Arterial Hypertension

Arterial Hypertension

Blood pressure refers to the pressure that blood exerts on the walls of the arteries...

I. Blood Pressure — General Information

What is blood pressure?

Blood pressure refers to the pressure that blood exerts on the walls of the arteries as the heart pumps blood throughout the body. Blood pressure is measured in millimeters of mercury (mmHg) and is expressed as two numbers: systolic pressure (representing the pressure when the heart contracts to produce a heartbeat) and diastolic pressure (representing the pressure when the heart is at rest between two beats).

How is blood pressure measured correctly?

To obtain the most accurate reading when monitoring your blood pressure, it is necessary to follow a few rules to avoid having the measurement results influenced by external factors.

BEFORE measuring blood pressure:

30 minutes before measuring blood pressure:

  • Do not smoke
  • Do not consume caffeine
  • Do not engage in physical exercise

5 minutes before measuring blood pressure:

  • Remain at rest, preferably seated on a bed or chair

DURING blood pressure measurement:

  • Make sure the blood pressure cuff is the correct size
  • Make sure the cuff is positioned in the correct location
  • Keep your arm at heart level, preferably on a flat surface (for example, a table)
  • Sit upright with your back straight and your feet flat on the floor
  • Do not talk

AFTER measuring blood pressure:

  • Wait one minute and repeat the blood pressure measurement
  • Calculate the average of the two values obtained
  • Record the value in a table and bring it to every medical checkup
  • Bring the blood pressure monitor you use for measurement when you go to your medical checkup to ensure it is functioning correctly

What do systolic blood pressure and diastolic blood pressure mean?

Although the colloquial terms for systolic and diastolic pressure are not medically accurate, they are frequently used in everyday language to replace the terms systolic blood pressure and diastolic blood pressure respectively.

Systolic blood pressure represents the pressure that blood exerts on the walls of the arteries during systole. Systole is the contraction of the heart, felt as a heartbeat, which pumps blood to the entire body.

Diastolic blood pressure represents the pressure that blood exerts on the walls of the arteries while the heart is at rest between two beats — a period known as diastole.

During the contraction of the heart, as an additional volume of blood is pumped into the arterial circulation, the pressure of the blood against the elastic walls of the vessels increases. Meanwhile, during the period when the heart relaxes, blood continues to be taken up by the systemic circulation, and the pressure on the vascular walls decreases. This is why systolic blood pressure is higher than diastolic blood pressure.

What is a normal blood pressure value?

To be considered “normal,” blood pressure values must be interpreted in a clinical context, taking into account the individual characteristics of each person.

In general, blood pressure is considered optimal when systolic blood pressure is below 120 mmHg and diastolic blood pressure is below 80 mmHg. Values below 130/85 mmHg are accepted as normal.

If my blood pressure is elevated above normal values, does it mean I have arterial hypertension?

No. There are several factors that can cause a temporary increase in blood pressure, such as stress, anxiety, or physical activity. In some cases, a single elevated reading may not necessarily indicate arterial hypertension, but additional monitoring is certainly recommended to determine whether you have hypertension or whether there are other causes for the elevated blood pressure.

Typically, a diagnosis of arterial hypertension is made when blood pressure values remain above 140/90 mmHg for 3 consecutive days.

II. Overview of Arterial Hypertension

What is arterial hypertension?

Arterial hypertension (AHT) is a common medical condition in which the pressure exerted by the column of blood on the walls of the arteries is consistently elevated above values considered normal. Arterial hypertension has a dual nature: it can be considered both a disease and a risk factor, being the most common cardiovascular risk factor. It is estimated that 10 million people die annually from arterial hypertension worldwide.

How common is arterial hypertension in the population?

According to estimates, the global prevalence of arterial hypertension exceeds 1 billion hypertensive individuals. Among adults, the overall prevalence of arterial hypertension is approximately 30—45%. We can therefore consider that globally, 1 in 3 adults has arterial hypertension.

Arterial hypertension becomes more common with advancing age, with a prevalence exceeding 60% among individuals over 60 years of age.

As populations age and adopt a more sedentary lifestyle, the global prevalence of arterial hypertension will continue to rise. It is estimated that the number of people with arterial hypertension will increase by 15—20% by 2025, reaching nearly 1.5 billion.

How is arterial hypertension diagnosed?

