Dr Claudio Italiano,
your medical friend
Do you have shopping bags in hand and you have to stop because you're tired and you feel your heart in your throat?
Have you measured your blood pressure?
Do you suffer with heart and have heart failure?
Talk to your doctor, after reading this article and, anyway, measure your pressure on several occasions during the day, possibly going to your pharmacist or, more simply, to your home with a pressure measuring device, preferably classic.
Measuring the pressure with the old system is easy!
After attaching the blood pressure cuff and placing the phonendoscope in the in the crease of the elbow, pump the air up to 200 mmHg (A). In this way it blocks the circulation of the arteries of the arm.
Slowly, you have to deflate the cuff until the blood flows again (B), while observing the pressure gauge with the eye, and at the same time you are listening: the first tone that you hear in your ears is the maximum pressure, that is when the first flow of blood into the artery, pushed by the heart, which exceeds the pressure of the arm which pushes on the arm; the last tone of the pushing heart is the minimum pressure.
Easy, right?
Arterial pressure is the result of:
- thrust of the heart on the wall of the arteries during the phases of cardiac
activity
- vessel resistances to flow passage
It is a function of the contraction of the left ventricle (systole) and its relaxation (diastole).
In the systolic phase the maximum pressure value (systolic or maximum pressure) is detected, while in diastole the minimum value (diastolic or minimum pressure)
Arterial pressure therefore depends on the force with
which the heart pumps blood into the system of the arterial vessels and the
resistance they present to the flow; that is, if my heart does not make it, that
is if it is insufficient as a pump, my pressure will be low, if, vice versa, my
vessels are narrow, for example for a stenosis (narrowing), the pressure will be
high and the flow will be whirling and turbulent, sometimes visible to the
auscultation as a "breath".
It is a hypertensive subject who has a higher pressure (from the Greek "hyper", hight), that is a blood pressure higher than normal (see the table); the heart must work harder to push the blood into the bloodstream and, in the long run, this state leads to damage to the arteries, starting with the smaller arterioles, especially the kidneys and the retina.
A patient with diabetes must bring blood pressure even lower than an individual without diabetes, for example 120 mmHg for systolic pressure and 65 for diastolic.
Only in 5% of cases the cause of hypertension is known (chronic renal failure, pheochromocytoma, renal artery stenosis, drugs, Conn syndrome, etc.); In these cases we define hypertension secondary to a known pathology and not as a primary hypertension.
In about 95%, however, it is not attributable to any identifiable cause and therefore the hypertension is called primitive, idiopathic or essential.
However, there are
some predisposing factors, able to modify the arterial pressure: genetic,
environmental, allotment factors exercise, diet and stress.
In particular :
Hypertensive heart disease: hypertrophy of the left ventricle due to hypertension organ damage due to resistance to blood flow
Systolic blood pressure (mmHg) - Diastolic blood pressure (mmHg)
Optimal: <120- <80
Normal: 120-129 - 80-84
Normal high: 130-139 - 85-89
Grade I hypertension: 140-159- 90-99
Grade 2 hypertension: 160-179 - 100-109
Grade 3 hypertension:> 180 -> 110
Isolated systolic hypertension:> 140 - <90
It was the great Italian doctor Scipione Riva-Rocci who invented the mercury sphygmomanometer and the first to measure the pressure using a cuff with a pressure gauge to measure the pressure (sphygmomanometer) that he inflated with a pump; when the pressure of the cuff was able to block the vessel, that is the radial artery, then that was the pressure of the systole, that is, that which derives from the pulsation of the heart (systolic pressure).
The doctor rests the phonendoscope on the bend of the elbow and listens to the flow of blood that resumes passing, when this happens he feels a first blow and looks at the pressure gauge with the needle that begins to oscillate under the blows of the blood that the heart pushes inside the brachial artery. The last blow he hears in the olives of the stethoscope is that of diastolic pressure.
Then, when the cuff was deflated, the touches of the sphygmic wave were no longer heard, then it meant that this was diastolic pressure, that is diastolic. And so far we do not understand anything, if not given by assumption, that the difference between a systolic and a diastolic pressure, ie the pressure gradient, is important for the calculation of cardiovascular risk, predictive of mortality, especially in those with more 55 years old !!
Risk assessment, ie the risk that a patient may develop organ damage, for example a heart attack, depends in turn on other factors and can be also calculated with sophisticated computer systems, to assess whether an individual will have a risk of becoming ill within 10 years. But far from these hypotheses of jettatori, let's see, in practice, what are the risk factors to avoid.
The risk factors for complications of high blood pressure are divided into
non-modifiable factors, e.g. constitutional or genetic factors and modifiable
factors.
We can intervene in a preventive way, correcting the modifiable factors.
First of all it is not good to have a high differential pressure, i.e. a
significant difference between the maximum and the minimum pressure, e.g. 180/60
mmHg because this type of pressure, defined as "pulsing", tightens the blood
vessels.
Smoking must always be avoided in the hypertensive patient, as well as high
cholesterol, greater than 190 mg / dl, LDL greater than 115 mg / dl, a low HDL,
for males less than 40 and for females at 46 mg / dl.
In addition, diabetes must be treated well with the famaci innovated today, in
2020, available, such as SGLT2 inhibitors and GLP1 agonists. A good rule of
thumb is to reduce the waist, that is, to cure dangerous abdominal obesity, when
the waist is greater than 102 cm for men and 88 for women. This treatment should
be recommended if parents have had cardiovascular disease in the family, e.g. if
the father or mother died of a heart attack or if they suffer from ischemic
heart disease.
