Take blood pressure, such a simple medical act, can have significant benefits. It allows you to know if someone is at risk or suffers from hypertension, a disorder called “the silent killer”, one of the most important public health issues in the world.
The magnitude of its importance is indicated in the first report, its impact as a global health problem of the World Health Organization (WHO). The WHO Global Report on Hypertension showed that 1.3 billion adults worldwide suffer from the condition, if you take into account those who have a blood pressure of 140/90 mmHg or moreor those who are already taking medication to treat the disease.
This is more than one in three adultsand double the cases of a previous report in 1990. Although the figures are partly due to population growth and aging, they point out a series of worrying factors regarding the quality of life in general.
Hypertension is a leading cause of premature death and a risk factor central for chronic kidney disease, cardiovascular diseases, heart failure, arrhythmia and also dementia. However, it is considered that almost half of those affected are not aware of their condition, and less than half are diagnosed and treated.
In this report, as well as in other reports and works, it is estimated that several hundred million people suffer from the pathology without it being treated. Specifically, there is talk of a number of 700 million.
Based on these data, the WHO has set as a global objective the reduce the prevalence of the disease by 33% by 2030. In this sense, the World Hypertension League (WHL) celebrates the International Day of this condition on May 17 of each year, and on that day health professionals around the world carry out free blood pressure measurements and awareness and prevention campaigns. In relation to this, this year’s motto is: “Measure your blood pressure accurately, control it and live longer” (Measure Your Blood Pressure Accurately, Control It, Live Longer).
It is interesting that the WHO global report has a subtitle and this is: “the race against a silent killer”, which points out a very dangerous aspect of this pathology and that is that many people may not experience symptoms for prolonged periods without obvious symptoms, until it is objectified because significant damage has occurred.
The arterial hypertension It is a clinical condition of multiple expressions due to the characteristics of the extension of the arterial tree and affects the entire body with a variety of manifestations. Some of them can begin long before they are perceived.
One organ in particular, given its anatomical characteristics, is at particular risk: the brainand this can manifest itself through both psychiatric and neurological symptoms and very frequently both. Early detection in these cases can be crucial.
The neurological consequences of uncontrolled hypertension are profound.
The name “silent killer” is especially important in the brain because it may not present noticeable symptoms until it causes serious damage, such as a Stroke, ischemic or hemorrhagic stroke.
Chronic hypertension has been associated with structural changes in the brain, such as brain atrophy and microangiopathy, which can further lead to progressive cognitive decline and dementia, according to a study.
At the same time, it can lead to subclinical cerebrovascular anomalies, or directly to an ischemic or hemorrhagic stroke (CVA), the latter sometimes known as a “brain stroke.”
Some initial signs may be gradual and include severe headaches, fatigue, blurred vision, and difficulty breathing. They can also appear suddenly and also include:
- Difficulty speaking or understanding others.
- Numbness or weakness in the face, arm, or leg, especially on one side of the body.
- Problems seeing with one or both eyes.
- Sudden, severe headache with no known cause.
The key is the early detectionwhich implies the regular blood pressure measurementespecially if there are risk factors such as family history, obesity or smoking.
Recognizing symptoms quickly and acting immediately can be vitally important. Rule “FAST” (Face, Arm, Speech, Time) which refers to asymmetries or alterations in the face, weakness in the arms, difficulty speakingsince the importance in time to call emergenciesis a useful tool to identify a possible stroke.
In another concept, small vessel disease related to hypertension is a significant cause of vascular dementia and can also enhance the pathology of the Alzheimer’swhich is neurodegenerative.
Various studies have shown that this cardiovascular pathology can contribute to cognitive impairment even in principle attributed to other causes, such as age, stress and depressive symptoms, but which in turn can lead to more serious conditions such as dementia and Alzheimer’s disease.
This association of symptoms of cognitive impairment, as well as emotional symptoms, particularly in a certain age group, highlights the need for a comprehensive evaluation to plan appropriate treatment and reduce the risk of dementia.
The initial symptoms of cognitive impairment related to high blood pressure They are usually related to difficulties with memory in the short term, problems concentrating, difficulties performing previously simple tasks, and later changes in judgment or reasoning. Early detection is key and can be done through regular cognitive assessments, especially in people with known hypertension or those with associated risk factors.
At a psychiatric level, hypertension can influence the pathogenesis of disorders such as depression, anxiety and stressand at the same time it has been observed that effective blood pressure management can improve certain psychiatric symptoms.
A comparative study between people with essential arterial hypertension and people with normal blood pressure revealed that those with the disease showed higher levels of anxiety, as well as irritability, anger, aggressiveness They can even be confused, or at the same time be indicators of a process of cognitive deterioration or dementia, hence the importance of considering the psychological aspects in the treatment of the pathology.
Conversely, the psychosocial stress It is a factor strongly associated with high blood pressure and cardiovascular risk. He Work stress, anxiety and post-traumatic stress disorder are some of the psychosocial factors most related to hypertension, suggesting that stress management could be a crucial component in prevention and treatment.
There is a relationship already confirmed by multiple studies between hypertension and psychiatric disorders. Conditions such as unipolar and bipolar depression, anxiety, post-traumatic stress disorder (PTSD), psychosis, schizophrenia, mania and the aforementioned dementia or cognitive impairment have been linked to hypertension.
The awareness It is very important since, despite the possible severity of these symptoms, many people with hypertension may not present notable signs. Although some of the symptoms reported are individualized and taken into account, such as headaches, difficulty breathing, or chest pain, in many cases these are relativized and attributed to various causes.
This is what makes this simple gesture of taking blood pressure regularly something so important, and unfortunately sometimes forgotten, particularly in areas where physical aspects are not supposed to be evaluated, such as in some psychiatric settings.
For example, in a painting of depression With atypical characteristics in an older person who is even on antidepressants, blood pressure is often left unevaluated. All of this despite the fact that such a simple evaluation allows for the establishment of modifications in the Lifestyle like a balanced diet, regular exercise and stress reduction with multiple benefits in risk prevention, including suggesting a more in-depth specialized evaluation.
In conclusion, Hypertension is a widespread health problem with the potential to cause significant neurological and psychiatric symptoms and it is not only a risk factor for cardiovascular diseases.
Understanding these effects is essential for the comprehensive management of hypertension and requires close collaboration between cardiologists, neurologists, and psychiatrists to optimize treatment outcomes and improve patients’ quality of life. Being alert and considering that possibility and evaluating it frequently in a certain population is critical for the early detection and intervention.
* Doctor Enrique De Rosa Alabaster specializes in mental health issues. He is a psychiatrist, neurologist, sexologist and medical examiner.