Arterial hypertension is a major cardiovascular risk factor whose incidence continues to grow in terms of population aging.
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;
Signs of capillary fragility; various manifestations of bleeding (epistaxis, uterine bleeding, sometimes hematemesis, retinal hemorrhages).
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;
Tingling of the extremities, dizziness, feeling “dead finger”;
In 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
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.
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.
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.
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).
Action: decrease cardiac output and plasma volume, decreases peripheral vascular resistance.
Side effects: hypokalemia, hypomagnesemia, hyperuricemia, diabetes, insulin resistance, hypertriglyceridemia, hypercholesterolemia, photosensitivity.
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).