Hypertension

Summary of hypertension

Hypertension is a very common cardiovascular disease, complications can be serious such as heart attack (myocardial infarction) or stroke (cerebral vascular accident CVA), therefore the importance of prompt treatment and well management of blood pressure.

Hypertension is mainly an asymptomatic disease (mostly without clear symptoms) that affects a large part of the population. In many countries (USA, UK) it is estimated that on average 30% of the population suffers from hypertension (more information at: statistics). One can estimates that there is high blood pressure, when the tension is higher than 140/90 mmHg or 14/9.

For about 90% of patients or cases, the cause of hypertension is not known and is the result of a poor diet (too much fat and especially salt), obesity, age, the use of hypertensive drugs, genetic factors, stress, sedentary lifestyle, etc. Unfortunately the modern lifestyle (fast food, stress) promotes hypertension. In August 2011 a Chinese study showed a possible link between cytomegalovirus (CMV) and hypertension. Read also causes hypertension.
In 10% of cases, high blood pressure has a clear known cause: a problem with the renin-angiotensin system, atherosclerosis, kidney problems, etc…

Complications can be very serious such as stroke, heart attack, kidney problems, erectile dysfunction, vision problems, etc.

The treatment of hypertension is to first change the lifestyle habits and opt for different patterns (see good advice hypertension) but in many cases this is not enough and the doctor will prescribe medications (antihypertensives), often with a combination of several drugs and not only one, to increase efficiency. See hypertension treatment

The doctor, in general, determines a target systolic and diastolic blood pressure to achieve. Drug and / or changes in the lifestyle will help to achieve this goal.

Regular monitoring of your blood pressure (at home, doctor or pharmacist) and a significant commitment of the patient (regular use of medications, lifestyle changes) are key factors for a good therapeutic success.

It is interesting to note that treatment of hypertension prolongs life expectancy in the long term, according to a clinical trial carried out in the United States in late December 2011.

Finally two medicines plants such as garlic and olive leaves may have some effect to treat hypertension. However, studies are not always clear about its effectiveness. Always prefer first conventional treatments and talk to your doctor.

Definition Hypertension

High blood pressure (arterial tension) is characterized by a tension or too high pressure in the arteries. This abnormally high pressure is often permanent.

In fact, the blood pressure is determined by the amount of blood pumped and by the resistance force of blood flow in the arteries. If the heart has to pump more blood and the arteries are tighter then the tension is high (risk of hypertension). [source : Mayo Clinic Book, 2007]

Hypertension is a serious and common disease that can lead to serious problems such as heart attack, stroke or kidney problems when this pathology is not diagnosed and treated. See in complications.

We distinguish systolic (highest tension) which is defined as the maximum pressure in the arteries when the heart (left ventricle) pushes blood into the aorta and on the opposite diastolic (lower tension) that is characterized by the minimal blood pressure when the blood is removed from the aorta.

High blood pressure can be measured with devices for measuring blood pressure as automatic blood pressure (self-measurement device) or manuals devices related to a stethoscope.

Good tips for measuring the tension :

1. When you measure your blood pressure, remember to rest for 5 minutes before the measurement and sit comfortably. Your blood pressure will be more realistic and should theoretically decrease.
2. Remember to measure your blood pressure if possible at the same time of day in order to better analyze the results over a certain period (eg. One week).

Statistics hypertension – Epidemiology

– In the world hypertension kills 9.4 million people a year from cardiovascular diseases such as stroke or myocardial infarction. [Source: WHO, April 8, 2013].

Statements of WHO in April 2013 believe that hypertension now affect 1 in 3 people in the world, more than 2 billion people (however also read the editorial below).

– In France it is estimated that nearly 10 million people (1 sixth of the population) were hypertensive.

– In Brazil (200 million people) it is estimated that 24% of Brazilians have hypertension, that makes about 50 million people.

– In China, 200 million people (out of a population of about 1.3 billion people) have high blood pressure.

– In Africa, about 46% of adults suffer from hypertension. [Source: WHO, April 7, 2013] This disease is responsible for nearly half of all deaths from stroke and heart disease. Most of these people are undiagnosed. [Source: WHO]

One should know that hypertension also increases the risk of developing other health problems such as kidney failure or blindness.

