Hypertension

Key Facts

• Hypertension – or high blood pressure – is a serious pathological condition that significantly increases the risk of developing diseases of the cardiovascular system, brain, kidneys and other diseases.
• An estimated 1.28 billion adults aged 30–79 worldwide have hypertension, the majority (two-thirds) of whom live in low- and middle-income countries.
• An estimated 46% of adults with hypertension are unaware they have the condition.
• Less than half (42%) of adult patients with hypertension are diagnosed and treated.
• Approximately one in five (21%) hypertensive adults have the disease under control.
• Hypertension is one of the leading causes of death worldwide.
• Reducing the prevalence of hypertension by 33% between 2010 and 2030 is one of the global targets for the control of noncommunicable diseases. 

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What is hypertension?

Blood pressure is the force exerted by circulating blood on the arteries, the most important blood vessels in the body. Hypertension is characterized by an excessive increase in blood pressure.

Blood pressure is described by two indicators. The first indicator (systolic pressure) is the pressure in the blood vessels at the time of contraction, or contraction, of the heart muscle. The second indicator (diastolic pressure) is the pressure in the vessels at the moment when the heart is at rest between two contractions.

The diagnosis of “hypertension” is made in cases where, according to pressure measurements taken on two different days, the value of systolic pressure on both days is equal to or exceeds 140 mm Hg. Art. and / or the value of diastolic pressure on both days is equal to or greater than 90 mm Hg. Art.

What are the risk factors for hypertension?

Manageable risk factors include unhealthy diets (excessive salt intake, high levels of saturated fat and wasters, insufficient consumption of fruits and vegetables), physical inactivity, tobacco and alcohol use, and overweight and obesity.

Uncontrollable risk factors include a family history of hypertension, age over 65, and comorbidities such as diabetes or kidney disease.

What are the typical symptoms of hypertension?

Hypertension is called the “silent killer”. Most patients with hypertension are not even aware of the problem, since hypertension often does not give alarms and is asymptomatic. This is why it is so important to measure your blood pressure regularly.

If symptoms do occur, they may include headaches in the early morning hours, nosebleeds, abnormal heart rhythms, blurred vision, and ringing in the ears. Severe hypertension can cause weakness, nausea, vomiting, confusion, internal tension, chest pain, and muscle tremors.

The only way to detect hypertension is to have your blood pressure measured by a healthcare professional. Measurement of blood pressure is carried out quickly and painlessly. Although it is possible to measure blood pressure yourself using automatic devices, a medical specialist should conduct an examination to assess the risk and related disorders.

What are the complications of uncontrolled hypertension?

Among other complications, hypertension can cause serious damage to the heart. Excessive pressure can cause the walls of the arteries to lose their elasticity and reduce the flow of blood and oxygen to the heart muscle. This increased blood pressure and reduced blood flow can cause:

• chest pain, also called angina;
• a heart attack that occurs when blood flow to the heart is blocked, as a result of which the heart muscle cells die from oxygen starvation; the longer blood flow is blocked, the more serious the damage to the heart;
• heart failure, in which the pumping function of the heart muscle cannot fully provide other critical organs with blood and oxygen;
• cardiac arrhythmia, which can lead to sudden death.

Hypertension can also cause a stroke by tearing or blocking the arteries that supply blood and oxygen to the brain. In addition, hypertension can be a cause of kidney failure caused by kidney damage.

Why is hypertension relevant in low- and middle-income countries?

The prevalence of hypertension varies across regions and countries across income groups. The prevalence of hypertension is highest in the WHO African Region (27%) and lowest in the Region of the Americas (18%).

The number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015, predominantly in low- and middle-income countries. This increase is mainly due to increased risk factors for hypertension among the populations of these countries.

How can the burden of hypertension be reduced?

Lowering high blood pressure prevents heart attacks, strokes, and kidney damage, among other health problems.

