"My head and neck hurt, I must have high blood pressure." "It gets on my nerves, I calm down and I'm sure it'll go away." "With taking care of myself a little for a while, I lower it." "I always had high blood pressure and nothing ever happened to me, it's not serious."
Much is said about hypertension, but
little is controlled
.
And not always everything that is said, heard -and even read- is aligned with scientific evidence.
Sometimes there are doubts, others ignorance and sometimes myths are simply reproduced.
And that is a problem, especially if one takes into account that in Argentina almost 4 out of 10 adults live with hypertension, according to the latest National Survey of Risk Factors.
"
Almost 40% of hypertensive people do not know that they are hypertensive
and of the 60% who are diagnosed, more than half are treated and are not well controlled. Therefore, the first reflection is that only two out of 10 hypertensives have their blood pressure well-controlled arterial blood pressure," says
Marcos Marín, president of the Argentine Society of Arterial Hypertension (SAHA),
in dialogue with
Clarín .
"And if we take into account that high blood pressure in middle-income countries is the leading cause of premature mortality, the leading cause of stroke and disability, and the second of heart attacks, there is clearly little awareness of the seriousness of this issue," he adds. in relation to the importance of informing and
clearing up frequent doubts and myths
.
According to Marín, who is the coordinator of the Know and Control
campaign
of the SAHA, the poor control of hypertension and the low knowledge regarding its consequences that this has responds to multifactorial causes, with responsibilities shared between the health system, the medical community and the patients themselves.
In the first place, he mentions the
lack of access to care
suffered by some sectors.
"Many people don't even make it to the health system," he laments.
But in those that do arrive and are treated, "it is difficult for us as specialists to understand
why they are not well controlled
," he acknowledges.
In these cases, it identifies a certain responsibility of health professionals who maintain a behavior called
"therapeutic inertia"
.
In this regard, he says that "the majority of our hypertensive patients
are taking a single drug
, when most of the intervention studies carried out to demonstrate the benefit of antihypertensive treatment and to achieve blood pressure control -that is, values below of 9/14 - show that they should be taking between two and three drugs".
Thirdly, he mentions the lack of adherence of the patients.
"As in any chronic disease, after one or two years,
many abandon treatment
."
The reasons?
Hypertension
does not usually cause symptoms
, so the benefits of having blood pressure controlled are not immediately apparent.
"
What treatment achieves is to prolong life
, which is no less," underlines Marín, who is one of the directors of the Argentine Consensus on Arterial Hypertension, prepared jointly by the SAHA, the Argentine Society of Cardiology (SAC) and the Argentine Federation of Cardiology (FAC).
How is hypertension diagnosed?
The diagnosis is very simple.
All we have to do is measure our blood pressure correctly with an automatic and validated device and perform several measurements.
If the average of these shots is
above 135/85
, we are almost in a position to say that a person has arterial hypertension.
The doctor will confirm this in the office or with the indication of ambulatory blood pressure monitoring.
—How often should a hypertensive adult check their blood pressure?
—The concept should be that all hypertensive patients have to have their blood pressure controlled.
With each change of season, the ideal would be for the patient to go to the doctor and have him measure his blood pressure in
two or three measurements in the same visit
.
Sometimes, the professional has to use another tool, which is home blood pressure monitoring.
It is correct to do it
four days in a row
, two shots in the morning and two at night and take an average.
This would have to be
repeated every three months
and the patient's pressure should always be below 135/85.
This is the best way to know if a hypertensive is well controlled.
Keeping a periodic record of pressure levels favors control.
Photo Shutterstock.
—Does the control frequency change with age and the presence of comorbidities?
—The prevalence of hypertension clearly
increases with age
(and consequently the need for greater control).
It is a disease that at 5-10 years affects only 3%, at 40 years 20-25%, but at 70 years it occurs
in almost 70%
.
That is, the most important factor that determines arterial hypertension is age, with the years the prevalence increases.
There are other comorbidities, such as chronic kidney disease, obesity, these are factors that are generally more associated with arterial hypertension.
—Can the blood pressure of hypertensive people be lowered only with healthy habits?
—Healthy habits are fundamental (eating with less salt, doing physical activity, maintaining an adequate weight, being careful with alcohol, not smoking), but in general they are
complementary
to drug treatment.
In the therapeutic algorithm proposed by the
Hearts
project of the Pan American Health Organization (PAHO), when it is detected that the person has a score above 140/90, the two tools are indicated:
non-pharmacological treatment
(healthy habits) and
pharmacological
(a tablet containing two drugs in low doses).
—Which is more important: pharmacological or non-pharmacological treatment?
"That's a very difficult thing to answer."
They are definitely complementary.
I know very few people who have hypertension controlled by non-drug treatment alone.
They are very mild hypertensives, very skilled, who perhaps by removing their salt intake, doing physical activity, can maintain normal blood pressure levels.
The vast majority of hypertensive patients require significant pharmacological treatment, even with two drugs -in a single tablet, to improve adherence-.
In other words,
both things are important
.
I always tell my patients to take the salt off the table and try to keep the consumption of salty foods
very sporadic
.
It is not true that a hypertensive person cannot eat a slice of pizza, a crumb sandwich or a hot dog from time to time.
But it should not be everyday food.
—Can treatment be paused or abandoned when the pressure is controlled?
-Definitely not.
That is a myth.
