High blood pressure (hypertension) is a hyperpressure of blood on the walls of the arteries. High blood pressure is the most common cardiovascular disease affecting about 20% of the population. Its incidence increases with age and affects 90% of 85-year-olds. Only half of those affected are aware of their hypertension because this disease is often silent. We take stock of this disease, its diagnosis and its treatments.

Summary

High blood pressure (HTA) is the permanent rise in the numbers of blood pressure (called blood pressure or BP) above 149.
Normal blood pressure is less than 149. Ideally, it is 128.
The notion of HTA limit corresponds to figures between 149 and 169,5.

It is a common disease, which increases with age, with a hereditary component.

Blood pressure is not fixed. It varies continuously throughout the day and depending on the activity.

Before asserting high blood pressure in a patient, the doctor must give himself a delay and ensure the permanence of blood pressure figures by regularly monitoring the patient and taking the tension with a mercury manometer, resting in a supine position at least twice in 15 days.

Permanent high blood pressure is called when BP is always high. The figure of the minima is important because it directly translates the flexibility and the resistance of the arterial walls.

Signs of high blood pressure

In general, high blood pressure does not give any symptoms that can alert the patient. This is frequently a routine medical discovery.

When the doctor has discovered an arterial hypertension, he controls it several times under different conditions: rest, effort, standing, lying down, right arm then left arm … He thus ensures its permanence.

The generalization of blood pressure measuring devices for the general public allows the patient to monitor his blood pressure in the conditions of his daily life.

Ambulatory blood pressure monitors (ABPMs) allow for continuous blood pressure monitoring. Indeed, it may be, especially in young people, labile hypertension, that is to say, alternating with periods of normal blood pressure. This condition is benign in the short term and very well tolerated. There is no visceral complication. However, monitoring is necessary because this condition can progress to permanent hypertension. The cause of this condition is unknown but emotional subjects are more frequently affected.

Sometimes, however, there are signs of high blood pressure:

  • Headaches in the morning on the top or behind the head;
  • Dizziness;
  • Visual disturbances: flying flies, fog in front of the eyes …
  • Tiredness ;
  • Nosebleeds;
  • Conjunctival haemorrhages;
  • Muscle cramps;
  • Pollakiuria (frequent urge to urinate)
  • Dyspnea (breathing difficulty resulting in left ventricular failure).

Hypertension: evolution of the disease

Sometimes, high blood pressure is recognized during a revealing accident:

Neurological:

  • Transient ischemic attack ;
  • Stroke (cerebral softening, cerebral hemorrhage, meningeal or cerebral meningeal, intracerebral hematoma, cerebro-meningeal

Sensory:

  • Labyrinthine hemorrhage (vertigo true);
  • Ocular haemorrhages;
  • Paralysis of the oculomotor nerves.

Cardiac:

Renal:

Apart from these acute accidents, the increase in blood pressure alters over time the vessel wall which is not designed to undergo such pressure regimes. Among the harmful effects, there is the acceleration of the process of atherosclerosis.
The organs that suffer most often are:

  • Central nervous system: risk of haemorrhage and cerebral thrombosis;
  • Heart: left ventricular overload, coronary atherosclerosis;
  • The kidney: nephroangiosclerosis;

It is to avoid these complications that it is essential to treat high blood pressure, even if it causes no symptoms in the patient.

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Causes and risk factors of high blood pressure

In 95% of cases, the cause of arterial hypertension remains unknown: it is called "essential" or idiopathic. In this case the treatment will aim to treat the symptom or symptoms to know how to lower the tension.

However, the doctor may discover a cause whose treatment can cure high blood pressure.

Renal causes

Renal diseases that are not surgically curable are separated from those that may be curable by surgery.

Among the non-surgical renal causes of high blood pressure:

  • Glomerulonephritis: proteinuria, hematuria, nephrotic syndrome;
  • Diabetic glomerulopathy;
  • Metabolic interstitial nephritis: gout, hypercalcemia (hyperparathyroidism);
  • Polycystic kidney disease (polycystic kidney) …

Among the renal causes that may be surgically curable:

  • Chronic pyelonephritis (sequelae of chronic and repeated urinary tract infections);
  • Stenosis of the renal artery which can be treated by angioplasty (swelling of a balloon in the narrowed artery).

