Arterial hypertension and organ damage

1. Gastroepato
2. Cardiology
3. Arterial hypertension and organ damage

A patient suffering from elevated blood pressure cannot remain calm but must know that he may have complications.
The problems are represented by organ damage.
It means, for example, that the heart, the eye, the arterial vessels are subjected to damage because they are subject to high blood pressure values.
This corruption can be irreversible.
It is clear to all of you that the tires of your car swell to 1.8 -2 ATA.
Nobody would inflate a 5 ATA pressure tire!

Why leave a high pressure inside your vessels?
The heart that works against the "post-load" represent high blood pressure, like any muscle, undergoes hypertrophy and struggles, but this modification of the structure of the heart is not a useful transformation. In fact, a hypertrophic heart is an enlarged organ, with dilated cardiac chambers: it can undergo alterations such as ischemic heart disease and arrhythmias.
We can understand this when we read an electrocardiogram and we discover that the "pen strokes" of the track have an excessive size which results in the alterations of the ECG that we technically call the Sokolow-Lyon index.Indice di Sokolov

The eye of a patient with elevated pressure undergoes changes in the arterioles of the fundus of the eye (hypertensive retinopathy).

Who is writing this article, subjected to the stress of continuous shifts in the hospital, one evening suffered the devastating effects of a blood pressure of 200/100 mmHg.
In fact, to work at night, a doctor continues to have coffee, is always open and stresses himself to overcome his human limits.

So, sooner or later, a doctor could get sick and have high blood pressure, he was felt like a weight in the chest, almost as if I was short of breath.
For this reason, anyone who is reading this article and is subjected to exhausting work must check their blood pressure to avoid damage to their body. Finally, remember that the kidney works under the pressure that generates the heart: in the case of high pressure, the kidney undergoes a damage that we call "hypertensive glomerulopathy". (see >> Complications of hypertension).

If, in addition to high blood pressure, you smoke and drink coffee, stand still in the office chair, eat badly and seasoned with lard and butter, if you eat sweets, you are diabetic and stressed, you must immediately think about changing your lifestyle and make checks .
But what should normal pressure be?
What are the treatments for pressure?


According to the ESH / ESC guidelines, "Guidelines for the Management of Arterial Hypertension", the patient is defined as hypertensive who does not fall within the pressure "normal" meters, ie the optimal pressure, in the optimal range between <120 and <80 for the minimum mmHg.

Arterial hypertension, Systolic (mmHg) and Diastolic (mmHg) category

Optimal <120 and <80
Normal 120-129 and / or 80-84
Normal-high 130-139 and / or 85-89

In addition, patients are divided into different stages of hypertension, according to the risk they present of developing organ damage, according to the cardiovascular risk calculation table.

Stages of arterial hypertension

Hypertension - stage 1 140-159 and / or 90-99 mmHg
Hypertension - stage 2 160-179 and / or 100-109 mmHg
Hypertension - stage 3 ≥ 180 and / or ≥110 mmHg
Isolated systolic hypertension ≥140 and / or <90 mmHg

But one of the problems that the clinician must face to understand if a patient is already suffering from organ damage is to evaluate some parameters, through a careful visit of the patient and the acquisition of parameters through instrumental investigations of the patient. For example. if the signs of hypertrophy of the left ventricle appear at the electrocardiographic tracing, I still proceed with an echocardiography, in order to better quantify the damage of cardiac organ, for the purpose of the correct evaluation of hypertrophic heart disease

Signs of organ damage in high blood pressure

Cardiological and vascular signs
LVH (Sokolow-Lyon> 38mm; Cornell> 2440mm * ms)
LVH echocardiography (LVMI> 125 g / m2, W> 110 g / m2
Thickening of the carotid wall> 0.9 mm at the TSA echocolordoppler investigation
Carotid / femoral pulsation wave> 12 m / s
Arm / ankle index <0.9 (i.e. arm pressure / ankle pressure ratio)


Nephrological signs of damage for arterial hypertension
Slight increase in creatinine parameters:
M: 115-133 1.3-1.5 mg / dl
F: 107-124 1.2-1.4 mg / dl


Percentage of glomerular filtrate <60ml / min / 1.73 m2 or clearance <60ml / min
Microalbuminuria 30-300 mg / 24 or albumin / creatinine ratio> 22 (M) or> 31 mg / g (F)

At the time when cardiovascular damage becomes full-blown, then we can have the following pathologies always related to poor management of the hypertensive patient.
• Cerebrovascular disease: vascular patient, ischemic stroke, hemorrhagic stroke, transient ischemic attack
• Cardiovascular disease: myocardial infarction, angina pectoris, heart failure
• Kidney disease: diabetic nephropathy, the patient with increased blood urea nitrogen (serum creatinine M> 133, F> 124 mmol / l, proteinuria> 300 mg / 24
• Peripheral artery disease (AOCP)
• Complicated retinopathy: bleeding and exudates, papilloedema (see also diabetic retinopathy)
• Arterial hypertension and organ damage, markers

Cardiology