Dr. Luis Guillermo Castillo Haro






       Hypertension....the Silent Killer
    
     (En Español Hipertension Arterial... El asesino silencioso)

 

Hypertension.

What is hypertension?

El corazón es un músculo que funciona como una máquina de bombeo.The heart is a muscle that works like a machine pumping. Cuando se contrae envía un torrente de sangre a las víasWhen it contracts it sends a rush of blood to the circulatorias ya este empuje se le llama presión de sístole.circulatory system and this push is called systolic pressure. Cuando el corazón se relaja entre latidos, disminuye la presión en las vías When the heart relaxes between beats, reduces the pressure on  
circulatorias, ya esto se le llama presión de diástole.circulatory system,and this is called diastolic pressure.

Los niveles normales de presión son por debajo de 140 para la sístole y por debajo de 85 para la diástole.Normal levels of pressure are below 140 for the systolic and below 85 for diastolic.

¿Cuáles son los valores normales de tensión arterial (TA) y que significan?What are the normal values of blood pressure (BP) and mean? ¿Como se determinan? How is it determined?

Con independencia del estado de salud que se tenga, la presión arterial de cualquier persona no es constante sino que sufre muchasRegardless of the health you have, the blood pressure of any person is not constant but suffers many
variaciones normales durante el día, aunque se mida siempre en reposo.normal variations during the day, but always measured at rest.

Las cifras de presión arterial siguen un ritmo a lo largo de las 24 horas, que se reproduce de un día a otro y se llama ritmo nictameral deThe figures follow a rhythm blood pressure over 24 hours, which is reproduced from one day to another and is called rhythm of nictameralla presión arterial, de manera que las cifras de presión son más altas durante el día y se reducen durante el sueño. blood pressure, so pressure numbers are higher during the day and are reduced during sleep.

These are the circumstances that increase transiently tension values:

*El esfuerzo físico. * The physical effort.
*Un cambio de tiempo, el frío. * A change of weather, cold.
*El traslado a un lugar de clima diferente. * The move to a place of different climate.
*Emociones fuertes, el dolor, el miedo. * Strong emotions, pain, fear.
*Tensiones psíquicas, conducción de automóviles, hablar en público, discusiones enérgicas, ruidos entre otras. * Tensions psychic driving, public speaking, energetic discussions, including sounds.

Moreover, taking blood pressure causes a reaction occurs which tends to raise alert, as they are repeated take blood pressure, it tends to fall. Por eso no está de más que se tomen dos o tres veces las presiones y se considere laSo do not take more than two or three times the pressures and considering last or the average of all as real pressure.

Si usted es normotenso conviene hacerlo cada dos años, con el fin de detectar precozmente cualquier elevación, puesto que no produceIf you are normotensive should do every two years in order to early detect any elevation, since it produces symptoms.
If you have hypertension and its pressure dropped to desired levels is sufficient to determine the pressures in three
meses, salvo que haya alguna circunstancia o síntoma nuevo.months unless there is some circumstance or new symptoms.

Hypertension. Diagnosis

The medical staff diagnosed hypertension with the use of a device that measured in a column of mercury, or digital devices. La lectura se The reading is expressed in mmHg, the abbreviation that indicates millimeters of mercury to the extent partial pressure of gases. In most cases it takes the pressure blood in the forearm, with the patient sitting, lying or standing. Se puedeYou can attending primary care clinics and pharmacies for pressure control, and there are devices that can be used at home.

For adults measuring guides are as follows

*Presión de diástole por debajo de 85 mmHG *Normal . * Diastolic pressure below 85 mmHg * Normal.
*Presión de diástole de 85 a 89 Normal alta. * Diastolic pressure of 85 to 89 High normal.
*Presión de diástole de 90 a 104 Hipertensión leve. * Diastolic pressure of 90 to 104 mild hypertension.
*Presión de diástole 105 a 114 Hipertensión moderada. * Diastolic pressure from 105 to 114 moderate hypertension.
*Presión de diástole por encima de 114 Hipertensión grave. * Diastolic pressure above 114 Severe hypertension.