Adrenal gland diseases

Cushing's syndrome
Conn's syndrome (primary hyperaldosteronism)
Pheochromocytoma

Some poisons including liquorice abuse

The glycyrrhizin of licorice is transformed in the body into acid whose chemical structure is close to that of aldosterone. The symptoms simulate Conn's syndrome. Stopping licorice normalizes BP.

Other products are sometimes responsible: banana, coconut, vanilla, phenacetin, nonsteroidal anti-inflammatory drugs, ciclosporin, nasal vasoconstrictors used for chronic rhinitis or migraine, synthetic estrogen contraception, prolonged corticosteroids …

Contributing factors:

  • A diet too salty;
  • Alcoholism;
  • Smoking;
  • Emotional and repeated shocks;
  • Some medicines;
  • Lack of physical exercise

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Hypertension: additional examinations and analyzes

In the case of permanent hypertension, the assessment performed by the doctor is twofold. It allows to appreciate the repercussion of the HTA on the body, and to discover a possible cause.

Cardiac assessment

  • Looking for anginal pains and dyspnea of effort;
  • ECG and chest x-ray;
  • Cardiac ultrasound, fundamental to judge the importance of left ventricular hypertrophy which is a prognostic factor.

Neuro-sensory balance

  • Looking for headache, dead finger sensation or flying flies;
  • Investigation of transient episodes of amaurosis (sudden and brief loss of sight);

Renal balance

Determination of blood creatinine to a minimum.

According to the fundus results and the blood pressure number, arterial hypertension is classified into four stages:

  • Stage I: shiny arteries at the back of the eye and benign or recent arterial hypertension;
  • Stage II: sign of the cross at the fundus, arterial hypertension of average severity and generally old;
  • Stage III: exudates and haemorrhages on the retina and severe arterial hypertension requiring emergency measures;
  • Stage IV: papillary odema and malignant arterial hypertension requiring hospitalization in a specialized environment.

Treatment of high blood pressure

The lifestyle

The hygienic and dietary measures are very important, and are even the only ones prescribed in case of low or limited hypertension:

  • Low salty diet;
  • Lifestyle ;
  • Stopping alcohol and tobacco;
  • Regular physical activity;
  • Relaxation.

The low salt diet

A diet without salt is tasteless and can not be continued for long, so it is rarely recommended. On the other hand, a too salty diet prevents the treatment of hypertension. It is therefore necessary to limit the salt intake, without completely eliminating them.

Some practical tips are helpful:

  • Do not salt the cooking water of food;
  • Do not add salt while eating (do not put salt shakers on the table);
  • Avoid industrial preserves that all contain salt and prefer fresh or frozen products;
  • Avoid foods rich in salt: cold cuts (ham included), sauerkraut, smoked meats and fish, cooked dishes, cheeses …
  • Choose bread without salt and low-sodium milk;
  • Avoid commercial cakes and pastries and prefer homemade cakes without salt or baking powder;
  • Prefer oil and butter to margarine which is richer in salt if there is no hypercholesterolemia;
  • Avoid some mineral waters: Vichy, Saint-Yorre, Vals, Badoit;
  • Avoid liquorice, antese and pastis without alcohol;
  • Reduce consumption of coffee, tobacco and licorice;
  • Do not abuse the so-called diet salts because they are potassium salts that may cause hyperkalemia;
  • Be wary of so-called low sodium diet products that still contain too much salt;
  • Be wary of certain medicines containing salt (effervescent tablets, cough drops, syrups, powders for digestion etc …).

By cons, all spices and condiments (except salt) are allowed: lemon juice, parsley, chives, watercress, pepper, garlic, onion, thyme, chervil, tarragon, cumin, curry, paprika, etc.