Editorial – From Creapharma

These figures are quite alarming and probably closer to reality. However, although hypertension is undoubtedly an illness or a serious and dangerous symptom, you should know that this condition is with cancer, probably the most lucrative disease of the pharmaceutical industry. In this case we are not talking about billions of dollars in revenue per year, but dozens or even hundreds of billions of dollars of sales revenue per year worldwide (included all drugs in the cardiovascular system).
Thus if in very large countries like the United States and Brazil (easier to influence, because every time one capital, a health minister, a supervisory authority, than Europe with many countries). With these two countries there are already 500 million people (about 8% of the world population) and if you can influence the guidelines (guides) to know when to start high blood pressure and try to lower the value of the guidelines, you mathematically add millions of people with high blood pressure in your statistics.

For example, a patient has a pressure of 140/90 mmHg, then one day a health authority (in the U.S., to name the most influential and powerful country in the world, including in medicine, pharmacy) decides that is someone is hypertensive with a tension of 130/80 mmHg, then you greatly increase the revenue of the pharmaceutical industry, because doctors will begin to prescribe antihypertensive in people who were not before.

That is why with statistics on hypertension you should always keep a critical mind and learn from what we are talking about high blood pressure, eg. in Switzerland high blood pressure is from 140/90 mmHg (or 14/9).

Xavier Gruffat Pharmacist Editor Creapharma.com, Switzerland, updated in April 2013

Causes of hypertension

– In 90% of cases of hypertension has no clear cause, it is called primary or essential hypertension.
Nevertheless, some factors may influence this essential hypertension: a poor diet, excess weight, genetic causes, stress, age, obesity, excessive salt intake ( in the United States, food is too salty and would be the main cause of hypertension, according to research published in the “Journal of the American Medical Association”), alcohol, certain drugs such as the pill, etc.).
Moreover according to a study from the University of Chicago published in 2009, not enough sleep can cause hypertension.

The study showed that among the middle-aged adult, the fact of missing an hour of sleep per night on average for five years raises the risk of hypertension by 37%.

– In 10% of cases, causes of hypertension are known and this is called secondary hypertension.
The causes of hypertension can be: a problem of the renin-angiotensin system (hormonal), diabetes, kidney problems, hormonal problems, arteriosclerosis…

Virus and hypertension ?

According to a Chinese study published in August 2011, the high blood pressure could be caused by a virus. Namely a cytomegalovirus (CMV), this virus causes infections in most humans at some point in their lives but without symptoms and therefore most often goes unnoticed. The discovery could eventually lead to the development of a vaccine that would prevent the occurrence of hypertension. However, the research is only a preliminary stage and it is premature now to advance a date for the release of a vaccine.

People at risk of hypertension

– Those aged over 60 years (hypertension clearly increases with age)

– Postmenopausal women (because the hormone estrogen exerts a protective effect and as with menopause, concentration of this hormone decreases, it promotes hypertension). An estimated 27% of women in general are affected by hypertension against 21% of men.

– Being lonely (one study found a link between loneliness and hypertension)

– People with other metabolic diseases such as diabetes, overweight…

– People with unhealthy eating habits (unhealthy lifestyle): alcohol, excessive salt intake.

Symptoms of hypertension

In general hypertension is a silent disease that shows no alarming symptoms or clearly identifiable ones. This is what makes it dangerous and pernicious. Many people are unaware they have high blood pressure! It is estimated that one third person ignores that it has high blood pressure. We call it too the “silent killer”.

This is why regular monitoring to measure your blood pressure with your doctor or pharmacist is highly recommended. So, is always advisable to measure the blood pressure several times for better accuracy.

Sometimes for some people, including people with severe hypertension, symptoms may be more identifiable, they are for example: headaches, vision problems, dizziness, tiredness, nervousness, a buzzing ear, nose bleeds, palpitations…

When do we talk about high blood pressure ?

Generally we speak of hypertension when diastolic (minimum) pressure is greater than 90 mmHg, and the systolic pressure is greater than 140 mmHg. See the summary table below.

Sometimes it is estimated that a high diastolic pressure (over 80 mmHg) could mean stress (nervousness).

We can summarize the following values in a table, note that with age some values may vary (the lower limits can increase).

