Arterial hypertension

Blood pressure is the pressure of the blood due to pressure on the wall of the arteries of the heart during cardiac activity, as represented by left ventricular contraction (systole) and its relaxation (diastole). When you encounter the maximum systolic pressure (systolic or maximum), while the minimum value in diastole (diastolic or minimum). Blood pressure depends, therefore, the force with which the heart pumps blood into the system of arteries and the resistance they present to the flow, that is if my heart can not do it, that it is insufficient as a pump, my blood pressure will be low if, conversely, my pots are restricted, for example, stenosis (narrowing), the pressure is high and the flow is turbulent and swirling, sometimes detectable on auscultation as a "breath".

That said, what 'is the pressure normal?

And 'hypertensive person who has more pressure (from the greek hyper), ie a blood pressure higher than normal, the heart must work harder to push blood into the circulation and in the long run, this state leads to damage of blood vessels arterial, beginning with the smallest arterioles, especially the kidneys and eyes.


The causes of hypertension

Only 5% of cases the cause is known hypertension (chronic renal insufficiency, pheochromocytoma, renal artery stenosis, drugs, etc. Conn's syndrome.) Speaks thus of secondary hypertension, related, that is known pathologies . In about 95%, however, is not attributable to any identifiable cause and therefore is called primary, or idiopathic essenziale.Conosciamo However, some predisposing factors that can alter blood pressure: factors of genetic, environmental, related to 'exercise, diet, and stress.

In particular:
Classification of blood pressure.


Systolic blood pressure (mmHg)
Diastolic blood pressure

Optimum
<120
and
<80

Normal
120-129
and / or
80-84

Normal high
130-139
and / or
85-89

Hypertension Grade I
140-159
and / or
90-99

Grade 2 hypertension
160-179
and / or
100-109

Grade 3 hypertension
> 180
and / or
> 110

Isolated systolic hypertension
> 140
and
<90




Looking at this table, we understand little, but the fact of putting the pressure in millimeters of mercury (mm Hg) was because it was the grand emedia RivaRocci the first to measure the pressure using a cuff with a manometer to measure the pressure (sphygmomanometer) that swelled with a blower and when the cuff pressure could stop the vessel, ie the radial artery, then it was the pressure of systole, ie that resulting from pulsation of the heart (systolic blood pressure.) When, deflating the cuff, did not hear more touches sphygmic wave, then it meant that it was the pressure of diastole, ie the diastolic. So far we do not understand anything except dates assumed that the difference between a systolic and a diastolic pressure gradient that is, it is important for the calculation of cardiovascular risk predictor of mortality, especially in those with more 55 years! Risk assessment is the risk that a patient may develop organ damage, such as a heart attack, in turn depends on other factors and can be calculated even with sophisticated computer systems to assess whether an individual will have a risk of 10 years before becoming ill. But we are far from these assumptions of Evil Eye, we see rather than in practice what are the risk factors to avoid.

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RISK FACTORS
Systolic and diastolic
Pulse pressure (the elderly)
Age <55 years if female> 65
Smoke
Dyslipidemia: total cholesterol> 190 mg%, LDL cholesterol> 115 mg%, HDL (good cholesterol that is) for males <40 mmHg for females and <46 mg%, triglycerides> 150 mg%
Glucose "moves" fasting between 102-125 mg%
Blood sugar curve after loading altered (see link diabetes),
Abdominal obesity (belly!)> 102 cm for men and> 88 cm for women
Family history of cardiovascular disease (eg the parent who dies of a heart attack!)
Diabetes with fasting glucose> 126 mg%
The blood sugar levels after dinner> 198 mg%.

Organ damage

Electrocardiographic evidence of LVH (see link)
Carotid wall thickening or atherosclerotic plaques
Speed carotid-femoral pulse wave> 12 m / s
Pressure index lower limb / limbs superior class> 0.9
Slight increase in plasma creatinine Male 1.3-1.5 mg / dl and females 1.2-1.4 mg / dl
Reduction of GFR <60 ml / min
Microalbuminuria 30-300 mg/24 h
CARDIOVASCULAR DISEASES resulting

Cerebrovascular disease: ischemic stroke, brain hemorrhage, TIA
Heart disease: myocardial infarction, angina pectoris, cardiac failure
Renal diseases: diabetic nephropathy, renal failure
Peripheral vascular
Advanced retinopathy: haemorrhages or exudates, papilloedema.

Care.


Firstly we begin by following rules of behavior (lifestyle): reduce the consumption of salt, coffee or stimulants (drugs, narcotics) reduce body weight in obese, moderate consumption of wine and coffee, smoke and lift spirits, make a light exercise (walking, swimming, cycling), etc.. Should be avoided all foods containing sodium, as salt (sodium chloride) or compounds such as monosodium glutamate, sodium nitrate, sodium bicarbonate, starting with convenience foods, frozen or envelope, canned meat (tuna , sardines, beef in jelly), sausages, cheeses (pecorino, parmesan, gorgonzola, etc..) seafood, bouillon cubes, the sauces, preserves, pickles and so on. Smoking causes vasoconstriction of the arteries leading to upward pressure values in the long run increases the risk of coronary heart disease

If these tricks do not get any results is required pharmacological therapy, as assessed by the physician according to patient characteristics and associated cardiovascular risk, including, in the presence of comorbidities, in principle start from a monotherapy for switch to a combined treatment with multiple drugs.


At the beginning of antihypertensive treatment will be necessary to measure blood pressure several times a day, noting in a diary: date and hour of measurement, the drugs taken, the particular situation, symptoms, etc.., Then 2 times a day is sufficient, the immediately after the morning rise and evening before going to sleep. without exaggerating or applied to the measurement!

Drugs belong to various classes that are used depending upon what you want to achieve. Let me explain. If care for hypertension in young and want to prevent myocardial hypertrophy, that the heart is "bloat" and then that imbalance, the use far4maci beta-blockers, ACE inhibitors in diabetic and heart disease because over time prevents the myocardial damage. Still there are calcium channel blockers are useful in patients who need to reduce the pressure vessel, for example useful in nefropazienti. The old loop diuretics, eg. furosemide, are still useful when used to make ridorre the blood volume, ie "do discharge liquids" of the cardiac patient, the patient with cirrhosis and in all subjects with, for example, peripheral edema. Finally there are the ARBs, which are used also in heart infarction and in patients with left ventricular hypertrophy. Still be quoted clonidine, used with transdermal and oral systems, now used in special cases.

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So this to say that the treatment of hypertension is far from trivial, nor easy to implement.

Claudio Italiano
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