Typically, a diagnosis of arterial hypertension is made when blood pressure values remain above 140/90 mmHg. It is considered sufficient to diagnose arterial hypertension in a person not previously known to have the condition if elevated blood pressure values are recorded when measuring blood pressure in the morning and evening for at least 3 consecutive days.

Home blood pressure self-monitoring is a common approach when a routine measurement has revealed an elevated blood pressure value. This can be useful for some individuals because measurements taken in a medical office can sometimes be influenced by the emotional stress of being at the doctor. Conversely, in the case of other individuals, blood pressure values may appear normal during a medical consultation but will be elevated at home due to environmental factors.

Are there symptoms that indicate the presence of arterial hypertension?

In most cases, arterial hypertension does not cause any symptoms, which is why it is often called the “silent killer.” It can be present for long periods of time and can progress to complications without the person being aware of it or feeling any different. Some people may experience symptoms if blood pressure rises rapidly to very high values (as occurs in a hypertensive crisis). Symptoms that may accompany the complications of arterial hypertension and the involvement of other organs include: headaches, dizziness, visual disturbances, palpitations, chest pain, difficulty breathing after exertion, increased urinary frequency or nighttime urination, and cold extremities.

Nevertheless, it is worth mentioning again that many people with arterial hypertension may not present any visible symptoms, which is why regular blood pressure monitoring is crucial.

III. Risk Factors

Since arterial hypertension has a dual nature — being both an independent disease and a condition that leads to the development of other diseases as it progresses — we have found it useful to divide the risk factor section into two categories: risk factors that contribute to the development of arterial hypertension, and additional risk factors that can complicate the progression of arterial hypertension with other diseases.

What are the risk factors for developing arterial hypertension?

Over time, a number of factors have been identified that increase the risk of a person developing arterial hypertension. Among the most important risk factors associated with the development of arterial hypertension are:

  1. Age. The risk of arterial hypertension increases with age; by the age of 70, approximately 70% of people will have arterial hypertension.
  2. Male sex. In general, men are more predisposed to developing arterial hypertension. Up to the age of 64, hypertension is more common in men; after menopause, women in turn become more predisposed.
  3. Family history of arterial hypertension. You are more likely to develop arterial hypertension if you have a parent or sibling with this condition.
  4. Obesity or being overweight. Excess weight associated with elevated cholesterol levels causes changes that frequently increase blood pressure.
  5. Sedentary lifestyle. Lack of regular physical activity can lead to weight gain and increases the risk of arterial hypertension.
  6. Smoking. Smoking, chewing tobacco, or vaping raise blood pressure immediately after use for a short period of time. Over time, smoking damages the walls of blood vessels and accelerates the process of arterial hardening and the risk of developing arterial hypertension.
  7. Excessive salt intake. Excess salt in the body can cause the body to retain fluids. This increases blood pressure.
  8. Excessive alcohol consumption. Alcohol consumption has been associated with increased blood pressure, especially in men.
  9. Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as overeating, tobacco use, or alcohol consumption can further elevate blood pressure.
  10. Other chronic diseases. Certain chronic conditions such as kidney disease, diabetes, and sleep apnea are among the conditions that can lead to arterial hypertension.
  11. Pregnancy. During pregnancy, arterial hypertension can develop, sometimes reaching very high values; blood pressure may remain elevated even after delivery.

What are the additional risk factors that can complicate the course of a hypertensive patient?

Some of the risk factors that contribute to the development of arterial hypertension can also contribute to the development of complications related to hypertension. These include advanced age (over 55 years in men, over 65 years in women), obesity, elevated blood cholesterol levels, physical inactivity, smoking, or excessive alcohol consumption. Other factors that can increase the risk of complications in people with arterial hypertension include:

  • Severity and duration of arterial hypertension: the longer blood pressure remains elevated and the higher its value, the greater the risk of complications.
  • Presence of other health conditions: people with arterial hypertension who also have other health conditions, such as diabetes, kidney disease, or other cardiovascular diseases, may be at a higher risk of complications.

IV. Complications of Arterial Hypertension

What are the possible complications of arterial hypertension?

