High blood pressure (hypertension)

What is it about ?

Blood pressure is the pressure of blood in the large arteries. The heart expels, via these arteries, the blood rich in oxygen to the various organs.

Blood pressure is measured in the upper arm. There are two figures: the maximum pressure or “systolic blood pressure” (PAS) and the minimum pressure or “diastolic blood pressure” (PAD):

• The systolic pressure is the blood pressure during the contraction phase of the heart, that is, when the heart pushes blood through the arteries.
• The diastolic pressure corresponds to the blood pressure during the relaxation phase of the heart, that is to say when the heart fills with blood.

The measured values ​​are expressed in millimeters of mercury (mmHg). A maximum tension greater than 140 mmHg and / or a minimum tension greater than 90 mmHg are synonymous withhypertension. In the event of a maximum tension greater than 180 mmHg and / or a minimum tension greater than 110 mmHg, we speak ofsevere hypertension.

Persistent hypertension increases the risk of:

• heart attack (infarction) ;
• stroke ;
• dementia ;
• heart failure ;
• blocked blood vessels;
• decreased kidney function ;
• sight impairment.

Hypertension can be primary or secondary:

• In L’primary hypertension, there is no disease causing hypertension.
• In L’secondary hypertension, another disease is the cause of the rise in blood pressure.

What is its frequency?

Hypertension is responsible for nearly one in 6 adult deaths worldwide ¹. Blood pressure increases with age. About half of adult men aged 35 to 64 and a third of women in the same age group have high blood pressure ².

In 95 out of 100 people with hypertension, no other underlying disease (causing the rise in blood pressure) can be identified. It is therefore a primary hypertension.

White coat hypertension (see below) is a temporary form of hypertension, present only at the time of the consultation, which affects approximately one in 4 people.

In young adults, almost one in 6 cases of hypertension goes undiagnosed ³.

How to recognize it?

People with high blood pressure usually have no symptoms. It is precisely because we generally do not feel symptoms that hypertension is a dangerous disease. In fact, hypertension damages the blood vessels. This damage is often present for a long time when the consequences are felt.

Only one very large increase in blood pressure is sometimes accompanied by symptoms such as:

• nosebleed ;
• headache ;
• reduced tolerance to effort;
• shortness of breath ;
• sight loss.

How is the diagnosis made?

The general practitioner systematically measures blood pressure:

• in all people aged 40 to 80, regardless of the reason for their consultation;
• in case of suspicion of migraine ;
• before prescribing the contraceptive pill ;
• in case of pregnancy ;
• as part of the monitoring of known hypertension.

High blood pressure, measured on an ad hoc basis, does not mean that you have hypertension. Therefore, the doctor will usually not start treatment immediately, but will first check the blood pressure several times. Your doctor will also ask you to take your blood pressure at home because sometimes the stress and anxiety associated with the consultation is enough to cause the blood pressure to rise. This phenomenon is known as white coat hypertension.

If the blood pressure values ​​measured at home are very different from those measured by the doctor, a blood pressure measurement at home, in daily life, for 24 hours (outpatient measurement) is sometimes carried out. You must then wear a blood pressure monitor for 24 hours. This blood pressure monitor automatically measures blood pressure at fixed times. This gives the doctor an overview of your blood pressure throughout the day.

Your high blood pressure may be the result of an underlying disease. If your doctor suspects either cause, he will order a series of additional tests. In addition to an in-depth discussion of your complaints and a full physical examination, they will do a blood test, analyze your urine, and request a electrocardiogram or ECG, that is, an examination that records the activity of the heart. Finally, your doctor will check regularly whether high blood pressure is affecting your organs.

What can you do ?

If you think you have hypertension, you can measure your blood pressure at home using a blood pressure monitor (you can get one from your pharmacist, for example):

• The ideal is to do it for 7 consecutive days, 4 times a day:
• twice in the morning between 6 a.m. and 9 a.m.
• twice in the evening, between 6 p.m. and 9 p.m.
• Do this preferably in a seated position, with the cuff around your bare upper arm.
• Relax for at least 5 minutes before the measurement. Therefore, do not measure your blood pressure immediately after getting up, after a meal, after exercise or if you are stressed.
• Note the measured values ​​and mention any relevant details (badly slept, nervous, long journey in the car, sick, …).

