Hipertensión (presión arterial alta)

What is blood pressure?

Blood pressure is measured as the force of blood pushing against the arterial wall as it flows from the heart to the body. A blood pressure reading consists of two values.

The top number is the systolic blood pressure, which is the pressure in the arterial wall generated from the contraction of the heart and expulsion of blood to the arterial circulation. The bottom number is the diastolic blood pressure, which is the lowest pressure in the arterial wall when the heart relaxes in order to fill with blood to begin the next cardiac cycle.

The difference between the systolic pressure and the diastolic pressure is known as the pulse pressure. For example, a 120/80 reading reflects a pulse pressure of 40, while a 140/80 reading reflects a pulse pressure of 60.

How is hypertension diagnosed?

A blood pressure cuff, also known as a sphygmomanometer, is used to measure blood pressure. When the cuff is put around the upper arm and inflated with air, the pressure eventually blocks the flow of blood down the arm past the cuff. The pressure in the cuff is then slowly released.

When the pressure of the cuff is less than the systolic pressure, the arterial blood will begin to flow past the cuff. This pulsation of arterial flow can be felt—or heard with a stethoscope—at that point. As the rest of the air is slowly let out of the blood pressure cuff, the pulse will become quiet again. This level of pressure at this point is the diastolic pressure.

The definition of high blood pressure or hypertension may be a little bit confusing, so let’s start with what is a normal blood pressure. A normal blood pressure is less than 120/80 mmHg. That means both the top number (systolic) and bottom number (diastolic) are below this cutoff value.  

Traditionally a reading equal to or above 140/90 in an office setting was the definition of hypertension. What about readings between 120/80 and 140/90? That’s where some of the confusion ensues. Terms such as elevated blood pressure and prehypertension are sometimes used for readings between 120-129 systolic despite a normal diastolic reading. Recently, the American Heart Association lowered the cutoff for the diagnosis of hypertension to 130-139 systolic or 80-89 diastolic.

Are there common symptoms of hypertension?

Most patients have no symptoms related to high blood pressure, although especially with more severe elevation of blood pressure, some patients will experience headaches, chest pressure, shortness of breath, or visual changes.

Why does knowing your blood pressure matter?

Essential hypertension or high blood pressure is a common, treatable condition which is an important risk factor for heart attack, heart failure, stroke, and kidney failure. Hypertension is also implicated in earlier onset and worsening progression of Alzheimer’s disease and vascular dementia, erectile dysfunction, and many other health problems.

Because so often people experience no symptoms, hypertension has been called “the silent killer.” This is why a routine blood pressure check is recommended annually for all adults over age 40, and at least every three years for adults age 18-39.

Why does hypertension increase risk for cardiovascular disease? What is the underlying biology?

If left uncontrolled, hypertension can lead to a heart attack, an enlargement of the heart, and eventually heart failure. Blood vessels may develop bulges (aneurysms) and weak spots that make them more likely to clog and burst. The pressure in the blood vessels can also cause blood to leak out into the brain and cause a stroke. Hypertension can even lead to kidney failure, blindness, and cognitive impairment.

The underlying biology of hypertension is not fully understood. Blood pressure interacts with several important factors (including family history, race, older age, decreased physical activity, obesity, high-sodium diet, and excessive alcohol consumption) to create arterial stiffness. The actual risk for cardiac events is then greatly multiplied by the presence of several independent cardiac risk factors (e.g. smoking, diabetes, and hypercholesterolemia).

How long can people have high blood pressure before there are deleterious consequences?

The damage to arterial blood vessels and the consequent risk for vascular events is a function of both the duration and severity of high blood pressure. If blood pressure stays elevated above 140/90 for months or years, the muscular arterial walls become thickened and stiff due to loss of elastic tissue, which increases the likelihood of atherosclerosis and subsequent vascular blockages.

Similar to what we know about heavy smoking or uncontrolled diabetes, people who have untreated hypertension for many years are more likely to have irreversible vascular damage and worse cardiovascular disease than their peers.