Cuando la presión de diástole está por debajo de los 90mmHG:When diastolic pressure is below 90mmHg:
*Presión de sístole por debajo de 140 Normal. * Systolic pressure below 140 Normal.
*Presión de sístole de 140 a 159 En el límite de hipertensión. * Systolic pressure of 140 to 159 in the limit of hypertension.
*Presión de sístole por encima de 160 Hipertensión de sístole. * Systolic pressure above 160 systolic hypertension.

Los síntomas comunes de la hipertensión aguda incluyen ansiedad, mareos, fatiga y dolores de cabeza.Common symptoms of acute hypertension include anxiety, dizziness, fatigue and headaches. Si la presión arterial es graveIf blood pressure is serious
los síntomas pueden incluir confusión, distorsión de la visión, náuseas, vómitos, dolor de pecho, respiración entrecortada, zumbidos enSymptoms may include confusion, distorted vision, nausea, vomiting, chest pain, shortness of breath, ringing in ear, nose bleeding and excessive sweating.

The medical evaluation includes a physical examination and analysis of retinal changes that indicate high blood pressure, blood tests (which indicate the functioning of the thyroid and adrenal glands) and urine, electrocardiogram, and chest X-rays.

What happens when BP is elevated? Qué síntomas produce? What symptoms occur?

La hipertensión, al inicio, muchas veces no da síntomas marcados, sin embargoHypertension, at the beginning, often marked no symptoms, however can produce various complaints, which should alert us that something is wrong.

* Dolor de cabeza (cefalea) * Headache (headache)
* Zumbido de oídos * Ringing in the ears
* Adormecimiento de mitad del cuerpo. * Numbness of half of the body.
* Visión borrosa o visión de "luces". * Blurred vision or vision of "lights".
* Mareos al levantarse o al cambiar de posición. * Dizziness when getting up or changing position.

The pressure can change from one moment to another depending on the activity, moods, with position changes with exercise or during sleep. La gente con presión alta no tiene que ser exageradamente ansiosa, compulsiva o "nerviosa". People with high blood pressure need not be overly anxious, compulsive or "nervous".

A very important fact is that you can have high blood pressure and not know it usually has no symptoms. Por eso So
se le llama "la muerte silenciosa".is called "silent death".

En el 90% de los casos de hipertensión se desconocen las causas que la provocan.In 90% of cases of hypertension with unknown causes that provoke it. A este tipo se le llama hipertensión primaria.This type is called primary hypertension.

¿Cómo se puede clasificar la hipertensión arterial?How do you classify high blood pressure?

Se desconoce el mecanismo de la hipertensión arterial más frecuente, denominada "hipertensión esencial", "Primaria" o "idiopática".The mechanism of hypertension most common, called "essential hypertension", "Primary" or "idiopathic".
Existen otros tipos de hipertensiones, en las que se puede identificar claramente su causa desencadenante y reciben el nombre deThere are other types of hypertension, which can be clearly identified and its underlying cause are called Secondary hypertension. Thus, some kidney diseases are associated with hypertension (renal hypertension), excessive function of some endocrine glands, cause elevation of blood pressure by increasing production of mineralocorticoids
(hyperaldosteronism) or catecholamines (pheochromocytoma).

¿Cuál es la causa de la Hipertensión Arterial (HTA)?What is the cause of High Blood Pressure (HBP)?

