The arterial hypertension (HTA) is defined as the rising in figures of arterial blood pressure over 140/90 mmHg, correctly measured.
It is estimated that over 35% of the Spanish adult population is hypertensive, with 40% in middle age and 60% among the population over 65 years. Of these, only 65% are known and only 25% is properly diagnosed and controlled. Henceforth, it follows that a big number of people in high risk of having serious consequences of HTA.
The HTA acts on arteries and organs with more vascularization as heart, central nervous system and kidneys.
Considering that deaths or disabilities are produced by the vascular affectation of these organs are statically leading developed countries, doubtless the fight against HTA is indeed justified.
Currently the HTA classification is as follows:
|ESH – ESC 2007|
|Hypertension GRADE 1||140-159||And/or|
|Hypertension GRADE 2||160-179||And/or|
|Hypertension GRADE 3||≥180||And/or|
How does Hypertension damage artery?
The pressure increase in arteries affects its walls producing a “tightening,” easing arteriosclerosis, dilatations and favouring the thrombose creation. As a consequence, organs impairment is produced receiving a bigger blood flow: Heart, central nervous system and kidneys.
Heart is affected by two ways: Damaging the arteries that are feeding it (coronary arteries) and by thickening and growth of a left ventricle, which needs to be developed to overcome the peripheral arteries resistances that are expanded. When limits are surpassed, an ischemic cardiopathy arises with strokes, arrhythmias and cardiac failure, causing the big amount of deaths given every year.
The most important damage in central nevous system is related to big vessels which irrigate it. They are called acute cerebrum-vascular stroke (CVA). When there is a break, we have a cerebral bleeding (20% of cases) and lack of irrigation due to a thrombus (ischemia) provoking the labelled cerebral strokes (80%). The consequences are from transitional vascular lesions (transitory ischemic attacks TIA) without neurologic aftermaths, to decease, going through by handicap neurologic big lesions and irreversible, involving enormous expensive economic and social costs. On the other hand, in the central nervous system rises another type of lesion that takes place when small glasses irrigating them are surrendered to many pressures for long time. Dementia events progressively come forth then with a vascular origin.
Renal affectation by HTA starts by small failures in some of the multiple kidney functions (uric acid retention, for example) up to the so called “nephroangiosclerosis” or renal sclerosis phase, which leads the patient to be obliged to dialysis treatment and renal transplant. In Spain, there are more than 1500 people in dialysis treatment due to a lack of diagnosis and control of Arterial Tension, which has become the second cause of advanced chronic renal insufficiency, after Diabetes Mellitus, and it is a cause that can be hugely avoided.
Before previously shown and considering vascular origin deaths, which are heading the mortality in developed countries, doubtless ARTERIAL HYPERTENSION struggle is extremely worthy.
What Arterial Hypertension figures do we have to trust in?
AT figures, properly measured, in patients with other risk factors is 135/85. The measurement of 140/90 is not acceptable for a hypertense patient control.
There are other situations in which it is necessary to apply different figures, as there are the Diabetes Mellitus, renal insufficiency or high coronary risks, they must not exceed 130/80.
How to measure blood pressure?
Blood pressure is measured by a sphygmomanometer, which is a tool with a bracelet or “cuff” pressing the arm with a pneumatic mechanism adjoined to a manometer that is displaying us the pressure in mercury millimetres (mmHg).
There are two methods:
• Korotkoff acoustic system
• Oscillometric system
The first one requires the use of a phonendoscope or a microphone, to hear the beats. At the beginning, while the pressure is lowered of inflated, we will obtain the systolic arterial blood pressure (or maximum) and when the beats disappear, we will have the diastolic blood pressure (or minimum). They can be of a column of mercury, but the current regulation prohibits its use.
The oscillometry method will detect the vibrating changes produced by the cardiac tones when the arm arteries are pressed. It is the method used in automatic sphygmomanometers.
It is important that the cuff to adjust in the arm is the appropriate size of each patient. The wrist sphygmomanometer can be useless in young people not obsesses.
Ways of measuring the blood pressure
The more frequent way to control the blood pressure is at doctor’s consultancy. Often this visit causes an emotional component in a patient who provokes that the pressure is slightly higher than normal, and sometimes it incites a false hypertension, called “white robe hypertension”. In these cases, we have to refer to the arterial pressure auto measuring (MAP) with home dosage in correct conditions to reach an accurate diagnosis of the HTA.
The measuring should be done with the appropriate cuff, without rush. Measurement never should be done just awaked or recently having eaten, it is better 2-3 hours later. It should be done sit around ten minutes and quietly. Without smoking (of course) not having drank excitants as coffee. A first measurement will be done and, after 3 minutes approximately, it should be repeated, which is the one that will serve us to control it.
Sometimes we will have unsure situations about tension figures or difficulties to adjust the medication, and then we will go to a blood pressure monitoring (ABPM) also so-called “Holter pressure monitoring”.
It is a cuff that holds 24 hours the arm, with a recorder and a portable inflating system to allow us to program the measurements during day and night. It will give us the patient’s arterial pressure figures in resting and activity, awake and asleep situations, providing a full data for diagnosis and treatment.