To begin to understand each other…
What is blood pressure?
blood pressure is the force that blood exerts on the walls of the arteries as it is pumped by the heart.
It is easy to understand that the pressure in the great arteries reaches its highest value when the heart contracts (systole) and its lowest values when the heart relaxes between one beat and the next, that is, during diastole.
We speak, therefore, of Blood pressure (PA) systolic (PAS)also called maximum or high, and of Blood pressure (PA) diastolic (PAD)minimal or low.
Blood pressure is measured in millimeters of mercury (mmHg).
The systolic blood pressure value is always recorded first and then the diastolic. For example, if they tell us that our blood pressure is 12/8, it means that the systolic blood pressure is 120 mmHg and the distolic blood pressure is 80 mmHg.
In the world, high blood pressure (AHT) is responsible for:
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7.6 million deaths each year (13% of the total)
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54% of strokes
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47% of coronary problems.
Myocardial infarction and cerebrovascular accidents are the leading cause of death in Europe (stroke is the leading cause of death in women in Spain). Therefore, Even if a hypertensive person is asymptomatic, it is mandatory to take measures to control your Blood Pressure (BP) figures.
In what numbers should the voltage be?
Arterial Hypertension (HTA) is defined as the persistent elevation of Systolic Blood Pressure (SBP), also called high, and/or Diastolic Blood Pressure (DBP), also called minimum or low, above limits established as normal.
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In the adult population, 18 years of age or older, arterial hypertension (AHT) is considered to exist when the SBP/DBP figures are equal to or greater than 140/90 mmHg.
Based on these figures, we speak of light, moderate, or severe arterial hypertension (HBP) depending on the levels of Arterial Pressure (BP), and the cause or injury that HBP exerts on its target organs, which are the heart, the vessels, kidney and brain.
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In pregnant women, we speak of mild hypertension when the figures are between 140-159 / 90-109 mmHg and severe hypertension if the figures are equal to or greater than 160 / 110 mmHg.
The objectives of the treatment of AHT set by the European Societies of Cardiology and Hypertension are shown in the attached table below.
An asymptomatic process that in many patients is discovered by chance
One of the biggest problems is that Arterial Hypertension (AHT) is a silent-asymptomatic process, that is, it does not give symptoms (“it neither itches nor hurts”), so in many patients its discovery is accidental.
Sometimes the patient presents:
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Headache (headaches)
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Irritability
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Gait unsteadiness
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Noise in the ears (tinnitus)
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Nocturia (getting up to urinate at night)
But these symptoms do not present a good correlation with the values of Blood Pressure (BP).
However, a sustained elevation in BP produces changes in the structure and function of target organs (heart, blood vessels, brain, and kidney) by two mechanisms:
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The increase in blood pressure itself damages the vascular endothelium, which is the innermost layer of the vascular wall and makes contact with the circulating blood.
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In addition, the increase in BP is a stimulus that induces the growth and proliferation of muscle cells and fibrous tissue of the heart and vessels.
As a consequence of these changes:
– Decreases the internal diameter of the vessels and increases the thickness of the wall of the arteries that become more rigid and difficult to dilate. That is, it increases the resistance that the vessels oppose to the flow of blood (peripheral vascular resistance).
– Increases the size and volume of the heart (hypertrophy), which, although initially allows for an increase in the force with which it contracts, is detrimental in the long run because this increase in size is not accompanied by an equivalent increase in coronary vessels, which translates into a lower blood flow. blood to the heart, causing coronary ischemia (angina pectoris, myocardial infarction), heart failure and cardiac arrhythmias.
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It facilitates the accumulation of fat in the arterial wall (atheroma plaque) that reduces the diameter of the arteries and hinders the flow of blood. That is to say, that the sustained increase in BP increases the alterations in the vessels, the heart, the brain and the kidneys.
Blood pressure increases with age and almost 35% are obese
We are now going to analyze some factors that facilitate the development of Hypertension.
- Age and sex. BP increases with age in both sexes. The SBP/DBP figures are higher in young men than in premenopausal women, but from the age of 50 the prevalence of AHT in women exceeds that of men. Oral contraceptives and hormone replacement therapy in postmenopausal women may increase BP.
- Race. In blacks, AHT and its complications are more frequent at any age than in white hypertensives.
- Inheritance. HTA is a multigenic disease (there are numerous genes involved) and heterogeneous. Studies in families and twins indicate that the risk of being hypertensive is 25% if one of the parents is hypertensive and 50% if both are.
- Environmental factors. Stress, emotions and cold are factors that modulate BP figures. The prevalence of hypertension is higher the lower the socioeconomic and educational level. Personality is also important, with AHT being more frequent in patients with anxiety, depression, authority conflicts, a tendency to perfectionism, contained tension, and greater aggressiveness.
- dietary factors. Almost 35% of hypertensives are obese and it has been calculated that for every 10 kilos of weight gained, BP increases by 2-3 mm Hg.