What is hypertension (HBP)?

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Definition

Arterial Hypertension (HBP) is the increase in the pressure exerted by the blood on the walls of the arteries with voltage values greater than or equal to 140mmHg at the systolic level and 90mmHg at the diastolic level, reported 2 or more times.

Classification

  • Essential hypertension

It is a multifactorial disorder, which derives from the combined effects of multiple genetic polymorphisms, together with the interaction of environmental factors.1

  • Secondary hypertension

It is defined as the elevation of blood pressure above 140mmHg at the systolic level and 90mmHg at the diastolic level secondary to a base disease.

  • Hypertensive crisis

It is defined as the elevation of the voltage values greater than 179mmHg at the systolic level and 109mmHg at the diastolic level and is divided into two types

  • Hypertensive emergency

They are patients who have severe elevation of the tensional figures with white organ involvement, such as: Brain, Heart, retina and kidney and require immediate control, these patients are managed with intravenous antihypertensive drugs, but without reaching normal values

  • Hypertensive Urgency

They are patients who have severe elevation of the voltage figures without white organ involvement and can be managed within the first 24 to 48 hours

  • Resistant Arterial Hypertension

It occurs when there is a failure in the objectives of the therapy in patients who have been handled with the maximum doses in an appropriate manner

The JNC7 classified the HTA and its management according to the value of the blood pressure as seen in the following table.

Image 1:

Image taken from:(JNC7 Express, 2003)

Epidemiology

From 90 to 95% of the cases of Essential Hypertension, the remaining percentage present secondary hypertension.1

Every year, HTA worldwide causes 7.6 million deaths.2 In the United States, mean arterial blood pressure is higher in men than in women.2

Etiology

Essential hypertension is idiopathic

Secondary hypertension:

  1. Renal
  2. Endocrine
  3. Cardiovascular
  4. Nervous

Risk factor’s

There are different risk factors that can produce HTA:

  1. The older you are, the more likely you are to have HBP
  2. Body mass index greater than 25
  3. High consumption of sodium
  4. Physical inactivity
  5. Cigarette smoking
  6. Dyslipidemia

Pathophysiology

Essential hypertension

There are different theories about the pathophysiology of essential hypertension which are discussed below:

  1. Monogenic disorders

They generate relatively infrequent forms of hypertension by modifying the net reabsorption of sodium in the kidney.

It must be taken into account that the kidney filters 170L of plasma daily containing 23 moles of salt; In a typical diet that provides 100 mEq of sodium, 99.5% should be absorbed, of which only 98% is reabsorbed.

Then the monogenic alterations produce:

Genetic defects that affect the enzymes involved in the metabolism of aldosterone (aldosterone synthase, 11beta-hydroxylase or 17alpha-hydroxylase), which would produce an increase in aldosterone secretion and an increase in the reabsorption of water and salt.

Liddle syndrome causes mutations in a protein of the epithelial sodium channel that provides an increase in its reabsorption in the distal tubule.

2. Intravascular volume

Sodium is a predominantly extracellular ion and a primary determinant of extracellular volume. When the consumption of sodium chloride exceeds the capacity of the kidneys to excrete it, it produces an increase in intravascular volume and an increase in cardiac output, this is due to the fact that sodium generates an increase in osmotic pressure. It has also been shown that over time it increases peripheral vascular resistance, to decrease cardiac output, which would ultimately lead to an increase in mean arterial pressure

3. Decrease in sodium secretion

When there is a decrease in the excretion of sodium, it can successively result in increased fluid volume and cardiac output, and a peripheral vasoconstriction that ends up raising blood pressure.

Clinical manifestations

In general, these patients do not present clinical manifestations, for this reason this pathology is called the Silent disease. usually it is diagnosed when they go to the medical control or when they have a basic disease.

In patients with hypertensive emergency, they may present with papilledema, sudden onset headache, Angina, or Acute Renal Impairment.

Diagnostic methods

-To take the blood pressure should be done with a calibrated tensiometer, and a stethoscope taking into account the following steps:

  1. The patient should find 5 minutes at rest.
  2. The feet should be supported on the floor.
  3. The arm where you are going to take the tension must be supported at the level of the heart
  4. Locate the humeral artery.
  5. With the deflated sleeve, place it around the arm in a tight way, ensuring that the lower edge is about 2cm from the bend of the elbow.
  6. The cuff should be inflated until the radial pulse is lost and an additional 10mmHg increase from that point.
  7. The stethoscope is positioned where the humeral artery was located (Remember to use the bell)
  8. Start releasing the tensioner air slowly
  9. As soon as you hear the first sound or first corocoff noise, the pressure marked by the pressure gauge will be registered as the systolic pressure.
  10. By continuing to release the air corocoff noises will disappear, the pressure that marks at that time in the manometer should be recorded as the diastolic pressure.

General rules when taking the tension

The patient must be seated or with a dorsal ulna, with the arm slightly flexed at the level of the heart and firmly resting on a flat surface.

The arm and forearm should be uncovered, ensuring that the garments are not exerting some kind of compression

Complications

The high levels of blood pressure have a high probability of producing:

  1. Acute Myocardial Infarction
  2. Heart failure
  3. Vascular Brain Accident
  4. Kidney Disease

Individuals between 40 and 70 years of age, with an increase in blood pressure of 20mmHg at the systolic level or 10mmHg at the diastolic level, have twice the risk of developing a Cardio-Vascular Disease (CVD).

Treatment

Treatment objectives

-Reduce cardiovascular and renal morbidity and mortality-Maintain blood pressure less than 140 / 90mmHg -Maintain blood pressure less than 130 / 80mmHg in patients with diabetes or renal disease Base

The JNC 7 recommends that the treatment of each patient depends on the classification of blood pressure as shown in Figure 1

Modification of lifestyle

It is essential in the management of patients with hypertension

Pharmacotherapy

In construction

References

  • JNC 7
  • Harrison 8th Edition, Chapter Arterial Hypertension

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