Arterial hypertension
"Physical exercise and a low-salt diet are some very effective measures for its treatment, without having to resort to drugs".
DR. JUAN JOSÉ GAVIRA GÓMEZ
SPECIALIST. CARDIOLOGY DEPARTMENT
Blood pressure is the pressure of the blood circulating in the arteries. The heart pumps the blood into the aorta where it is distributed to other arteries that are divided into successive arterial branches that reach all the organs.
The pressure is maintained by the elasticity of the aorta and the main arteries. This elasticity decreases over the years, which is why it is so common to find high blood pressure in older people.
The consequences of hypertension can be very varied. They are worse when other processes coexist: hypercholesterolemia, diabetes, etc.
The Clinic has the only cardiovascular checkup that incorporates the highest diagnostic imaging technology to accurately quantify your cardiovascular risk
Thanks to the exclusive dedication of our professionals, they allow us to perform the ICAP Checkup in less than 48 hours with a high precision diagnosis.
What are the symptoms of high blood pressure?
The symptomatology that can accompany arterial hypertension is very varied. It can happen that arterial hypertension does not give any symptom and its discovery is casual (by medical revisions, surgeries, etc.).
On other occasions, it is discovered as a result of the presence of frequent headaches, spontaneous nosebleeds, sensation of restlessness, nervousness, etc. and, less frequently, because of intense headaches, sensation of coldness and anguish, palpitations and trembling.
When these symptoms occur together with a significant rise in blood pressure figures, it is called hypertensive crisis.
¿Cuál es la tensión arterial normal?
140/90
En una persona adulta, las cifras normales de tensión arterial están por debajo de 140 de sistólica (popularmente "TA máxima") y 90 de diastólica (popularmente "TA mínima")
Do you have any of these symptoms?
You may have high blood pressure
What are the causes of high blood pressure?
Essential or unexplained high blood pressure: This is the most common type of high blood pressure, about 90-95 percent. It usually occurs above the age of 50 and there is often a family history of hypertension.
Secondary arterial hypertension: is that hypertension whose cause is known.
Said cause can be very varied, the most frequent being vasculo-renal, that is, the one produced as a consequence of a lack of flow at the level of the kidneys, due to arteriosclerosis or a vascular malformation, which triggers arterial hypertension in response to the signal of bad perfusion received by the affected kidney.
Other causes are the existence of a coarctation of the aorta, a parenchymal kidney disease, endocrines, etc.
¿Cuáles son los factores de riesgo?
El aumento de presión arterial no es una enfermedad hereditaria típica en cuanto a transmisión de padres a hijos.
Su génesis es multifactorial, digamos que se hereda una mayor predisposición a padecerla que, unida a diversos factores medioambientales, puede desencadenar su aparición.
What is the prognosis of high blood pressure?
Acute: A sudden and significant rise in blood pressure can produce a variety of symptoms such as alterations in vision, chest pain or neurological disorders, encephalopathy, etc.
Hypertensive crisis is only mentioned when there are symptoms accompanying the rise in blood pressure. However, the fact of finding very high figures in a patient who has no symptoms is not a cause for alarm and that patient should not go to the emergency room. It will be enough to increase the antihypertensive treatment and discuss it with your family doctor.
Chronicles: The chronic complications derived from high blood pressure depend on the control that has been made of this or that is associated with other diseases, mainly metabolic.
At the cardiac level, the thickness of the wall of the ventricle increases and a certain rigidity appears that makes it difficult to fill it, compromising both alterations in the irrigation of the myocardial muscle and favoring, along with a deterioration of the coronary arteries, ischemic diseases (due to lack of irrigation) of the heart.
In the kidney, the arteries that irrigate it deteriorate, generating ischemia of its functional units (nephrons) which, together with the hypertension transmitted to these units, generates a progressive and irreversible destruction. This hyperpressure will favour an increase in the elimination of proteins through the urine, which can be evaluated as a marker of renal damage.
In the central nervous system can produce diseases resulting from thrombotic phenomena (strokes in an episodic or chronic, can lead to a situation of dementia) or bleeding (brain hemorrhages). These diseases give rise to a great morbidity due to the repercussion they have on the patient.
Finally, the vascular damage generated by arterial hypertension can lead to diseases derived from poor perfusion that can affect any territory (intestine, extremities, eyes, etc.)
