in this article:
Blood pressure depends on the amount of blood pumped by the heart and the resistance it meets when it flows into the arteries. As these factors increase, there is an increase in blood pressure. In more than 90% of cases hypertension manifests itself without any apparent cause (it is said idiopathic or essential), while in the remaining percentage of cases there are predisposing factors, such as kidney and endocrine diseases.
In 2014, hypertension involved around one billion people worldwide (or almost 22% of the global population). According to a reliable study of 2010, hypertension would have played a decisive role in 18% of global deaths. The problem of hypertension is more common among men, it concerns above all the economically less well-to-do classes and mainly affects older people.
What is hypertension?
Blood pressure is one of the so-called vital signs, such as respiration rate, heart rate, oxygen saturation and body temperature. Arterial hypertension is a constant, non-occasional state in which resting arterial pressure is higher than normal physiological standards. Hypertension is one of the most widespread diseases in industrialized countries; in fact, it affects about 20% of the adult population and is one of the major clinical problems of modern times. Arterial hypertension is also known as ‘silent killer’, because it does not involve any symptoms and acts in the shadows, degenerating into severe complications, sometimes from the mortal outcome.
Hypertension therapy is based on the important goal of bringing altered blood pressure levels back to normal. To achieve this goal, it is essential to reduce the consumption of salt, practice physical activity regularly, follow a healthy and balanced diet, follow appropriate drug therapy (if the previous remedies are not sufficient) and treat specifically the cause (if there is one) of the pathological elevation of the arterial pressure.
Arterial pressure, or blood pressure, is the force that the blood exerts against the walls of blood vessels, as a result of the action of a pump carried by the heart.
Its value depends on various factors, including:
- The force of contraction of the heart;
- The systolic range, that is the quantity of blood coming out of the heart at each ventricular contraction;
- Heart rate, that is, the number of heartbeats per minute;
- The peripheral resistances, that is the resistances opposed to the blood circulation from the state of constriction of the small arterial vessels (arterioles);
- The elasticity of the aorta and of the great arteries (the so-called vascular compliance);
- The volemia, i.e. the total volume of blood circulating in the body.
Measured in millimeters of mercury (mmHg), with the patient in a resting state, blood pressure is usually defined by systolic or ‘maximum’ blood pressure (it is the arterial pressure of when the heart contracts) and diastolic pressure or ‘minimum’ (is the arterial pressure of when the heart is relaxing).
An individual at rest may show systolic blood pressure values between 90 and 129 mmHg, and diastolic blood pressure values between 60 and 84 mmHg. According to the medical-scientific community, the optimal arterial pressure at rest is equal to 120 (systolic) / 80 (diastolic) mmHg.
Hypertension, or arterial hypertension, is a pathological condition characterized by the constant (non-occasional) presence of resting pressure levels above normal. In other words, hypertension is a state in which resting arterial pressure is consistently higher than normal.
In numerical terms, a person suffers from hypertension (i.e., he is hypertensive), when: The minimum arterial pressure (or diastolic pressure) exceeds ‘constantly’ the value of 90 mm / Hg and the maximum arterial pressure (or systolic pressure) exceeds constantly ‘the value of 140 mm / Hg. In common parlance, hypertension is that condition defined by the term ‘high blood pressure’. Hence, hypertension, arterial hypertension and high blood pressure are three different ways to express the same altered state of blood pressure.
Why is the adjective constant important when it comes to hypertension?
In describing arterial hypertension, the adjective ‘constant’ and the adverbs derived are fundamental, since in the course of the day blood pressure can undergo transient changes, linked for example to:
- The time of day: the pressure is the object of constant growth immediately after awakening from nocturnal sleep (in which it is particularly low) and reaches its peak at midday; after that, it lowers (usually due to lunch) and then goes up again and reaches fairly high values in the late afternoon.
- Physical activity: during exercise, arterial pressure increases; the magnitude of the increase varies according to the type and intensity of exercise.
- Emotional state: intense emotions, stress and anxiety can temporarily increase blood pressure; on the other hand, relaxation and moments of relaxation have the opposite effect, i.e. they involve a temporary reduction in blood pressure.
An interesting fact
In some individuals and in particular circumstances, control of blood pressure is a source of anxiety and agitation; this anxiety and this agitation may result in a temporary increase in blood pressure levels, such that the results of the aforesaid control are not very reliable. Moreover, they would report an increase in blood pressure which is of little relevance from the medical-clinical point of view.
