Dr. Enrica Falbo
Consultant Nephrologist
Hypertension is defined as that condition with a persistently high blood pressure. It is systolic hypertension when only the maximum pressure is increased; on the contrary it is diastolic hypertension when the values of the minimum pressure are altered. Systolic-diastolic hypertension is defined as the condition in which both blood pressure values (minimum and maximum) are higher than normal.
The World Health Organization (WHO) defines hypertension as one of the main public health problems, affecting one billion people worldwide and causing nine million deaths a year. It is responsible for about half of the deaths from cardio and cerebrovascular disease. . In Western countries, between 15% and 20% of the adult population suffer from high blood pressure, in USA 46% of the population, so 115 millions of people, have hypertension. It also develops, with high incidence in China, Japan and other areas of East Asian or Pacific descent (such as Koreans, Thais, Polynesians, Micronesians, Filipinos and Maori). The consequences of hypertension appear to be more serious for African-American and Asian people; 29 per cent of the UAE population suffering from hypertension.
High blood pressure is relatively rare in childhood but extremely common in old age. Among the youth population, men are more prone to this disorder than women. With age, the difference between the sexs decreases, and about 40% of men and women between the ages of 55 and 65 have higher than normal blood pressure values on an initial test. Over the age of 60, the chance of suffering from high blood pressure is high. High blood pressure during pregnancy is a particular problem: however, it can be said that if high blood pressure values are recorded in the last months of pregnancy and these values were absent previously, it is likely that the disorder will cease after delivery.
Some factors predispose people to hypertension: Age: Blood pressure increases with age due to changes in arterial vessels (which become stiffer with age). At some point, while the (maximum) systolic pressure continues to increase with age, the (minimum) diastolic pressure no longer increases or even tends to decrease; this explains the forms of isolated systolic hypertension typical of the elderly. Familiarity: the presence, in the family, of hypertensive relatives. Overweight and obesity, through different and complex mechanisms, are associated with an increase in blood pressure. Diabetes: this condition is very often associated with an increase in blood pressure, greatly increasing the risk of cardiovascular disease. Smoking: cigarette smoke sharply alters blood pressure (after smoking, the pressure remains higher for about half an hour); this is associated with the chronic damage that smoking causes on arterial vessels: loss of elasticity, damage to the vascular walls, predisposition to the formation of atherosclerotic plaques. Sodium and potassium imbalance: Eating too salty foods and, in general, a diet that is too high in sodium or too low in potassium, contributes to high blood pressure. Alcohol: more than one glass a day for women, two for men can contribute to the increase in blood pressure, as well as damage the heart (which, due to an excess of alcohol, tends to dilate and lose its pump function, with serious consequences on the whole organism). Stress (physical and emotional) contributes to the maintenance of higher blood pressure values; blood pressure can be higher on work days than during holidays and also because blood pressure readings increase during exercise. In some cases, the increase in blood pressure depends on the use / abuse of: liquorice, nasal sprays, cortisone, birth control pills, cocaine and amphetamines. In these cases, by stopping the intake of these substances, blood pressure values return to normal.
Causes of hypertension:
It can be classified into primary and secondary. The primary (or essential) hypertension, accounts for about 95% of cases, there is no precise, identifiable and treatable cause: high blood pressure values are the result the alteration of the complex mechanisms that regulate pressure. In the remaining 5% of cases is Secondary hypertension: the consequence of congenital or acquired diseases affecting the kidneys, adrenal glands, vessels, heart, and for this reason it is defined as secondary hypertension. In these cases, the identification and removal of the causes (ie, the treatment of the underlying disease) can be accompanied by the normalization of blood pressure values. The essential hypertension, affects the adult population, secondary hypertension also affects younger subjects and is often characterized by higher pressure values that are more difficult to control with therapy. There is also the White coat hypertension, which occurs in 20% of people with high blood pressure. In these people, elevated blood pressure values are only detected in the presence of a doctor or nurse or in hospital. Values return to normal levels when the subject leaves the doctor’s office or hospital. Although white coat hypertension is not a normal phenomenon (as it is not found in all subjects), the risk for those with this condition is significantly lower than for patients with permanently high blood pressure. However, with age these people can suffer from high blood pressure.
Therefore, once the presence of white coat hypertension has been diagnosed, it may not be necessary to resort to therapy immediately, but there is a risk that later in the years the blood pressure stabilizes on high values. It is therefore important to measure your blood pressure annually. Naturally, it is also necessary to act in the presence of other risk factors. This condition has been observed thanks to the development of devices capable of measuring blood pressure over 24 hours. Therefore the doctor may ask to carry out this type of test, known as ABPM monitoring, to verify if the high values found with traditional measurements are actually present. The 24hrs Blood pressure monitoring is also very useful in other forms of hypertension for the evaluation of the therapeutic efficacy and the reduction of blood pressure levels during the day’s activities, evidence of any episodes of hypotension or peaks of hypertension, both to be avoided.
Symptoms and signs of hypertension:
The increase in blood pressure values is not always accompanied by the appearance of symptoms, especially if it occurs not suddenly: the body gradually gets used to the values that are always a little higher, and does not send signals to the patient. For this reason, many people with hypertension do not complain of symptoms, even in the presence of very high blood pressure values. In any case, the symptoms related to hypertension are not specific, and for this reason they are often underestimated. Common symptoms include: Headache, especially in the morning, Light headedness and dizziness, ringing in the ears, changes in vision (black vision, or the presence of bright spots in front of the eyes) Nosebleeds (epistaxis) In cases of secondary hypertension, nonspecific symptoms may be associated with others, more specific, due to the underlying disease. The scarcity of symptoms and their non-specificity are the main reason why the patient often does not notice high blood pressure. This is why it is essential to periodically check blood pressure: making an early diagnosis of hypertension means preventing the damage associated with it and, therefore, even disabling cardiovascular diseases.
Therapy and monitoring of its effectiveness over time:
Once the diagnosis of hypertension has been confirmed, it is important to follow a correct lifestyle: stop smoking, lose weight, reduce salt intake, stop junk food, exercise adequate and regularly take prescribed medications, with blood pressure monitoring at home, taking blood pressure diary to show to the doctor during the follow up visit. ABPM and cardiac echo are also useful for monitoring therapy. The efficacy of the therapy over time can also be assessed with echo-cardiac which allows to verify the effects on the cardiovascular system already observed with the previous same test, before the start of therapy, therefore, the enlargement of the left ventricle which should be reduced or disappeared at an advanced stage of the therapy itself. The absence of enlargement of the left ventricle at the time of diagnosis may indicate that the hypertension has recently appeared.
Today we can say that it is more and more frequent to diagnose hypertension less than 40 years of age, linked above all to lifestyle. Hypertension is an often silent killer that slowly affects the kidneys, heart, eyes, brain, so it is very important early diagnosis to avoid cardiovascular complications.