How is high blood pressure diagnosed?
High blood pressure is usually diagnosed at a medical check-up. Several measurements must be taken and it must be verified that high blood pressure figures really exist. Sometimes, it is discovered when some of its harmful consequences or complications appear: heart problems, kidney failure or brain injuries.
The study of high blood pressure is aimed at determining the cause, the presence of other cardiovascular risk factors (hypercholesterolemia, hyperglycemia, etc...) and their impact on different organs.
It begins with a complete medical examination, physical examination and analytical studies. Arterial hypertension is almost always essential (without apparent cause), but it can be secondary to other diseases.
When it is suspected that there is a disease causing high blood pressure, it is advisable to complete the cardiological study with other studies aimed at finding the cause.
There are also other tests available that evaluate the impact that high blood pressure produces on the target organs (heart, kidney, brain, eyes).
How is high blood pressure treated?
They are fundamental. They must be exhausted before starting the pharmacological treatment. If the hypertension is serious, they are put into practice at the same time as the drug treatment is started. The general measures are as follows:
- Adequate weight. The best measurement is the waist/height index: for this, the waist circumference is divided by the height in cm. It is increased when it is greater than 0.50, in which case the patient should be advised to lose weight.
- Walk at a fast pace, for a minimum of 45 minutes, every day.
- LDL cholesterol should not exceed 115 mg/dl. If it is higher, a Mediterranean diet is recommended: low in saturated fat and with abundant fruit, vegetables, fish and olive oil.
- Alcohol: do not ingest more than 30 g./day of ethanol (not exceeding 300 ml. of wine, 720 ml. of beer or 60 ml. of whiskey). It is generally advised that men do not drink more than two glasses of wine a day and women no more than one.
- Initially, strict diet without salt for two weeks. If the AT figures are not reduced, a low-salt diet can be continued (4-5 g/day).
- Diuretics: promote sodium loss through urine and water. Side effects, metabolic abnormalities.
- Beta-blockers: cardiosuppressive and vasodilatory action. Side effects, metabolic abnormalities. Recommended to monitor their use in patients with heart failure, diabetics or people with lung diseases.
- Calcium antagonists: great vasodilatory capacity, although some also have cardiosuppressive action. Side effects: headaches, edema in extremities and heat sensation.
- IECAs: act on a hormonal axis involved in the management of sodium at the renal level and the contraction of peripheral vessels. They reduce protein loss through urine. They can produce metabolic abnormalities and negatively influence renal function.
- Angiotensin receptor antagonists: block the final action of the renin-angiotensin axis.
- Alpha-beta blockers: block alpha and beta sympathetic receptors. Cardiosuppressive and vasodilatory action.
- Central alpha adrenergic agonists: act on the central nervous system, decreasing the sympathetic tone with increased vagal. They promote peripheral vasodilation.
- Peripheral alpha 1 adrenergic blockers: peripheral arterial and venous vasodilatory action. They can produce an excessive drop in blood pressure when standing up.
- Vasodilators: They usually produce an increase in hair and an increase in pulse.
With regard to hypotensive drugs, it is recommended to start with diuretics and beta-blockers, unless there is some characteristic that indicates some other treatment.
Where do we treat it?
IN NAVARRE AND MADRID
The Department of Cardiology
of the Clínica Universidad de Navarra
The Department of Cardiology of the Clinica Universidad de Navarra is a center of reference in different diagnostic techniques and coronary treatments.
We have been the first center in Europe to place a pacemaker by means of a catheterization without the need to open the chest, for cases of severe heart failure.
The Cardiology Department of the Clinic collaborates with the Radiology and Cardiac Surgery Departments to achieve a quick and precise diagnosis of the patient.
Why at the Clinica?
- Specialized Arrhythmia Unit of national reference.
- Unit of Hemodynamics and Interventionist Cardiology equipped with the best technology.
- Cardiac Imaging Unit to achieve the highest diagnostic accuracy.
Our team of professionals
Cardiovascular Checkup
ICAP
INTEGRATED CARDIOVASCULAR
ASSESSMENT PROGRAM
A new approach to cardiovascular risk
The only checkup that incorporates the latest diagnostic imaging technology to accurately quantify your risk of stroke and myocardial infarction.
Thanks to the exclusive dedication of our professionals, we are able to perform the ICAP checkup in less than 48 hours with a highly accurate diagnosis.