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Blood circulation is due to a pressure difference between the high pressure arterial system and venous system with low pressure. For example, in venous capillary pressure is close to 0 mmHg. The pressure difference created by the pump activity of the heart: every contraction of the left ventricle heart takes a certain amount of blood (flow range) in the aorta and large arteries; increasing pressure in the vessels arising maximum or systolic pressure.

During the rest of the heart (diastolic) blood reaches the tissues through arterioles opposing a resistance to flow: minimum pressure or diastolic result. Drain resistance is explained by the abundance of arteriole muscle fibers of the walls, which can be in a state of contraction or expansion, "basic tone" of arterioles, controlled by the neurovegetative system, various substances metabolic hormones.

Dilation and constriction of arterioles is determined by various physiological states, effort, digestion. An increased activity of the sympathetic nervous system due to increased tone, various hormones (adrenaline, aldosterone), the nature of the kidney or muscle tunic by fibrosclerosis changes lead to an increase in the minimum pressure.

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In some circumstances prevailing maximum pressure increases (in effort, emotion) in other circumstances are found even at rest only an increase in the maximum pressure (eg the elderly), or only minima or both pressures. It is considered hypertension increase the minimum and maximum pressure above 140 over 90 mmHg.

Causes

In most cases (90%), hypertension can not specify the cause; It is the so-called "essential hypertension" (hypertensive disease). Essential hypertension mechanisms have been proposed various assumptions; one of the most accepted is "mosaic theory" in which predisposing factors or determinants such as heredity, vascular factors, repeated emotional states, some adrenal disorders, calorie diet, excessive intake of salt in the diet.

In 10% of cases is secondary hypertension, caused by causes renal, endocrine, congenital abnormalities of the aorta or loss of elasticity of the aorta, common in the elderly and in various brain disorders.

Symptoms

These are very different, being conditioned by disease stage, patient personality, association with other diseases is whether secondary or essential hypertension. The manifestations are diverse: headache, sometimes more important morning, dizziness, vajaieli ears, epistaxis, dead finger sensation, appearance of bright or black points in the visual field.

In many cases, even high blood disorder patients have no subjective; the same lack of disturbance can be ascertained in the early stages of essential hypertension. The disease is benign in many cases, especially when maximum and minimum pressure increases are moderate. But even in these cases, if not treated properly essential hypertension, atherosclerosis localization can occur symptoms (heart, brain, kidneys)

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Pronostic

Prognosis and evolution of hypertension depend on the maximum and minimum values, as of early detection of hypertension. Experience shows that various medical checkups at least 20% of those examined do not know they have hypertension, even in high values. This forces to control blood pressure at least once a year, even in the absence of any disturbance.

Specifying an HTA permanent is an important fact for sick because except for secondary hypertension are only 10% of cases and some of them are curable, most immense of cases (90%) are essential hypertension, which although not known what causes is a disease influenced and improved by a hypotensive medication.

Untreated essential hypertension is known as a risk factor that favors the location and development of atherosclerosis, training cardiac complications (ischemic heart disease), stroke, carotid stenosis or legs (arthritis). It has been reported that 50% of hypertensive patients had ischemic heart disease and myocardial infarction patients had hypertension frequently in the past. Epidemiological studies show that 2% of hypertensive succumb to heart disease, and 20% of cases of bleeding or softening (heart) brain.

Coexistence with other risk factors like smoking, obesity, impaired fat metabolism, increased uricaemia atherosclerosis accelerates evolution to hypertension. One danger is increased pressure during evolution becomes very dangerous if the minimum exceeds 105-110 mmHg the echo that it has on the arteries. There is a form of malignant hypertension with elevated minimum pressure over 120-130 mmHg characterized by rapid progression to complications of heart, brain or kidney. Sometimes it can complicate an essential hypertension. Fortunately new antihypertensive medications have modified the course of malignant hypertension.