Hypertension and arterial pressure
Hypertension is a disease affecting the cardiac system, connoted by a non-physiological increase in systolic and diastolic blood pressure. The physiological parameters delimit a maximum systolic blood pressure of 140 mmHg, and a maximum diastolic pressure of 90 mmHg. A major variation in these parameters causes serious problems at the cardiac level, and in the most serious cases can lead to real structural modifications of the heart and vessels; the increase in blood pressure, in fact, irreparably damages the wall of the capillaries, causing serious damage to all the terminal organs, such as brain, heart, kidneys and eyes.
Primary hypertension, otherwise called essential, does not present a known etiology and is absolutely the most common form of hypertension; however, it seems to be characterized by common risk factors: inheritance in 30% of cases; age, more easily found in men over 50; the presence of diseases such as diabetes and / or hyperglycemia, which causes a thickening of the walls of the vessels generating a partial reduction of the vessel caliber and a pressure increase that mainly affects the eye and the kidney; hypercholesterolemia; the race, for example the black race presents a higher risk of damage to the terminal organs; the diuretic and the alimentary regimen (a diet too rich in salt and saturated fats favors the appearance of obesity and hypertension).
Secondary hypertension may have well-identified causes, such as renal artery occlusion, phaeochromocytoma (adrenal tumor), non-physiological increase in adrenaline concentration, Cushing’s disease (which induces excessive retention of sodium), or primary hyperaldosteronism (which induces an excessive increase in mineralocorticoids); in all the cases listed, it is possible to intervene at the origin to cure hypertension.
What does blood pressure depend on? How is it regulated?
According to the so-called hydraulic equation, arterial pressure is given by the relationship between: cardiac output that starts from the left ventricle towards the aorta (this range is in turn influenced by the frequency and the force of cardiac contraction); filling pressure of the heart dictated by venous return; peripheral resistance, which increases proportionally to the increase in blood flow. It is therefore possible to intervene at various levels to reduce blood pressure.
Cardiac output and peripheral resistance are regulated by barocectoral reflexes, the tone of the orthosympathetic system with the release of the adrenaline and norepinephrine neurotransmitters, and the renin-angiotensin system; these phenomena define the so-called endogenous mechanisms of blood pressure control, that is, modification of cardiac output and peripheral resistance.
Baroreceptors constitute a short-term pressure control mechanism and give rise to an immediate response at the vessel-motor centers; are pressure receptors located on the vessel walls of the carotids and the aorta, sensitive to distention: when the pressure increases the wall relaxes and the baroreceptors are activated, sending inhibitory signals of the orthosympathetic system to the bulb, with a reduction of norepinephrine and of the adrenaline (which have vasoconstrictor effect and increased cardiac output); vice versa, when the pressure is reduced the baroreceptors are not activated and noradrenaline and adrenaline can act regularly at the cardiac and vasal level as vasoconstrictive agents.
The renin-angiotensin system represents the mechanism of long-term control of pressure surges; when the blood pressure decreases, renin is produced at renal level by a group of iuxtaglomerular cells, which activates angiotensinogen to angiotensin; the latter molecule exerts a powerful vasoconstrictor effect by increasing peripheral resistance and, in addition, stimulates the secretion of aldosterone in the kidney, favoring the absorption of sodium and water, thus increasing the circulatory volume and bringing the pressure back to normal levels. In the case of hypertension, it is possible to intervene on these mechanisms with different pharmacological categories.
Degrees of hypertension
There are different degrees of hypertension:
- When the pressure increase exceeds 130/85 mmHg but is less than 139/89 mmHg, the degree of hypertension is mild and the current condition is more properly called pre-hypertension;
- When the blood pressure increase exceeds 140/90 mmHg but is below 159/99 mmHg, the hypertension degree is mild to moderate, and the resulting condition is called stage 1 hypertension;
- When the pressure increase exceeds 160/100 mmHg but remains below 179/109 mmHg, the degree of hypertension is moderate to high and the current condition is known as stage 2 hypertension;
- Finally, when the pressure increase is greater than or equal to 180/110 mmHg, the degree of hypertension is high and the resulting condition takes the name of stage 3 hypertension or hypertensive crisis.
The higher the degree of hypertension, the more concerned the patient’s health status is.
Beside the more traditional form of hypertension, in which both the minimum and the maximum arterial pressure constantly exceed the normal values, hypertension forms that could fall under the heading ‘special cases’.
Hypertension is the exact opposite of hypotension (or arterial hypotension or low blood pressure). Hypotension is the condition characterized by resting blood pressure values below 90/60 mmHg. Compared to hypertension, hypotension is a condition that is far less worrying from a medical-clinical point of view; indeed, in some particular circumstances, it represents a benign condition, which preserves from cardiovascular disease.
Doctors distinguish hypertension mainly in two major types: essential or primary hypertension and secondary hypertension.