Can you talk about the changing numbers for what “high” blood pressure is and how people should make sense of it?

As noted in the introduction of the diagnosis of hypertension, for many years, healthcare providers followed guidelines that defined hypertension as readings above 140/90, and the goal was to have patients achieve levels less than that value.

In 2015, a landmark study called the SPRINT trial was published, proving that tighter blood pressure control resulted in fewer cardiovascular events and decreased all-cause mortality. Based on this study, the American College of Cardiology and the American Heart Association redefined hypertension as anything greater than 130/80.

These new guidelines were highly controversial, as an additional 31 million Americans were now labelled as having hypertension. Two of the nation’s largest medical societies, the American Academy of Family Physicians (AAFP) and the American College of Physicians(ACP), rejected the guidelines, and the controversy over the definition of hypertension gathered national media attention.

The bottom line is that patients need to engage in a shared decision-making process with their healthcare provider to decide about when to initiate medical therapy and the goal they want to achieve. Factors such as family history, other medical conditions, and age would be important considerations in this discussion.

Are systolic (top number) and diastolic (bottom number) blood pressures equally important?  

The cardiac cycle includes systole (the contraction of the heart pumping the blood from the heart to the arteries) and diastole (relaxation to fill the heart for the next cycle). Because about two-thirds of the entire cardiac cycle is spent in diastole, the “mean arterial pressure” is weighted more heavily towards diastole. In addition, the systolic reading varies much more in response to physiologic and emotional stresses due to the effects of adrenaline.

As a result, physicians were previously taught to be more concerned by elevations of diastolic pressure (e.g., a reading of 130/90 is somewhat worse than 140/80). Although this might make intuitive sense, research indicates that this is only true for younger patients.

While the diastolic pressure is a better predictor of mortality for people under age 50, the systolic pressure and the pulse pressure (the difference between the systolic and diastolic reading) are thought to be equally important predictors of mortality for patients aged 50-59. After age 60, the pulse pressure becomes the strongest predictor of coronary heart disease.

How important are genetics in hypertension?

Primary hypertension (also known as essential hypertension) refers to hypertension with no single identifiable cause. It is by far the most common type of high blood pressure, and it is thought to be mostly determined by lifestyle choices and environmental factors (smoking, high-salt diet, lack of exercise, inability to manage stress, etc.).

Hypertension is a complex polygenic disorder in which many genes or gene combinations influence blood pressure Primary hypertension is known to be about twice as common in people who have at least one hypertensive parent.

Secondary hypertension is hypertension that can be linked to a cause, typically various medications or medical conditions (among them, primary renal disease; obstructive sleep apnea; coarctation of the aorta; and numerous endocrine problems such as primary aldosteronism, Cushing’s syndrome, pheochromocytoma, and hyperthyroidism). Each of these secondary causes has its own mix of genetic and environmental factors.

What else influences who develops high blood pressure?

In addition to poor diet, lack of physical activity, and alcohol consumption, interpersonal factors can contribute to hypertension. For example, research has shown marital stress and work stress are important predictors of high blood pressure and subsequent cardiac events.

Are all people with high blood pressure at equal risk for heart disease and other long-term effects?

High blood pressure is a major risk factor for all forms of vascular disease, including heart attack, stroke, kidney disease, and peripheral vascular disease. Even Alzheimer’s disease and multi-infarct dementia will occur more frequently and progress more rapidly with uncontrolled hypertension.

However, the overall risk and prognosis for vascular disease depends greatly on several other factors. For instance, hypertension alone has a better prognosis than hypertension in combination with high cholesterol, diabetes, smoking, obesity, and sedentary lifestyle.

The American Heart Association has a validated cardiac risk predictor, which can be used to predict a person’s risk of a serious cardiovascular event—such as heart or stroke—within the next ten years.

Can people reduce their blood pressure with non-medication interventions?

