Are You Living With a Silent Killer?

Arterial Hypertension is a Silent Killer.

Exist many people walking around with this disease without any symptoms o sing that something is wrong. The hypertension is called the century XXI silent plague.

Arterial Hypertension is a chronic disease characterized for the continued increase of the blood pressure amount above the limits, to carry the cardiovascular risk. Regarding International studies the cardiovascular morbidity and mortality have direct relationship with the increase of the numbers in the systolic pressure above the 139 mmHg or a diastolic  pressure keep high of 89 mmHg for complications of coronaries disease and the renal insufficiency. Close to the third part of the adult population from development countries suffer of HAS is the principal cause of hypertensive crisis and medical attention. Over measure of 115.75 of arterial pressure for every increment of 20 mmHg of the systolic pressure or 10 mmHg of the diastolic pressure. The risk of one cardiovascular event can be duplicate.
Statistics show the man have more predisposition to develop Arterial hypertension compared with woman, situation that change when the woman get the menopause. Woman has protection with the hormonal balance, which disappear with the menopause and the Arterial hypertension can equally. That means menopause woman has more predisposition to get vascular disease and stroke The Arterial pressure is expressed in two sizes, the Arterial systolic pressure and diastolic, for example 120/80 mmHg. The systolic arterial pressure (first count) is the blood pressure in the  arteries around the ventricular systole, when the blood is expulsed from the heart to the arteries. The arterial diastolic pressure (the inferior) is the pressure in the diastolic, when the heart is relaxed an the pressure fail. The hypertension is a cardiovascular risk factor, the antihypertensive treatment is focused to the reduction in the cardiovascular risk, however, the instance of treatment has in account, of the arterial pressure, and another cardiovascular risk, kidney disease, diabetes or metabolic syndrome.

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8 Causes of Arterial Hypertension
Some of the environment factors contribute to development of Arterial hypertension include the obesity, the alcohol consumption, genetic issues and stress profession. There is connection between the economic stable societies and the increase of hypertension with the age.                                                   #1.The salt

The excessive consume of salt induce and keep the Arterial hypertension. The hypertension sensible to salt consist in the exaggerate increase of the pressure induce for salt. The increase of the ingestion of salt increase the osmotic pressure blood that keep water and increase the blood pressure.
#2.Renin.
Observation that renin, excreted from the kidney is associated with Aldosterone. However, the Arterial hypertension associated to low level in renin is frequent in black people.                                                                                                   #3.Insulin Resistance.
In normal people, the stimulation of Insulin in the Sympathetic nervous System without the elevation of Arterial pressure. However, in people with pathologic conditions like metabolic syndrome. The resistance to the Insulin is proposed like the cause in the increase of Arterial pressure in such patients with metabolic diseases.
#4.Diabetes.
The diabetic patients have higher Arterial pressure than the rest of the population.
#5.Obesity
There exist a huge correlation between the corporal mass index and the pressure. It’s convenient a hypo caloric diet plan in patients with obesity and hypertension that conduce to lower the pressure.
#6.Sleep apnea
It’s a common disorder and a possible cause of Arterial hypertension. The treatment of this pathology through the arterial positive pressure.
#7.Genetic.
The Arterial hypertension is one of the complex genetic disorder associate with more than 50 genes. Recent localization of 12 new genes in relation with diverse phenotypes. It found 35 SNPs associated with Obesity, Diabetes Mellitus type II, Coronary disease and the kidney function, given evidence that those genes have connection with the Arterial pressure with cardiovascular activity.
#8. Age.
With age the numbers of collagen fiber increases, produce rigidly in the blood vessels, reduction in the elastic created blood flow resistance and consequence compensatory increased in the Arterial pressure.

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P A T O G E N I C
The Arterial pressure is the cardiac waste and vascular resistance product. However the factors affect determined the cardiac waste and the physiology and structure of the little arteries. When high viscosity of the blood have significate affects over the necessary work for bumping the amount of blood and can give persistency in the Arterial pressure. The malleability of the wall from blood vessels (pulse components) affect the velocity of the blood flow, have important relationship in the regulation of the Arterial pressure. The changes in the thickness of the wall affect the amplification of the periphery vascular resistance in the hypertensive patient, conduce to the relaxing waves in direction of Aorta artery and opposite to the blood flow, with increase in the systolic arterial pressure. The volume of the circulate blood is regulated for the sodium (Na) from the Kidney system and the manage of water, this phenomenon plays an important role in the sensible hypertension in response to sodium concentration in blood. The associated mechanism to the secondary hypertension are evident. However, such related with the essential hypertension. The cardiac waste is elevated in the beginning, in the natural curse with a resistance periphery total (RPT) normal, but an increase in the total peripheral resistance.