Risk factors for hypertension
In the list of factors that favor the onset of hypertension, doctors include:
- Advanced age;
- A family predisposition to hypertension;
- The belonging to the African, African-American and Caribbean race;
- Excess salt in the diet;
- Vitamin D deficiency;
- The sedentary lifestyle;
- Overweight and obesity;
- Regular consumption of large quantities of alcohol;
- Insomnia and a reduced number of hours dedicated to nighttime sleep;
- The presence of chronic diseases, such as diabetes, some kidney diseases or the syndrome of sleep apnea.
As you can see from this list, many of the risk factors of hypertension are behaviors contrary to a healthy lifestyle. So, do not be surprised if one of the main rules of prevention of hypertension is the conduct of a healthy lifestyle.
Symptoms and complications
Hypertension is a subtle condition because, despite the serious complications it can cause, it is almost always asymptomatic, that is, without symptoms. It is not by chance that the definition of ‘silent killer’ is used to describe hypertension. On very rare occasions, hypertension can give rise to symptoms such as headaches, dyspnoea and nosebleeds. However, as you can see, they are so little specific disorders that do not help the person concerned to worry about what is happening to them.
Prolonged or improperly treated hypertension involves damage to the blood vessels; identified mainly in atherosclerosis, this vascular damage has a negative effect on the blood flow of the body’s organs, which, due to the ineffective blood supply, are themselves victims of damage.
Thus, from a prolonged presence of hypertension serious complications can arise, such as:
- Heart attack and stroke. These are two serious medical conditions resulting from hardening and thickening of the arteries, two characteristic phenomena of atherosclerosis.
- Formation of aneurysms. The rupture of an aneurysm is a highly lethal condition;
- Heart failure. Hypertension calls the heart to work more. This increased work on the part of the heart involves the thickening of the myocardium (hypertrophy). Myocardial thickening permanently compromises cardiac function, establishing the state of heart failure;
- Weakening and stenosis of the arteries that lead blood to the kidneys (hypertensive nephropathy). These two events compromise renal function;
- Narrowing of blood vessels leading to blood in the eyes, retina in particular (hypertensive retinopathy). From this derive problems of sight;
- Serious memory deficits and cognitive problems. Hypertension alters mnemonic and thought abilities, favoring the onset of conditions such as dementia.
Normal range of blood pressure values in various age groups – TABLE
|Patient age||Min||Med||Max||Patient age||Min||Med||Max|
|15 to 19 years||40 – 44 years|
|Maximum pressure values|
Minimum pressure values
|Maximum pressure values|
Minimum pressure values
|20 to 24 years||45 – 49 years|
|Maximum pressure values|
Minimum pressure values
|Maximum pressure values|
Minimum pressure values
|25 to 29 years||50 – 54 years|
|Maximum pressure values|
Minimum pressure values
|Maximum pressure values|
Minimum pressure values
|30 to 34 years||55 – 59 years|
|Maximum pressure values|
Minimum pressure values
|Maximum pressure values|
Minimum pressure values
|35 – 39 years||60 – 64 years|
|Maximum pressure values|
Minimum pressure values
|Maximum pressure values|
Minimum pressure values
Pressure and cardiovascular risk values
The cardiovascular risk quantifies the probabilities of suffering a disease of the heart or blood vessels, depending on the presence or absence of certain risk factors. This danger is increased, as well as by high values of pressure, smoking, diabetes, overweight (especially abdominal), a diet rich in cholesterol, saturated fat and simple sugars, sedentary lifestyle, alcohol abuse, from entry into menopause (especially if early), and from aging. Cardiovascular risk can also be assessed through a series of blood tests, including total cholesterol and LDL, HDL cholesterol, triglycerides, homocysteine, fibrinogen, C-reactive protein and antithrombin III.
The causes of high blood pressure are numerous and are based on the important distinction between the various types of arterial hypertension, which sees the existence of so-called essential hypertension and the so-called secondary hypertension. Also known as primary hypertension, essential hypertension is the hypertensive state whose presence is imputed to a multiplicity of predisposing factors, as it is impossible to establish with certainty a precise and univocal triggering cause.
Essential hypertension is therefore due to a combination of different situations and not to a single circumstance, such as an illness, the intake of a certain drug, etc.
According to some estimates, pregnant women who develop hypertension would be between 8 and 10%, in other words 8-10 pregnant women every 100. Hypertension in pregnancy is a phenomenon not to be overlooked, as it can degenerate into pre-eclampsia or, worse still, in eclampsia, a potentially lethal condition for the pregnant woman and the fetus. In the list of factors that favor the onset of hypertension, doctors include several risk factors for hypertension are behaviors that are contrary to a healthy lifestyle. Therefore, one should not be surprised that one of the main norms for the prevention of hypertension is precisely the conduct of a healthy lifestyle.