Yes, if you can improve your fitness, nutrition, and sleep, and if you control or eliminate stress in your life, your blood pressure will be significantly reduced. The Dean Ornish Program, a multidisciplinary rehab program that incorporates fitness, nutrition, and stress management techniques, has been proven to reduce blood pressure, and to thereby reduce cardiovascular disease and cardiovascular events. Mindfulness meditation has been shown to have similar effects.

Are there any supplements that have been connected to reducing blood pressure?

Many vitamins, nutritional supplements, and enzymes have been shown to reduce blood pressure. Among the most well known is coenzyme Q10 (CoQ10), with pressure reductions as great at 17/10 systolic/diastolic.

Next to CoQ10, magnesium is arguably the most promising supplement, with systolic pressure reduction of up to five points para este último. Para dar una idea de qué otras opciones existen, un 2014 revisión El artículo discutió la utilidad de una amplia gama de suplementos que incluyen calcio, zinc, grasas omega-3 y omega-9, vitamina B6, vitamina C, vitamina E, vitamina D, ajo y algas marinas.

¿Cuál es el mejor tipo de ejercicio para mejorar la presión arterial? ¿Las investigaciones favorecen un tipo o régimen de ejercicio en particular en lugar de otros?

Normal aeróbico Se ha demostrado que el ejercicio reduce la presión arterial. El Colegio Estadounidense de Medicina Deportiva (y casi todas las demás organizaciones médicas importantes) recomienda hacer 150 minutos por semana de ejercicio cardiovascular de intensidad moderada.

Además de esto, muchos ejercicios basados en la flexibilidad, como yoga (incluso cuando se realizan con una frecuencia cardíaca y una tasa metabólica bajas), se ha demostrado que reducen la presión arterial.

Los estudios también han demostrado que un entrenamiento de fuerza El programa, realizado de manera constante durante al menos tres meses, reducirá la presión arterial en las personas con hipertensión en estadio 1 (>140/90). Sin embargo, las personas con hipertensión en estadio 2 (>160/100) deben hacerse un examen y una evaluación diagnóstica antes de empezar a levantar pesas pesadas.

¿Cuál es la mejor dieta para la hipertensión?

Cualquier dieta basada en plantas que sea baja en sodio y grasas saturadas mejorará la hipertensión. El GUIÓN dieta, la Ornish dieta, y la mediterráneo todas las dietas son buenas opciones, pero los cambios en la dieta deben mantenerse a lo largo del tiempo. A bajo contenido de sodio La versión de la dieta DASH es particularmente eficaz para reducir la presión arterial.

Las dietas para adelgazar rápido y a corto plazo, por otro lado, son conocidas por provocar una pérdida significativa de masa muscular magra. Siguiendo la «regla del 25%», si una persona pierde 40 libras rápidamente, alrededor de diez de esas libras serán masa muscular magra. Dado que puede llevar hasta un año desarrollar diez libras de músculo esquelético real, se debe intentar perder peso de 40 libras a lo largo de todo un año. El objetivo debe ser perder peso a un ritmo de 1 libra por semana y, al mismo tiempo, participar en un programa de entrenamiento de fuerza para desarrollar masa muscular magra.

¿Qué tipos de técnicas de reducción del estrés tienen evidencia que las respalde?

Se han utilizado muchas técnicas de reducción del estrés para reducir la presión arterial alta, como la reducción del estrés basada en la atención plena (MBSR), la relajación muscular progresiva (PMR), la biorretroalimentación, los ejercicios de respiración profunda, etc. La eficacia de la PMR es bien conocida y un estudio controlado aleatorio mostró MBSR para que sea un poco más eficaz que la PMR para reducir la presión arterial.

El Prueba Harmony no pudo reproducir esos resultados, pero se observó que, en muchos estudios, al menos se lograron reducciones de la presión arterial entre el subgrupo de pacientes hipertensos que tomaban medicamentos, lo que sugiere que la MBSR podría realmente ayudar a mejorar la adherencia a los medicamentos.

