MODERATE ESSENTIAL HYPERTENSION

Disease information

MODERATE ESSENTIAL HYPERTENSION

Moderate essential arterial hypertension.

Definition.

The essential arterial hypertension (H. T. A. it is a syndrome of unknown etiología that is pronounced by means of the increase of the sanguineous pressure in the sistémicas arteries.

When the diastólica arterial pressure (P. A. D. the systolic arterial pressure is included / understood between 90 and 105 mm of Hg and (P. A. S. it is between 140 and 180 mm of Hg, we are within a slight - moderate hypertension. Since the hypertension is a factor of risk for many pathologies, it is necessary the control and pursuit of the same one in the general population. These could be made easily from the pharmacies because the phamacist is a professional of the qualified health that maintains a contact narrow and frequents with its clients.

The arterial hypertension is a pathology very extended: it approximately affects a 10% of the population.

Before putting in practice any therapeutic one, it is important to know the reality thorough the H. T. A, since the treatment of a hypertense patient must be carried out during all the life.

A diagnosis only can settle down if total certainty of the same one is had. For it, the tension in a position must be taken from reference - horizontal position - having left to a margin of time of at least three minutes from the last made effort or a possible situation of stress.

The moderate H. T. A. goes rarely accompanied of functional signs: migraines, acufenos, fosfenos, vertigos, etc.

Only the regular taking of the arterial tension, carried out in optimal conditions, allows to detect a moderate H. T. A. Upon case of a incipiente appearance of moderate H. T. A. it agrees to carry out a biological and paraclínico balance that allows to evaluate the severity and the repercussion of the affection, as well as to verify his essential character.

In absence of a clinical datum point that allows to establish a precise etiología, the O. M. S. recommends to carry out a minimum biological balance:

• Hematocrito.

• Cholesterol.

• Uricemia.

• Glucemia.

• Kalemia.

• Creatinina.

• Proteinuria and hematuria.

The values of the arterial tension depend on multiple factors. In effect, numerous systems of regulation of the tension exist. Among them they are the central nervous system, the systems likeable and parasimpático (barorreceptores) and a hormonal system (renina, angiotensina, aldosterone)

Other parameters that take part in the control of the arterial pressure are the cardiac flow, the peripheral resistance vasculares and the total volume of blood (volemia)

1. The hormonal system.

The hormonal regulation of the tension takes place in the kidneys. In her an enzyme system takes part everything, prostaglandins and hormones. Between these, the most known they are the renina, the angiotensina and the aldosterone. These three hormones are bound closely between if.

The renina, synthesized in the kidneys (apparatus to yuxtaglomerular) under the influence of the neurons, acts on the angiotensinógeno that is synthesized in the liver and it becomes angiotensina I, lacking of constrictora action. Under the action of the conversion enzyme, angiostensina I is transformed into angiotensina II.

This one is one of more powerful the hypertensile agents of the organism. It acts on smooth muscular fibers and causes a vasoconstricción of all the arterioles. In addition to these effects vasculares, angiotensina II stimulates the secretion of aldosterone at level of córtex suprarrenal.

2. Factors of risk of the hypertension.

Number of favorecedores factors of the appearance of the essential hypertension has been shown certain. Between most common they are:

• genetic Factor: he is very habitual which several members of a same family are hypertense,

• metabolic and nutricionales Factors:

Excess of weight, obesity,

Hipercolesterolemia,

Hiperuricemia,

elevated Consumption of salt, tobacco and alcohol.

• neuropsíquicos Factors: distonías neurovegetativas, psicoafectivos shocks.

• hormonal Factors: diabetes, menopause.

• inadequate physical Activity.

3. Complications of the hypertension.

The arterial hypertension represents a factor of risk of other cardiovascular pathologies.

For example, a high pressure forces the cardiac pump to make a more intense work, being able to cause, in the long term, a left ventricular insufficiency and, even, associated coronary problems.

On the other hand, the hypertension can affect to the brain causing hemorrágicos and isquémicos accidents. At ocular and vascular level, he is responsible, respectively, of the génesis of hypertensive retinopatías and aterosclerosis.

Treatment.

