World Hypertension Day is celebrated today, May 17. The aim is to promote awareness to prevent, diagnose and correctly control high blood pressure, a pathology that is the main risk factor for cardiovascular disease. The WHO’s goal is to reduce the prevalence of hypertension by 25% by 2025.
With the aim of contributing to this awareness we spoke to Dr. Juan Carlos Portugal del Pino, cardiologist and member of Top Doctors, about this.
Doctor, what exactly is high blood pressure and why is it important to keep it “under control”?
Arterial hypertension is perhaps the cardiovascular risk factor that has the greatest impact on health. The number of patients suffering from high blood pressure is so high that it may be the most frequent reason for consultation after a routine check-up. However, controlling and even reversing it is possible today, through a healthy lifestyle and the use of very safe and effective drugs.
The blood that travels through the arteries carrying oxygen and nutrients must have an adequate flow and also sufficient force to be able to reach all organs and tissues. This force with which the blood flow is distributed is called blood pressure. When this force is excessive or exceeds the necessary force it is called arterial hypertension. To make an analogy, if we have a large rose garden and we need to water it with a hose, it will need sufficient force to reach the entire field. However, if the pressure of the hose is excessive we risk damaging our roses. The same occurs in our organism.
Are there groups or patients more prone to suffer arterial hypertension? What percentage of patients does it affect in Spain and worldwide?
In reality we can all suffer from arterial hypertension but it is estimated that around 30% of the adult population over 18 years of age suffers from it. In this case, it is more frequent the older the age, as well as in men, but women are not exempt from suffering from it. In addition, some toxic habits such as tobacco, alcohol, some narcotic drugs and diets with high sodium intake may contribute to its development.
The easiest way to diagnose hypertension is to have regular check-ups, especially after the age of 35, although hypertension may occur even earlier. The definition of hypertension varies according to the guidelines of different countries or regions. In Europe it is defined as a persistent elevation with values above 140/90 mmHg or its equivalents with other diagnostic tools.
How can we know that we have high blood pressure, or the patient will not notice “anything”?
Unfortunately, there is no characteristic symptom, since the most common is that it does not give any. On the other hand, it is true that some presentations in the emergency department, such as bleeding from the nose (or epistaxis), as well as leg swelling (or edema) can give us some clue about the existence of this pathology. However, headache is not in itself a symptom of hypertension, and patients commonly report this symptom as a consequence of hypertension.
It is important to keep in mind that blood pressure is dynamic. It is normal for it to rise under certain circumstances such as exertion, stress or pain. What is pathological is that it does not go back down to normal values. So, when we have a headache it is not a good time to take our blood pressure unless it is very strong or disabling, in which case it is better to go to the emergency room.
Therefore, when we take our blood pressure at home we should always do it under normal conditions and at rest. If we take it when we are under stress or in pain, it is normal that it comes out higher than usual and even in figures of arterial hypertension.
In consultation it can be diagnosed with a physical examination and by performing other tests. Personally, I am not a big fan of the one-time test in the office because, sometimes, it can be falsely elevated. Other tests such as the stress test or the 24-hour holter will help us to make the final diagnosis.
What influence can it have on cardiovascular disease, and what consequences can it have?
Arterial hypertension is a silent killer. As it is asymptomatic, it does not give many clues that we suffer from it. Fortunately, it does not (almost never) cause problems in the short term, since it is necessary to suffer from it for a period of time for it to have an effect. Both the time we suffer from it and its intensity have an influence. Three years with mild hypertension is not the same as three years with severe hypertension. In the second case, it is very likely that we will start to see a doctor for secondary diseases.
The main effect of arterial hypertension is the development of arteriosclerosis. Arteriosclerosis is the accumulation of cholesterol plaques inside the arteries, which will end up obstructing blood flow to organs and tissues. On its own, its impact is quite high, but if we also suffer from other cardiovascular risk factors such as high cholesterol or smoking, its development will be much more accelerated. The best known diseases caused by arteriosclerosis are stroke, myocardial infarction, angina pectoris, intermittent claudication and others such as impotence.
In addition, it can cause cardiac, renal and even eye problems. At the level of the heart it can cause hypertrophy of the cardiac muscle, which can cause heart failure or dilation of the cavities that can favor the appearance of arrhythmias, such as atrial fibrillation. At the renal level, it deteriorates renal function and, at the ophthalmological level, it can cause decreased vision due to damage to the retina.
How can we keep hypertension at bay?
The first thing to do if we suspect it is to see a doctor to confirm the diagnosis and rule out secondary causes. That is, that hypertension is the effect of another health problem we have. There are multiple treatments that have evolved over many years and that, today, are effective and safe.
However, the most important thing is to lead a healthy lifestyle. As I always say, many, if not most of the time we medicate ourselves for the excesses we commit. A healthy lifestyle includes moderate physical activity and avoiding overconsumption of sodium and salt. These last two measures are the ones that, in my clinical practice, have the greatest impact on patients. Obviously, giving up intoxicants such as alcohol, tobacco and other narcotics must also be considered. Even many food supplements or sports supplements can be a trigger.
It should not be forgotten that sodium in our usual diet is very high. It is recommended to limit it to