The hygiene of life

Hygiene advice is essential. Often, a healthy lifestyle and a proper diet are enough. In case of well controlled blood pressure, the professional activity can be conserved as well as the reasonable and regular sports activities (without competition), by privileging the endurance sports and the relaxation: walking, bicycle, swimming.

  • Avoid significant physical or brutal physical effort;
  • In case of access to arterial hypertension: absolute rest;
  • Avoid worries and annoyances (sedatives are sometimes useful);
  • Avoid prolonged exposure to the sun without protection;
  • Avoid swimming if the temperature of the water is below 20 ° C;
  • Avoid altitude stays above 1500-2000 meters (travel by pressurized aircraft is allowed);
  • For women, stop the pill to be replaced by another contraceptive method (condom, IUD).

Medications = antihypertensives

The goal of the treatment is to normalize blood pressure to prevent long-term complications. Therefore, in most cases, this treatment must be followed for life .

Hypertension is certainly the disease for which there are the most drugs. It is possible to classify them by family. Each of them has peculiarities. To learn more about the antihypertensives of the following classes:

  • Alpha1 blockers;
  • Central antihypertensives;
  • Beta-blockers ;
  • Calcium inhibitors;
  • Thiazide diuretics;
  • Hyperkaliemic diuretics
  • Inhibitors of the conversion enzyme;
  • Inhibitors of angiotensin 2;
  • Associations.

A consultation of our guide of medicines is necessary …

Currently when medical treatment is indicated, one starts with a single antihypertensive at low doses.
Then, unless side effects occur, the dose is gradually increased until normal blood pressure is achieved. In case of too troublesome side effects or inefficiency, the treatment can be modified, or an antihypertensor of another class added. It can sometimes be necessary to combine three or four drugs before reaching normal pressure!

Some advocate, however, to start from the start treatment with fixed combinations (in a single tablet) of two drugs at low doses; this would reduce side effects by increasing the effectiveness of each taken separately.

Regular monitoring of the treatment is essential:

  • Take BP every month until stable blood pressure <149;
  • Serum electrolytes ;
  • Electrocardiogram.

The patient should never stop medications prescribed by the doctor or reduce doses on his own.
Abnormal symptoms (headache, nosebleeds, shortness of breath, chest pain) should be reported to the attending physician.
In case of surgical operation, the anesthesiologist must be warned of the antihypertensive treatment.

For women, local contraception is better than the pill.

In case of pregnancy, medical supervision must be strict.

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New treatments

The search for new treatments concerns people who are refractory to conventional medicines.

  • Renal denervation : destroys the sympathetic nerve fibers that engulf the renal arteries by applying a low intensity electric current. This is a heavy treatment that requires at least 48 hours of hospitalization. The adverse effects and cardiovascular benefits of this procedure are still under study.
  • Inhibitors of aminopeptidase A : initially discovered by the professors of the College of France, Inserm and CNRS, this new family of molecules can inhibit the renin-angiotensin system by acting in the brain. Aminopeptidase converts angiotensin 2 to angiotensin 3 at the central level.

Hypertension and pregnancy

During pregnancy, blood pressure is part of medical supervision. Indeed, high blood pressure in a pregnant woman can reveal:

  • Worsening of previous hypertension;
  • Recurrent gravidarket hypertension.

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Paroxysmal hypertension (or hypertensive crisis)

It is high blood pressure evolving paroxysmal attacks. Apart from relapses, blood pressure may be normal or elevated.

She sees herself:

  • During certain medical treatments: (Monoamine Oxidase Inhibitors or MAOIs);

Malignant hypertension

It is a severe arterial hypertension with papillary odema visible at the back of the eye. It can occur anytime in a hypertensive but especially in the young man. An emotional shock is sometimes a triggering cause.

Without treatment, the complications are serious:

  • Renal (nephroangiosclerosis and renal failure);
  • Cerebral: cerebrospinal hemorrhage;
  • Heart: acute lung odema.

Urgent treatment is required before transfer to a specialized setting.

Medical Review: Dr. Jesus Cardenas, Allergen Physician, March 08, 2017

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