This theory explain the process
1. The kidney capacity to excrete sodium, result in the apparition of sodium excretion factors, like the secretion of atrial natriuretic peptide that promotes the excretion of salt with the side effect of increase of the total peripheral  resistance.                                                                                                       2. The renin-angiotensin-aldosterone hyperactive system that conduce to vasoconstriction and the consequence sodium retention and water. The reflex increase the blood volume that conduce to the Arterial hypertension.

3. The hyperactivity of the Sympathetic Nervous System produces high levels of stress. The hypertension is highly heritage and polygenic (causes for more of one gen). The endothelial changes are produced for the persistent elevated arterial pressure.
Affected Organs.
The organs such structure and function are alternated like a consequence of the Arterial hypertension is called “Diana organs”. For example a individuals between ages of 40 and 70 when the Arterial pressure between 115/75 to 185/115 mmHg. Every increase of 20  mmHg in the systolic pressure or 10 mmHg in the diastolic pressure duplicate the risk in the apparition of some this disease.
-Hypertensive retinopathy, vasospasm, increase of arterial brightness, arteriovenous pathologic cross, hemorrhages, exudates, papilledema and venous retina thrombosis.
-Central Nervous System.
The systolic pressure in more of 160 mmHg. The increase amount of systolic of diastolic are harmful, or one diastolic pressure of more than 100 mmHg.  Oher manifestations of hypertensive crisis conduce to cerebrovascular disease (stroke), hypertensive encephalopathy, cerebral microvascular damage and dementia of vascular origin consequent to multiples infarctions in the Central Nervous System.
-Peripheral Arteries.  Chronic endothelial dysfunction, arteriosclerosis progressive, atherosclerosis of great vessel, in special cerebral vessels aorta, coronaries and low limb arteries. The complicated aneurism eventually with the dissection or rupture, at the level of thoracic aorta. Left ventricular hypertrophy in the beginning is parietal think without increase in the muscle ventricular that progress to concentric hypertrophy, that develop the dilate phase (eccentric hypertrophy).
-Myocardial fibrosis, like the hypertrophic process with the deteriorate of the parietal distensible and the viscoelastic propertied of the myocardia contractibility.
-Coronary microvascular ischemic principally for rarefaction of the capillary red and endothelial dysfunction of the remnants vessels.
-Acute coronary syndrome; unstable angina or infarct without Q wave, called too like infarction without elevation of the segment S-T. Acute Myocardial infarction. The left ventricular diastolic dysfunction that consequence of ischemic, hypertrophy and ventricular fibrosis.   The left ventricular systolic dysfunction with the drop of the ejection fraction from the left ventricular (the percentage of the blood, that fill up the ventricle in diastole, is effective pumped out of the cavity).
-Congestive Cardiac Insufficiency (ICC) global consequently of the fail left ventricular there is secondary compromise from right hemicardium with dilatation of the chambers the secondary pulmonary arterial hypertension. & What does Pulmonary Arterial Hypertension means is, a complication of the insufficiency Cardiac Congestive global, consequently to the fail from the left ventricular and secondary compromise from right ventricular a total cardiac fail. The causes of PAH (Pulmonary Arterial Hypertension is a total fail from the heart can be ischemic Cardiopathy (75%) infarction of myocardium and hypertensive valvulopati (severe hypertension).
-Ventricular arrhythmia, like c consequence o metro centric for fibrosis damage or ischemic.
-Micro albuminuria. Early marks of nephropathy and independent factor of risk of cardiovascular morbidity. Focal and diffuse glomerulosclerosis win loss of nephrons, like consequence of hypertension intraglomerular chronic.
-Chronic renal ischemic due to atherosclerosis accelerate of the kidney
-Reduction of the glomerular filter rate, for the loss of the amount of functional nephrons, progressive process that it’s accelerated in hypertension and more much in the presence of the diabetes mellitus.
-Chronic Kidney insufficiency is the complicated and terminal event. Early detection with the correct take of Arterial Pressure. The take of the arterial pressure in patients with high risk, take the right measure in correct way with the finality of avoid false results. With the use of sphygmomanometers and stethoscope.

D I A G N O S T I C.

The clinical records from hypertension patient it be details and enrich with provision of information from close parents, or other medical or paramedical staff from the pass. La hypertension is the asymptomatic disease for excellency, due is called “silent killer” don wonder not record of so much symptomatology in the medical records, or less specific symptoms (headache, dizzies, visual disorder, red flash). Defining the motive from the visit. If the person has cardiovascular symptoms (dyspnea, orthopnea, dyspnea paroxistic, palpitation, syncope, edema, intermittent claudication) or in specific mood state, erectile dysfunction, etc.       Cardiovascular symptoms: ischemic cerebral transitory, cerebrovascular accidents, chest angina, myocardial infarct, congestive cardiac insufficiency, chronic kidney insufficiency.
Early Detention From Arterial Hypertension

