Each heartbeat pushes blood to the rest of the body through the blood vessels. Blood vessels are similar to a system of pipes in our body, although somewhat more complex as they are organic, dynamic pipes. But for teaching purposes, it is good to think of our blood vessels as a system of pipes through which our blood flows. The blood vessels that leave the heart and carry blood and its nutrients to the rest of the body are known as arteries. The blood vessels that carry out the opposite route, from the body to the heart (to re-oxygenate in a circuit with the lungs), are called veins. Well, when blood leaves the heart towards the arteries, pressure is generated on the walls of these arteries. Just as the water in a glass presses on the vessel walls, the blood in the arteries also produces pressure, which we know as blood pressure. That there is blood pressure indicates that there is blood circulation in the blood vessels, but too high a pressure can stress the heart and damage arteries and organs. In other words, if the blood vessels are a hose, if the pressure inside the hose is too low, the water will not flow, but if it is too high, the hose or even the water pump (in this case, the water pump) could be damaged. the blood pump, the heart).
It is thus understood that normal blood pressure moves in a range . It is worth mentioning that having high blood pressure one day does not constitute a disease , as it is an isolated event. Arterial hypertension (AHT) is considered to be high blood pressure maintained over time. This is so because blood pressure can vary daily depending on many factors (pain, stress, lack of sleep, etc.), but the real problem comes from sustained hypertension over time, not occasional hypertension.
Perhaps one of the most striking characteristics of AHT is that it is known by some as “the silent killer” , since it does not cause symptoms until it is too late and it has already damaged a vital organ. In other words, if you have high blood pressure, the most common is that you do not notice anything. In other cases, there are those who notice a slight headache. With time and the erosion of uncontrolled blood pressure, we can end up suffering from serious problems, such as heart attacks, heart failure, aneurysms or kidney damage.
According to data from the World Health Organization (WHO), almost 1.28 billion adults between the ages of 30 and 79 suffer from the disease and almost two-thirds of patients reside in low- and middle-income countries. The disease is one of the main causes of premature death in the world .
how is the arterial pressure measured?
When a person measures blood pressure with a blood pressure monitor, two values appear. Under normal conditions, the highest value reflects the tension suffered by the arteries during cardiac contraction (systole), while the lowest reflects the pressure of the arteries before a new heartbeat (diastole).
Blood pressure is measured in millimeters of mercury (mmHg), and is expressed as “systolic pressure/diastolic pressure” . Regarding the normal range, in recent years there has been an exhaustive review of the scientific evidence and the main American and European societies do not agree on all points. However, there are some guidelines in which there is a consensus and a standard to maintain and in general the following are very reasonable figures. In adults, blood pressure can be classified as normal blood pressure (
There are also hypertensive crises , elevations in systolic blood pressure >180 mmHg and/or diastolic >120 mmHg. We may be talking about hypertensive emergency (the most serious stage of hypertensive crisis), which associates severe acute injury to a vital organ (brain, heart, kidneys, etc.) and requires urgent treatment, or hypertensive emergency (does not involve acute injury to a vital organ ), less severe and with more scope for treatment.
Finally, it is worth mentioning malignant arterial hypertension , a form of hypertensive emergency, with a poor prognosis and in which there is involvement of the retina.
It is worth mentioning the following: although at this time there is some uncertainty regarding the best and most precise definition of arterial hypertension, the values are not very far from each other, and doctors are not dedicated to treating values, but cardiovascular risk of each specific patient. So if you have doubts about how to proceed regarding your blood pressure figures, the ideal is to consult your doctor.
How does high blood pressure affect us?
People can have high blood pressure for years and not have any symptoms . Some patients may experience any symptoms, such as headaches or nosebleeds. However, these are non-specific symptoms and usually do not manifest until blood pressure levels reach life-threatening levels and remain so for some time.
Long-term high blood pressure can cause damage to organs and blood vessels . These damages tend to increase with uncontrolled or undiagnosed cases of moderate or severe hypertension over months or years. When not well controlled, it can cause a series of associated disorders that negatively affect cardiac, renal, metabolic, circulatory, cardiovascular and cerebral function.
It can also cause the walls of the arteries to thicken and harden, which can make the heart work worse and worse. This can cause the walls of the heart’s pumping chamber to thicken, which in turn makes it harder for the heart to pump enough blood to the body, eventually leading to heart failure.