Prevention

• Reducing salt intake (to less than 5 g per day)
• Increasing the proportion of fruits and vegetables in the diet
• Regular physical activity
• Tobacco cessation
• Reducing alcohol consumption
• Limiting the intake of foods high in saturated fat
• Exclusion of trans fats from the composition of food products or reduction of their content

Case Management

• Reduction and control of stress conditions
• Regular blood pressure check
• High blood pressure treatment
• Treatment of other diseases

How is WHO responding to the problem of hypertension?

The World Health Organization (WHO) is supporting countries in reducing the prevalence of hypertension as a public health problem.

In 2021, WHO released new guidelines for the pharmacological treatment of hypertension in adults . The publication provides evidence-based recommendations on when to start treatment for hypertension, as well as recommended patient follow-up intervals. The document also outlines the blood pressure targets to be achieved to control hypertension and provides information on health system actors who can initiate treatment.

In September 2016, to help governments improve the prevention and treatment of cardiovascular disease, WHO and the United States Centers for Disease Control and Prevention (USCDC) launched the Global Hearts initiative, which developed the HEARTS technical intervention package. The six modules of the HEARTS technical package (healthy lifestyle counseling, evidence-based treatment protocols, access to essential medicines and technologies, risk-based management, team care and monitoring systems) provide a strategic approach to promoting cardiovascular health. -vascular system in various countries of the world.

In September 2017, WHO partnered with Vital Strategies’ Resolve to Save Lives initiative to support governments in implementing the Global Hearts initiative. Other partners involved in the Global Hearts initiative include the US CDC Foundation, the Global Health Advocacy Incubator, the Johns Hopkins Bloomberg School of Public Health, the Pan American Health Organization (PAHO), and the US CDC. Since the program began in 2017, 3 million people in 18 low- and middle-income countries have been treated for hypertension through appropriate protocols through patient-centered care models.

The higher the blood pressure, the higher the risk of damage to the heart or blood vessels in major organs such as the brain or kidneys. Hypertension is the most important preventable cause of heart disease and stroke worldwide. Uncontrolled hypertension can lead to a heart attack, an enlarged heart, and eventually heart failure. Hypertension can also lead to kidney failure, blindness, and cognitive impairment.

The health consequences of hypertension can be exacerbated by other factors that increase the likelihood of heart attack, stroke, and kidney failure. These factors include tobacco use, unhealthy diets, harmful use of alcohol, physical inactivity and persistent stress, as well as obesity, high cholesterol and diabetes.

All adults should monitor their blood pressure, knowing your blood pressure is important. In case of high blood pressure, a healthcare professional should be consulted.

For some people, lifestyle changes such as quitting tobacco use, eating healthy, exercising regularly, and avoiding the harmful use of alcohol may be enough to normalize blood pressure. It can also be helped by reducing salt intake.

For other people, these changes are not enough, and they need drugs to regulate their blood pressure.

Adults should support treatment by following medical orders and monitoring their own health. People with high blood pressure who also have high blood sugar, high blood cholesterol, or kidney problems are at an increased risk of heart attack and stroke. Therefore, it is important to check your blood sugar, blood cholesterol, and urine protein levels regularly.

To minimize the risk of developing high blood pressure and its adverse effects, each person can take five specific steps:

• Organize a healthy diet: reduce salt intake to less than 5 g per day (just under one teaspoon); eat five servings of fruits and vegetables a day; reduce saturated fat intake and total fat intake.
• Avoid the harmful use of alcohol.
• Engage in physical activity: regularly maintain physical activity and encourage physical activity of children and young people (at least 30 minutes a day); maintain normal weight: Losing every 5 kg of excess weight can reduce systolic blood pressure by 2-10 points.
• Cease tobacco use and exposure to tobacco products.
• Manage stress in healthy ways such as meditation, proper exercise, and positive social contacts.

Treatment of hypertension. New effective methods.

Essential hypertension (hypertension) is a chronic disease, the main symptom of which is a persistent increase in pressure in the vessels. Approximately one in 4-5 adults has high blood pressure.

Factors that most often provoke the occurrence of CVD:

• overweight;
• eating salt in large quantities;
• sedentary lifestyle;
• alcohol abuse;
• smoking;
• genetic predisposition;
• stress.