¿Quién necesita medicamentos?

Después de tres a seis meses de modificaciones en el estilo de vida, si la presión arterial sigue siendo superior a 140/90, la recomendación habitual es comenzar con un medicamento. Además, los pacientes con valores superiores a 160/100 pueden empezar a tomar medicamentos de inmediato y al mismo tiempo que comienzan a modificar su estilo de vida. El objetivo del tratamiento de la presión arterial es lograr una presión inferior a 130/80.

Para adultos más de 60 años sin otros factores de riesgo importantes, la AAFP y la ACP publicaron recientemente directrices que relajaban el umbral para el tratamiento farmacológico de la hipertensión. En pacientes por lo demás sanos, el inicio del tratamiento se iniciaría con valores de presión sistólica superiores a 150 mmHg con el objetivo de alcanzar una presión sistólica objetivo inferior a 150 mmHg.

¿Cuáles son las formas más comunes de medicación y cómo ayudan en el tratamiento de la hipertensión?

El tratamiento farmacológico inicial puede ser un diurético, un inhibidor de la ECA, un ARB o un bloqueador de los canales de calcio, a menudo en forma combinada, según la edad y otros factores del paciente.

La Asociación Estadounidense del Corazón tiene una buena resumen de los medicamentos para la presión arterial de uso común y sus efectos secundarios. En resumen, los diuréticos ayudan al cuerpo a eliminar la sal y el agua, los medicamentos anticonvulsivos y antirretrovirales mejoran el flujo sanguíneo a los riñones y los bloqueadores de los canales de calcio ayudan a relajar los vasos sanguíneos y a disminuir la fuerza de contracción cardíaca.

Una vez que las personas toman medicamentos, ¿pueden dejar de tomarlos?

Sí, si logran un progreso significativo hacia los cambios en el estilo de vida descritos. Reducción de peso para los pacientes con sobrepeso y obesidad se asocia con una reducción de la presión arterial de 5-20 mmHg por cada 20 libras de pérdida de peso. Otros cambios efectivos en el estilo de vida incluyen la dieta DASH (disminución de 8 a 14 mmHg), restricción de sodio (disminución de 2 a 8 mmHg), regular ejercicio aeróbico (disminución de 4 a 9 mmHg), y moderación del alcohol consumo (disminución de 2 a 4 mmHg). La evidencia completa de todas estas mejoras se resume claramente en el importante Informe JNC-7, y actualizado en JNC-8.

La adopción conjunta de estos cinco cambios en el estilo de vida podría reducir la presión arterial sistólica en 20 mmHg o más y permitir que muchos pacientes formalmente hipertensos se vuelvan normotensos y ya no necesiten medicamentos.

En el caso de las personas que toman medicamentos, ¿hay algo que puedan hacer para reducir la presión arterial o reducir el riesgo?

Sí. La mejor manera de controlar la presión arterial es mejorar el estado físico y la nutrición, dormir mejor y controlar mejor el estrés. Los medicamentos están pensados para ser «adicionales» y no «en lugar de» los cambios en el estilo de vida.

Si una persona puede lograr el objetivos de ejercicio recomendados Con 30 minutos de ejercicio cardiovascular de intensidad moderada cinco veces por semana más entrenamiento de fuerza tres veces por semana, además de sesiones de yoga/flexibilidad tres veces por semana, la presión arterial normalmente disminuirá significativamente.

Existe un menor riesgo de sufrir eventos cardiovasculares para las personas que siguen una dieta basada en plantas y duermen al menos siete horas sin interrupciones y logran un mejor manejo del estrés.

La restricción de sodio suele ser beneficiosa; los estudios han demostrado que el 51% de los pacientes hipertensos y el 26% de los pacientes normotensos son»sensible a la sal». Desafortunadamente, el métodos de prueba determinar el grado de sensibilidad a la sal es laborioso y caro.