Table source: European guidelines on hypertension
– * Values for informational purposes only, please consult a doctor with any questions of diagnostic
– In general systolic hypertension (only, so with no diastolic hypertension) are linked to emotions. In all proven cases of hypertension, consult a doctor.
– * Below a certain pressure we can also speak of hypotension, in any questions of diagnosis and treatment, please consult your doctor.
Good tips for measuring the tension :
1. When you measure your blood pressure, remember to rest for 5 minutes before the measurement and sit comfortably. Your blood pressure will be more realistic and should theoretically decrease.
2. Remember to measure your blood pressure if possible at the same time of day in order to better analyze the results over a certain period (eg. One week).

Diagnosis of hypertension

The diagnosis of hypertension is preferably done at the beginning at a doctor’s office. The doctor uses a reliable device for measuring tension (blood pressure), if possible with a wrist blood pressure monitor. The doctor will decide, based on your age if you suffer from hypertension (see figures under symptoms) and select the most appropriate treatment for you.

Subsequently it is possible to measure the tension yourself at home or at the pharmacy, but it is strongly recommended to go nevertheless regularly to your doctor’s office to confirm the data or to adjust treatment because hypertension is a serious disease.

Complications of hypertension

Complications or risks linked to high blood pressure can be :

– Stroke (cerebrovascular accident), also called brain attack
– A heart attack (myocardial infarction)
– From the heart failure
– The dementias such as Alzheimer’s disease
– The erectile dysfunction
– Kidney problems (kidney failure)
– Vision problems (retinopathy)
– Arteriosclerosis

When to see a doctor in case of hypertension ?

Hypertension is a disease that develops slowly, is silent and rarely has symptoms so it is advisable to regularly check your blood pressure (from a certain age do a check every six months or at least every year at your doctor’s office or your pharmacy).

Hypertension medicines

To treat essential hypertension, the doctor will suggest as a first step a change of lifestyle, that is to say :

– Decrease or quit smoking (better), practical exercise, reduced salt intake, specific diet, etc… See: prevention and good advice.

Then medication may be necessary depending on your blood pressure, the theoretical goal is usually to lower systolic blood pressure below 140 mmHg and diastolic pressure below 90 mmHg.
That is said, depending on each patient (sex, age, risk) the doctor will determine a target tension to be reached, either for systolic or diastolic. Changes in lifestyle and / or drug therapy will aim to achieve these tension values. A very important factor for success is to take properly the medications and regular monitoring of blood pressure. Read also : good advice hypertension.

* Medications typically used to treat hypertension = blood pressure

Doctors can use different classes of drugs

1. Those interacting with the renin-angiotensin system :

Angiotensin converting enzyme inhibitors (ACEI) :
These drugs block the conversion of angiotensin I into angiotensin II, a hormone that is responsible for an increase in blood pressure, attention to some drugs of this class can cause side effects such as a dry cough. Molecule eg, enalapril.

Receptor antagonists blockers (ARBs) block the effect of angiotensin II (causing an increase in blood pressure) and thus acts as an antagonist.
These drugs are increasingly sold in the world, certainly for their high efficiency, some drugs are already important blockbusters (over a billion dollars in sales). Ex molecule: Irbesartan (the classes of ARBs). ARBs are antagonists of angiotensin II.

Direct renin inhibitors : for example aliskiren, it is a new class of anti-hypertensive drugs (as of 2008). This can be a good alternative to ACE inhibitors, especially if there is a dry cough as a side effect.

2. The calcium channel blockers (calcium antagonists)

This class of drug acts as an antagonist of calcium, it is responsible for the activation of smooth muscles in the heart vessels. With smooth muscle calcium channel blockers are more relaxed and the blood pressure decreases.
Attention to the possible side effects: flushing, headache, constipation, swollen ankles.

3. Diuretics :

There are different types of diuretics (osmotic, thiazides, potassium savers…). Generally their action is to increase the removal of water and sodium, which lowers blood pressure.
Important for specialist: Never associate two diuretics anti-kaliuretics and this type of diuretic with a complement of K +.

4. Beta-blockers :
They act on the sympathetic system, it is generally responsible for a reaction to stress or physical activity. By acting on this system beta-blocker drugs partially block the reactions, which generally cause an increase in blood pressure.
Important note on beta-blockers: Never stop treatment abruptly as a possible risk of tremors, sweating, angina pectoris, cardiac arrhythmia … exists. Always consult your pharmacist or doctor for information about your treatment or diagnosis.