Let us remember that a diabetic is someone who has fasting blood glucose greater
than 126 mg% on 2 occasions, or after the oral glucose load test, at 2 hours, a
blood glucose greater than 200 mg / dl or an HBa1c (glycosylated hemoglobin or
glycated) of 6.5%.
(see Hypertrophic cardiomyopathy)
Hypertensive heart disease: hypertrophy of the
left ventricle due to hypertension organ damage
due to resistance to blood flow
In subjects with high blood pressure initially there are no big symptoms if you exclude the hunger of air under stress and a feeling of breathlessness in the chest when a person is under stress, with the need to inhale deeply and a feeling of blocked breathing.
However, over time the damage occurs with a series of pathological changes in the various organs involved, starting with the heart that swells, we say it becomes "hypertrophic", but in reality this occurrence is not a good thing because the heart will soon go into decompensation of pump or in myocardial ischemia. Following other diseases affect the organism, e.g. the kidney will go on to kidney disease, with an increase in creatinine values and kidney failure, a condition that we call hypertensive "kidney wrinkle".
Renal damage will manifest itself in the presence of microalbuminuria in the
urine, i.e. the presence of protein in the urine, an expression of damage to the
renal filter.Electrocardiographic evidence of IVS (see link)
Thickening of the carotid wall or atheromatous plaques
Carotid-femoral pulse wave velocity> 12 m / s
Lower limb pressure index / upper limbs> 0.9
Slight increase in plasma creatinineemia. Males 1.3-1.5 mg / dl and females
1.2-1.4 mg / dl
Reduction of the glomerular filtrate <60 ml / min
Microalbuminuria 30-300 mg / 24 hours
High pressure can determinate:
-
Cerebrovascular diseases: ischemic stroke, cerebral hemorrhage; TIA
-
Heart disease: heart attack, angina pectoris, heart failure
-
Kidney disease: diabetic nephropathy, renal failure
-
Peripheral vasculopathy
-
Advanced retinopathies: hemorrhages or exudates papilledema.
See also
First of all care must be taken following behavioral norms: reduce the consumption of salt, coffee or exciting substances (drugs, coffe, tea..), reduce body weight in the obese, moderate the consumption of wine, abolish smoking and spirits, make a light physical activity (walking, swimming, cycling) etc.
If your wife stresses you out, plug your ears or get divorced, if the office manager mobbing you, change your job or assert your rights as a cleaner. In short, avoid stressful conditions!
All foods containing sodium should be avoided, in the form of salt (sodium chloride) or of compounds such as monosodium glutamate, sodium nitrate, sodium bicarbonate, that you can find in ready meals, frozen foods or in bags, canned meat (tuna), sardines, beef in jelly), sausages, aged cheeses ( parmesan, gorgonzola etc.), seafood, stock cubes, ready sauces, preserves, pickles and so on.
Eat healthy foods, prefer the Mediterranean diet, vegetables, fresh vegetables, legumes, fresh fish, do not use sauces, oily condiments, but raw virgin oil, for example that of Sicily or Italian even if it costs a lot. Better to use a little seasoning but not fried oil.
Smoking causes vasoconstriction of the arteries with a consequent rise in pressure values and in the long run increases the risk of coronary artery disease.
If no results are obtained with these measures, pharmacological therapy is necessary, evaluated by the doctor on the basis of the patient's characteristics and the cardiovascular risk, also linked to the presence of concomitant diseases; in principle we start from a monotherapy to go to a treatment combined with more drugs. At the beginning of the antihypertensive treatment it will be necessary to measure the pressure several times a day, noting in a diary: date and time of the measurement, the drugs taken, the special situations, the symptoms etc .
Then it will be sufficient 2 times a day, in the morning immediately after getting up and in the evening before going to sleep, without exaggerating or applying to the measurement.
The drugs belong to various classes that are used depending on what you want to get.
I'll explain.
For example in the young man if I want to prevent the heart from hypertrophy I can use a beta-blocker drug, but if I think this drug can cause sexual impotence, then I prescribe an ace inhibitor or a sartan, which represent the first medicinal specialties to be prescribed.
Calcium-antagonists still exist, useful in those who need to reduce the pressure of the vessels, for example useful in nephropathies. The old loop diuretics, ex. furosemide, they are still useful if used to make the volemia, ie "to discharge the fluids" of the cardiopathic patient, of the cirrhotic patient and in all the subjects that present, for example, declining edema.
So in the elderly patient I prefer to prescribe diuretics and antialdosteronic drugs if I have to treat the hydrosaline retention and heart failure. Another very interesting drug family is represented by the calcium channel blockers, the old amlodipine, or the new ones like lercanidipine.
Finally, there are the sartans, which are also used in myocardial decompensation and in subjects with hypertrophy of the left ventricle. Clonidine, used with transdermal and oral systems, is nowadays used in particular cases. In short, this is to say that the treatment of hypertension is not a trivial matter, nor simple to implement.
Old alfalitic drugs are less used, used only in patients with prostatic
hypertrophy or clonidine. Furthermore, if one drug is not enough, it is possible
to take 2 or 3 drugs. In Italy we prefer a sartan together with
hydrochlorothiazide to be administered in the morning, while in the afternoon
you can take a calcium channel blocker.
Finally, to see if everything is in place, the pressure should be measured
often, preferably at home, not by the doctor, relying on electronic measuring
devices that will soon be connected to the smart phone.
See other link such as:
rene e pressione
Le complicanze nel paziente
con ipertensione arteriosa
L'ipertensione arteriosa: la cura farmacologica
L'ipertensione arteriosa: le cure 2010