En la hipertensión esencial no se han descrito todavía, sus causas específicas, aunque se ha relacionado con una serie de factores queIn essential hypertension have not been described yet, its specific causes, but has been linked with a number of factors
suelen estar presentes en la mayoría de estos sujetos.usually present in most of these subjects. Should be separated from those related to heredity, gender, age and race and tanto poco modificables, de aquellos otros que se podrían cambiar al variar los hábitos, ambiente, y costumbres de las personas, como: so little modifiable, those that could be changed by varying habits, environment, and habits of people, including: obesity, sodium sensitivity, excessive alcohol consumption, oral contraceptive use and a lifestyle very sedentary. Algunos factores que pueden desarrollar la HTA son:Some factors that may develop hypertension are:

Inheritance:
From parents to offspring is transmitted a tendency or predisposition to develop high levels of blood pressure. Is unknown
mecanismo exacto, pero la experiencia acumulada demuestra que cuando una persona tiene un progenitor (o ambos) hipertenso/s, lasexact mechanism, but past experience shows that when a person has a parent (or both) hypertensive/s, the
posibilidades de desarrollar hipertensión son el doble que las de otras personas con ambos padres normotensos.likely to develop hypertension are twice those of other people with both parents normotensive.

Si usted descubre que en su familia existen parientes consanguíneos que han sufrido ataques cardiacos (infarto de miocardio) a edadIf you find that in your family blood relatives who have suffered heart attacks (myocardial infarction) at age
temprana (menores de 50 años) o hipertensión arterial, tanto usted como su familia deberán tomarse la tensión arterial con ciertayoung (under 50) or hypertension, you and your family must be taken with certain blood pressure
regularidad.regularity. proceso).

 At this time we lack means to identify the gene or the genes (in case the genes really take part in this process).
 What  we could do is insist on the desirability of the children and descendants of hypertensive individuals are

tomaran la tensión arterial una vez al año ( en cualquier caso todos nos tendríamos que tomar la tensión arterial con esa periodicidad) y take blood pressure once a year (in any case we all would have to take blood pressure with that frequency) and
que estas personas presentaran especial atención a los factores que elevan la tensión arterial y que se han llamado modificables y por these people paying particular attention to factors that raise blood pressure and have been called modifiable and
tanto susceptibles de control como la obesidad, el exceso de sal en la dieta, consumo elevado de alcohol y la vida sedentaria. therefore amenable to such as obesity, excessive salt intake, high alcohol consumption and sedentary lifestyles.

Sex:
Los hombres tienen más predisposición a desarrollar hipertensión arterial que las mujeres hasta que estas llegan a la edad de la Men are more prone to develop hypertension than women, until they reach the age of
menopausia, a partir de la cual la frecuencia en ambos sexos es igualada. menopause, after which the frequency in both sexes is equal.

Esto es así porque la naturaleza ha dotado a la mujer mientras se encuentra en edad fértil con unas hormonas protectoras que son los This is because nature has given to women while you are of childbearing age with a protective hormones that are the
estrógenos y por ello tiene menos riesgo de padecer enfermedades cardio-vasculares durante la edad fértil. estrogen and thus have less risk of cardiovascular disease during their childbearing years. De esta forma la naturaleza Thus the nature
protege a la mujer asegurando la procreación. protects women by ensuring procreation. Sin embargo, en las mujeres más jóvenes existe un especial riesgo cuando toman However, in younger women there is a particular risk when they take
pastillas anticonceptivas. birth control pills.

Age and ethnicity:
La edad es otro factor, por desgracia no modificable, que va a influir sobre las cifras de presión arterial, de manera que tanto la presión Age is another factor, unfortunately coded, which will influence the blood pressure numbers, so that both pressure
arterial sistólica o máxima como la diastólica o mínima aumentan con la edad y lógicamente se encuentra un mayor número de Maximum systolic or diastolic or minimal increase with age and is obviously a larger number of
hipertensos en los grupos de más edad. hypertension in older age groups.

 In industrialized countries the prevalence of hypertension among the population over 65 years is almost 60% which is not to say that as frequent hypertension in the elderly, this is normal and to be hypersensitive to any age carries increased
cardiovascular risk, i.e. the risk of complications such as myocardial infarction, cerebral hemorrhage or thrombosis,insuficiencia renal, etc. renal etc.

