Arterial Hypertension

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Arterial Hypertension
Hypertension Causes

Arterial hypertension (hypertension) is a prolonged increase in arterial blood pressure. Hypertension is diagnosed when blood pressure is increased during several measurements. Blood pressure is increased when it is equal to or higher than 140/90 mmHg. Arterial hypertension (AH) can be primary and secondary. Secondary hypertension could develop as a result of other diseases (kidney, vessel diseases). However, in over 90 percent of cases the causes are unknown - that is called primary AH.

Arterial hypertension is a very common and dangerous disease. In Europe 50 - 60 percent of residents aged 25 - 65 years have AH. Hypertension is more common in men. Patients with AH are more susceptible to myocardial infarction, stroke and heart failure. The risk of developing these diseases is especially increased after many years of uncorrected AH. That is why it is very important to take prescribed drugs thoroughly and keep optimal blood pressure. There is a direct link between the height of blood pressure and mortality (higher blood pressure has a higher risk of mortality). 75 percent of deaths from heart and vessel diseases are linked with arterial hypertension. However, heart and vessel diseases are the most common cause of death in Europe.

Causes

Many factors play a role in the development of primary arterial hypertension. If the function of one or more factors responsible for regulating blood pressure becomes impaired, AH may develop. Other factors (inner, environmental and genetic) may also add up. In most cases, the exact causes of arterial hypertension remain unknown. Here are some of the factors which may have an impact on developing AH: genetic predisposition (the most important one, it commonly causes conditions for harmful environmental factors to operate on the organism); increased activity of the sympathetic nervous system, kidney disorders (hormone imbalance, impaired sodium excretion), endothelium diseases, too much salt in one’s diet, insulin disorders, unhealthy lifestyle (obesity, smoking, excessive use of alcohol, fatty foods, not enough physical activity).

Signs and symptoms

The main problem of arterial hypertension is that the disease is usually asymptomatic until complications develop. Most of the patients do not know about their elevated blood pressure. Some patients may experience pain in the back of the head or in the chest, during physical overload. AH silently damages the small vessels, the heart, the brain and the kidneys.

Complications

The complications of arterial hypertension are:

  • Vessel lesions - the vessels thicken and rupture due to increased blood pressure. Atherosclerosis tends to develop, as well as artery aneurysms (dilatations of vessel walls). That leads to impaired blood flow into different organs, thus impairing their function.
  • Pathology of the heart. Due to increased workload, the left ventricle becomes hypertrophied (increases in size). The demand of blood exceeds the flow to the ventricle, which leads to atherosclerosis of the coronary arteries. Therefore, the risk of myocardial infarction, heart failure and sudden death increases.
  • Kidney lesions. The endothelium of kidney arteries becomes damaged. That leads to impaired concentration function and kidney failure. Progressed kidney dysfunction makes arterial hypertension very difficult to treat.
  • Central nervous system (the brain). Hypertension damages the brain arteries. That might cause a stroke. Atherosclerosis of the brain arteries causes dementia (impaired cognitive brain function). Other neurological diseases, related to AH, are also commonly diagnosed.

Diagnostics

Arterial hypertension is diagnosed by observing increased blood pressure during several measurements. The diagnosis is confirmed when blood pressure remains elevated for several weeks. It is impossible to diagnose hypertension with just one measurement of arterial blood pressure (that could be a normal reaction to physical exercise or stress).

Classification of blood pressure

  • Optimal: <120/<80 mmHg.
  • Normal: <130/<85 mmHg.
  • Elevated normal: 130-139/85-89 mmHg.
  • I grade hypertension 140-159/90-99 mmHg.
  • II grade hypertension: 160-179/100-109 mmHg.
  • III grade hypertension: >180/>110 mmHg.
  • Isolated systolic hypertension: >140/<90 mmHg (usually common in the elderly).

The damage to other organs (the heart, vessels, even the eyes) is determined by specific tests. If arterial hypertension is diagnosed to a young adult, the hypertension might be secondary. In those cases, the causes leading to it are sought thoroughly.

Treatment

The treatment of arterial hypertension helps to prevent its dangerous complications. The main principal of the treatment is preserving normal blood pressure. Depending on the age of the patient, the degree of the damage to the internal organs, the risk factors and the actual blood pressure, appropriate treatment is prescribed.

Firstly, adjustments to lifestyle have to be made. That is the most effective way of dealing with hypertension. Drugs are usually prescribed as well. Lifestyle corrections include a less salty diet, treating obesity, physical exercises, eradicating smoking and alcohol.

Medical treatment is also used. The goal of medical treatment is to achieve maximal effect using the smallest doses possible. Combinations of several drugs are usually used. The types of drugs used to treat arterial hypertension are: ACE inhibitors (captopril, lisinopril), diuretics (furosemide, spironolactone), beta blockers (atenolol, propranolol), alpha antagonists (prazosin, doxazosin), calcium antagonists (nifidepine, verapamil), angiotensin II antagonists (losartan, valsartan) and others.

The condition of the damaged organs usually improves after treating increased blood pressure. Some of the medications (ACE inhibitors, calcium antagonists) also have protective qualities.

Prognosis

Untreated arterial hypertension progresses and shortens the life of the patients up to 20 years. As mentioned above, the patients die from strokes, myocardial infarction and heart or kidney failure. Life can be prolonged and the complications prevented by correctly treating increased blood pressure.

   

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