According to some scientific studies, hereditary predisposition and family predisposition to high blood pressure could increase the risk of the onset of hypertension by up to 30%. It is for this reason that subjects with family members of hypertension should scrupulously follow the rules of primary prevention of hypertension, so as to limit as much as possible the aforementioned risk.
2. Belonging to the African race
It is an objective fact that hypertension is much more common among African and Afro-American individuals than Caucasians.
According to the most recent studies, this interesting phenomenon would find explanation in several factors, such as:
- Presence of a gene, in the genome of African and Afro-American individuals, which makes the latter more sensitive to the negative effects of salt on blood pressure;
- Reduced response by African and African-American individuals to antihypertensive drugs, in particular ACE inhibitors. This insensitivity to antihypertensive medicines would have a genetic basis;
- Greater sensitivity, on the part of the African and Afro-American race, to alcohol, whose high consumption represents an important risk factor of high pressure;
- Increased renal sodium retention, by those belonging to the African and African-American race.
It is interesting to point out to readers how the spread of hypertension among Afro-Americans overcomes the already high spread of the same problem among Africans, probably due to the greater tendency on the part of the first to have a bad lifestyle (smoking, obesity, sedentary lifestyle, alcohol abuse, etc.).
3. Overweight and obesity of children
It is a fact that overweight children have a higher probability of becoming hypertensive and obese in the post-adolescent age compared to normal-weight children. This important evidence explains why the primary prevention of hypertension should start at a young age, starting the youngster to practice sports and controlling eating habits.
4. Old age
The new knowledge about high blood pressure has led to a downsizing of the idea that hypertension is an inevitable and harmless event of the elderly. Today, in fact, experts say that, for the elderly, it is acceptable, as physiological, an increase in maximum pressure between 10 and 20 mmHg. This means that higher increases are the result of factors other than aging, such as smoking, alcohol, sedentariness, etc.
Accomplice with the protective action of estrogen, women of childbearing potential have a lower risk of hypertension than men of the same age group. However, with the arrival of menopause (at 45-50 years) and of the hormonal disruptions that this phenomenon determines, the risk of hypertension in female subjects increases significantly, in some cases even 50%.
6. Excessive consumption of salt, alcohol abuse and overweight
To get an idea of how influential are the excessive consumption of salt, the abuse of alcohol and the overweight / obesity, the reader thinks that, at the initial stage of hypertension (called pre-hypertension), the therapy consists in the simple correction of these three wrong behaviors, through the adoption of healthy diet habits. On the other hand, among the various evidences, the medical-scientific community has also shown that, in general, every kilogram of body lost reduces blood pressure by 1 mmHg, both maximum and minimum. Strictly combined with regular physical activity, the ideal diet for mild hypertensive, and for anyone who wants to prevent high blood pressure, must be:
- Rich in fiber (therefore, a conspicuous supply of vegetables and fruit, and preference for cereals and wholemeal pasta rather than for refined cereals and pasta);
- Poor in fat, especially saturated fats;
- Low salt content (in grams, the salt taken daily should not exceed 5-6 grams).
A sedentary lifestyle and reduced physical activity are probably among the most important risk factors for high blood pressure, regardless of the age group considered. To learn more about this topic, readers can consult the article on hypertension and sport.
8. Smoking and tabagism
Cigarette smoking increases blood pressure, because it is a powerful vasoconstrictor; moreover, it favors the formation of atherosclerotic plaques (atherosclerosis) inside the arteries. Responsible for thickening and hardening of arterial vessels, atherosclerosis is a phenomenon closely linked to hypertension, being both a cause and an effect.
Vasoconstriction – that is, the narrowing of blood vessels – increases blood pressure, because it reduces blood flow, increasing the so-called peripheral resistance, and requires the heart to exert a major pump action, precisely to cope with the major resistant peripherals.
In some cases, for example when it is very high, psychic stress is able to take on the role of main actor on the appearance of hypertension.
Among the circumstances that can determine psychical stress so high as to raise the pressure in a pathological way, are: episodes of restrained anger, great anger, intense emotions, serious work responsibilities and excessive commitment to study and / or work.
10. Vitamin D deficiency
Currently, together with some doubts on this, several studies are underway to understand if vitamin D deficiency can fall, rightfully, between the risk factors and the causes of hypertension. In many cases hypertension lasts a long time without giving any particular symptoms, even when it reaches rather high values. Despite this, if high blood pressure is not adequately treated, it determines – in the long run – a significant increase in the risk of developing serious health problems, such as heart attacks, aneurysms, strokes, heart failure and kidney failure.
