SUMMARY :
- What is the definition of high blood pressure?
- What causes arterial hypertension ?
- What are the symptoms ?
- Hypertension: what risks and complications?
- How is the diagnosis made?
- What are the risk factors for hypertension?
- Hypertension and stress: what links?
- High blood pressure during pregnancy: what are the risks?
- What hygiene and dietary measures to fight against hypertension?
- What drug treatments?
- Is herbal medicine useful for hypertension?
In France, about 15 million people have a arterial hypertension (HTA). Arterial hypertension is still too often underdiagnosed because it is not detected: 30% of the world’s population is affected, half of them without knowing it. One out of two hypertensive adults is unaware of suffering from this disease. In addition, 50% of treated hypertensives still have a arterial pressure poorly controlled (treatment poorly followed, too intense or poorly adapted). “This disease does not give any symptoms, many people are not observant: they do not take their treatment regularly”, underlines Pr Alain Furber, former head of the cardiology department of the CHU of Angers, and president of the French Federation of Cardiology (FFC). On the occasion of World Hypertension Day this May 17, 2022, we take stock.
What is the definition of high blood pressure?
High blood pressure is characterized by abnormally high blood pressure in the blood vessels. The hypertension is defined by:
- systolic blood pressure (BP) ≥ 140mmHg
- and or diastolic blood pressure (BP) ≥ 90 mmHg,
measured in medical consultation and confirmed by self-measurement or ambulatory blood pressure measurement (ABPM) over 24 hours.
During a self-measurement of blood pressure carried out homehypertension is defined as blood pressure ≥135/85mmHg.
The normal value blood pressure is 120/80 mmHg.
What causes arterial hypertension ?
High blood pressure is primary or essential in 90% of cases. She didn’t no causes identified but is due to a set of factors that potentiate each other: age, family predisposition, poor lifestyle (sedentary lifestyle, overweight), stress.
Much more rarely, arterial hypertension is secondary, that is to say that another disease is the cause of this arterial hypertension (diseases of the kidneys, endocrine glands, artery walls, etc.) or that drugs are the cause (anti-inflammatories , estrogen-progestogen pill, corticosteroids, antidepressants, etc.). Alcohol and certain drugs (cocaine, amphetamines) are frequently the cause of high blood pressure.
What are the symptoms ?
“High blood pressure is a disease that does not show signs for years”, informs Pr Alain Furber. This is why it is called a silent disease. Non-specific signs such as visual disturbances, dizziness, fatigue or ringing in the ears attributed to high blood pressure are in fact rarely related to it. “Occipital, morning headaches (headaches), which resist analgesics and give way spontaneously in the morning are signs frequently found during consultation for arterial hypertension, the causal link state however uncertain”, says Professor Furber. “Afterwards, the telltale signs of hypertension are the complications”he says.
Arterial hypertension being asymptomatic for a very long time, it is essential from the age of 40 to have your blood pressure measured once a year by a doctor. A self-measurement on medical prescription can be done one week before the appointment with the attending physician. It is a question of taking the measure of its pressure:
- 3 times in the morning upon waking before taking medication,
- 3 times in the evening at bedtime
- and this 3 days in a row (rule of 3),
and to take the average of these self-measurements, with a blood pressure self-measurement device on the arm, which is more reliable than those on the wrist.
Hypertension: what risks and complications?
Arterial hypertension can have serious consequences, in particular cardiovascular, because it tires the heart (heart failure). Arterial hypertension is one of the main risk factors for cardiovascular diseases (myocardial infarction, stroke, aortic aneurysm, obliterating arteriopathy of the lower limbs) secondary to the appearance of atherosclerotic lesions in the walls of the arteries.
The higher the blood pressure, the greater the cardiovascular risk. High blood pressure is also a risk factor for chronic kidney disease. High blood pressure would also increase the risk of developing dementia.
How is the diagnosis made?
the diagnosis of high blood pressure cannot be based on a single blood pressure measurement. The pressure varies throughout the day and according to physical activities. In addition, pressure taken in the doctor’s office exposes you to what is called “the white coat effect”: high blood pressure is noted by the doctor while the blood pressure is normal outside the doctor’s office. “Before starting treatment for moderate hypertension (between 14 and 16 mmHg in systolic and between 9 and 10 mmHg in diastolic), hypertension diagnosed in the doctor’s office must be confirmed by a self-measurement of blood pressure or a measurement ambulatory blood pressure (MAPA)“, teaches Professor Furber. If severe hypertension is detected by the doctor, confirmation is not necessary and treatment is started.
