Arterial hypertension: the silent disease

Definition

Arterial hypertension (AHT) is the most commonly observed cardiovascular disorder. It is also the world's chief preventable cause of cardiovascular disease and strokes with more than 1 in 3 adults affected. In France, AHT affects more than 14 million people.

Hypertension, or high arterial blood pressure, is a disease that places blood vessels under permanent high pressure which can damage them. Each heartbeat sends blood to the vessels and it is distributed throughout the body. Arterial blood pressure is created by the pressure of blood against the blood vessel (artery) walls when it is expelled by the heart. The higher the pressure, the harder the heart must pump and the higher the risk of damaging the heart and blood vessels in vital organs such as the brain and kidneys.

Most people suffering from hypertension do not experience any symptoms. That is why it is known as the 'silent killer'. Nevertheless, hypertension may manifest in various symptoms such as headaches, breathlessness, dizziness, chest pain, heart palpitations and nose bleeds.

In most cases, the condition can be controlled by changes to lifestyle and diet, which can also be combined with drug therapy if required. However, some patients are resistant to all forms of treatment. These resistance phenomena and new therapies are currently being actively researched.

AHT causes anomalies and hardening of the artery walls due to the permanent mechanical pressure on them. The most commonly affected arteries are those that supply the brain (carotid artery), heart (coronary artery), kidneys and lower members. Arterial hypertension therefore increases the risk of strokes, ischaemic heart disease (angina, heart attacks), peripheral arterial disease (narrowing of the arteries supplying the legs) and chronic kidney failure that may eventually require dialysis. Complications rarely occur immediately. The severity of hypertension as a condition lies in its long-term impact on the various organs.

The main complications associated with arterial hypertension

main compllication associated with arterial hypertension

source: inserm.fr

Prevention and treatment: regular monitoring is essential

Arterial hypertension is classified as blood pressure of 140 mmHg (systolic) or 90 mmHg (diastolic) or above after several repeated readings of arterial blood pressure. The systolic reading represents blood pressure when the heart contracts and pumps the blood to the arteries and lungs from the aorta and pulmonary artery. The diastolic reading represents blood pressure when the ventricular chambers dilate to receive blood flowing into the auricles via the venae cavae and pulmonary veins. Arterial blood pressure varies over the course of the day. It is lower during sleep and rest and higher during the daytime. It also rises due to various factors such as exercise, cold, emotional shock, stress, etc. Consequently, hypertension diagnoses must be confirmed by repeating blood pressure readings at three successive consultations over 3 to 6 months. Physicians may also ask patients to perform readings at home to confirm the diagnosis.

Although some studies have shown that eating dark chocolate may reduce arterial blood pressure, this method is unfortunately no substitute for regular monitoring and a healthy lifestyle! For some patients, stopping smoking, eating healthily, exercising regularly, drinking in moderation and reducing salt intake can have a positive effect and limit arterial blood pressure. However, this is not enough for others who must undergo drug therapy. Other factors also play a role such as:

  • Age: the risk of arterial hypertension increases with age and affects 40% of people aged 65 and 90% of people aged 85.
  • Ethnic origin: people of West Indian and South Asian origin are more at risk of developing  arterial hypertension.
  • Family history: patients with blood relatives currently suffering from hypertension or with a history of hypertension are more at risk.

Although arterial hypertension cannot be cured, it can be controlled. Various treatments are available to normalise resting and exercise blood pressure.

Drugs used to restore normal arterial pressure are known as antihypertensive treatments. These are split into several therapeutic classes, some of which can be combined to increase their effects:

  • thiazide diuretics target the kidneys and help eliminate water and salt
  • beta-blockers inhibit the stimulant effect of adrenalin on the heart and slow heart rate, thus limiting the intensity of the blood pressure on the artery walls
  • calcium channel blockers slow the entry of calcium into the arteries' muscle cells causing vasodilation and decreased arterial blood pressure
  • angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II recepter blockers (ARBs) both inhibit the renin-angiotensin system involved in regulating blood pressure
  • alpha blockers target the alpha-1 receptors of cells that make up the blood vessel walls They are most commonly prescribed if at least two other treatments have failed.

Modern drug therapy for arterial hypertension often entails just one tablet a day. This is sufficient to control blood pressure for 24 hours. If this control proves insufficient, a second drug is added, sometimes in the form of a 'fixed combination', i.e. two different anti-hypertensive treatments with complementary mechanisms of action in one pill (e.g. a diuretic and ACE inhibitor). This way, the dose is not changed. There is less risk of patients forgetting or giving up on their treatment, especially if they have a pill dispenser that allows them to organise their medication. Observance is not helped by AHT being asymptomatic. However, it is vital that patients take their treatment properly every day in order for it to be effective.

Some patients do not respond to any treatment even when four therapeutic classes are combined including a diuretic. This is known as resistant hypertension. It is thought to affect between 10 and 30% hypertensive patients according to research.

Although major therapeutic progress has been made in terms of managing arterial hypertension, there is no substitute for a healthy lifestyle.

Sources: ameli-sante.fr, inserm.frwho.int

A dispenser for the arterial hypertension

Most of the medical treatments against the arterial hypertension contain sachets. Pilbox offers an esthetic and practical weekly dispenser which can store these sachets. It is the Pilbox Smart.