Fortunately, unlike many diseases, hypertension is very easy to diagnose and keep under control, preventing the onset of symptoms and diseases. For this reason it is a good idea to check your blood pressure every two years from the second decade of life.
Portal hypertension is often a consequence of cirrhosis of the liver and alcoholic hepatitis; in this case the structural alterations of the liver obstruct the blood flow inside it, increasing the blood pressure in the portal vein. Also the presence of an obstruction within the same (thrombosis of the portal vein) determines the same result, exactly as when the obstacle is located downstream and prevents a normal outflow of blood from the liver to the general circulation (for example for thrombosis of the suprahepatic veins or congestive heart failure).
In the presence of portal hypertension, the body tries to compensate for the blockage of circulation by developing or strengthening collateral circulation; if the obstruction is inherent in the liver, consequently, part of the toxic substances habitually inactivated by the organ (both endogenous and exogenous, such as drugs taken by os) ‘jump’ the hepatic passage and find themselves unchanged in the circulation.
Moreover, there are phenomena of suffering of the vessels in which a greater inflow of blood is conveyed because of the obstruction, with the appearance of lesions to the esophageal varices and hemorrhoids, pathological aspect of the umbilical veins (caput medusae) and enlargement of the spleen. In the presence of portal hypertension, ascites are also common (accumulation of fluid in the peritoneum); there is also an abnormal enlargement of the spleen (splenomegaly) and of the phenomena of suffering in the brain (hepatic encephalopathy) and renal (hepatoral syndrome).
Hypertension in pregnancy
Hypertension in pregnancy is defined as the presence of one or more of the criteria illustrated below, found in at least two measurements taken at least 4 hours apart:
Hypertension in pregnancy has a dangerous complication, preeclampsia. Preeclampsia is characterized by the appearance of hypertension (as defined above), proteinuria (> 0.3 g / 24 hours) and / or edema (feet, face, hands) after the twentieth gestation week, in a woman before normotesa. Preeclampsia is an alarm bell for a form of even more severe gestational hypertension, eclampsia, characterized by the appearance of convulsive attacks.
Factors predisposing to pre-eclampsia are:
- Nulliparity (risk> 6-8 times)
- Twin pregnancy (risk> 5 times)
- Idatidiform moles and fetal hydrops (risk> 10 times)
- Preeclampsia in previous pregnancies
- Chronic hypertension
- Extreme age
Clinical manifestations of hypertensive disorders may appear at any time during pregnancy, starting from the second trimester until several days after delivery.
Eclampsia is defined as the presence of generalized convulsions due to encephalopathy associated with preeclampsia and not attributable to other causes. it is a rare, but serious complication (1: 2000 births in developed countries) of gravid hypertension.
Blood pressure begins to decline progressively after the first weeks of pregnancy, stabilizing at around 75 mmHg (diastolic blood pressure) throughout the remainder of the first and second trimester of pregnancy. In the last two or three months before the birth, however, the blood pressure values return to the pregravidic levels, therefore around 85 mmHg for diastolic. We talked about the minimum pressure since the drop is mainly due to the diastolic blood pressure (PAD) and – beyond the starting values - in the first and second quarters it is quantifiable in about 7-10 mmHg.
The decrease in blood pressure values during the early stages of pregnancy is essentially linked to the vasodilatory – hypotensive effect of particular hormones and cytokines, followed by an increase in the volume of the circulating blood (in itself hypertensive effect), cardiac output and glomerular filtration.
An important organ for the successful outcome of pregnancy is the placenta, which represents the communication interface between mother and fetus. At this level, in fact, thanks to an articulated system of blood vessels and microvessels, the exchange of nutrients, waste substances and gases takes place between the blood of the two organisms, without there being direct contact between the two fluids. In order for all these exchanges to take place, it is necessary that a considerable amount of maternal blood arrives at a placental level, with reduced speed and equally low blood pressure.
When the placenta formation is not complete or defective, the final product does not work as it should: its resistances, not sufficiently low, induce an increase of upstream pressure, that is in the maternal organism. Unfortunately, during pregnancy high blood pressure is dangerous for maternal and fetal health, so that in extreme cases it can jeopardize the life of both organisms. This form of hypertension, which affects about 6-8% of pregnant women, is known as gestational hypertension or pregnancy induced. It is often associated with urinary loss of protein (proteinuria) and in this case it is called gestosis or preeclampsia. Precisely for this reason, the blood pressure values are carefully checked at each obstetric check, during which the urinalysis is always expected.