Hypertension is often symptom free but when it is symptomatic the main symptoms are:

• headache;
• dizziness;
• noise in ears;
• blurred vision, flickering before the eyes;
• heartache;
• anxiety, insomnia.

To detect the disease, it is necessary to control blood pressure for 1 month (measure twice a day).
Optimal blood pressure ꞊ 120/80 mm Hg. Art.
Normal blood pressure = 120-129 / 80-84 mmHg Art.
High normal blood pressure = 130-139 / 85-89 mmHg Art.

Higher blood pressure indicates hypertension!

There are such degrees of hypertension:

• First degree 140-159 / 90-95 mmHg Art.
• Second degree 160-179 / 100-109 mmHg Art.
• Third degree above 180/110 mm Hg. Art.

The uncontrolled course of hypertension leads to a hypertensive crisis and, as a result, to the development of various cardiovascular events: stroke, heart attack. The consequences of this may be disability or even death of the patient. Ukraine ranks first among European countries in terms of mortality from cardiovascular diseases.
Therefore, an important component in the treatment of hypertension is the constant monitoring of blood pressure and adjusting it by taking medication as prescribed by a doctor. It is also necessary to eliminate or reduce the influence of factors contributing to the development of the disease (listed above).

What is blood pressure and what indicators are considered normal?

Blood pressure is a general concept that determines the force with which blood presses on the walls of blood vessels, it is more correct to call it blood pressure, because pressure is important not only in the arteries, but also in veins and capillaries. But it is possible to measure without the help of special instruments only the pressure in large vessels located on the surface of the body – in the arteries.

Blood pressure – blood pressure – depends on how fast and force the human heart contracts, how much blood it can pump in one minute, on the properties of the blood itself and the resistance of the walls of blood vessels.

Factors affecting the magnitude of blood pressure:

• the ability of the heart to contract with sufficient force and ensure a normal ejection of blood through the vessels;
• from the rheological properties of blood – the “thicker” the blood, the more difficult it is to move through the vessels, diseases such as diabetes mellitus, increased clotting, greatly impede blood flow and can lead to problems with blood pressure, with thick blood, some doctors in the past use to prescribe treatment with leeches;
• elasticity of the walls of blood vessels – blood vessels wear out over time and cannot withstand increased stress – this causes the development of hypertension in the elderly,
• atherosclerotic changes – reduce the elasticity of the walls;
• a sharp narrowing or expansion of blood vessels – as a result of nervous shocks or hormonal changes, a sharp narrowing or expansion of blood vessels is possible – for example, with fear, anger or other strong emotions;
• diseases of the endocrine glands.

Normal pressure is determined by a combination of a large number of parameters, and for each age, gender and for an individual, its indicators can vary greatly. For medical norms, average indicators are taken from healthy people of a certain age. It has long been proven that a pressure of 120/80 cannot and should not be considered the ideal norm for people of different ages.

To find out what normal pressure a person should have at different age periods, you can use the following table.

Adult blood pressure readings:

• Normal blood pressure is considered to be between 110/70 and 130/85 mm. rt. Art.
• Reduced normal pressure – 110\70 – 100\60;
• Low blood pressure – hypotension – below 100/60;
• Increased normal pressure – 130\85-139\89;
• High blood pressure – hypertension – more than 140\90 mm. rt. Art.

Indicators of normal blood pressure for different age periods:

• 16 – 20 years old – 100 \ 70 – 120 \ 80 mm. rt. Art.
• 20 – 40 years – 120\70-130\80;
• 40 -60 – up to 140\90;
• over 60 years old – up to 150\90 mm. rt. Art.

From the table above, it can be seen that the greater the age of a person, the higher the normal blood pressure, this is due to age-related changes in the vessels, in the heart muscle and in other organs. High blood pressure, as well as low blood pressure, can cause various health problems, but in order to determine whether a change in the level of pressure is to blame for feeling unwell, it is necessary to regularly measure it and keep a special diary. For this, several trips to the clinic or visits to the doctor are not enough, only daily regular pressure measurements can give the correct results.

