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Let's talk about Hypertension
Commonly referred to as “high blood pressure”, Arterial Hypertension is a chronic and silent disease, characterized by high pressure of the blood that is maintained over a period of time.
High blood pressure occurs when the blood has difficulty circulating in the blood vessels, which means that the heart has to increase the strength and rhythm of its beats so that the blood can reach the entire body. This difficulty of circulation can have several causes.
In order to in fact consider that a patient suffers from high blood pressure as a pathology, it has to be at or above a certain value for an extended period of time. However, the fact that in most people « high blood pressure » does not present any symptoms makes this pathology silent, being usually only detected when the patient goes to a routine appointment and his blood pressure is measured, or when the stage is already advanced and there are consequences or injuries associated with the disease.
Hypertension is considered a serious global public health problem, with greater incidence in Western countries, which is estimated to affect about 1.5 billion people worldwide, leading to the death of about 9.4 million people per year. In Portugal, according to the Portuguese Society of Hypertension (Sociedade Portuguesa de Hipertensão – SPH), around half of the adult population suffers from this disease (about 43%), however, about a quarter of hypertensive people are unaware that they suffer from Arterial Hypertension. It is also known that only 75% of hypertensive patients receive the appropriate medication for the disease and only about 43% of people with hypertension have the disease under control.
According to the SPH, the number of new cases has remained stable over the last 15 years in the adult population and cardiovascular mortality associated with hypertension (the main risk factor) has been systematically decreasing to below 30%, with this being considered a historic landmark.
There is currently an increasing concern around the growing percentage of young people and children diagnosed with hypertension, as it suggests that the number of undiagnosed people may be much higher. This rise is strongly linked to excessive salt intake combined with lack of physical exercise linked to obesity.
The fact that this disease is silent, as mentioned above, means that it has no specific symptoms (in most cases). This absence of symptoms causes hypertensive individuals to remain undiagnosed for long periods of time, usually years, until some kind of symptom eventually emerges. When these symptoms finally appear, they are usually already related to consequences or injuries associated with the fact of the patient is suffering from high blood pressure for an extended period of time, and not directly caused by the high blood pressure.
In general, the most common is for the person to experiment symptoms associated with a sudden spike in blood pressure, that is, a very sudden rise that cause sensations that are considered strange and unusual, but that are rarely associated with hypertension which translates to high blood pressure over a long period of time. Some of the symptoms associated with sudden rises (or falls) in blood pressure are:
- Spontaneous hemorrhages;
- Difficulty breathing;
- Vision changes.
It is imperative that you consult your doctor so that, in consultation, he can measure your blood pressure values and determine if what happened was in fact an isolated peak of blood pressure rise or if there is a possibility of you suffer from hypertension and, in that case, begin the appropriate treatment. This possibility is best estimated through regular blood pressure measurements, meaning that a proper prevention and monitoring strategy translates into having check-ups 2-3 times a year with your doctor.
The fact that patients, when they go to an appointment, already reveal consequences and injuries derived from undiagnosed arterial hypertension is a major concern related with this pathology. Amongst these consequences and injuries we often find:
- Myocardial infarction;
- Angina pectoris;
- Stroke (CVA);
- Cardiac insufficiency;
- Obstruction of a large blood vessel;
- Kidney insufficiency;
- Retinal damage.
Understanding blood pressure values
Since it is through the regular measurement of the blood pressure that the best form of prevention and an early diagnosis of Hypertension is achieved, it is important to bear in mind the following fundamental values:
- Systolic pressure: which represents the pressure made by the blood in the arteries at the moment of the heartbeat and which is (usually) the highest value in the measurement (ex: 140 mmHg);
- Diastolic pressure: which represents the pressure on the artery walls in the periods between heartbeats and which is (usually) the lowest value in the measurement (eg, 65 mmHg).
Once the blood pressure is measured, it is necessary to compare the results with the standard measurements with which blood pressure is usually assessed:
- optimal — less than 120/80 mmHg (ie, below 120 mmHg systolic pressure and below 80 mmHg diastolic pressure);
- normal — between 120/80 mmHg and 129/84 mmHg;
- normal high (pre-hypertension) — between 130/85 mmHg and 139/89 mmHg;
- hypertension — above 140/90 mmHg.
If the measured values are (several times) above the normal high or borderline pressure (pre-hypertension), we are in a state of arterial hypertension. Within hypertension there are varying degrees of increasing severity:
- Grade 1 hypertension: when the systolic pressure is between 140 and 159 mmHg and the diastolic between 90 and 99 mmHg;
- Grade 2 hypertension: when the systolic pressure is between 160 and 179 mmHg and the diastolic between 100 and 109 mmHg;
- Grade 3 hypertension: when the systolic pressure is greater than 180 mmHg and the diastolic is greater than 110 mmHg.
