Overview of Hypertension

Blood pressure is the pressure of blood flow on the walls of blood vessels. Blood pressure consists of two numbers (for example 140/80mmHg, 130/90mmHg). The higher number is called systolic blood pressure (maximum blood pressure), the lower number is diastolic blood pressure (minimum blood pressure). According to current recommendations of the European Society of Cardiology and the Vietnam Heart Association, hypertension is when systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥ 90mmHg (the American Heart Association considers blood pressure ≥130/80mmHg to be hypertension). That is, normal blood pressure must be less than 140/90mmHg

Hypertension is a disease that develops silently over many years, mostly discovered by chance or only when the patient has complications. Hypertension causes many bad consequences if not detected and treated promptly such as: myocardial infarction, cerebral infarction, kidney failure…

Hypertension is divided into two types: primary hypertension (essential hypertension) and secondary hypertension (hypertension with a cause). Essential hypertension is the most common type of hypertension, accounting for 90% and the cause of hypertension is unknown.

Hypertensive crisis is a condition in which blood pressure suddenly increases above 180/120mmHg. Hypertensive crisis is divided into two types: hypertensive emergency and hypertensive urgency. Hypertensive emergency is defined as blood pressure above 180/120mmHg and there is evidence of target organ damage (hypertensive encephalopathy, retinal damage, acute renal failure, myocardial infarction, aortic dissection). Hypertensive urgency does not have target organ damage. However, both types must be treated immediately and promptly.

Causes of Hypertension

The causes of hypertension are also divided into two groups

Idiopathic hypertension: the cause is unknown

Secondary hypertension: possible causes:

• Kidney diseases: acute glomerulonephritis, chronic glomerulonephritis, kidney stones, renal artery stenosis
• Endocrine diseases: Pheochromocytoma, Cushing’s, hyperaldosteronism, hyperthyroidism, etc.
• Cardiovascular diseases: aortic valve regurgitation (causing isolated systolic hypertension), aortic coarctation (causing hypertension in the upper limbs), atherosclerotic stenosis affecting the renal artery
• Due to drugs: licorice, birth control pills, some sympathomimetic drugs
• Other causes: pregnancy poisoning, neurological disorders

Symptoms of Hypertension

Hypertension often has no specific symptoms for a long time. Sometimes the patient may experience headaches, chest pain, shortness of breath when there is a hypertensive crisis. Or symptoms of target organ damage: blurred vision, severe chest pain, blood in the urine, hemiplegia (stroke) … but when these symptoms appear, the prognosis is often not good.

Risk factors for Hypertension

• Male
• Postmenopausal women
• Family history of hypertension
• Obesity, overweight
• Low physical activity
• Smoking
• High salt diet
• Stress and psychological stress
• Drinking too much alcohol
• Chronic kidney disease, diabetes, sleep apnea

Prevention of Hypertension

• Diet: reduce salt, more green vegetables, less animal fat, replace with vegetable oil
• Exercise regularly: at least 30 minutes a day, 5 days a week
• Quit smoking, tobacco
• Lose weight, maintain body mass index (BMI) from 18.5-22.9 kg/m2
• Maintain waist circumference below 90cm in men and below 80cm in women
• Limit alcohol consumption
• Avoid anxiety, nervous tension, relax and rest properly

Measures to diagnose Hypertension

Diagnosis of hypertension only requires measuring blood pressure according to standard procedures at the clinic. Or you can wear a blood pressure Holter (monitor blood pressure 24 hours), measure blood pressure yourself at home.

• If measuring blood pressure at the clinic: high blood pressure when blood pressure ≥ 140/90mmHg
• Measuring blood pressure with a Holter monitor: high blood pressure when average daytime blood pressure ≥ 135/85mmHg, average nighttime blood pressure ≥ 120/70mmHg
• Self-measured blood pressure at home many times: high blood pressure when blood pressure ≥ 135/85 mmHg

Measures to treat Hypertension

Hypertension is a disease that requires lifelong treatment, and cannot be stopped from taking medication. It is necessary to maintain regular medication, avoiding cases where blood pressure is high before taking medication. The treatment goal for all patients is to lower blood pressure below 140/90mmHg. Special subjects can lower blood pressure to 130/80mmHg. Take medication absolutely as prescribed by your doctor.

Main drugs for treating hypertension:

• Calcium channel blockers: amlodipine, nifedipine, felodipine… Can cause side effects such as leg swelling, tachycardia. Do not use sublingual Nifedipine because it can cause hypotension
• ACE inhibitors/AT1 receptor inhibitors: lisinopril, captopril, Vasartan, Losartan… Usually lower blood pressure gently, however ACE inhibitors can cause dry cough. Receptor inhibitors do not cause cough but are expensive. The effectiveness is similar.
• Beta-sympathetic blockers: metoprolol, bisoprolol… Must start with a low dose and gradually increase
• Diuretics: there are many groups of drugs but thiazide diuretics are often used. Side effects can cause electrolyte and metabolic disorders.