Measurement.

The correctness of the diagnosis and the appointment of treatment largely depends on the correctness of the measurement of blood pressure, because the doctor, prescribing a medicine or prescribing treatment, is largely guided by the measurement numbers.

Today there are different ways to measure pressure:

1. The simplest and oldest – with the help of a cuff and a tonometer – it is of great importance here to correctly apply the cuff, the ability to use a tonometer and listen to heart sounds. Such a measurement requires special training and skills, but when used correctly, it gives fairly accurate and reliable results.
2. Electrotonometer – the principle of operation is the same, but the results are visible on a special scoreboard. This facilitates self-measurement of pressure and provides more accurate results. But such blood pressure monitors often break down and may show incorrect numbers.

No matter how blood pressure is measured, a few general rules must be observed:

• before measurement, half an hour before the start, exclude physical activity, nervous tension, smoking, eating, and so on,
• relax, sit comfortably when measuring,
• the posture should be comfortable, the back should be straight, support is required, the arm should lie freely at the level of the patient’s chest,
• during the measurement, you can not talk and move,
• the measurement is carried out on both hands and it is desirable to conduct a series of measurements with an interval of 5-10 minutes.

If, after a correctly measured blood pressure, the readings are very different from the norm, you need to repeat the measurements within a few days and, if confirmed, consult a doctor.

Increased blood pressure.

Considered one of the most dangerous diseases of mankind, about 25% of people worldwide suffer from hypertension, and this figure continues to increase. Hypertension is an increase in blood pressure above 140/90 mm. rt. Art. The causes of hypertension can be:

• overweight,
• genetic predisposition,
• diseases of the internal organs,
• lack of physical activity
• smoking and drinking alcohol,
• excessive consumption of salt,
• nervous stress,
• other factors.

With hypertension, the patient suffers from headaches (and here headache pills will not help), shortness of breath, heart pain, fatigue, insomnia, feeling unwell and other symptoms. In addition, the risk of developing cardiovascular diseases, brain damage, pathology of the urinary system and eye diseases increases.

The treatment of hypertension is a very complex and time-consuming process, where the outcome of the disease depends on the observance of the doctor’s recommendations. It is important to find the cause of the increase in pressure and act on it. At the same time providing symptomatic treatment. In each case, drugs, doses and their combination should be selected individually by the attending physician.

Without timely treatment or uncontrolled use of drugs, hypertension can not only severely damage health, but also cause such a life-threatening condition as a hypertensive crisis.

Hypertensive crisis.

A hypertensive crisis is a life-threatening condition caused by a sharp increase in blood pressure and damage to the nervous system and target organs. The blood pressure figures in a hypertensive crisis can vary greatly in different patients – someone normally tolerates 200\150 mm. rt. st, and someone feels bad already at 150 \ 85 mm. rt. Art. The nature of the lesions in GC depends on the organs in which the pathology was previously – if the heart hurt, myocardial infarction may occur, if it was tormented – headaches – then a stroke, and so on.

Causes of GC can be:

• psycho-emotional stress,
• exercise stress,
• weather changes,
• drinking alcohol,
• rich food with high salt content,
• improperly selected antihypertensive drugs,
• diseases of the endocrine system and internal organs.

With the development of GC, the patient’s well-being deteriorates sharply, there is a feeling of fear, anxiety, nausea, vomiting, darkness before the eyes, swelling and flushing of the face, chills, tremor of the limbs, fainting, up to coma.

If such symptoms appear, you need to lay the patient on any flat surface with a raised headboard and urgently call an ambulance. Before her arrival, try to provide the patient with peace, an influx of fresh air, get rid of tight clothing, if the patient has had hypertension for a long time, then most likely he is taking some kind of antihypertensive drug, in this case, you can give the patient the usual dosage before arrival.

Hypotension, low blood pressure.

