What is primary hypertension?
Hypertension is persistent elevation of the blood pressure in the arteries.
A great majority (more than 90%) of all cases of hypertension is of primary nature and is caused by various environmental and genetic conditions, which interfere with physiological regulation of arterial blood tension. Unlike secondary hypertension, in primary hypertension, a clearly defined cause of the disease cannot be diagnosed.
Epidemiology and prevention, symptoms.
Data for the last 20 years indicates an increase in incidence of hypertension in Poland. According to NATPOL 2011 research project, among persons aged 18 to 79, it increased in 10 years from 30 to 32%, that is, to about 9 million people. This number should be increased – on the basis of POLSENIOR research – by about one million people with hypertension after 80 years of age. If such trend is maintained, until year 2035, the number of patients with arterial hypertension will increase by one half.
Improper diet, obesity, lack of physical activity, smoking, excessive consumption of alcohol and other substances, as well as chronic stress, but also age, diabetes, dyslipidemia, kidney disorders are risk factors for arterial hypertension and other diseases of the cardiovascular system.
Development of arterial hypertension can be prevented in two ways – by primary prevention, aimed at avoidance or delaying of development of hypertension, and secondary prevention, aimed at increasing traceability of hypertension, as well as prevention or delaying of development of cardiovascular and kidney-related complications.
Non-specific clinical symptoms, which may indicate arterial hypertension, include: headaches of various location and nature, sleeping disorders, quick fatigue, flashing lights, irritability, palpitation, hyperhidrosis, ear buzzing, dyspnea, vertigo and the sensation of exhaustion. It should be kept in mind, though, that the disease may give no symptoms at all.
In Poland, about 30% patients are not aware of their hypertension. Due to low detection rates of arterial hypertension, the most recent guidelines of the Polish Society for Arterial Hypertension recommend screening blood pressure measurements in all adults, who should undergo such measurements, at least once a year.
Diagnostics of primary arterial hypertension
The diagnostic procedure in the case of suspected hypertension should include:
- Blood pressure measurement,
- Determination of the cause of hypertension (primary or secondary),
- Assessment of cardiovascular risk factors,
- Detection of potential organ-related complications,
- Detection of potential concurrent conditions,
Determination of overall cardiovascular risk.
The basis for diagnosing of arterial hypertension is a blood pressure measurement, conducted properly at the doctor’s office. Arterial hypertension can be diagnosed if the average BP values (based on at least two measurements performed during at least two different doctor appointments) are equal or higher than 140 mm HG for systolic and/or 90 mm HG for diastolic blood pressure.
Therapeutic proceedings in the case of primary hypertension.
The basic objective of therapy in a patient with arterial hypertension is to reduce mortality and the risk of cardiovascular complications. The treatment should lead to reduction of blood pressure below 140/90 mm Hg in most patients with arterial hypertension.
The procedure should include:
- Changes in lifestyle, consisting of body mass reduction, modification of diet, increasing physical activity, quitting smoking,
- Use of hypotensive drugs,
- Adjustment of all other cardiovascular risk factors, such as treatment of dyslipidemia, diabetes or antiplatelet treatment.
The main classes of medications used in treatment of arterial hypertension include thiazide diuretics, β-adrenergic blocking agents, calcium antagonists, angiotensin-converting-enzyme inhibitors and AT1 receptor blockers.
Very often, treatment of arterial hypertension is based on a combination of several medications of complementary mechanisms of action.
Prepared on the basis of:
- Kardiologia – podręcznik oparty na zasadach EBM, t.II. Szczeklik A., Tendera M. Medycyna Praktyczna, Kraków 2010.
- Zasady postępowania w nadciśnieniu tętniczym — 2015 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego. Tykarski A., Narkiewicz K.