En cuanto a la raza, únicamente señalar que los individuos de raza negra tienen el doble de posibilidades de desarrollar hipertensión As for the race, only to note that individuals of African descent are twice as likely to develop hypertension than whites also have a worse prognosis.

Overweight:
Regardless of the non-modifiable factors that influence hypertension other factors which we callambientales (estilo de vida, dieta, etc.) son capaces de poner de manifiesto la enfermedad de forma más leve o más severa. environmental (lifestyle, diet, etc..) are able to highlight the disease is milder or more severe. In thissentido, indudablemente, en la gran mayoría de los casos, el nivel de presión arterial e incluso la hipertensión arterial es el resultado del sense, certainly, in most cases, the blood pressure level and even high blood pressure is the result of lifestyle of a person. The relationship between weight and blood pressures and between overweight and hypertension, known many years, and reduction of overweight is used to treat the same too long.

Hay que partir del hecho de que un individuo con sobrepeso esta más expuesto a tener más alta la presión arterial que un individuo con Must start with the fact that an overweight individual is more likely to have higher blood pressure than an individual with
peso normal. normal weight. A medida que se aumenta de peso se eleva la tensión arterial y esto es mucho más evidente en los menores de 40 años y As weight increases blood pressure rises and this is much more evident in those under 40 years
en las mujeres. in women.

La frecuencia de hipertensión arterial entre los obesos, a cualquier edad que se considere, es entre dos y tres veces superior a la de los The frequency of hypertension among the obese, at any age under consideration, is two to three times higher than the
individuos de la misma edad que estén en su peso ideal. individuals of the same age who are at your ideal weight.

No se sabe con claridad si es la obesidad por si misma la causa de la hipertensión o si hay un factor asociado que aumente la presión It was unclear if obesity by itself the cause of hypertension or if there is an associated factor that increases pressure
en personas con sobrepeso, aunque las últimas investigaciones apuntan a que a la obesidad se asocian otra serie de alteraciones que in overweight, although recent research suggests that obesity is associated with another series of alterations that
serían en parte responsables del aumento de presión arterial. be in part responsible for increased blood pressure. También es cierto, que a la reducción de peso hace que desaparezcan It is also true that weight reduction does disappear
estas alteraciones. these alterations.

What is a hypertensive crisis?

There are specific circumstances under which the high demand immediate treatment without which they face high
riesgos.risks. Among these special situations can be underlined the hypertensive crisis.

It comes with a significant increase in blood pressure, diastolic pressure usually greater than 120 mm Hg. Las crisis The crisis
se han clasificado en emergencias o urgencias.have been classified as emergencies or urgencies. Hypertensive emergencies include states in which there is severe or progressive organ damage. Organic damagepuede manifestar como: can manifest as:

1) Lesión de la retina (hemorragias, exudados, edema de papila), 1) Retinal damage (haemorrhages, exudates, papilledema),
2) Alteraciones cardíacas (edema pulmonar, isquemia miocárdica o infarto), 2) cardiac disorders (pulmonary edema, myocardial ischemia or infarction),
3) Alteraciones del SNC (cefalea, alteraciones de la conciencia, convulsiones, coma) o alteraciones renales (hematuria, aumento de la 3) disorders of the CNS (headache, impaired consciousness, convulsions, coma) or renal (hematuria, increased
creatinina). creatinine).

Si se desea evitar el riesgo de lesión permanente o muerte, en estas situaciones se debe reducir la presión arterial en una hora comoIf you want to avoid the risk of permanent injury or death in these situations should reduce blood pressure in one hour
máximo.Max.