As the name itself suggests, the gravid hypertension disappears at the end of gestation. Of course, women who complain of high blood pressure before pregnancy tend to maintain their hypertensive status even during and after gestation. However, as anticipated in the introductory part, this magical event is accompanied by a physiological pressure drop, which requires a possible therapeutic adjustment or even the suspension of the same until the third quarter.
The greatest risks occur when a previous hypertension is added to that induced by pregnancy, whose causes are to be found in the placental hypoperfusion, in reduced renal function, as well as in vasospasm and hemoconcentration. One of the most serious clinical pictures associated with gravid hypertension is the so-called HELLP syndrome, acronym of the signs and symptoms that characterize it: hemolysis (Haemolysis), elevated values of liver enzymes (Elevated Liver enzymes) and reduced platelet values (Low Platelets). In summary, hypertension in pregnancy may be present in four distinct forms:
- Pre-existing chronic hypertension
- Gestational hypertension
- Preeclampsia / eclampsia
- Chronic hypertension + preeclampsia
Risks of hypertension during pregnancy
Hypertension occurs in about 6-8% of all pregnancies and contributes significantly to the arrest of fetal growth, as well as fetal and neonatal morbidity and mortality. In Western societies, in particular, hypertension in pregnancy is the second cause of maternal death after thromboembolism, accounting for about 15% of all causes of death during pregnancy. The pregnant hypertensive is in fact more predisposed to some potentially lethal complications, such as detachment of the placenta, disseminated intravasal coagulation, cerebral hemorrhage and hepatic and renal failure.
Care and prevention of high blood pressure during pregnancy
The picture that emerged from the previous paragraph is rather disturbing; however, talking about increased risk does not necessarily mean high probability. In fact, hypertension in pregnancy can be controlled by appropriate pharmacological therapies; however, it is essential to discover and treat the disorder at an early age, putting in place a whole series of preventive measures. The therapeutic choice differs in relation to the type of gravid hypertension and its severity. When the condition is chronic, then pre-existing:
In the case of diastolic blood pressure between 90 and 99 mmHg the treatment is essentially behavioral, therefore aimed at the control or eventual reduction of body weight, the moderation of food sodium, and abstention from alcohol, smoking and severe efforts. The risks for mother and fetus are quite low.
If the diastolic pressure reaches and exceeds 100 mmHg, the treatment is pharmacological and based on the use of drugs such as alpha-methyldopa, nifedipine, clonidine or labetalol. Also in this case, the risks for mother and fetus are low but increase with the increase in the extent of the hypertensive phenomenon.
In the mild forms, the physiological pressure drop that occurs during the first trimesters of pregnancy often gives the possibility of reducing - and sometimes suspending - the antihypertensive drugs, which will eventually be resumed in the last two or three months of gestation.
Some medications used to treat hypertension are contraindicated during pregnancy; therefore, women of child bearing age who suffer from chronic hypertension should consider the dangers associated with the use of ACE inhibitors, diuretics and sartans (to be avoided if they are trying to become pregnant).
In the presence of pre-eclampsia the treatment becomes more articulated, so as to provide careful monitoring of the patient, possible hospitalization with bed rest and accurate delivery timing. This event must be taken seriously in consideration of episodes of fetal distress or a worsening of maternal conditions. Neonatal complications are mostly related to the need to anticipate childbirth in a very early age, so as to limit maternal complications.
Specialists recommend initiating antihypertensive therapy when the minimum pressure is equal to or greater than 100- 105 mmHg; the World Health Organization, instead, recommends lowering blood pressure when it is around 170/110 mmHg, in order to protect the mother from the risk of stroke or eclampsia; finally, for other experts, the PAD should be kept between 90 and 100 mmHg. Magnesium sulphate is the treatment of choice for the prevention and treatment of eclampsia.
Women who have suffered from high blood pressure during pregnancy are at greater risk of becoming hypertensive again as they age. Positivity to this test, which in some respects could be considered screening, should therefore be understood as a warning to regularly monitor their own pressure (even after the end of pregnancy), and to implement all the healthy behavioral habits necessary to contain the cardiovascular risk (achievement and maintenance of weight, abstention from smoking and drugs, moderation of alcohol consumption, regular physical activity, optimal management of daily stress and balanced diet).
Contraceptive pill and hypertension
In predisposed women, the use of the contraceptive pill can cause a slight increase in blood pressure, both as regards the maximum (systolic) and the minimum (diastolic) values. In the most serious cases, fortunately minority, the pressure increase can be such as to make the woman hypertensive (> 140/90 mmHg).