In combination (more drugs) drug mentioned in points 1. to 4. above. Eg combine a diuretic with a beta-blocker, etc…

This is often with combined treatments that the results are more effective in lowering blood pressure, especially when the tension is above the desired therapeutic goal.
Doctors often have guidelines (an algorithm) to help them achieve their goals.

Notes :

– The different classes of antihypertensive drugs all have the same effectiveness to decrease tension. The doctor can then prescribe the drug class or molecule he knows best.
– Antihypertensive agents are among the most prescribed drugs in the world.
– According to a U.S. guideline on hypertension (source: Jama.com, July 3, 2013), in patients with mild hypertension (between 1 and 19 mmHg above the systolic goal set and 1-9 mmHg above the target diastolic blood pressure), the doctor may start by prescribing a diuretic and encourage the patient to change his lifestyle. If these two methods do not work, it may involve another class of blood pressure medication as a beta-blocker, an ACE inhibitor, etc…

Plants to treat hypertension

– Garlic appears to be a particularly effective herb to help lower blood pressure, in our opinion rather as a complementary treatment in combination with other measures or medication.
– The olive leaf is also sometimes recommended to treat hypertension, to take in capsule form. However, the scientific impact of this plant is not yet fully proven (in our opinion). It is therefore, like garlic, better to prefer conventional drug treatments.
– Hibiscus in tea may help treat mild hypertension.
– Beet, consumed especially in the form of beetroot juice has a positive effect against hypertension.
Warning hypertension is a disease with serious potential consequences, always ask your doctor or pharmacist any questions about your treatment or diagnosis.

Tips for hypertension – Hypertension Prevention

As main preventive measures and treatments to reduce the risks associated with essential hypertension, also known as change of lifestyle (lifestyle), you can :

– Limit your intake of salt, this food promotes hypertension osmosis effect (increases the absorption of water into the vessels, which increases blood pressure).

– Reduce your body weight, a BMI below 25 is very beneficial in the fight against hypertension. More healthy food and rich in fiber (fruits, vegetables…) is highly recommended.
The influence of diet to reduce hypertension is studied and we speak of the DASH concept (Dietary Approaches to Stop Hypertension).

– Make regular exercise or sport. Including endurance sports are very beneficial for reducing hypertension, as the practice of jogging, swimming, biking…

– Reduce stress : it can increase blood pressure, especially systolic pressure.

– Consume enough dairy products, as these products are rich in calcium. This mineral is very useful and plays an important role in regulating blood pressure. You can also take food supplements rich in calcium.

– Decrease if possible or stop tobacco and alcohol.

– Limit and / or control other metabolic diseases such as diabetes or cholesterol.

– Eat every day two squares of dark chocolate would lower the pressure by German researchers (study published in July 2007).

– If you take antiyhypertensiv drugs respect the regular use of these drugs. According to a U.S. survey in 2005, after a year of treatment with antihypertensive drugs, half of those analyzed had stopped taking their treatment !

– Acupuncture may help lower blood pressure. However, according to a book of the famous “Mayo Clinic” in the United States acupuncture remains controversial to treat hypertension, but if acupuncture is done by a professional serious health risk remains low and therefore that is safe to try this alternative method.

– Consumption of omega-3 can help lower blood pressure. That said taken at a too high dose (more than 3 grams per day) risk of bleeding (too thin blood) may exist.

Talk to your doctor to find the right dosage.

– Co-enzyme Q10 is also recommended in cases of hypertension, according to the “Mayo Clinic” (a famous American clinic) we still lack hindsight to know the long-term effects of consumption of coenzyme Q10.

– The potassium intake is beneficial for lowering blood. For exact dosage, ask your doctor or pharmacist.

– Some alternative techniques like yoga and qi gong can also have a positive effect on hypertension.

– Drinking coffee, it increases the blood pressure at the time but lowers over time.

Indeed, according to a Swiss study published in April 2012 led the team Murielle Bochud, CHUV in Lausanne (Switzerland), a coffee a day reduce some people’s blood pressure up to 9 millimeters of mercury. This advice is only valid for non-smokers. For the genetic level smoke masks the protective effect of coffee.