▷ Hypertension: causes, symptoms, diagnosis and treatment

High blood pressure corresponds to hypertension of the blood in the wall of the arteries. It is the most common cardiovascular disease and affects around 20% of the population. Its incidence increases with age and affects 90% of 85-year-olds. Update on this disease, its diagnosis and its treatments.

What is high blood pressure?

High blood pressure or hypertension is a continuously elevated blood pressure count (called blood pressure or BP) above 14/9. Ideally, it is 12/8. It is a common disease that increases with age, with a hereditary component.

Before affirming arterial hypertension in a patient, the doctor must give himself a delay and ensure the permanence of the blood pressure figures by regularly monitoring the patient (blood pressure varies during the day) and taking his blood pressure. With a mercury manometer, at rest. in supine position, at least twice in 15 days.

We speak of permanent high blood pressure when the BP is high all the time. The minimum value figure is important because it directly reflects the flexibility and strength of the arterial walls.

Signs of high blood pressure

In general, high blood pressure does not present any symptoms that can alert the patient. It is often a finding from a routine medical exam. Sometimes, however, certain signs suggest high blood pressure:

  • From headaches in the morning above or behind the head;
  • From dizziness;
  • Of visual disorders: floaters, fog before the eyes …
  • A tired;
  • Nosebleeds;
  • Of hemorrhages;
  • From muscle cramps;
  • A urinary frequency (frequent urination);
  • Dyspnea (shortness of breath reflecting left ventricular failure).
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When the doctor has discovered arterial hypertension, he checks it several times under different conditions: rest, effort, standing, lying down, right arm, then left arm… Thus, he ensures its permanence. The generalization of blood pressure measuring devices to the general public allows the patient to monitor his blood pressure under the conditions of his daily life.

Labile hypertension

Ambulatory blood pressure devices (ABPM) allow you to take your blood pressure continuously. In fact, it can be, especially in young subjects, labile arterial hypertension, that is to say alternating with periods of normal arterial pressure. This condition is mild in the short term and very well tolerated. There are no visceral complications. Control is still necessary because the disease can progress to permanent hypertension. The cause of this condition is unknown, but emotional subjects are more frequently affected.

The evolution of high blood pressure

Sometimes high blood pressure is recognized in a telltale accident.

Neurological accident

  • Transient ischemic attack ;
  • Stroke (brain softening, cerebral, meningeal or cerebro-meningeal hemorrhage, intracerebral hematoma, cerebral-meningeal edema).

Sensory accident

  • Labyrinthine hemorrhage (true vertigo);
  • Bleeding from the eyes;
  • Oculomotor nerve palsy.

Heart attack

Kidney injury

  • Hematuria (presence of blood in the urine);
  • Renal insufficiency .

Complication of atherosclerosis

Apart from these acute accidents, the increase in blood pressure over time alters the walls of the vessels that are not intended to undergo such pressure regimes. Among the harmful effects is the acceleration of the atherosclerosis process.

The organs that suffer the most are:

  • The central nervous system: risk of cerebral hemorrhage and thrombosis;
  • The retina: hypertensive retinopathy;
  • The heart: left ventricular overload, coronary atherosclerosis;
  • The kidney: nephroangiosclerosis;
  • The penis: erectile dysfunction;

It is to avoid these complications that it is absolutely necessary to treat high blood pressure, even if it does not cause any symptoms in the patient.

Causes and risk factors of high blood pressure

In 95% of cases, the cause of high blood pressure remains unknown: it is said to be “essential” or idiopathic. In this case, the treatment will aim to treat the symptoms, that is, to lower the blood pressure. However, the doctor can find a cause whose treatment can cure high blood pressure.

Kidney causes

It separates the non-surgically curable kidney disease from the potentially curable by surgery.

Among the non-surgical renal causes of high blood pressure:

  • Glomerulonephritis proteinuria, hematuria, nephrotic syndrome;
  • Diabetic glomerulopathy;
  • Metabolic interstitial nephritis: gout, hypercalcemia (hyperparathyroidism);
  • Polycystic kidney disease (PKD) …

Among the kidney causes that can be surgically curable:

  • Chronic pyelonephritis (sequelae of repeated chronic and urinary tract infections);
  • The kidney from tuberculosis;
  • Renal artery stenosis that can be treated with angioplasty (inflation of a balloon in the narrowed artery).

Adrenal gland diseases

We found among them Cushing’s syndrome, Conn’s syndrome (primary aldosteronism).

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Risk factor’s

There are also factors that favor high blood pressure:

  • A diet that is too salty;
  • The alcoholism ;
  • To smoke ;
  • Oral contraceptives;
  • Pregnancy (preeclampsia);
  • The emotional and repeated shocks;
  • Certain drugs;
  • The obesity ;
  • Lack of physical exercise.

High blood pressure: additional tests and tests

In case of permanent arterial hypertension, the evaluation carried out by the doctor is twofold. It allows to appreciate the repercussions of hypertension in the organism and to discover a possible cause.

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Heart check

  • Look for angina pain and dyspnea on exertion;
  • ECG and chest x-ray;
  • Cardiac ultrasound, essential to judge the importance of left ventricular hypertrophy, which is a prognostic factor.