The risk of suffering from high blood pressure associated with the use of the contraceptive pill is higher in women over the age of 35, obese, who have suffered from gravid hypertension, with kidney disease and familiarity with high blood pressure. Contraceptive pressure pill Even the duration of contraceptive estrogen-progestin therapy seems to influence this risk, increasing it proportionally.
Regardless of blood pressure, smoking increases the risk of cardiovascular complications associated with the use of the contraceptive pill. It should be avoided if you want to use the pill, or other hormonal contraceptives, including those with a hypotensive effect (drospirenone).
Contraceptive therapies may contain synthetic derivatives of estrogen and progesterone, or only the latter. The risk of suffering significant pressure increases seems higher for the former, but some studies point out slight increases in diastolic blood pressure even in some women who use the so-called minipill (progestin), also imputed to worsen the lipidemic profile of those who assume . Some recently introduced contraceptives, such as drospirenone, can also be used in cases of hypertension (which until recently was a contraindication to the use of traditional contraceptive pills).
Drospirenone is a synthetic progestin with an analogous action to spironolactone (it is a light diuretic); therefore, its use is not only separated from any increase in blood pressure, but also exerts a protective action on the front of high blood pressure.
The current availability of various types of hormonal contraceptives, with different indications and constantly updated, allows the gynecologist to customize the choice based on the contraceptive needs of the woman and her state of health. Drospirenone too, to cite an example, has to its charge a list certainly not negligible contraindications and potential side effects.
For malignant hypertension we mean an abnormal increase in the average arterial pressure, so substantial that it causes serious damage to the ocular level, and not only. The adjective ‘malignant’ is therefore not referring to a hypothetical cancerous origin, but rather to the serious damage that this syndrome can cause. If left untreated, malignant hypertension is in fact exacerbated by a mortality of more than 90% within a year. However, the prognosis depends on the average pressure levels reached and on the speed with which this syndrome has been established and treated; when medical treatments intervene early, the prognosis is good.
Malignant hypertension should not be confused with the hypertensive crisis, which has an acute character. Malignant hypertension, rather, can be considered a particularly unfavorable evolution of hypertension; as such it can affect people suffering from high blood pressure at any time and at any age. To prevent its occurrence, it is important to periodically check your blood pressure and – in the case of hypertension – take the medicines according to the methods prescribed by the doctor, while respecting any dietary and behavioral measures aimed at weight reduction and sodium intake.
Malignant hypertension therapy requires hospitalization to treat and prevent complications, to administer appropriate intravenous medications and to monitor the function of various organs. Once the pressure values have stabilized, the patient is discharged from the hospital; home therapy continues with a preventive approach by administering drugs against hypertension, such as beta-blockers and ACE inhibitors. Additional medications or special treatments may be necessary if malignant hypertension has produced organ damage.
Hypertensive crises consist of dramatic increases in blood pressure, which significantly increase the risk of suffering a heart attack and other organ complications. Extremely high blood pressure levels – reached when the systolic (maximum) pressure equals or exceeds the threshold of 180 mmHg, and the diastolic pressure (minimum) exceeds 120 mmHg – can in fact damage blood vessels.
During a hypertensive crisis, the pressure exerted by blood on the walls of the vessels is so high that it can weaken or even break them; it is a bit like when, watering the vegetable garden, we hinder with a finger the water spill to increase the length of the jet. All this submits to an important effort the motor that draws water from the well (in this case our heart), but also the walls of the conductive tube (in this case the blood vessels), which in extreme cases can yield and fix.
Depending on the extent of the blood pressure rise and its consequences, hypertensive crises are divided into two categories, that of urgencies and that of emergencies. In the latter case, unlike the first, there is an objective suspicion that the hypertensive crisis has produced acute and progressive organ damage. moreover, the pressure values are generally higher (equal to or higher than 220/140 mm Hg).
The signs and symptoms of hypertensive urgency, therefore not complicated, may include severe headaches, dyspnoea (air hunger, shortness of breath), anxiety and distress. In hypertensive emergencies, however, severe and potentially lethal complications may occur, such as myocardial infarction, stroke, cerebral hemorrhage, mental confusion up to coma, chest pain (angina pectoris), aortic dissection (tear of the intimate aorta), eclampsia (during pregnancy), acute renal failure and fluid accumulation in the lungs (pulmonary edema) due to left ventricular failure.
Fortunately, hypertensive emergencies are rare and mostly affect hypertensive patients who do not follow adequate therapy to maintain the blood pressure values; sometimes they can be caused by an undiagnosed phaeochromocytoma, therefore without pharmacological control. The diagnosis of hypertensive emergence is placed, as well as by means of anamnesis and objective examination of the patient, by checking the blood pressure, blood pressure (renal and cardiac damage), urinary sediment and electrocardiographic trace.