Since hypertension is one of the main causes of cardiovascular disease, it is very important to adopt a healthy lifestyle :

• Stop smoking.
• Get enough exercise.
• Watch your weight.
• Eat less fat, less sugar and less salt.
• Consume no more than 6 grams of salt per day, which is roughly equivalent to a level teaspoon.
• Keep in mind that many foods already contain salt. For example, a regular large bread contains 4 grams of salt. Stock cubes and processed meats can also contain a lot of salt. It is therefore not necessary to add salt to a normal diet.

What can your doctor do?

• At theadult, we aim for a blood pressure lower than 140/90 mmHg.
• In the patient diabetic without kidney problem, one aims ideally a blood pressure lower than 130/80 mmHg.
• In the presence of protein in urine, one aims ideally a blood pressure lower than 125/75 mmHg.
• A value of 150/90 mmHg is acceptable in a person over 80 years old.

When the systolic pressure is above 180 mmHg and / or the diastolic pressure is above 110 mmHg, the doctor will immediately start treatment.

When the systolic pressure is above 160 mmHg and the diastolic pressure is above 100 mmHg, your doctor will first advise you to adopt a healthy lifestyle. Indeed, healthy habits are often enough to lower blood pressure. If your blood pressure has not fallen enough after a few months, your doctor will prescribe additional medication.

If the blood pressure values ​​are lower, your doctor will first determine your cardiovascular risk. This assessment is based on your personal risk factors:

• age ;
• sex;
• smoking;
• weight ;
• blood pressure ;
• cholesterol and fat in the blood;
• physical activity ;
• hereditary predisposition.

If you have a high risk cardiovascular disease (i.e. more than 10 in 100 people with your profile die within 10 years), your doctor will quickly start treatment and aim for strict control of your blood pressure.
If you have a moderate risk cardiovascular disease (i.e. between 5 and 10 in 100 people with your profile die within 10 years) your doctor will look at a number of factors, such as your family history of cardiovascular disease, your physical activity and possibly excess weight or obesity. He will decide with you on this basis whether or not you should take any medication.
If you have a low risk cardiovascular disease (i.e. less than 5 in 100 people with your profile die within the next 10 years), your doctor will only start drug treatment in the presence of particularly high blood pressure values.

Medications

The drugs used in the treatment of hypertension are mainly the following:

• diuretics;
• beta-blockers ;
• angiotensin converting enzyme inhibitors (ACEIs);
• sartans;
• calcium antagonists or calcium channel blockers.

The treatment of hypertension is not the same for everyone. Your doctor will find the most appropriate medication based on your medical history.

You usually start with a low dose of thiazide, a drug that helps eliminate salt and water. If the blood pressure does not drop enough, other drugs are added. It should be noted that the combination of low doses of drugs with different mechanisms of action produces a better effect than a high dose of a single drug.

If hypertension is accompanied by cardiovascular disease, kidney disease or a diabetes, your doctor may choose another medicine.

Control

Monthly blood pressure monitoring is recommended until desired values ​​are reached and remain stable. After that, a check every 3 months or even every 6 months is sufficient.

Once a year, a blood and urine test will be performed and the cardiovascular risk will be assessed. In the presence of other diseases, such as diabetes and kidney disease, the controls will be closer.

Want to know more?

• Arterial hypertension – mongeneraliste.be – SSMG – Scientific Society of General Medicine
• Hypertension – AVIQ – Agency for Quality Life
• Arterial hypertension – Belgian Cardiological League

• Eating and gaining years of life is possible! (video) – CSS – Superior Health Council
• Salt: just a grain – mongeneraliste.be – SSMG – Scientific Society of General Medicine
• Salt: pay attention to industrial preparations – SSMG – Scientific Society of General Medicine
• The food pyramid – Eat Move – Health Question
• Nutri-Score – SPF Public health, food chain safety and the environment

• Physical activity – Eat Move – Health question

• Stop smoking. It’s possible – Tabacstop – Foundation against cancer

• Medicines against hypertension – CBIP – Belgian Center for Pharmacotherapeutic Information
• Thiazide diuretics – CBIP – Belgian Center for Pharmacotherapeutic Information

Sources

• Belgian practice guide ‘Hypertension’ (2004), updated on 01.11.2009 – SSMG – Scientific Society of General Medicine
• CBIP – Belgian Center for Pharmacotherapeutic Information

¹ https://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/
² https://www.ebpnet.be/fr
³ http://www.minerva-ebm.be/FR/Analysis/506