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The individual need to be sit with the back reclined in the chair and the upper limb should rest over the superficies from the desk, and the forearm in pronation, to the high of heart. The soles are over the floor without cross the legs. After some minutes of res (about 5 minutes, after the interrogatories) put the wrist BP monitor or aneroid sfingomanometer appropriated in good conditions in the middle of forearm portion take the two thirds from the arm. Expose the area, preferred use physical exam gown, in persons with heart problems. Try to use the healthy arm without any compromise to avoid false result. Precaution in some patients don’t take the pressure in of compromise arm with amputation, radical upper surgery history or the presence of arteriovenous fistula. Actually exist diverse diagnostic ways (aneroid sphygmomanometer, writs BP) it’s recommended the use of the Tensiometer or mercury that need it to calibrated regularly. The procedure from take of pressure measure. This procedure it doesn’t need to be discomfort and painful. The inflow from the inflation bulb need be less 20-10 mmHg high of the necessary pressure for disappears the pulse of the wrist or elbow, that separated the pressure of 220 mmHg. The stethoscope over the arterial to deflate slowly until hear audible the first time the Korotkoff sound (systolic pressure). The early disappear of the sounds and your ulterior reappear, it called the auscultatory gag breach is frequent in elderly people, that reason deflate the inflation bulb slowly until disappear all sounds (phase of Korotkoff diastolic pressure) arm be immobilized.
The measure of the arterial pressure in stand up patient is recommended in elderly person, leave the stand person around five minutes before to make the measure.
In the first appointment or early detection of the arterial pressure, it’s ideal took in two arms and make clarified in which of the limb it found more high and consequently take the same arm for the arterial pressure.
The doctor need to teach to the patient the importance of take right measure of Arterial pressure (with heart disease of HA like complication) the use of this machines in home is a confinable measure for the control and avoid strokes and sudden death. The measure of the pressure in the home are around the 5 mmHg less that in medical office, for both pressure systolic and diastolic.
Clinic Sings For the Diagnostic of Arterial Hypertension

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Eyes Exploration. Count with the Keith Wagener classification of hypertensive retinopathy (shying arterial cross pathologic arteriovenous (Gunn sing), lose relationship venous arterial, exude, hemorrhages and anomalies of optic disc and periphery retina. Remember the hypertensive incipient retinopathy (relation arteriovenous changes) are specific to the hemorrhages and exude.
Neck inspection of Jugular veins, palpation and auscultation of carotid arteries and thyroid glandules valuation. Exhauster exploration cardiopulmonary describe aspect and expansion of thorax, lung ventilation, impulse max point of heart, fremitus and cardiac sound, the normal, accessories and pathologic.
Abdomen, adipose, visible pulsation presence venous circulation complementary, visceromagaly and tumor. Exploration of the peripheral pulses (amplitude, pulse wave and symmetry) of the capillary fill, acrales zones temperature, venous peripheric nets.
Basic neurologic exploration it be exhausted in case of preview lesion or actual from peripheric and central nervous system) pupils, oculars movements, facial symmetry, equilibrium, coordination tongue and force a sensibility, reflex osteotendinous and musculocutanous normal and pathologic.
Laboratory Exams. Creatinine (Ureic nitrogen is necessary in case of acute cardia insufficiency).
Potassium serum, glycaemia, lipid profile; Cholesterol total / HDL and triglycerides, uric acid, EGO we look for micro albuminuria (proteinuria the possible kidney lesion for the type of risk present risk factor (diabetes mellitus).
Additional Exams.
The use to confirm the diagnostic to dismiss secondary causes and determined the presence of lesion of Diana organs and the severity.
Electrocardiogram. The use for the diagnostic of left ventricular hypertrophy, arrhythmia evaluation, presence of X ray of poster anterior from thorax and lateral radiography is necessary. To value the cardiac shape, aorta, lungs, Helios, mediastina, bone thorax and the lung parenchyma.
Effort test with electrocardiogram. Help to value the physical condition, the pressure answer to the exercises in patient in treatment and the presence or absence of ischemic lesion or inducible arrhythmias.
Doppler color echocardiogram; It’s a not invade study with great diagnostic value. It’s recommended only in case the persons with patient with hypertension without symptoms or clinic evidence or damage in the cardiac organ.  Another procedures kidney arteries Doppler, Holter monitorization, autonomic function studies, vascular mechanic probe, studies of nuclear medicine, computerized axial tomography, nuclear magnetic resonance.   In the treatment the use of diuretic and beta blocker reduce the apparition of site adverse for hypertension arterial related with the cerebrovascular disease. However, the diuretics are more effective in the reduction of event related with the coronary heart disease. The hypertensive patient that have the treatment has less possibilities for developing risk hypertension or insufficiency congestive heart disease. In elderly patient with aisle systolic hypertension utilized alternative one inhibitor of channel of calcium.

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