What are the risk factors for hypertension?
The atherosclerosis risk factors are editable or non-editable. Non-modifiable factors are age, sex and heredity.
On the other hand, other risk factors are preventable:
- overweight,
- physical inactivity,
- excessive consumption of salt,
- smoking,
- diabetes,
- high cholesterol in the blood,
- excessive alcohol consumption,
- the stress.
The combination of these risk factors multiplies the cardiovascular risk of arterial hypertension.
Hypertension and stress: what links?
A shock emotional and stress raise blood pressure, but temporarily. This is why if a blood pressure reading showed high blood pressure in a period of stress, the blood pressure measurement should be measured again. In hypertensive people under treatment as in non-hypertensive people, stress can be accompanied by sudden punctual rise in blood pressure.
High blood pressure during pregnancy: what are the risks?
Arterial hypertension (HTA) of pregnancy remains the leading cause of maternal and fetal morbidity and mortality. About 10% of pregnancies are complicated by hypertension. Gestational hypertension usually occurs after the 20and week of pregnancy and in most cases disappears after delivery. The treatment of high blood pressure during pregnancy is based on taking antihypertensive drugs and sometimes on inducing labor.
“Few antihypertensive drugs can be used during pregnancy. Diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARA-II) are thus contraindicated. We come however balance the pressure with other treatments, especially calcium channel blockers. Women who were already hypertensive before their pregnancy should therefore not be surprised to see their antihypertensive treatment modified during pregnancy. Their usual treatment will be resumed after pregnancy and the period of pregnancy. ‘feeding with milk”, says the cardiologist.
What hygiene and dietary measures to fight against hypertension?
The objective of the management of arterial hypertension is to reduce the cardiovascular risk. Lifestyle and dietary measures are recommended for all hypertensive people regardless of the blood pressure level, with or without associated medication. These measures include:
- consumption 6 grams of salt per day maximum : “a large amount of salt leads to water and sodium retention, therefore an increase in blood pressure and an excessively salty diet is a cause of resistance to treatment”, explains Professor Furber;
- a weight reduction if overweightin order to maintain the body mass index (BMI) below 25 kg/m2, or, failing that, in order to obtain a 10% drop in the initial weight;
- the practice of a regular physical activity, at least 30 minutes a day ;
- the limiting alcohol consumption 2 glasses of wine or equivalent maximum per day and not every day for men and women;
- smoking cessation;
- a rich diet in vegetables, fruits and low in saturated fats (fats of animal origin).
“Regular self-measurement of blood pressure empowers patients and thus improves treatment compliance”, inform the cardiologist.
What drug treatments?
The main objectives of antihypertensive pharmacological treatment are to reduce cardiovascular mortality and morbidity, i.e. to ensure the prevention of myocardial infarction, stroke and heart failure, to avoid evolution towards renal insufficiency in hypertensives, especially in subjects particularly at risk such as diabetics.
Several classes of antihypertensive drugs can be used: thiazide diuretics, beta-blockers, calcium channel blockers (ICA), angiotensin-converting enzyme inhibitors (ACE), angiotensin II receptor antagonists (ARA-II ). “We now tend as soon as high blood pressure is confirmed to immediately prescribe dual therapy : combination of drugs from 2 different classes. This makes it possible to give lower doses of each drug and therefore to have fewer side effects, which helps to improve compliance with treatment”, teaches us Professor Furber.
Is herbal medicine useful for hypertension?
different plants have been the subject of pharmacological and/or clinical studies in the field of arterial hypertension: plants with direct hypotensive properties such as garlic or olive tree, relaxing plants such as hawthorn or valerian as well as than diuretic plants such as Orthosiphon. However, these studies do not make it possible to suggest taking these plants to treat mild arterial hypertension.
Sources:
- Interview with Pr Alain Furber, President of the French Federation of Cardiology (FFC), March 2022.
- Management of arterial hypertension in adults, Recommendation for good practice, HAS, 27 Oct. 2016.
- Site of the French Federation of Cardiology.
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