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Arterial hypertension: the silent killer

One in four people has high blood pressure. However, in 30 % of cases, they are unaware that they are hypertensive: hypertension often has no symptoms. This is why it has been called "the silent killer".

Pilar Riobó-June 12, 2017-Reading time: 3 minutes

People with high blood pressure have an increased cardiovascular risk. Specifically, they are three times more likely to have a coronary problem (such as a heart attack) and six times more likely to develop heart failure. In addition, hypertension is the first risk factor for brain disease, and an important factor in kidney disease.

But do not panic if you have high blood pressure: the risk decreases with correct and sustained treatment.

Blood pressure is the force exerted by the blood on the walls of the arteries. Systolic pressure (the "maximum") indicates the pressure produced by the contraction of the heart; diastolic pressure (the "minimum") indicates the "distensibility" or tone of the vascular system. Blood moves because of this pressure difference.

We speak of hypertension when blood pressure (BP) is above 140/90 mmHg; but from 120 mmHg of maximum BP and 80 mmHg of minimum BP there is a continuous and growing relationship with mortality due to vascular diseases of the heart or brain. It is also considered high at lower levels in the case of diabetics and patients who have had heart problems.

Since the pressure can vary according to the circumstances, it is sometimes necessary to repeat the measurement several times. But the permanent elevation of the pressure translates into an anomalous situation of the arteries, which lose part of their elasticity and thus force the heart to make more effort to expel the blood at a higher pressure. This results in hypertrophy of the heart muscle, which leads to heart, kidney and brain problems and even dementia. 

Occasionally, blood pressure may increase due to a stress reaction; this is called "emotional hypertension". One of its variants is known as "white coat hypertension", which occurs in the doctor's office due to stress when taking blood pressure. Even if the stress is not a major problem, it tends to recur in many everyday situations and, in the end, can make the hypertension permanent. Therefore, these usually stressed people need to have their blood pressure checked regularly. 

As hypertension is chronic, it requires lifelong follow-up. Sometimes dietary treatment and increased physical exercise may be sufficient. Influencing nutritional factors are obesity (it is estimated that about 25 % of hypertension cases are related to obesity), lack of exercise and excess salt or alcohol. Often medication, even several associated drugs, must also be used to achieve adequate control.

It is common for patients to measure their blood pressure at home, with one of the electronic devices available on the market. In addition to avoiding "white coat" hypertension, this favors the desirable participation of the patient in the control of the disease and the efficacy of the drugs, except in cases of an anxious personality that leads to obsessive blood pressure measurement.

The most reliable devices are still the classic mercury ones, but the electronic ones avoid the problems derived from the toxicity of this material and are easy to use and inexpensive. It is advisable to choose the arm ones, as the wrist ones are less easy to use correctly. The finger ones are not very accurate. The cuff or inflatable chamber should be the right size, neither short nor long. The chamber should cover 80 % of the arm circumference, which avoids falsely high readings. All devices should be checked at least once a year. As for the number of self-measurements to be performed, at least three days is advised, taking duplicate readings at two times of the day (morning and evening). 

The authorPilar Riobó

Medical specialist in Endocrinology and Nutrition.

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