For many people, especially those suffering from hypertension, it seems that lowering the pressure can not be a problem, but in fact it is not. Constantly low blood pressure can cause no less inconvenience and cause health problems than hypertension.

The causes of this pathology can be hereditary predisposition, poor nutrition and beriberi, endocrine diseases, nervous strain, general exhaustion of the body and other problems.

A person suffering from hypotension constantly feels tired, overwhelmed, he hardly performs daily duties and is emotionally retarded. In addition, there is a decrease in memory and brain activity, poor thermoregulation, increased sweating, headaches, drowsiness, pain in the joints and muscles, and a general deterioration in well-being.

Although unlike hypertension, hypotension does not cause serious health problems, it also needs to be treated. And only a doctor can determine the cause of hypotension and prescribe treatment, after a detailed examination. And without medical help, we can advise you to establish a regime of work and rest, eat well, not be nervous and give up bad habits.

What do you need to know, be able to and most importantly do in order to feel good?

1. Know what hypertension is and how to control it.
In modern medicine, arterial hypertension is commonly understood as a persistent increase in blood pressure up to 140/90 mm Hg . and higher in the absence of drugs that reduce blood pressure. It is important to remember that an increase in blood pressure should be recorded at least twice with an interval of two weeks. There are three degrees of increase in blood pressure.

Categories	Systolic blood pressure, mm Hg	Diastolic blood pressure, mm Hg
Normal	< 130	< 85
high normal	130-139	85-89
hypertensionI degreeII degreeIII degree	140-159 160-179 180 and above	90-99 100-109 110 and above
Isolated systolic hypertension	> 160	< 90

However, in addition to the degree of arterial hypertension, the doctor in the diagnosis indicates the degree of risk of developing cardiovascular complications (myocardial infarction, cerebral stroke, etc.). There are four degrees of risk of developing cardiovascular complications: low, medium, high and very high. Low risk means that in the next 10 years the probability of developing cardiovascular complications is less than 15%, and at very high risk more than 30%. In other words, out of 100 hypertensive patients with a low risk of developing cardiovascular complications, no more than 15 people will end up in a hospital with these complications within 10 years, and among people with a very high risk, more than a third of patients will suffer cardiovascular accidents. In order to correctly determine the risk of arterial hypertension, it is necessary to undergo an examination,
It is important to know that the awareness of each patient about their own risk factors is necessary not only to determine the prognosis and sadness about their fate. Remember that knowing about the harm to the body of certain risk factors, they can be influenced. You can change the prognosis of your illness and, consequently, your life for the better. Many people know the sad epithet that arterial hypertension has received – “silent killer”. But it is better to remember another thesis – arterial hypertension is a manageable  risk factor for cardiovascular diseases. This means that any patient with arterial hypertension, together with a doctor, is able to cope with his illness.
 