It should be noted that elderly people are especially (but not only) affected by a condition called isolated systolic hypertension, which is defined by a measurement of systolic pressure values above 140 mmHg and diastolic pressure below 90 mmHg.
It is easy to understand that the greater the degree of hypertension, the greater the risk of developing more serious complications. As a general rule, a person with high normal blood pressure sees the risk of developing cardiovascular disease doubled when compared to a person with optimal blood pressure.
People with high normal blood pressure and grade 1 hypertension may be able to regulate their blood pressure with some lifestyle and dietary changes, while people with grade 2 and 3 hypertension usually have to be medicated and accompanied by a doctor.
We already know that hypertension arises when the heart has to exert greater force for the blood to flow efficiently through our body, however, the causes for this to happen can vary:
Primary Hypertension — This is the most common type of hypertension (more than 90% of hypertensive patients) and it is not automatically related to any identifiable cause, such as, for example, the use of any type of substance or medication, or any problem with health. It is usually associated with factors such as:
- diets rich in sugar, salt and fried foods;
- lack of physical activity;
- excessive consumption of alcoholic beverages and smoking;
Secondary Hypertension — Being rarer (about 8% of hypertensive patients), this variant has more identifiable causes that can lead to high blood pressure, such as:
- Kidney and renovascular diseases;
- Heart problems;
- Thyroid alterations;
- Use of medication (eg, oral contraceptives);
- Sleep apnea;
- Hormonal diseases.
It is important to understand that the blood pressure varies throughout the day. When we are lying down, the pressure goes down. When we move, values go up. This means that high blood pressure is not synonymous with hypertension. It is normal, in healthy people, that blood pressure at certain times and in temporary situations to increase sharply, such as when exercising, when feeling pain, after drinking coffee or another stimulant, when experiencing a stressful situation, just to name some examples. Normal is also the drop in pressure shortly after these situations or moments pass. If this is not the case and your blood pressure remains for several days, or if you notice that for no apparent reason your blood pressure rises and remains high for long periods of time, it is important that you see your doctor so that he may assess the situation.
So, if there are situations and times that can lead to an increase in blood pressure, how can we know if we are hypertensive?
The answer can be found by taking multiple blood pressure measurements spaced by a time interval. Ideally 3 measurements should be taken on 3 different days, with a minimum interval of one week between measurements. In this way the diagnosis may be confirmed.
It is important to note that measurements should be carried out by a doctor or healthcare professional (for example at a pharmacy) in order to obtain a correct interpretation of the measurement values. The patient can, however, take measurements at home as a prevention and also in order to eliminate the possibility of an eventual rise in blood pressure caused by going to the clinic, the so-called “white coat syndrome”.
After a doctor’s pre-diagnosis of a suspected hypertension, the patient may be referred for other tests to help identify a possible source of the hypertension, such as urine exams, blood tests, an electrocardiogram or a kidney ultrasound.
Once the diagnosis of arterial hypertension has been confirmed, by having taken the various time-lapse measurements and additional tests, the physician is finally in a position to start the proper medical treatment, that differs between the two variants of hypertension, the primary and the secondary .
If the diagnosis points to secondary hypertension (which has identifiable causes, such as a disease), the treatment will be to treat that very disease or health problem that is raising the blood pressure. However, it is always beneficial to make lifestyle changes and to the patient’s diet in order to promote a rapid and effective normalization.
If the diagnosis is of primary hypertension (the most common and without an identifiable cause), as a first measure, changes and improvements in the patient’s lifestyle should be made in order to promote the stabilization of blood pressure, such as:
- change in eating habits, with reduced intake of salt, sugar, fat, red meat and coffee, giving preference to fruit, vegetables, cereals and lean proteins, such as white meat and fish;
- practice physical exercise regularly, spending at least 30 minutes a day, 3 to 5 times a week, hiking, running, cycling or swimming, the so-called aerobic exercises;
- seek to reduce stress.
Sometimes pharmacological therapy may be necessary, in which medications that lower the blood pressure are prescribed to the patient. These should always be prescribed by a doctor, who will need to adjust the medication over time.
Hypertension is a lifelong disease, in which the treatment seeks, over time, to reach normality and stabilization of the blood pressure. The very treatment measures are also important forms of prevention, such as the practice of regular exercise or dietary improvements.
If you think you may suffer from hypertension, if you feel that you have episodes of high blood pressure spikes, or if you think you may have any of the diseases that can cause hypertension, do not hesitate and seek your doctor, who can diagnose you and, if necessary, begin the proper treatment.