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.
Email the doctor at
this link
Dr. Guillermo Castillo
--------------------------------------
Translation via Computer and Webmaster, please let me know it is incorrect at this email Gary W. Logan