Non-pharmacological treatments (or, more precisely, lifestyle modification) are indicated for all patients with arterial hypertension, regardless of its degree and medications.
A healthy lifestyle can lower blood pressure levels and reduce the amount of medication. But very often, compliance with health recommendations requires the patient to reconsider and overcome the usual daily routine, to show willpower.
First, you need to forcegive up bad habits and a sedentary lifestyle. First of all, stop smoking. Why is smoking dangerous? Because even one cigarette increases blood pressure for 15 minutes, with constant smoking, vascular tone increases, and the effectiveness of drugs decreases. If a person smokes 5 cigarettes a day – this is a 40% increase in the risk of death, if one pack a day – 400%, then there are 10 times more likely to die!
Rational nutrition is a balanced, regular (at least 4 times a day) diet with limited salt intake. Salt is harmful not only to hypertensive patients, but also to patients with other cardiovascular diseases. Research scientists have shown that if you limit your salt intake, the risk of myocardial infarction and other cardiac events can be reduced by 25%. No more than 5 grams of salt (teaspoon without top) – that’s the daily dose of hypertension. At the same time, it must be remembered that there is 10 times more salt in sausage than in natural meat. It is very useful to increase the intake of foods containing potassium and magnesium (seaweed, raisins, beets, apricots, zucchini, pumpkin, buckwheat). It is important to control your weight .. To estimate your weight, use a simple formula for determining body mass index (weight (kg) / height (m ²) = body mass index). If the body mass index is more than 28 for women and 30 for men, we can talk about obesity. It is with the obesity epidemic that has hit many countries that scientists attribute the increase in the number of people with high blood pressure.
Regular exercise is very important for both fighting obesity and lowering blood pressure. Even moderate, but constant physical training helps to reduce blood pressure by 10-15 mmHg. Brisk walking in the fresh air, cycling, swimming for 30-40 minutes 6-7 times a week are the most physiological types of exercise for patients with arterial hypertension. Isometric loads, such as barbell exercises, are not recommended.
Before engaging in physical training, you should consult a doctor, or even better, start exercising with a methodologist in physiotherapy exercises.
Doctors today call non-drug treatments for hypertension lifestyle modification, because only lifestyle changes, and not short-term dietary measures and occasional exercise, can really help lower blood pressure. And one more thing we forget. Dear parents and teachers, healthy lifestyle activities should be taught already in childhood and adolescence, when the foundations of human behavior and lifestyle are laid. It is no secret that the hereditary factor is of great importance in the development of hypertension, and in children, an increase in blood pressure can begin 10-12 years earlier than in their parents, if measures are not taken for a healthy lifestyle.

To what level should blood pressure be reduced?

After large clinical studies in which several tens of thousands of patients were observed and received drugs, scientists have determined the target levels of blood pressure to be aimed at in the treatment of arterial hypertension. The target level of blood pressure is such figures of blood pressure at which the risk of complications, including fatal ones, will be minimal. The target level of blood pressure largely depends on concomitant diseases. For patients with arterial hypertension, the target blood pressure level should be below 140/90 mm Hg. If hypertension is associated with diabetes mellitus, the target blood pressure should be below 130/85 mm Hg. Of course, for most patients with hypertension, to achieve such levels of blood pressure, it is necessary to constantly take antihypertensive drugs.
So we come to medicationpatients with arterial hypertension. Currently, the pharmaceutical market of our republic presents drugs from all five groups of drugs that the European Society for Cardiology and the European League for Arterial Hypertension recommend for the treatment of patients with arterial hypertension. These are angiotensin-converting enzyme inhibitors, diuretics, calcium channel antagonists, beta-receptor blockers, angiotensin II receptor antagonists. It should be noted that effective control of blood pressure levels is rarely possible with only one drug. Most patients for adequate control of blood pressure should receive 2-3 drugs. For the convenience of treatment, many fixed combinations of drugs are now offered, which contain two drugs with different mechanisms of action. The optimal drugs or combinations of drugs are those that act smoothly throughout the day, have a protective effect on target organs, do not worsen the carbohydrate and lipid profile, and also do not reduce the performance and quality of life of patients. Where can you get such a pill? They are in our pharmacies, and moreover, in a wide economic range. The Belarusian pharmaceutical industry is actively involved in the production of domestic antihypertensive drugs, which has reduced their cost. It is only necessary to remember that each patient with hypertension has his own pill and only a doctor can prescribe it correctly. That is why patient follow-up is so important. During the period of selection of the dose of an antihypertensive drug, at least monthly visits to the doctor are recommended. Very well, if the patient keeps a diary of blood pressure self-monitoring, measuring it twice in the morning and twice in the evening. The average results of these measurements should be recorded in a diary and shown to the doctor at the visit. When the target level of blood pressure is reached, the doctor can be visited no more than once a quarter / half a year. Be sure to conduct a control examination of target organs once a year, because modern drugs can not only reduce blood pressure, but also reduce the thickness of the walls of the left ventricle of the heart, increase the elasticity of blood vessels, and prevent the development of renal and heart failure.

And remember, when choosing a medicine, you and your doctor are allies, not opponents. The effectiveness of treatment largely depends on the patient himself, his adherence to the prescribed treatment, since it must be long-term, often throughout life.