Las urgencias hipertensivas son los estados en los que el daño orgánico es mínimo o poco evidente.Hypertensive emergencies are the states where organ damage is minimal or little evident. They have more tiempo para reducir la presión arterial.time to reduce blood pressure. El objetivo inicial del tratamiento consiste en reducir la presión arterial diastólica hasta 100 - 110The initial goal of treatment is to reduce diastolic blood pressure to 100 to 110 mmHg; have to avoid excessive or too rapid decrease in BP, which could enhance cerebral hypoperfusion and inadequate coronary. En general, la TA debe normalizarse en el plazo de varios días, según lo tolere el paciente.Overall, the TA should return to normal within several days, as tolerated by the patient.

How important is diet for the prevention of hypertension? Qué papel juega el ejercicio en la HTA?What is the role of exercise in hypertension?

La sal excesiva en la dieta causa retención de líquidos y aumento de TA.The excess salt in the diet causes fluid retention and increased BP. Para disminuir la TA, el primer paso es disminuir el consumoTo lower the TA, the first step is to reduce consumption total salt (including that contained in the bread, broth concentrates, prepared foods, etc..) to a smaller amount of acucharadita al día. teaspoon a day.

Salt daily needs are around half a gram a day (½ tsp), but in a normal Western diet consumes eight times that amount, not only in salt shaker, but also snacks, cheeses, meats, condiments, soups.

El sodio no está sólo en la sal, sino también en el glutamato monosódico, la levadura, etc, por lo que hay que leer las etiquetas de losSodium is not only salt but also in the monosodium glutamate, yeast, etc, so you have to read labels productos envasados al hacer una dieta hiposodica estricta.packaged products to make a strict low sodium diet.

Puede mejorar la presión arterial el comer más frutas y verduras que contiene Potasio, y por ello favorecen esta reducción.You can improve blood pressure eating more fruits and vegetables that contain potassium, and therefore favor the reduction.

Por otra parte, el exceso de peso contribuye a un mayor trabajo cardíaco.Moreover, being overweight contributes to increased cardiac work. La obesidad está asociada a la hipertensión arterial en gran Obesity is associated with hypertension in a large
medida, en parte debido a que los obesos tienen un aumento de la insulina que a través de un menor flujo de la circulación renalmeasure, partly because the obese have increased insulin through a smaller flow of the renal circulation produces a retention of salt (sodium). A diet low in calories (1200 cal) with low fat intake can occur for every 10 kg of reducing weight, one decrease of 10 mmHg. En algunas personas basta disminuir de peso para controlar la TA. In some people reduce weight is sufficient to control BP.

Other dietary factors:

El tabaco y las bebidas con cafeína tienen un efecto de corta duración de aumento de la TA, pero no existe evidencia clara de que su usoThe tobacco and drinks with caffeine are short-term effect of increased BP, but no clear evidence that their use standard can contribute to an HTA (hypertension.) However, the use of tobacco can accelerate the processarteriosclerosis en gente con HTA. atherosclerosis in people with hypertension. Also, the habitual abuse of alcohol can contribute to the development and maintenance of hypertension.

Consideration should also be aware that certain medications increase vascular resistance, including anti-inflammatory non prescription drugs (aspirin, diclofenac, ketorolac among others) contraceptives, sympathomimetics (salbutamol, ephedrine, phenylephrine, naphazoline, pseudoephedrine, amphetamines, etc.). and steroids.

An aerobic exercise program helps strengthen the heart, control weight and lower BP. No se sabe el mecanismo exacto por el No one knows the exact mechanism by that helps lower blood pressure. Se debe realizar un ejercicio adecuado a cada edad ya cada persona, por ello la realización de media hora de There must be a proper exercise for every age and every person, so the half-hour performance jogging 2 or 3 days a week is enough for most people.

The drugs made by the doctor should take how long?

Al haberse introducido nuevos grupos de fármacos y estas observaciones han llevado a orientar el tratamiento de la hipertensión a unBeen introduced to new groups of drugs, and these observations have led to guide the treatment of hypertension to a
nuevo concepto, basado en un sistema más flexible que el anterior.new concept, based on a more flexible system than the last.