Sensorineural evaluation

  • Headaches, sensation of a dead finger, or flying flies;
  • Search for transient episodes of amaurosis (sudden and brief loss of vision);
  • Fundus examination.

Kidney check

Minimum level of creatinine in the blood. Based on the results of the fundus and the blood pressure figure, high blood pressure is classified into four stages:

  • Stage I: bright arteries in the fundus and mild or recent high blood pressure;
  • Stage II: fundus crossover sign, hypertension of moderate severity and generally old;
  • Stage III: presence of exudates and hemorrhages in the retina and severe arterial hypertension that requires emergency measures;
  • Stage IV: papillary edema and malignant hypertension requiring hospitalization in a specialized setting.

Treatment of hypertension

Dietary measures

Hygiene-dietary measures are very important, and even the only ones prescribed in case of low or borderline hypertension: low-salt diet, weight loss in case of obesity, abandonment of alcohol and tobacco, regular physical activity, relaxation. ..

The low salt diet

A salt-free diet is tasteless and cannot be continued for long, so it is rarely recommended. On the other hand, a diet that is too salty prevents the treatment of hypertension. Therefore, it is necessary to limit the intake of salt, without eliminating it completely.

Some practical tips are helpful:

  • Do not add salt to the cooking water of food or add more salt to food;
  • Do not eat foods that are too salty;
  • Avoid industrial cans that contain salt and prefer fresh or frozen products;
  • Prefer oil and butter over margarine, which is richer in salt;
  • Avoid certain mineral waters (Vichy, Saint-Yorre, Vals, Badoit…);
  • Reduce the consumption of coffee, tobacco and licorice;
  • Be careful with certain medications that contain salt (effervescent tablets, cough drops, syrups, digestive powders, etc.).

However, all spices and condiments (except salt) are allowed: lemon juice, parsley, chives, watercress, bell pepper, garlic, onion, thyme, chervil, tarragon, cumin, curry, paprika, etc.

Life hygiene

Lifestyle advice is essential. Very often, a correct hygiene of life and an adapted diet are sufficient. In case of well-controlled blood pressure, professional activity can be maintained, as well as reasonable and regular sports activities (without competition), with an emphasis on endurance and relaxation sports: walking, cycling, swimming. Some tips should be followed:

  • Avoid significant or brutal physical exertion;
  • In case of an attack of arterial hypertension: absolute rest;
  • Worries and annoyances (sedatives are sometimes helpful);
  • Avoid prolonged exposure to the sun without protection;
  • Swimming if the water temperature is below 20 ° C;
  • Avoid stays at altitudes above 1500-2000 meters (travel by pressurized aircraft is authorized);
  • For women, stop the pill and replace it with another method of birth control (condom, IUD).

Antihypertensive drugs

The goal of treatment is to normalize blood pressure to avoid long-term complications. Therefore, in most cases, this treatment must be taken for life. Pressure is definitely the disease for which there are the most drugs. Antihypertensive drugs can be classified by family:

  • Alpha 1 blockers;
  • Central antihypertensive drugs;
  • Beta blockers;
  • Calcium channel blockers ;
  • Thiazide diuretics;
  • Hyperkalemic diuretics;
  • ACE inhibitors;
  • Angiotensin 2 inhibitors;
  • Associations.

How to adapt the treatment?

Currently, when medical treatment is indicated, a single low-dose antihypertensive is started. Then, unless side effects occur, the dose is gradually increased until normal blood pressure is reached. In case of side effects that are too bothersome or ineffective, the treatment can be changed or an antihypertensive drug of another class can be added. Sometimes it may be necessary to combine three or four medications before reaching normal pressure!

However, some doctors recommend starting treatment right away with fixed combinations (in a single tablet) of two low-dose drugs: this would reduce side effects by increasing the effectiveness of each separately.

Regular monitoring of treatment is essential:

  • Take your blood pressure every month until you get a stable blood pressure below 14/9;
  • Eye fundus every 6 months;
  • Ionogram of blood;
  • Electrocardiogram.

The patient should never stop the medications prescribed by the doctor or reduce the doses on their own. Abnormal symptoms (headache, nosebleed, shortness of breath, chest pain) should be reported to the doctor. In case of surgery, the anesthesiologist should be informed of the antihypertensive treatment.

For women, local contraception is preferable to the pill. In case of pregnancy, medical supervision must be strict.

High blood pressure and pregnancy.

During pregnancy, taking blood pressure is part of medical supervision. In fact, high blood pressure in a pregnant woman can reveal:

  • A pre-eclampsia;
  • The worsening of a previous arterial hypertension;
  • A recurrent hypertension of pregnancy.

Malignant hypertension, a form of complication.

It is severe hypertension with visible papillary edema at the back of the eye. It can occur at any time in a hypertensive person but especially in young men. An emotional shock is sometimes a trigger.

Without treatment, the complications are serious:

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  • Renal (nephroangiosclerosis (nephropathy resulting from old hypertension) and kidney failure);
  • Cerebral: cerebral meningeal hemorrhage;
  • Cardiac: acute edema of the lung.

Emergency treatment is required before transferring you to a specialist.

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