Arterial hypertension can begin to produce changes in the body years before any symptoms appear. Among the complications that can arise as a result of the effects of arterial hypertension, we can mention:

  • Cardiovascular diseases: arterial hypertension can increase the risk of ischemic heart disease, myocardial infarction, cardiac arrhythmias, or the development of heart failure.
  • Cerebrovascular disease: approximately 60% of individuals who have suffered a stroke previously had arterial hypertension.
  • Cognitive decline: arterial hypertension can increase the risk of cognitive decline and dementia, especially in older adults.
  • Chronic kidney disease: arterial hypertension can damage the kidneys and increase the risk of developing chronic kidney disease.
  • Eye damage: arterial hypertension can cause damage to the blood vessels in the eyes, leading to visual disturbances.
  • Peripheral vascular disease: arterial hypertension can cause changes in the peripheral arteries, caused by a narrowing of the arteries that supply blood to the extremities.
  • Pregnancy complications: arterial hypertension during pregnancy can increase the risk of complications for both the mother and the child.

How can you prevent the complications of arterial hypertension?

To prevent the complications associated with the presence of arterial hypertension, the primary goal is to prevent the development of blood pressure elevation that occurs with age. This can be achieved through lifestyle modifications from a young age by maintaining an active lifestyle, a normal body mass index (BMI), and a balanced diet.

Unfortunately, most people do not follow these recommendations and develop arterial hypertension in adulthood or later in life. To prevent the development of complications once arterial hypertension has appeared, it is important to maintain blood pressure levels at the recommended values.

To achieve this, it is advisable to:

  • Take medications as prescribed by your physician.
  • Maintain a healthy lifestyle. This includes a healthy diet, regular physical exercise, maintaining a normal weight, limiting salt and alcohol intake, quitting smoking, and managing stress.
  • Monitor your blood pressure regularly.
  • Properly manage other health conditions: if you have other health conditions (for example, diabetes or high cholesterol), it is important to manage them effectively to reduce the risk of complications.
  • Follow your physician’s recommendations and attend regular medical checkups.

V. Treatment of Arterial Hypertension

What is the treatment for arterial hypertension?

The treatment of arterial hypertension primarily includes measures related to lifestyle modification (called non-pharmacological therapeutic measures), which may be combined, depending on individual circumstances, with pharmacological treatment (pharmacological therapeutic measures).

As previously mentioned, lifestyle modification is recommended for all hypertensive patients and constitutes the first step in the treatment of arterial hypertension. The main non-pharmacological measures in the treatment of arterial hypertension include: weight reduction, maintaining a diet rich in fruits, vegetables, whole grains, and low-fat foods, reducing salt and sodium intake, regular physical activity, smoking cessation, and moderate alcohol consumption.

The goal of antihypertensive pharmacological treatment is to lower blood pressure values to optimal levels and to reduce the risk of complications. Treatment is initiated taking into account blood pressure values and the patient’s overall cardiovascular risk. The physician will consider each patient’s individual characteristics when initiating antihypertensive treatment and choosing the recommended class of medication. For this reason, your treatment may differ from the medications taken by acquaintances who have also been diagnosed with arterial hypertension.

Why should I eat a low-salt diet if I have arterial hypertension?

If you have arterial hypertension, reducing salt intake is an important step in managing elevated blood pressure values. When we consume salt, we provide an additional amount of sodium to the body, which contributes to the retention of excess fluid. This leads to an increase in blood pressure and can reduce the effectiveness of antihypertensive medications.

To reduce salt intake, you can try to:

  • Choose foods and seasonings with low sodium content or without added salt.
  • Cook at home: preparing meals at home allows you to control the amount of salt added. Use herbs and spices to add flavor to your meals instead of salt.
  • Choose fresh foods: fresh fruits and vegetables are naturally low in sodium.
  • Avoid processed and packaged foods, which often contain high levels of salt.
  • Read product labels to check the sodium content of foods.
  • Use salt substitutes: salt substitutes, such as potassium chloride, can be used as a replacement for table salt. However, if you have kidney conditions or take certain medications, you should consult your physician before using a salt substitute.

By reducing salt intake, you can lower your blood pressure and reduce the risk of developing complications associated with arterial hypertension, such as heart disease, stroke, and kidney disease.

What are the recommended blood pressure values while on treatment?

The target blood pressure values for individuals up to 70 years of age through antihypertensive treatment are generally 120—130 mmHg for systolic blood pressure and 70—79 mmHg for diastolic blood pressure. For individuals over 70 years of age, systolic blood pressure values up to 140 mmHg are accepted.