Of course after mentioning hypertension and appropriate therapy, hypertensive patients should regularly examine their blood pressure, without this control to constitute a sick obsession, because current medications and hypotensive arsenal is vast and very effective. Research blood pressure is still dictated by the disease and knowing the efficiency of hypotensive medication. Lately patients measure their own blood pressure.

This is beneficial for the patient? Of course, self measure blood pressure gives an indication of the effectiveness of certain medications hypotensive, and these checks patients are becoming more aware and more responsible for their illness. It was found however that the figures found sick are always lower than those found by the doctor or permanent hypertension during which the activity is exposed to risks. Self measure blood pressure may be admitted by recommendation does not become an obsession or a repetitive gesture such as shaving in the morning and found values

with those found to be controlled by a doctor.

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Treatment

Treatment of hypertension because HTA is conditioned by:

- A causal therapy can not be done only in secondary hypertension, which is found only in 5-10% of cases; correct anomalies renal artery or aorta (aortic coarctation), excision of tumors adrenal or pituitary tumors can cure hypertension

- Essential hypertension, which undoubtedly is the most common but still unknown origin, is influenced by antihypertensive medications that can profoundly alter the evolution and prevent complications.

Treatment of essential hypertension aims: correction of hypertension through medication hypotensive establish a lifestyle and diet to prevent the aggravation of high blood and locations of atherosclerosis.

Correction hypertension is done by various medications hypotensive diuretics (nefrix, furantril), antihypertensive that inhibits sympathetic nervous system (hiposerpil, clonidine, guanethidine), beta-blocker acting on the heart as propanolol or on vessels, vasodilators as blockers of calcium (amlodipine) converting enzyme inhibitors (enalapril, perindopril).

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Usually combining two medications and doses are individualized in comparison with the prior HTA. If normalization of blood pressure medication should continue, of course, in smaller doses, individualized physician. Hypotensive medication discontinuation is a mistake; lull is misleading because persistent high risk for progression of atherosclerosis is a coronary or cerebral arteries. Hipotensoarelor sudden cessation is often followed by increases of paroxysmal hypertension. 

Effective antihypertensive medication long-term decline is confirmed by brain hemorrhages, heart failure and uremia. In malignant hypertension survivals are found after 5 years over 45% of patients treated versus 17% in patients without treatment.

Living arrangements and food complements the effective antihypertensive medication. The three pillars of life of hypertensive are mentally and physically a balanced life, combating sedentary lifestyle and obesity, avoid foods high in cholesterol. Incidentally same recommendations are valid for healthy people.

A life calm, rest and relaxation intermittent have a good influence on HTA. Conflicts moods of mania (mental stress) are cause for aggravation receiving tranquillizers action. It requires minimal physical activity. They found decreases in blood at bonavii with moderate physical work compared to sedentary or only those with intellectual activity.

Avoid overexposure to sunlight, the bathrooms too cold or stay at high altitudes. Traveling by plane, driving a car are permitted, except in certain cases.

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The diet consists of reducing salt in the diet, low calorie diet and weight loss when obesity. Hearty lunches will be avoided; alcoholic beverages, coffee are permitted in moderation, but should be avoided in insomnia, palpitations, agitation. Knowing that hypertension is a risk factor for atherosclerosis among others, the diet should be avoided natural fats, foods that increase uric acid in the blood (sardines, young meats, venison) and smoking cigarettes.

Bibliography

1   Gaddam K K, Nishizaka M K, Pratt-Ubunama et al.  Characterization of  Resistant Hypertension.  

2  Durrani  A  M,Fatima  W. -Determinants  of  blood  pressure  distribution.

3  U.S.  Department  of  Health  and  Human  Services,  National  Institutes  of  Health, National  Heart  Lung,  and  Blood  Institute. The  Fourth  Report  on  the  Diagnosis, Evaluation, and Treatment  of  Hight  Blood  Pressure  in  Children and  Adolescents.

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