Arterial Hypertension

Arterial hypertension is a major cardiovascular risk factor whose incidence continues to grow in terms of population aging.

Definition

Diagnosis_for_HypertensionArterial hypertension is defined by values ​​of SBP> = 140 mmHg and / or DBP> = 90 mmHg, decreased by treatment in these values ​​being beneficial to the patient.

Mechanism

For most cases of arterial hypertension there is not a specific cause or singular, which can be called primary (essential). Blood pressure is the product of cardiac output and peripheral resistances: Blood pressure (BP) = cardiac output (CO) x peripheral vascular resistance (PVR).

The triggers of the disease can be multiple. There is a secondary sodium inappropriate excretion and a vascular hypertrophy.

Arterial Hypertension Symptoms

  • Pre-hypertension stage: the occurrence of bursts transient blood pressure and measured blood tension which establishes an abnormal increase in blood pressure compared to normal. The best known test is the cold compressor test, which is positive when introducing the hand in water at 4 degrees BP values ​​increase by more than 40 mmHg;

  • A state of intermittent hypertension: characterized by periods of hypertension without clinical signs, alternating with normal periods;

  • Permanent hypertension-stage: in 90% of the cases, hypertension is diagnosed at this stage;

Manifestations

  1. Signs of capillary fragility; various manifestations of bleeding (epistaxis, uterine bleeding, sometimes hematemesis, retinal hemorrhages).

  2. Cerebral signs: occipital headache, especially in the morning upon awakening, dizziness, fatigue, asthenia, insomnia, impaired memory and concentration, changes character, often visual disturbances (blurred vision), headache with throbbing character, dizziness, impaired view and transient disturbances of consciousness and language are the most common functional disorders common to all forms of hypertension;

  3. Tingling of the extremities, dizziness, feeling “dead finger”;

Disease prognosis

Arterial HypertensionIn benign form, the most common disease takes years or even decades. Under the administration of a correct treatment and precocious may occur important remission. In its malignant evolution it is a very rapid, disease stages are completed in 1-3 years. The prognosis depends on the clinical-benign or malignant. So in benign hypertension complications are due to atherosclerosis, the most common are cerebral thrombosis and myocardial infarction. In malignant hypertension dominates arterioles degradation. The most frequently met are hypertensive encephalopathy, cerebral hemorrhage, heart failure and kidney failure. The prognosis depends on heredity, of the level of the diastolic blood pressure and basal, of the age (youngsters have more severe forms), treatment compliance, the recommended lifestyle and finally the appearance of the complications. The prognosis is favorable in the first stage of the disease, being booked in the second stage and especially in the third. Death owes especially to heart complications, cerebral and kidney. Under current treatment, the prognosis has improved.

Arterial Hypertension Treatment

prevention of hypertensionIt must to target certain goals and first of all normalize blood pressure values. He must take in mind certain principles and orientations:

  • The treatment must be complex, hygienic-dietary, medicinal;

  • The treatment must be individualized and determined in ambulatory conditions;

  • hypotensive drugs will be administrated at first in smaller quantities and then increased gradually to normalize blood pressure;

  • should be taken into account associated atherosclerosis, from here (especially in the elderly) arising prudence in order to not to precipitate strokes, coronary, peripheral (will never start with high doses, brutal);

  • Because many hypertensions are caused or associated with atherosclerosis, the regime and treatment will be adapted latter. It will combat obesity, gout, diabetes mellitus, hyperlipidemia;

  • The repose must not be absolute. Physical exercise as walking and medical fitness is part of the treatment. The physical effort will be dosed and adapted to the possibility of the patient;

  • The diet will be low in cholesterol and saturated fat

  • It is good for the treatment to be also coronary vasodilator because the association between ischemic heart disease and arterial hypertension is very common.

Medicinal treatment

There are five major classes and four less major antihypertensive, with proven therapeutic effect by lowering BP: Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor antagonists, calcium antagonists, beta blockers, diuretics.

  1. Angiotensin-converting enzyme (ACE) inhibitors

Active substance: Captopril, Benazepril, Ramipril, Lisinopril, Quinapril, Trandolapril, Enalapril.

Action: Blocking angiotensin II formation producing vasodilation and decreased aldosterone.

Side effects: cough, hyperkalemia, proteinuria, rash, angioedema.

Absolute contraindications: pregnancy, bilateral renal artery stenosis, hyperkalemia, angioedema.

    2.     Angiotensin II receptor antagonists (ARG)

Active substance: Telmisartan, Candesartan, Valsartan, Irbesartan, Losartan.

Action: Block the AT 1 angiotensin II receptors.

Side effects: angioedema.

