Hypertension is a source of serious complications such as heart attack, stroke, etc. Yet at its source can hide a “simple” sleep apnea. 40% of people with hypertension are prone to sleep apnea. Knowing detect apnea to avoid future hypertension? And if that was accessible to all health professionals: specialists, general practitioners, and pharmacists? In France, high blood pressure affects over 14 million people and nearly 10 million take treatment to fight against this disease. Although the causes are often unclear, the risk factors are the ones well known: age, heredity, smoking, diet, etc. According to WHO, more than 1 in 3 adults in the world have arterial hypertension causing about half of the deaths due to stroke and heart disease and is the cause of 9.4 million deaths every year.
Hypertension is defined (HTA) as a chronic increase in blood pressure. Most people with high blood pressure are unaware that they have it because the voltage slyly evolves over the years. This is cardiovascular disease the most common and represents the most important risk factor.
Blood pressure is considered normal when it is less than 14/9 or 140/90 mmHg. Systolic blood pressure should not be worth more than the figure 15. Diastolic blood pressure can have a value greater than the number 9. Hypertension is characterized by a value greater than 14/9.
The majority of people with high blood pressure have no symptoms. Indeed hypertension is a disease that can remain silent for many years.
- High blood pressure can develop well without noise before cause complications. High blood pressure can be discovered during a simple visit to the doctor or at the onset of complications (heart, brain, kidney, etc.). The symptoms may occur in a hypertensive crisis.
- Headache occurring mainly in the morning and sitting in the neck may primarily reflect a severe hypertension thrust.
- The sensation of hearing ringing (tinnitus) may reflect blood pressure.
- A blurred vision like flies sensations before the eyes can be the witness hypertension. People with
- People with hypertension are often prone to vertigo.
- A rapid heartbeat (palpitations) may be a consequence of hypertension.
- Difficulty in breathing may also be the cause of hypertension. Epistaxis (nosebleeds) may prove hypertension.
- Finally, hematuria, blood in the urine may be an indicator of hypertension.
The treatment to be given will be decided after assessing the overall cardiovascular risk. Assessing the risk is based on the following risk factors:
- Age (50+ years in men and 60+ years in women)
- Smoking (current smoking or stopped for less than 3 years)
- Family history of a premature cardiovascular event (myocardial infarction or sudden death before age 55 years in the father or a relative of the first-degree male or before age 65 in the mother or although with a relative of the first-degree female).
- Early stroke (45+ years).
- Diabetes (diabetes treated or untreated)
- Dyslipidemia (LDL-Cholesterol? 1.60 g/L (4.1 mmol/L) and HDL cholesterol? 0.40 g / L (1 mmol/L regardless of gender).
- Other parameters are also to be considered as abdominal obesity or physical inactivity. The physician must also evaluate the achieved target organs and detect cardiovascular and renal diseases.
The major goal of antihypertensive drug treatment is to reduce systolic blood pressure below 14 and diastolic blood pressure below 9. The second objective drug antihypertensive drug treatment, even more important, is to avoid the onset of complications of hypertension.
The non-drug treatment of hypertension is to encourage the patient to make a number of lifestyle changes. According to the HAS, the High Authority of Health, the lifestyle changes are recommended in all hypertensive patients, regardless of the blood pressure level, with or without associated medication. It is above all essential that the medication, when advisable, it brings much-needed prevention measures: weight control, cholesterol and glucose levels, smoking cessation, reduced alcohol, regular exercise, balanced diet, decrease the amount of salt, etc.
There are many treatments to fight against uncomplicated essential hypertension: diuretics, beta-blockers, calcium channel blockers, antagonists of angiotensin II, angiotensin-converting enzyme (ACE) inhibitors.
Drug treatment proposed by the doctor depends on the stage and degree of hypertension and complications that may be present. The choice of antihypertensive drug depends on several factors such as the type and cause of hypertension, efficacy, and good tolerance of the drug, as well as motivations and the presence of associated risk factors.
Start with a drug or by the fixed combination of two drugs at low doses. The doctor initially prescribed a single antihypertensive drug. If the first drug does not reduce the numbers of blood pressure, despite the respect of preventive measures (weight control, cholesterol and glucose levels, smoking cessation, reduced alcohol, regular exercise, balanced diet, decrease the amount of salt …) the doctor prescribed two antihypertensive drugs.
Associate 2 second-line drugs within a period of at least 4 weeks. 2 prescribe medication in a shorter period:
- blood pressure of 180-110 mm Hg
- blood pressure of 140-179 / 90-109 mm Hg
If the blood pressure goal is achieved, treatment is extended. If no response to treatment or side effects, it is recommended to change the therapeutic class. In cases of severe hypertension, it is sometimes necessary to take 3 or more different types of drugs. Antihypertensive treatment is often prescribed for many years or even a lifetime. It is possible to reduce the doses of drugs when the pressure readings returned to normal and stable for several weeks with the advice of your doctor.
The antihypertensive treatment is a long-term therapy that must take many years even all throughout life. The patient must adhere to treatment and to accept it because, otherwise, it may quickly interrupt the daily intake of the drug. It is essential to understand the value of this treatment to prevent the onset of complications (heart, brain, kidney, erectile dysfunction, etc.). Too abrupt discontinuation of treatment of hypertension, unless the doctor has advised, can cause a “rebound effect” responsible for a worsening of hypertension.