What is arterial hypertension and why is it dangerous?
Arterial hypertension, or high blood pressure, is one of the most common chronic diseases in the world, affecting more than a billion people. It is the primary reversible cause of cardiovascular disease [1]. Constant exposure to elevated pressure on the heart leads to maladaptive remodeling, which can cause cardiac dysfunction [1].
Hypertension not only increases the risk of heart problems but is also a significant risk factor for the development of other serious conditions, such as stroke, kidney disease, and even influences the course of other diseases, for example, chronic lymphocytic leukemia [5, 6].
Symptoms of high blood pressure: what to look for?
Symptoms of arterial hypertension are often nonspecific and may include headache, lightheadedness, and vertigo (a sensation of spinning) [2]. It is important to note that these symptoms can also be caused by other factors, so a thorough examination is required for an accurate diagnosis.
Headache associated with hypertension must meet specific diagnostic criteria:
- High blood pressure level (≥180/120 mmHg) [2].
- Demonstrable causal relationship through temporal association [2].
- Relief of symptoms after the initiation of antihypertensive therapy [2].
Severe hypertension accompanied by headache (e.g., malignant or accelerated hypertension, grade 3 or 4 hypertensive retinopathy) requires immediate medical intervention [2]. Dizziness is often described as a feeling of lightheadedness or instability [2].
Diagnosis and assessment of heart condition in hypertension
The diagnosis of arterial hypertension is based on regular blood pressure measurement. However, deeper investigations are necessary to assess the impact of hypertension on the body and to choose the optimal treatment strategy.
Echocardiography is a key method for assessing heart function and identifying changes caused by hypertension. Studies show that antihypertensive therapy can significantly improve cardiac function, which is confirmed by echocardiographic indicators [1].
One promising indicator for assessing left ventricular filling pressure and monitoring treatment efficacy is global longitudinal strain (GLS) of the left ventricle, measured via ultrasound [4]. The improvement in the GLS index after treatment is significantly higher than that of other traditional indicators, such as E/e' [4]. Left ventricular hypertrophy (LVH) in uncontrolled hypertension is an independent predictor of mortality, and its regression during treatment improves outcomes [7].
Modern approaches to the treatment of arterial hypertension
The goal of treating arterial hypertension is to lower blood pressure to target levels, which helps prevent the development of complications and improves prognosis [1, 7].
Basic principles of treatment:
- Drug therapy: Includes various classes of antihypertensive drugs. Studies show that early and rapid blood pressure control (within 3 months for grade II/III hypertension) is associated with an improvement in left ventricular structure and function within 18 weeks [7].
- Individualized approach: The choice of drugs and treatment tactics depends on many factors, including the presence of comorbidities. For example, in patients with aortic stenosis, especially with low-flow and low-gradient, antihypertensive therapy requires special attention, while angiotensin modulators have shown antifibrotic effects in animal models [3].
- Regular monitoring: It is important to regularly monitor blood pressure and undergo examinations to assess treatment efficacy and adjust therapy [8].
Despite the availability of effective treatment methods, achieving target blood pressure levels remains a challenge. One study showed that only 37% of patients achieve BP control, and treatment intensification was performed in only 23% of patients with uncontrolled pressure [8].
Prevention of complications and blood pressure control
Control of arterial hypertension is crucial for preventing serious complications such as heart failure, stroke, and kidney damage. Hypertension is also a risk factor for the development of cerebral hyperperfusion syndrome after stent thrombectomy in patients with acute ischemic stroke [6]. Furthermore, it can negatively affect survival and treatment efficacy in other diseases, for example, in chronic lymphocytic leukemia [5].
To effectively control blood pressure and minimize risks, it is recommended to:
- Strictly follow the doctor's instructions and take prescribed medications regularly [8].
- Lead a healthy lifestyle: balanced diet, regular physical activity, smoking cessation, and moderate alcohol consumption.
- Measure blood pressure at home regularly and keep a log.
- Undergo scheduled medical check-ups and examinations.
Sources
- [1] Cardiac response to hypertension treatment: an advanced echocardiographic evaluation.
https://pubmed.ncbi.nlm.nih.gov/39014266/ - [2] Symptoms in hypertension: Diagnostic challenges, clinical implications and management strategies for headache, dizziness and vertigo.
https://pubmed.ncbi.nlm.nih.gov/42230221/ - [3] The Effect of Antihypertensive Medication Classes on the Hemodynamic Severity Parameters of Classical and Paradoxical Low-Flow, Low-Gradient Aortic Stenosis.
https://pubmed.ncbi.nlm.nih.gov/42436701/ - [4] Left ventricular long-axis ultrasound strain (GLS) is an ideal indicator for patients with anti-hypertension treatment.
https://pubmed.ncbi.nlm.nih.gov/34523366/ - [5] Hypertension affects survival and treatment in chronic lymphocytic leukemia.
https://pubmed.ncbi.nlm.nih.gov/41604617/ - [6] Analysis of factors influencing cerebral hyperperfusion syndrome after stent thrombectomy in patients with acute ischemic stroke due to large vessel occlusion: a retrospective study.
https://pubmed.ncbi.nlm.nih.gov/42630650/ - [7] Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study.
https://pubmed.ncbi.nlm.nih.gov/34689818/ - [8] Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia.
https://pubmed.ncbi.nlm.nih.gov/28775184/
The information in this article is for reference purposes only and cannot replace professional medical advice. Always consult a specialist for diagnosis and treatment.