High blood pressure, called in medicine hypertension, is the most frequent cause of sudden death internationally. The WHO reports that it affects nearly 30% of the mature population and over half of elderly individuals older than 65 have permanently increased arterial tension. The hemorrhagic aggravations of the disease (stroke, cardiac arrest) often become fatal.
Let’s discuss the norm and pathological changes, including those threatening the transition to a hypertensive crisis.
Key points about high blood pressure
What doctor to see
Family doctor, cardiologist
Usually, during the initial stage there are no symptoms.
Later, the following can develop:
- Shortness of breath when walking;
- Sleep disorders;
- Irregular heartbeat;
- Rapid heartbeat;
- Discomfort in the chest, and others.
Coronary artery disease, stroke, heart failure, peripheral arterial disease, vision loss, chronic kidney disease, dementia
Genetic predisposition, lifestyle
Excess salt, excess weight, smoking or consumption of other nicotine-containing products, alcohol abuse, other diseases and imbalances (diabetes, thyroid dysfunction, adrenal gland dysfunction, impaired glucose tolerance, high cholesterol, and others)
Resting blood pressure 130/80 or 140/90 mmHg registered several times a week
Lifestyle changes, medications
30% of total word population, 40-60% of people aged over 65 years
9.4 million/18% (2010)
How to know if you have raised arterial tension?
High blood pressure is diagnosed when upper and lower indications rise above the physiological threshold.
Arterial tension norm rate according to WHO data:
- Systolic (upper) - 120-129 mm Hg.
- Diastolic (lower) - 80-84 mm Hg.
If, when measuring arterial tension, the upper figure is 140 or higher, and the lower figure is 90 or higher, then we can talk about increased arterial tension. An occasional increase related to physical exertion or stress doesn’t indicate a disease. But it must be understood that systematically recorded high blood pressure is pathology. Episodes of its rise in the morning, during a workout, fear, stress are natural. But when it rises at rest, you should definitely see a doctor.
In pressure indications 180/120, there is a high probability of hypertensive crisis onset, i.e. a continuous rise of blood tension that cannot be stopped with the usual pills you have at home.
What causes increased arterial tension?
Most often, the disease occurs in individuals with a hereditary predisposition and/or chronic diseases of other organs and systems (pheochromocytoma, hyperthyroidism, atherosclerosis, diabetes, etc.).
Risk factors that cannot be changed:
- Age. After reaching the age of 65, 50%-60% of individuals develop the condition;
- Family history of heart and vessel diseases in close relatives diagnosed at a young age. High arterial tension is a disease in which hereditary predisposition plays an important role. Around 30% of the diagnosed cases are caused by genetics. Individuals whose close relatives had been diagnosed with heart and vessel diseases at the age younger than 55 (men) and 65 (women), are at the greatest risk.
Changeable risk factors:
- Increased arterial tension;
- Tobacco smoking. Smoking or the use of any nicotine-containing products possesses an enormous risk of heart diseases. A smoker’s risk of serious heart disease is 2-4 times higher than of a non-smoker’s. Nicotine increases the risk of arteriosclerosis, raised arterial tension, and poor blood coagulation. Smoking cessation lowers the risk to the level of a non-smoker in two years.
- Waist circumference increase. Excess adipose tissue influences the metabolism of glucose and induces the drop of the “good” cholesterol and rise of “bad” cholesterol in the blood.
- Unbalanced diet and excess weight provide an additional load to the heart, especially if it is already coping with high arterial tension. Weight loss is an effective way of treating high arterial tension. For instance, losing 10 kg (20 lbs) for patients with excess weight can lower arterial tension by 10 mm Hg. A healthy diet helps to maintain a normal weight and low “bad” cholesterol levels.
- Alcohol abuse. According to the WHO, alcohol is the third main reason for heart damage in the world after increased arterial tension and smoking. One unit of alcohol equals 10 grams of absolute alcohol. This indication is used to calculate the volume of consumed alcohol per day. It equals one shot of strong alcohol, a glass of wine, or 250 ml of beer. Women are advised to consume less than 2 units of alcohol per day, and men – less than 4 units. Besides, during a week, there should be no less than three alcohol-free days.
- Low physical activity.
- The imbalance of lipids in the blood called (dyslipidemia). Cholesterol is a lipid (fat) produced by the liver. It is a crucial substance that is contained in the walls of the organs and the blood. There are two sources of cholesterol – the human body and food. The body produces around 70% of cholesterol and 30% come with food. There are two types of cholesterol, so-called “good” and “bad”. With improper diet or genetic disorders causing the prevalence of “bad” cholesterol over the “good” one, dyslipidemia fraught with severe cardiovascular complications develops.
- High blood glucose level. The normal level of glucose on an empty stomach is lower than 6 mmol/l. In higher numbers, impaired glucose tolerance can be diagnosed. To detect this disorder, a glucose tolerance test is made. In case of impaired glucose tolerance, the level of glucose in the blood is stuck on the level of 7.8 and 11 mmol/l two hours after the administration of 75 g of glucose. In a healthy individual, glucose level drops lower than 7.8 mmol/l two hours after glucose ingestion.
- Metabolic syndrome. Individuals with increased arterial tension usually have other risk factors for heart diseases and this set of symptoms is called metabolic syndrome. It occurs when an individual has a dangerously high waist circumference, high level of bad lipids in the blood. For individuals with high arterial tension, it is crucial to measure cholesterol and glucose in the blood. In the elevation of these indicators, it is important to correct them with diet and drugs.
