side effects: hot flashes, headaches, constipation, swollen ankles.

3. Diuretics. We distinguish different types of diuretics (thiazides, potassium-sparing…). Generally, its action is to increase the elimination of water and sodium, which lowers blood pressure. Important note for specialists: never combine 2 anti-caliuretic diuretics with a K+ supplement.

Diuretics from the thiazide family are often prescribed by doctors in case of hypertension.

4. Beta blockers (eg atenolol). They act on the sympathetic nervous system. This system is generally responsible for the reaction to stress or physical activity. By acting on this system, beta-blocker drugs block part of the reactions, which generally cause an increase in blood pressure.
Important observation about beta-blockers: Never interrupt a treatment abruptly, as the risk of trembling, sweating, anguish, arrhythmia, …. exists. Always ask your doctor for advice for any information about your treatment or diagnosis.

5. In combination with drugs (several drugs) referred to in points 1 to 4 above. For example, combining a diuretic with a beta-blocker, etc.

Associated treatments are often more effective in lowering blood pressure, especially when the pressure is well above the desired therapeutic target.

Physicians often have a protocol (an algorithm) in place to help them achieve their goals.

*Please note the drug classes mentioned here are purely informative and should not be considered exhaustive, only your doctor can prescribe you an appropriate treatment and make an exact diagnosis. It is very possible that the doctor will prescribe drugs from different classes to be taken together or simultaneously (see point 5).

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Herbal medicine

– Garlic is particularly effective in reducing hypertension. Our opinion is that it serves more as a complementary treatment to other measures or drug treatments.
– Olive leaf is also sometimes recommended to treat high blood pressure. It must be taken in capsule form. However, the scientific effect of this plant is not yet fully proven. Therefore, as with garlic, classic medicinal treatments should be preferred.
– Beetroot  ( beetroot juice ), with a vasodilator effect, can be used against hypertension.
– The black tea🇧🇷 According to an Australian study published in 2012, drinking a cup of black tea 3 times a day helps lower blood pressure slightly, in the order of 2 to 3 mmHg. The study was carried out by the University of Western Australia in Perth (Australia), with 95 participants who drank black tea regularly. Flavonoids, which can be found in significant amounts in black tea, may be responsible for this hypotensive effect.

Attention hypertension is a disease with serious consequences, always ask your doctor or pharmacist for advice when you have any questions about your treatment or diagnosis.

Tips

As preventive measures and treatment to reduce the risks linked to essential hypertension, we are also talking about lifestyle changes, you can:

– Limit your salt intake. Salt favors hypertension due to the effect of osmosis (increases the absorption of water in the vessels, which increases blood pressure). This will involve consuming a maximum of 1500mg per day of salt, equivalent to about two-thirds of a teaspoon (a full teaspoon contains about 2300mg). Beware of industrialized or processed foods that often contain salt without you knowing it.

– Decrease your body weight, a BMI below 25 is beneficial in fighting high blood pressure. A healthy diet rich in fiber (fruits, vegetables) is highly recommended.
The renowned American institution Mayo Clinic estimates that one superfluous kilo lost allows the reduction of blood pressure by one millimeter of mercury. Be careful, the BMI is not the only thing to consider, it will also be necessary to control the measurement of the abdominal circumference, which must not exceed 89 cm in women and 102 cm in men.

The influence of diet to reduce hypertension is the subject of studies, in English we speak of the concept DASH (Dietary Approach to Stop Hypertension) or in Portuguese (translation): dietary approach to stop hypertension. See below foods or drinks for consumption in hypertension and check medicinal plants against hypertension  ( beetroot is particularly interesting).

– Doing exercise or sports. Endurance sports such as running, swimming, cycling are very beneficial in reducing hypertension. The practice of 30 minutes of sport or exercise a day or approximately 2h30 a week (jogging, brisk walking, swimming, yoga, Pilates) can lower blood pressure by 5 to 8 mmHg, according to Astrea magazine (December issue of 2019). Avoid more intense sports such as bodybuilding or some types of diving which, on the contrary, increase pressure.