Heart failure is what happens when the heart is unable to pump the blood that the body needs. Thus, many of these patients begin to have fluid in parts of their body that they should not, since the blood is not being able to pump normally. Also, the heart has to work harder to pump blood when the pressure is higher. Thus, some of the frequent symptoms are edema in the legs, pleural effusion (fluid in the lungs), ascites (fluid in the belly), weakness, less urination and even slowness of thought and confusion (the blood will not reach correctly to the brain, which can lead to something called vascular dementia). In the worst case, we can reach an arrhythmia, a stroke, a heart attack, a cardiac arrest, death,…
Causes of high blood pressure
Arterial hypertension is classified into two different types: primary, essential or idiopathic hypertension and secondary hypertension.
Primary hypertension is the most common form of hypertension. It usually appears in adults between 30 and 50 years of age, and a clear cause of the disease has not been identified, although we know that genetic factors (with several genes involved, not just one) and environmental factors (from high salt intake in the diet , or alcohol, a diet low in fruits and vegetables, to obesity, stress and sedentary lifestyle). It is also true that there are some factors that pose an increased risk of HTN causing damage, such as smoking, hypercholesterolemia, being male, diabetes, being young or, curiously, being African-American.
Secondary hypertension is often caused by an underlying disease, such as diabetes, kidney disease, obstructive sleep apnea, thyroid problems, adrenal gland tumors, and birth defects of the blood vessels; by medications such as cold remedies, birth control pills, over-the-counter pain relievers, decongestants, and some prescription drugs; and for illegal drugs such as amphetamines and cocaine.
Men are more likely than women to develop hypertension before age 65, while women are more susceptible than men after age 65.
How is hypertension treated?
There is no mystery, often your lifestyle has led you to develop this disease. Therefore, the first measure is to review and change the lifestyle towards a healthier one . However, this is a measure only applicable to mild cases. If the disease is already advanced, we must take medication. Lifestyle changes can include a better diet, exercising, avoiding alcohol, and regularly checking your blood pressure to see how you’re doing, among others.
When it comes to improving your diet, there are many things to consider and the help of a nutritionist can be of great value. General recommendations include eating a balanced diet containing vegetables, fruits, poultry, whole grains, low-fat dairy products and fish that can help control blood pressure. The intake of trans or saturated fats should be avoided or reduced. Limit salt intake to between 1,500 mg and 2,300 mg per day (although your case will have to be assessed individually). Increasing your potassium intake (if you don’t have it in the right range) will also help prevent and control the disease (warning, high potassium is dangerous, don’t take potassium on your own without consulting your doctor).
Maintaining a healthy body weight, increasing physical activity, exercising regularly, losing excess body fat, quitting smoking, limiting alcohol intake, and reducing stress through breathing exercises, yoga, meditation, or relaxation techniques are also useful in controlling the disease. Women can prevent the development of hypertension during pregnancy with regular medical check-ups and regular blood pressure monitoring.
Doctors prescribe medication if diet and lifestyle changes don’t help control high blood pressure. The prescription of medications depends on different factors, such as the age of the patient, the presence of underlying diseases, etc. Doctors may prescribe one or more types of medications, in combination, to achieve a specific blood pressure reading that is set as a treatment goal for a particular patient.
But if there is something that you should keep from all this, it is that, in terms of health, “nothing is free”. That is to say, that you do not notice anything, that you exercise or that you smoke or drink only very occasionally or at social events, are not a guarantee of health. The most basic medical check-ups are important (especially after fifty), and our actions (and inactions) do not tend to go unnoticed by the weight of time on our bodies.
References
Bakris, G.L. (2021). Arterial hypertension. MSD Manuals. https://www.msdmanuals.com/en/home/heart-disorders%C3%B3n-and-blood-vessels%C3%ADneos/hypertensi%C3%B3n-arterial/hypertensi%C3%B3n- arterial?query=hypertensi%C3%B3n
Hypertension clinical guidelines (ISH, 2020). (2020, July 8). Medscape. https://espanol.medscape.com/verarticulo/5905646
World Health Organization (2021). Hypertension. WHO: World Health Organization. https://www.who.int/en/news-room/fact-sheets/detail/hypertension
Unger, T., Borghi, C., Charchar, F., et. al. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Journal of hypertension, 38(6), 982–1004. https://doi.org/10.1097/HJH.0000000000002453
Organización Mundial de la Salud. (2021). Guideline for the pharmacological treatment of hypertension in adults. WHO: World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/344424/9789240033986-eng.pdf
