CARDIAC PATHOLOGIES
HIGH BLOOD PRESSURE
High blood pressure (hypertension) is characterized by abnormally high blood pressure (BP) in the arteries. Blood pressure measures the force exerted by the blood against the walls of the arteries while the heart pumps blood through the body.
Normally, blood pressure rises and falls throughout the day in response to different activities and situations, but consistently high blood pressure can put excessive pressure on blood vessels and organs, which can lead to serious complications, including heart disease (atheroma, infarction, hypertrophic heart disease, heart failure..), strokes, kidney problems, dementia, vascular occlusion of small cerebral and ocular vessels, the formation of thromboses...
The causes of hypertension can vary and can include genetic factors, lifestyle (such as diet, exercise, smoking, alcohol consumption), obesity, stress, certain underlying diseases (such as kidney or endocrine disease), and taking certain medications.
Hypertension is suspected on repeated blood pressure measurements taken during medical visits and must be confirmed by ABPM (24-hour ambulatory blood pressure measurement) or self-measurement of blood pressure. Normal blood pressure is generally defined as systolic pressure (the maximum pressure when the heart contracts) less than 120 mmHg and diastolic pressure (the minimum pressure when the heart rests between beats) less than 80 mmHg.
The epidemiological associations between BP (blood pressure <=> blood pressure) and cardiovascular risk extend from very low BP levels [i.e., systolic BP >115 mmHg].
However, hypertension is defined as the level of BP at which the benefits of treatment (whether with lifestyle interventions or medications) unequivocally outweigh the risks of treatment, as documented by clinical trials.
The attached table (ESC recommendation) defines the voltage levels based on the blood pressure measurement in the office.
A BP in the office at 140/90 is the equivalent in self-measurement of a BP at 135/85 and in ABPM of a BP at 130/80, because the BP in the office is always a little higher than that at home, or even very different in the case of hypertension known as "white coat", and the measurement conditions are different from those of self-measurement (in the quiet lying at home in the morning and evening) and ABPM measurements that take takes into account the BP during the day (normal < 135/85) and at night (normal < 120/70), since physiologically the BP decreases at night. Otherwise, (abolition of the nycthemeral rhythm), sleep apnea is strongly suspected.
​
Treatment of hypertension may involve lifestyle modifications such as regular exercise, a balanced diet, and reducing salt, alcohol, and licorice intake as well as taking antihypertensive medications as needed. Regular blood pressure monitoring is essential to prevent complications and maintain good cardiovascular health.
Learn more about hypertension:
In hypertensive patients, and compared to normotensive patients, cardiovascular mortality is doubled due to a greater incidence of cardiovascular complications:
• stroke (× 7);
• atrial fibrillation;
• coronary artery insufficiency (× 3) and in particular acute coronary syndromes;
• arterial disease of the lower limbs (× 2);
• heart failure (× 4);
• end-stage chronic kidney disease;
• vascular dementia.
​ Pathophysiology of hypertension:
A - Reminder of the regulating systems
Short-term regulation of BP is done by the sympathetic system via the carotid and aortic baroreflex, the centers in the reticular formation of the brainstem (vasopressor center), the arterial effector pathways from the laterovertebral sympathetic chains as well as the adrenal medulla. The neurotransmitters are α1-adrenergic vasoconstrictors or β2-adrenergic vasodilators.
The medium-term regulation of blood volume and vasomotricity is done by the renin-angiotensin-aldosterone system and natriuretic peptides (ANP and BNP).
Long-term regulation is done by the phenomenon known as pressure natriuresis, which corresponds to an excretion of sodium ions by the kidney in the event of pressure overload and by the arginine-vasopressin system.
B - Pathophysiological hypotheses
More than 90% of cases of hypertension are said to be essential hypertension and the consequence of aging, overweight and heredity, compared to 10% of cases of so-called secondary hypertension, which are essentially of renal or adrenal causes.
An increase in the contraction of the arterioles is observed during essential hypertension in young subjects with elevation of the DBP (diastolic BP). The loss of flexibility of the arteries (decrease in compliance) is observed during essential hypertension in the elderly subject with elevation of SBP (systolic blood pressure). These abnormalities of the arterial system observed in essential hypertension make essential hypertension considered today as a disease of the arteries.
A defect in long-term sodium excretion has been highlighted as the main mechanism of essential hypertension: this concerns about 40% of hypertensive patients who are said to be "salt-sensitive".
Other hypotheses concern the autonomic nervous system or the renin-angiotensin-aldosterone system, angiotensin 2 would induce calcium overload of the arterial wall via IP3/DAG (inositol triphosphate/diacylglycerol) signaling.
Essential hypertension is a family disease in 15% of hypertensive patients. It begins in an adult before the age of 30 with hypertension in the father or mother with a start before the age of 50. This hypertension is of polygenic cause without the possibility of performing a genetic test today.
Lifestyle factors act as aggravating factors, such as salt intake, overweight, alcohol consumption, insufficient fruit and vegetable intake, excessive sedentary lifestyle, etc.
C-Hygienic and dietary measures essential for all hypertensive patients, and others...
​
Instituted in all patients, their goal is to reduce BP, control other risk factors or pathologies, reduce cardiovascular risk and minimize the number and dose of antihypertensive drugs:
• Quitting smoking;
• Weight reduction in overweight or obese subjects. As body weight gradually increases with age, stabilizing weight can be considered an interesting goal, otherwise we aim for a BMI < 25 kg/m2;
• elimination or reduction of alcohol consumption < 30 mL/day for men and < 15 mL/day for women (3 and 2 standard drinks respectively);
• regular physical activity: ≥ 30 minutes ≥ 5 times a week;
• reduction in sodium intake (< 6–8 g/day),
• Enriched food intake of fruits and vegetables with reduced intake of saturated fats and cholesterol, and more frequent consumption of fish.
MAKE AN APPOINTMENT ON
