There is a disease that worries cardiologists, since it is associated with myocardial infarction, heart failure and stroke. It’s about the arterial hypertension (HTA), which today commemorates its World Day with the aim of raising awareness among the population about the importance of detecting it and treating it correctly.
Behind the diseases that usually occupy a central place on the public agenda, there are pathologies and risk factors that have a silent but constant impact on the health of Argentines.
The arterial hypertension (HTA) is one of the diseases that should occupy a place of greater relevance on the public agenda, since it hardly half of the patients are diagnosed and many of them do not properly comply with the recommended medical checkups to keep it under control.
This information arises from the latest National Risk Factor Survey (ENFR) and the data provided by the RENATA 1 and 2 studies, which indicate that about a third of the adult population of Argentina is hypertensive. Even some authors, such as those of the PURE study, warn that this prevalence could be even higher. This is because, when the people interviewed in the ENFR are added to those whose blood pressure (BP) was actually recorded, the prevalence increases to practically 50% of the population.
“Almost half of these patients does not know he is hypertensive, while the number of those who are treated and effectively controlled is approximately 25%. This way, Only 1 in 4 hypertensive patients has their BP adequately controlled“, constituting a serious public health problem, due to the strong link between high blood pressure and the development of other diseases,” explained the doctor. Pablo D. Rodríguez (MN 75816), head of the Arterial Hypertension Clinic of the ICBA Cardiovascular Institute.
Two risk factors are related to this. Unhealthy eating and a sedentary lifestyle, associated with the increase in overweight and obesity, contribute strongly to the prevalence figures being maintained over time, and even showing a slight upward trend. That is why this new edition of the World High Blood Pressure Daywhich is commemorated every May 17 by an initiative of the World Health Organizationrepresents an ideal time to disseminate information about this pathology and promote prevention and control guidelines.
High blood pressure is the sustained increase in blood pressure at values equal to or greater than 140/90 mmHg, or better known as 9/14 when we perform a routine measurement. “Is a disease and at the same time a risk factor for the development of cardiovascular, neurological and kidney diseases. According to different analyses, the presence of HTA is the first or second cause of morbidity and mortality in the world population,” said Dr. Rodríguez.
This morbidity is generally expressed in cardiovascular diseasesince it is about the first cause of stroke and one of the main triggers of myocardial infarction and heart failure. Furthermore, high blood pressure, along with diabetes, are the two main causes of chronic kidney disease and admission to dialysis.
In summary: heart, brain, kidney and arteries are the so-called target organs of HTN and the most compromised when BP is not adequately controlled.
Experts say that it is a asymptomatic disease, which is why it is known as a “silent killer.” The truth is that there are a series of symptoms or signs that are usually linked to this condition, such as headache, conjunctival effusion (red eye), epistaxis (nosebleed) or dizziness. However, in most of these cases, increased blood pressure is not the cause of the symptom, but rather its consequence.
Regarding the causes that cause high blood pressure, experts say that are unknown in most patients, which is why it is called essential or primary HTN. “This form of the disease, which covers approximately 90% of hypertensive patients, has a strong genetic component, so its prevalence increases in those who have one or both hypertensive parents. About 10% of hypertensive people may have a secondary causethat is, they have another disease that generates an increase in BP values,” added the expert and details that the most frequent are those of renal origin and those of endocrine origin (adrenal glands, thyroid, etc.).
Although the causes are largely unknown, there are mechanisms commonly related to increased pressure that can be studied non-invasively with methods such as impedance cardiography. Their knowledge could guide doctors in more effective treatment.
Statistics in Argentina indicate that only half of hypertensive patients are diagnosed. But a new obstacle lies in the fact that many of those who know they have hypertension do not respect the therapeutic regimens indicated by their doctors. “Adherence is the Achilles Heel of chronic treatments. It is considered that, one year after the indication, only 50% of patients comply with the treatment as indicated,” Rodríguez noted.
“Currently, the economic reasons linked to the cost of medication constitute one of the main causes of abandonment. And we should not ignore other causes, such as the presence of adverse effectswhich, although minor, often lead to the abandonment of a certain drug,” says the expert.
A third leg of this problem is much simpler and is tied to the daily whirlwind. Forgetting for short or sometimes longer periods It is the reason most commonly indicated by patients when arguing their lack of consistency. “The use of pharmacological combinations in a single tabletby reducing the number of daily intakes, facilitates treatment and has been proven to significantly improve adherence,” said Rodríguez.
“A good doctor-patient relationshipin which the latter clears all his doubts and is adequately informed of the objectives of the treatment, the need for it and the possible adverse effects of the drugs, is a fundamental tool in improving adherence,” added the expert.
To prevent high blood pressure, the medical recommendation is to control blood pressure at least once a year, from the age of 16. And children should also have a checkup at each visit to the pediatrician, since up to 10% may be hypertensive in that age group. If you have a family history, it is best to increase the frequency of checkups.
“It is important to note that the responsibility for controlling blood pressure should not fall solely on patients. The RAMPAC study, carried out by the Argentine Society of Arterial Hypertension in 9 hospitals throughout the country, showed that Only in 14% of consultations was BP measuredincluding in only half of the cardiology consultations in which this record should be a fundamental part,” recalled the expert from the ICBAan institute where he runs a clinic specialized in this pathology, made up of a group of professionals with vast experience in the management of hypertensive patients.
Different scientific societies have recommended for some years perform registrations with validated automatic equipmentwhich provide greater precision and avoid frequent errors in the measurement process that occur with traditional aneroid equipment.
Regarding the approach to this disease once diagnosed, there are two fundamental pillars: lifestyle changes and drug treatment. Among the first, the most important are reducing salt consumption (mainly that contained in processed foods), physical activity, maintaining an adequate weight and limiting alcohol consumption. Avoiding tobacco is also a recommendation in hypertensive patients, although its impact in this case is less than in other pathologies.
“Pharmacological treatment is key and it has been proven that most of the antihypertensive drugs available are effective, safe and contribute to reducing cardiovascular risk through different mechanisms. Around 70% of hypertensive patients will require treatment with two or more drugs to control their BP, preferring the indication of two and up to three drugs in a single tablet, which facilitates effectiveness and adherence to treatment,” explains Dr. Rodríguez. .
In recent years, treatments have emerged using invasive procedures aimed mainly at those patients with HTN resistant to a regimen of at least three drugs used in sufficient doses, including a diuretic.
“Of these procedures, the most studied and with the best results is renal denervationwhich induces significant decreases in BP by placing a catheter in both renal arteries that interrupt the action of the sympathetic nerves,” concludes the ICBA specialist, where an evaluation module works that allows for the certain selection of patients who will benefit from this therapeutic technique.
*Cardiovascular Institute of Buenos Aires (ICBA)