Actualmente se da más importancia a los tratamientos no farmacológicos (ejercicio, disminución de la obesidad, dietas pobres en sal)Currently, more emphasis on non-pharmacological treatments (exercise, decreased obesity, diets low in salt) then go to drug treatment. Starting with the choice of a drug selection becomes more individualized, having less tendency to push the dose. Si un If afármaco no controla la hipertensión se cambia a otro o se añade un segundo medicamento. does not control the hypertension drug is changed to another or adding a second medication.

Prescription medicines must be exclusively the doctor.

Incluso en hipertensos leves se tiende a suspender el tratamiento farmacológico al cabo de unos años, manteniendo o incrementandoEven in mild hypertensive patients tend to discontinue drug therapy after a few years, maintaining or increasing
las medidas no farmacológicas.nonpharmacologic measures.

En general el tratamiento debe instaurarse cuando la media de las presiones diastólicas durante tres o cuatro meses sea igual oIn general, treatments must be initiated when the average diastolic pressures for three to four months is equal to or
superior a 100 mm Hg.greater than 100 mm Hg.

Si es menor, para iniciar un tratamiento, debe haber otros factores de riesgo a la vez, como puede ser una lesión cardiaca (hipertrofiaIf smaller, to start treatment, there must be other risk factors at once, such as cardiac injury (hypertrophy
ventricular, insuficiencia renal, etc) u otros factores de riesgo (diabetes, historia familiar de enfermedad cardiovascular).ventricular, renal failure, etc.) or other risk factors (diabetes, family history of cardiovascular disease).

Must attempt to maintain diastolic pressure below 90 mm Hg, with treatment that the patient can tolerate. The Diuretics are frequently used in the treatment of hypertension because, as scavengers of water and salt help the function heart is maximized.

How does the HTA heart attack?

The excess pressure in the arteries maintained for a period of years and untreated can lead to a large number of
complications. Some of the most important are cardiac complications such as arteriosclerosis and coronary heart
hypertensive.
ARTERIOSCLEROSIS                

When blood vessels are subject to increased pressure maintained, respond to thicken, making them less flexible. En estas arterias duras se fijan con facilidad las grasas que circulan en exceso en la sangre.In these hard arteries easily fixed with excess fats circulating in the blood. A nivel de las arterias de los At the level of the arteries of the kidneys, arteriosclerosis causes less flow reaches the kidney and the kidneys respond by releasing rennin, a hormone that in turn causes an increase in BP. Esto exagera la HTA y causa aún más daño sobre los vasos sanguíneos.This exaggerates hypertension and cause further damage to blood vessels.

CARDIOPATIA HIPERTENSIVAHYPERTENSIVE HEART

When atherosclerosis affects the vessels that feed the heart muscle or myocardium (so-called coronary vessels), the
heart is forced to work harder to maintain blood flow in tissues. En algunos casos lo hace aumentando de In some cases it makes increasing tamaño, con una hipertrofia del músculo cardíaco, haciéndose más rígido y menos eficaz.size with hypertrophy of the heart muscle becomes more rigid and less effective. El resultado final puede ser la insuficiencia The end result may be heart failure: The heart is pumping back into the circulating blood as needed, and liquids stagnate around the body.

How helpful is medication to control BP?

Because hypertension does not usually cause symptoms, how to tell if the medications are working is to take blood pressure in always start at the same time (the TA varies throughout the day). Una vez que la TA se ha normalizado, conviene tomarla una o dos veces Once the TA has been standardized, it should take it once or twice per week, but at different times. The goal of treatment is to maintain BP in normal range throughout the day.

If necessary treat hypertension with drugs, in many cases these drugs have to be continuously for the rest of life. En ningún caso hay que dejar la medicación cuando la TA se normalice, salvo que su médico diga loIn any case we need to stop the medication when BP is normal, unless your doctor tells you otherwise. And despite treatment if BP goes up, also consult your doctor.

Dr. Luis Guillermo Castillo Haro.
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