27 February 2019 Author : Luís Grangeia It is a serious public health problem in Western countries. It contributes the largest proportion of morbidity and mortality in our country when associated with risk factors such as: Diabetes; Dyslipidaemia; Obesity. Anyone reading this text could be one of those affected by the condition, given that 43% of the Portuguese population are carriers of the disease. High blood pressure is, in all likelihood, the root cause of most medical consultations and the prescription of medication. One of the most worrying things is that only half of patients with high blood pressure are aware they have the disease. Of these patients, only half receive medication; and of those receiving medication, only half have the disease adequately controlled! What are the myths surrounding high blood pressure? There are many myths surrounding high blood pressure. Contrary to what one might think, the overwhelming majority of sufferers have no symptoms directly caused by their high blood pressure. By the time they attend health services, they are already suffering from the consequences of or irreparable damage associated with high blood pressure; for example: Angina pectoris; Myocardial infarction; Heart failure; Stroke (CVA); Obstruction of a large vessel; Kidney failure; Retinal lesions. The following symptoms are rarely associated with high blood pressure and, when they occur, it means the values are too high or there is a very sharp rise in blood pressure: Headache; Spontaneous bleeding; Dizziness; Tinnitus; Other unspecified symptoms. It is, therefore, unsurprising that high blood pressure is usually an accidental discovery when the patient is attending a routine consultation. As a general rule, it is diagnosed at a routine check-up or as part of a pre-surgery examination or during an examination for an insurance policy. High Blood Pressure: anything under 12-8 is great!! The recommendations for the classification of high blood pressure (2007 ESH-ESC guidelines) contain more rigorous values that are far below what common sense would have us believe. The new classification is more rigorous, establishing the following values: Optimal: lower than 120/80 mmHg; Normal: between 120/80 mmHg and 129/84 mmHg; High normal (also called pre-hypertension): between 130/85 mmHg and 139/89 mmHg. At what point are values considered to indicate high blood pressure? Anything higher than the values set out above will indicate that you are suffering from high blood pressure . It is graded according to severity : Grade 1 (systolic 140 to 159 mmHg and diastolic 90 to 99 mmHg); Grade 2 (systolic 160 to 179 mmHg and diastolic 100 to 109 mmHg); Grade 3 (systolic greater than 180 mmHg and diastolic greater than 110 mmHg). Isolated systolic hypertension is especially likely to affect older people. It is defined as when systolic values are greater than 140 mmHg and diastolic values are lower than 90 mmHg. The differences may seem insignificant, but having high normal levels of blood pressure mean your risk of cardiovascular disease is double that of a person with optimal blood pressure! What are the causes of high blood pressure? More than 90% of sufferers have primary or essential hypertension, or hypertension of no detectable cause. This is, as a rule, multifactorial. Only about 8% of sufferers have identifiable and potentially treatable causes for their high blood pressure: Endocrine and metabolic disorders (hyperaldosteronism, pheochromocytoma, and Cushing's syndrome, among others); Renal and renovascular disorders; Coarctation of the aorta; Medication (e.g. oral contraceptives); Sleep apnoea syndrome. It should be pointed out that the heart, kidney, central nervous system, eyes and other organs are more often the victim than the cause of high blood pressure. Non-modifiable factors are also identified as causes of the disease: Gender; Age; Race. Aetiological factors include: Excessive salt consumption; Dyslipidaemia; Obesity; Smoking; Sedentary lifestyle; Excessive alcohol intake. Anxiety can contribute to elevated blood pressure, but it cannot be held responsible on its own. What treatments can bring high blood pressure down to normal levels? Diagnostic and therapeutic approaches should not be entered into too hastily, but should be long-term and assertive, as hypertensive emergencies and malignant hypertension are uncommon. New patients should undergo a series of examinations in order to obtain a full picture of their condition. High blood pressure is a disease that requires consistent treatment until it returns to normal levels. It is important to emphasise that it is a lifelong condition; one that over time will require treatment to be adjusted in the following ways: Pharmacological measures; Non-pharmacological measures (these are as important or even more important than drugs). Changes in habits and lifestyle are essential. Drug treatment is provided by doctors who will use various drugs from different families, which in most cases will have to be combined. If you have high blood pressure, speak to your family doctor or a general medicine specialist. You will only need to see a specialist if you have a more uncontrolled, complex or special version of the condition. Meet the internal medicina team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