This is a chronic disease,
for life
, and if the blood pressure dropped, it was because we adhered to healthy habits and we are taking the medication.
When we stop taking it, in a few weeks the pressure returns to its usual state.
The exception is in very old people (85 years and older), who are more fragile, who have been hypertensive for a long time and when they reach that age it is necessary to start deprescribing.
It is only in this instance that the evaluation begins to lower their medication a little because it is precisely in these elderly and frail people where lowering their blood pressure is more risky.
—Is it advisable to self-monitor your blood pressure at home?
—I think having an automatic blood pressure monitor at home can be very good.
Only in a few cases can it be bad, basically in the most obsessive people, who would be measuring themselves under pressure all the time.
But in general terms, having a validated automatic blood pressure monitor is very important.
Just as in the covid era many people went out to buy a saturometer -with which today they do not know what to do-, the blood pressure monitor is useful for the whole family and for life.
If there are hypertensives in the family, parents, grandparents, uncles, much more.
It is a very useful tool.
Hypertension: myths and frequently asked questions
In the Corner of the Hypertensive, the section that the SAHA site dedicates to information for the community, specialists gathered another 10 myths and frequent doubts that they frequently receive in clinics.
Below, one by one and their answers.
If I take blood pressure medication will I have sexual difficulties?
Not all drugs to treat hypertension can cause erectile dysfunction, in fact high blood pressure can cause this commitment as organic damage.
In cases of side effect of any medication you should consult your doctor.
If I eat a healthy diet and exercise can I improve my hypertension?
To improve hypertension, a
hygienic dietary regime
must be followed : eat slowly, light food, low in salt and calories.
You also have to do light aerobic exercise such as walking, cycling, or jogging, always taking into account the patient and his weight.
It is preferable to do a prolonged exercise in time, with a low to moderate intensity.
Other beneficial habits are not smoking, not drinking too much alcohol or coffee, and trying to avoid stressful situations.
A healthy lifestyle protects against hypertension.
Photo Shutterstock.
Can hypertension be transmitted from generation to generation?
Although it is not correct to say that hypertension is hereditary,
the genetic load is fundamental
.
Family history determines the main risk factor for having arterial hypertension.
Does hypertension cause enlargement of the heart?
High blood pressure forces the heart to work harder.
Like any heavily used muscle, the heart increases in size.
The larger the heart, the less capable it is of maintaining proper blood flow.
When this happens, you feel
weak and tired
, unable to exercise or do physical activity.
The heart has begun to fail from the effort.
Without treatment, heart failure will continue to get worse.
To calculate the normal maximum blood pressure of a person, should age be added plus 100?
false
.
To begin with, this is a totally arbitrary statement with no real correlation.
Arterial hypertension is defined as any value equal to or greater than 140/90 mmHg from 18 to 80 years of age.
Is high blood pressure cured?
No. Arterial hypertension is suffered for life, but thanks to a healthy lifestyle, proper management of medications and regular medical check-ups, a hypertensive patient can maintain a
completely normal life
.
Is my hypertension nervous?
Fake.
In 90% of cases, arterial hypertension is primary, that is, no cause is identified.
It can be caused by a disorder, in which family history, sedentary life, salt intake, environment and stress exert an influence.
Therefore, hypertension is a disease,
it is not simply a product of nerves
.
Many nervous and stressed people are not hypertensive.
Can headache and neck pain be the symptoms?
The main thing is to understand that arterial hypertension is generally
asymptomatic
, and it is very important to keep in mind that symptoms should not be expected.
The only way to know is to check your blood pressure.
There may be three symptoms that worry patients:
1) Headache:
in general it responds to other pathologies not dependent on blood pressure.
Although sometimes it can coincide with high blood pressure.
2) Conjunctival hemorrhage (red eye):
usually does not correspond to high blood pressure figures.
3) Bleeding from the nose:
it is generally associated with a weakness of an internal vessel in the nose, in some cases it coincides with high blood pressure figures.
Treatment of hypertension includes pharmacological and non-pharmacological measures.
Illustrative photo Shutterstock.
Can the maximum blood pressure be combined with the minimum?
It is impossible for the minimum arterial pressure to equal the maximum, since cardiac systole (contraction of the left ventricle) is very similar to the systolic pressure of the left ventricle and normally manages values between 110 and 130 mmHg;
while the minimum or diastolic blood pressure is related to cardiac diastole (relaxation of the left ventricle) which is around 70 or 80 mmHg.
Can I only have hypertension after the age of 40?
No. Although it is more frequent after the age of 40, statistics indicate that more and more young people and children suffer from high blood pressure.
And in these notes from
Buena Vida
, answers to three other frequently asked questions:
Hypotension: in which cases is low blood pressure risky and how is it related to hypertension?
The answer here.
Should I take my blood pressure medication in the morning or at night?
Get informed here.
What is hidden hypertension and how to detect it?
Click here to read.
***
Do you want to read more about high blood pressure?
These notes may interest you:
➪Hypertension: how to measure blood pressure at home, at what times of the day and other guidelines to keep a good record
➪Hypertension and heat: 7 tips to face the summer if you have high blood pressure
➪DASH diet against hypertension: foods that cannot be missing and how to put together the shopping list
➪Hypertension: why you should consume a variety of proteins (and where to find them)
➪Hypertension: risks to the heart, brain, kidneys and eyesight
➪Hypertension in boys: how to prevent it and from what age should blood pressure be measured
***
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