Absolute Contraindications: pregnancy, bilateral renal artery stenosis, hyperkalemia.

    3.      Calcium channel blockers

Action: blocking the entry of intracellular calcium ions, producing slow muscle vasodilation.

Classification:

Benzothiazepine: diltiazem

Difenilalchilamine: Verapamil

Dihydropyridine: amlodipine, felodipine, nicardipine, nifedipine

Side effects: headache, fatigue, swelling of the ankle.

Absolute Contraindications: AV block (degree 2 or 3), heart failure.

     4.     Beta blockers

Cardioselective: Metoprolol, Atenolol, Bisoprolol.

Non cardioselective: Propranolol, Labetalol, Nadolol.

Action: Inhibits sympathetic activity.

Side effects: sexual dysfunction, bronchospasm, peripheral arterial ischemia, fatigue, high triglycerides.

Absolute Contraindications: asthma, AV block (degree 2 or 3).

      5.    Diuretics

Action: decrease cardiac output and plasma volume, decreases peripheral vascular resistance.

Side effects: hypokalemia, hypomagnesemia, hyperuricemia, diabetes, insulin resistance, hypertriglyceridemia, hypercholesterolemia, photosensitivity.

Classification:

Thiazide: hydrochlorothiazide, chlorothiazide, metolazone.

Loop diuretics: Furosemide, Bumetanide, Torasemide, Ethacrynic acid.

Potassium sparing diuretics: spironolactone, amiloride, triamterene.

Absolute Contraindications: Thiazide: gout; Loop diuretics: gout; Potassium sparing: renal insufficiency, hyperkalemia.

       6.   Adrenergic inhibitors

Active substance: reserpine, guanethidine, guanadrel.

Action: inhibits peripheral neurons.

Side effects: orthostatic hypotension, diarrhea, sexual dysfunction.

       7.   Alpha 1 blockers

Active substance: Prazosin, Terazosin, Doxazosin.

Action: Blocks alpha1 receptors postsynaptic and produce vasodilation.

Side effects: especially syncope at the first dose, orthostatic hypotension, nausea, headache, palpitations.

        8.   Alpha 2 central agonists

Active substance: Clonidine, moxonidine, Methyldopa.

Action: Inhibits imidazole receptors in the brainstem.

Side effects: sedation, dry mouth, orthostatic hypotension, sexual dysfunction.

        9.   Direct vasodilators

Active substance: Hydralazine, Minoxidil.

Action: direct vasodilators on smooth muscle.

Side effects: Headache, nausea, vomiting, diarrhea, palpitations, fluid retention, worsening angina, gynecomastia (potassium sparing).


You may also like...

13 Responses

  1. April 9, 2014

    […] blood pressure control (<130/80 mmHg); […]

  2. October 26, 2014

    […] is triggered when blood pressure, smoking and high cholesterol levels in the body affects the endothelium structure. At this point, […]

  3. October 29, 2014

    […] on the spot, when the arteries are in poor state due to an existing condition (diabetes, smoking, hypertension) or comes from an artery in the neck (carotid artery) and ascends to the brain, where it remains […]

  4. March 3, 2015

    […] atrial hypertension (high blood pressure in the vessels and aorta): untreated, it  leads to dilation of the […]

  5. March 13, 2015

    […] controlled high blood pressure, diabetes or thyroid […]

  6. March 16, 2015

    […] the disease history, such as elderly patients with multiple cardiovascular risk factors (diabetes, hypertension, hypercholesterolemia) or a history of myocardial infarction or myocardial revascularization […]

  7. July 2, 2015

    […] with hypertension should be aware that a pressure exceeding the maximum levels can affect the brain, kidneys and […]

  8. July 18, 2015

    […] is a difficult season for people suffering from hypertension. Monitoring and drug dosage adjustment are essential for these […]

  9. August 8, 2015

    […] The triad of diabetes, hypertension, obesity is frequently observed in women who develop cancer of the […]

  10. August 9, 2015

    […] are responsible for about 80% of ischemic heart disease and cerebrovascular disease, such as hypertension, dyslipidaemia (abnormal levels of cholesterol); diabetes / glucose tolerance disturbances; […]

  11. October 5, 2015

    […] a number of risk factors for its occurrence. The main risk factors are: smoking, diabetes, hypertension and elevated cholesterol levels (especially LDL […]

  12. October 8, 2015

    […] most common cardiopulmonary diseases are hypertension, stroke and coronary heart disease. Untreated, cardiopulmonary diseases can be […]

  13. December 8, 2015

    […] • Hypertension […]

Leave a Reply

Your email address will not be published. Required fields are marked *