– Decrease stress : the latter can increase blood pressure, especially systolic pressure.
– Consume dairy products, as these products are rich in calcium , and this mineral is very useful and plays a very important role in regulating blood pressure. You can also take calcium-rich food supplements.
– Consumption of potassium is beneficial for lowering blood pressure. For the exact dosage, ask your doctor or pharmacist.
– Decrease or, if possible, stop the consumption of tobacco and alcohol.

– Limit and/or control other metabolic diseases such as diabetes and cholesterol .

– Eating two pieces of semisweet chocolate every day lowers blood pressure, according to German researchers (study carried out in July 2007).

– If you take antihypertensive drugs, respect their regularity. According to a North American survey in 2005, after a year of treatment based on hypertension, half of the people analyzed stopped taking their medication.

– Acupuncture would help lower blood pressure, but according to a book by the renowned Mayo Clinic  in the United States, it remains a controversial treatment for hypertension. However, if it is carried out by serious professionals, the risks are few and therefore there is no danger in trying it.

– The consumption of omega-3 can contribute to lowering blood pressure, however, if consumed in high doses (more than 3g per day), there may be a risk of bleeding (very fluid blood). Talk to your doctor about the best dosage.

– Coenzyme Q10 is also recommended in case of high blood pressure, but according to the “Mayo Clinic” (famous North American clinic) studies are still lacking that report the effects of its consumption in the long term.

– Certain alternative techniques such as yoga and Qi gong can also have a positive effect on hypertension.

– Drinking coffee , which increases blood pressure at the time, but decreases over time. Indeed, according to a Swiss study published in April 2012 conducted by the Murielle Bochud team, from the CHUV in Lausanne (Switzerland), a cup of coffee a day would lower blood pressure by up to 9 millimeters of mercury in some people. This advice is valid only for non-smokers, because at a genetic level, smoke can mask the protective effect of coffee.
Caffeine is also estimated to temporarily increase blood pressure by 10 mmHg in people who rarely drink coffee or caffeine-rich substances, as revealed in December 2019 in the scientific journal Astrea. On the other hand, and always according to Astrea, in people who regularly consume caffeine, its effect on blood pressure is much lower. A good tip is to measure your blood pressure before having a coffee and 30 minutes later and observe the difference.

– Intense exposure to sunlight, especially UVA, can reduce blood pressure, as shown by the British study published in January 2014 in the “Journal of Investigate Dermatology”. Nitric oxide (NO) and its metabolites present in the skin, modified by UVA, are responsible for this effect. We can say that the sun promotes the transfer of NO and its metabolites from the skin to the bloodstream. NO is stored in an important fraction in the skin.

We already knew before this study that blood pressure is higher in winter than in summer, in countries far from the equator. Although excessive exposure to the sun can lead to skin cancer, British researchers from the universities of Southampton and Edinburgh who participated in this study note that lack of exposure to sunlight increases the risk of cardiovascular accidents (stroke, heart attack), due to an increased risk of hypertension.

Prevention

Some preventive measures can be adopted in order to reduce the risk of developing hypertension. They include:

– Reduce body weight through balanced and healthy diets, always with the guidance of a nutritionist.

– Replace animal fats with vegetable oils.

– Increase fiber intake.

– Reduce salt intake.

– Reduce alcohol consumption. After each smoked cigarette, blood pressure rises for several minutes. Therefore, quitting smoking can lastingly lower hypertension.
Consumption of alcohol can lower blood pressure by around 4 mmHg, according to the Swiss journal Astrea (December 2019 issue).

– Practice physical activity regularly, 3 to 5 times a week.

– Give up smoking.

– Control stress .

– Avoid drugs and medications that increase blood pressure.

Read also: AVC ( Cerebral Vascular Accident ), heart attack

 

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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