Hypertensive emergencies are clinical events in which the patient is in danger of life and a rapid reduction of blood pressure is therefore necessary; therefore, the aid includes the admission in intensive care and a prompt injection of hypotensive drugs intravenously, in order to limit the organ damage. The choice of the drug must obviously be made on the basis of the characteristics of the emergency occurring and of the damage of the organ associated with it. If hypertensive crises are instead of simple urgency, the blood pressure values are generally reduced with the administration of oral drugs, without the need of hospitalization, but only of an outpatient follow-up.
The patient can contribute to the prevention of hypertensive crises through careful blood pressure monitoring (regular monitoring of blood pressure and drug intake according to the prescribed doses and methods); under the medical indication, the maintenance of a healthy weight, a sober and balanced diet, together with a regular physical exercise and an optimal management of stress, can contribute to reduce the pressure values and with them the risk of suffering hypertensive crises.
When to contact the doctor?
Hypertension is a condition that deserves immediate and appropriate treatment. Therefore, its eventual feedback must sound like an alarm bell and induce the person concerned to contact their doctor as soon as possible and to scrupulously follow all the necessary care. Hypertension can be easily diagnosed by simply measuring blood pressure using a sphygmomanometer.
However, a careful diagnosis of high blood pressure can not be limited to the simple observation of the elevated resting pressure levels, but must also focus on the research of the triggering causes and on the features of the current problem. This explains why doctors, faced with a case of hypertension, subject the patient to a careful objective examination and a precise medical history, even going so far as to prescribe:
- Blood tests to analyze glucose levels, certain hormones, triglycerides, etc. and see if there is a relationship between the aforementioned elements and the high blood pressure;
- Urinalysis, to study mainly renal function;
- An electrocardiogram, an echocardiogram and a stress test, for the evaluation of heart health and the search for cardiac pathologies;
- Radiological examinations, such as chest CT scan or chest radiograph, to further study heart health;
- The pressure holter, to see if the degree of hypertension varies during a whole day.
Why research the causes of hypertension? The identification of the causes and factors favoring hypertension is important, because it allows the planning of the most appropriate therapy.
How often is blood pressure measured? Hypertension diagnosis By virtue of the possible consequences of hypertension and its subtle nature, doctors recommend measuring blood pressure every two years, starting at 18 years of age, and every year, starting at age 40.
High blood pressure therapy
Hypertension is a very dangerous condition, whose lack of treatment dramatically increases the risk of developing complications from lethal consequences (e.g. heart attack, stroke, aneurysm, etc.). Hypertension therapy is based on the important goal of bringing the blood pressure levels back to normal. To achieve this goal, the following recommendations are fundamental:
In the presence of hypertension, it is essential to avoid three bad habits: smoking, abusing alcohol and sleeping a few hours at night.
When it is particularly high and when it struggles to respond satisfactorily to previous remedies, hypertension requires the use of specific drugs.
Among the antihypertensive medicinal products are:
- Diuretics, such as so-called thiazide diuretics, chlorthalidone and indapamide;
- Calcium antagonists;
- ACE inhibitors;
- Angiotensin II receptor antagonists;
- Inhibitors of the renin-angiotensin system.
In a context of secondary hypertension, causal therapy – the cure of the triggering cause – is a cornerstone of the therapeutic plan, which is added to all the other treatments described above. Examples of causal therapy are: administration of synthetic thyroid hormones in the presence of hypertension due to hypothyroidism; the treatment of alcohol dependence, in the presence of hypertension due to alcoholism; the reduction in the consumption of licorice, in the presence of hypertension due to the excessive consumption of the latter; etc.
Patients with hypertension can benefit from relaxation techniques, such as yoga, which teach to control stressful situations. Learning to control stress is important, especially when it contributes to the pathological elevation of blood pressure.
Limiting the daily consumption of salt to 5-6 grams, keeping body weight normal, regularly practicing aerobic exercise, not smoking, limiting the consumption of alcohol and adopting a diet rich in fruit and vegetables are the main recommendations of doctors when the topic of discussion is the primary prevention of hypertension.
There are numerous factors that can change the pressure values recorded in a given population. These values can in fact vary according to sex, age, body weight, race, device used, time of day, and the psychophysical and general health of the individual. For example, the values of pressure of a child, influenced above all by height, are generally lower than those of an adult, who in turn shows lower blood pressure levels than those of the elderly. In fact, as we age, the arteries lose elasticity and oppose a greater resistance to the flow of blood. Blood pressure varies during the day, reaching maximum values during the early morning and late afternoon. Precisely in relation to this last point, it is spontaneous to ask whether there are ideal pressure values, and what the normal range is to be observed.