- Stress. Short-term stress is a natural reaction to different situations and physical loads. It is necessary for the healthy functioning of the body, but prolonged stress, for instance, caused by financial difficulties, dangerous or hazardous work, the stress of piling up responsibilities, and so on, significantly increases the risk of heart disease.
As you can see, there is a broad range of causes that can be prevented or eliminated. It is important to work on them not only to lower blood pressure per se but to prevent the risk of serious, life-threatening aggravations of the disease such as heart attack, stroke, and so on.
Symptoms of high pressure
Many people know that hypertension is often asymptomatic. It is true, but only at the beginning. Constantly high arterial tension over time results in a number of clinical symptoms:
1. The first signs: headaches, dizziness, fatigue, weakness, nervousness, sleep disorder;
2. With progression: headaches in the occipital region, "tingling" in the heart, the appearance of shortness of breath with light physical activity (walking, for example), a feeling of palpitations, "flies" in front of the eyes, visual impairment.
The difference in symptoms mainly relies on the level of tension and the rate at which it rises. Often, a sharp rise in pressure turns into a hypertensive crisis and rupture of the vessel wall.
High lower pressure
Lower or diastolic pressure is understood as the force with which the blood flow acts on the vessels during the diastole (relaxation) phase of the heart. Its value depends on the degree of vascular resistance, an increase in which is observed in such pathological conditions:
- Atherosclerosis - the elasticity of the vascular wall decreases, their lumen decreases, which increases the tone and resistance to blood flow;
- Kidney pathology leads to vasoconstriction due to the implementation of the renin-angiotensin-aldosterone reaction;
- Anatomical and functional changes in the myocardium (dilatation of the heart chambers, arrhythmia);
- Thyrotoxicosis - a high concentration of thyroid hormones in the blood causes vasospasm;
- Diabetes mellitus - vascular patency is impaired;
- Tumor of the pituitary and adrenal glands - the release of catecholamines into the blood, which constricts the vessels.
According to statistics, the elderly and men of any age often suffer from an elevated lower tension. Signs of its increase are a shooting pain in the head, dizziness, tinnitus, attacks of shortness of breath. Painful discomfort in the heart area is possible. Untreated long-lasting elevated diastolic pressure is fraught with a cardiac arrest.
Increased upper pressure
The upper (systolic) pressure reflects the contractile activity of the myocardium during systole (when parts of the heart contact). Its increase can be due to various reasons:
- Congenital malformations and acquired cardiac pathology - coarctation of the aorta, blockade of the atrioventricular node, insufficiency of valves at the entrance to the aorta, and others;
- Ionic deviations - the accumulation of sodium and calcium in the blood;
- Atherosclerosis of large and small vessels;
- Renal pathologies of an inflammatory, autoimmune nature;
- Dehydration of the body.
Over time, increased upper pressure leads first to hypertrophy, and then to myocardial wear, and heart failure. The wall of the aorta gets rigid due to constant trauma from the raised tension. Hemodynamic disorders of internal organs are also noted due to inadequate distribution of blood through the vessels.
This type of disease is more common in women. It manifests itself as regular headaches, heart discomfort, fatigue, memory impairment, tinnitus, and decreased vision.
The main goal of therapy for high arterial pressure is to lower its indicators to normal and the optimal possible correction of risk factors (fighting smoking, alcoholism, weight loss, doing morning exercises, etc.), and slowing down the negative impact to other organs.
Taking into account the disease history and objective data for hypertension, various medications are appointed, their main groups are presented below:
- Antihypertensive drugs to lower arterial tension (first-line medication is Nifedipine);
- Antiplatelet agents that reduce the risk of hemorrhagic complications;
- Statins for lipid metabolism correction;
- Diuretics that indirectly reduce arterial pressure;
- Alpha or Beta-blockers to correct myocardial contractility (only if there are indications).
If high blood pressure is a sign of the pathology of another organ, then the treatment of the underlying disease is of key importance.
An important aspect in the treatment of raised arterial pressure is a balanced diet, in which you need to limit salt intake, eat more vegetables, nuts, fruits, healthy vegetable oils (olive, pumpkin). If possible, replace red meat with fish. Reduce the amount of calcium-rich dairy products in the diet.
What doctor to see?
If you suspect the disease, you should first see your family doctor or therapist. The doctor will appoint the necessary examination to make a diagnosis and correct high blood pressure readings. A doctor who deeply knows the problem of raised arterial pressure in humans is a cardiologist. This specialist deals not only with the correction of hypertension but also fights its complications, often together with a neurologist, nephrologist, ophthalmologist, and resuscitator.
The coordination of the work of the heart and blood vessels is a key link in the health of the whole organism. Thanks to preventive measures, it is possible to preserve their harmony, thereby preventing the development of hypertension. These include:
- Adequate physical activity;
- Weight loss to normal levels;
- Balanced diet;
- Quitting smoking, alcohol, drugs;
- Reduction of stress or learning techniques to cope with it.
When the above symptoms appear, you should begin to systematically measure arterial tension using a blood pressure monitor. Regardless of the reasons for the elevated pressure, its long-term retention at high numbers is a reason for seeing a family doctor or cardiologist.
Post by: Natalie Keller, M.D. General Health Centre, Minneapolis, Minnesota