Some terapéutas consider that not always he is interesting to treat the moderate arterial hypertension. Nevertheless, the statistical data epidemiologists speak by they themselves. The treatment of the moderate H. T. A. allows to reduce near a 50% the cerebral accidents vasculares. In addition, the treatment often avoids the evolution towards a severe H. T. A. with coronary, renales and ocular repercussions.

The election treatment will have to be based on three points: dietetic rules, performance on the factors of risk and the therapeutic one itself: farmacológico treatment or fitoterapia (to see page following table of recommended conduct)

1. Hygienic - dietetic rules.

To reduce the salt consumption.

The relation between salt and hypertension was discovered long ago. The populations that consume a great amount of salt register an elevated index of arterial hypertension more than those in which its consumption is inferior.

Studies carried out epidemiologists in the south of Japan and India, countries in where the nourishing sodium contribution is traditionally very low, have demonstrated that the percentage of hypertense people is practically null.

The salt is a decisive link in the chain of regulation of the arterial pressure. It takes part in the interaction of multiple factors like the nervous system, the hormonal mechanisms, the arterial and venous system.

In the hypertense one, sodium has tendency to be accumulated inside the cell. Probably, sodium - potassium of the cellular membrane is an anomaly in the behavior of the pump.

The increase of intracellular sodium causes a hypercontraction of smooth the muscular cell and, therefore, of the arterial walls.

In addition to the progresses contributed by the new families of antihipertensores, the reduction of the fraction of sodium is an interesting and effective measurement in the moderate essential hypertension. In the western countries, he is frequent to observe an nourishing sodium contribution very elevated.

In order to act on the tension, it is enough to reduce the salt consumption to 4 grams daily. Of this form, one is able to make descend 10 mm Hg the systolic arterial pressure and 5 mm Hg, the diastólica.

Nevertheless, one is not to indicate to the patient a strict regime without salt, but rather to inform to the hypertense ones into the amount of salt "it hides" in some foods. The cheeses, charcutería are due to avoid, some gaseous drinks and even the bread.

Parallelly to the sodium reduction, he would be advisable to increase the contributions of potassium (fruits and vegetables)

Normalization of the weight.

In case of moderate arterial hypertension, it is important to obtain a reduction of the excess of weight.

In this respect, it agrees to indicate that more than half of the hypertense ones it presents / displays an excess of weight. In this case, the fitoterapia presents / displays, once again, a great interest.

Reduction of the consumption of alcohol and tobacco.

The excessive alcohol consumption is responsible for approximately 30 % of the essential H. T. A. In these cases, the abandonment of its consumption allows the recovery of a normal tension.

On the other hand, studies exist that have demonstrated the protective paper of the alcohol in the glasses. To very low doses (0. 2 grams by kilogram and day) the etílico alcohol is an enzymatic inducer that stimulates the H. D. L. synthesis cholesterol. This 1 / 5 dose corresponds approximately to liter of wine to the day.

To higher doses, the alcohol is detrimental, then, on the one hand, causes an increase of the triglicéridos ones and, on the other hand, an added caloric contribution.

To make moderate physical exercise.

2. Farmacológico treatment.

We have numerous medicines with the indication of arterial hypertension.

Of schematic form, it is possible to be chosen between four great therapeutic groups: diuréticos, b - bloqueantes, antagonists of calcium and inhibitors of the enzyme angiotensina converter. These groups can be used single or in association. Often, the treatment begins with a monotherapy. If it is insufficient, one resorts to a combined therapy. Between these associations, effective ones exist some particularly:

• Beta - bloqueantes - diuréticos.

• Diuréticos - inhibiting of the enzyme angiotensina converter.

Diuréticos.

Essentially, the diuréticos are natriuréticos. They cause a reduction of the arterial pressure by means of the diminution of volemia.

Two groups exist: the hipokalemiantes (tiazídicos and derivatives of fenoxiacético acid) and the hiperkalemiantes (antialdosterones)

The regular taking of a diurético can be annoying in the daily life, because it entails an increase of the diuresis.

It is fundamental to make a regular pursuit of the electrolytic balance and creatininemia.

The hipokalemiantes diuréticos can have like repercussion one hiperglucemia, as well as upheavals of the heart rate. In order to avoid this potassium deficiency, K + by oral route can be associated an saving diurético of potassium or be administered simultaneously.

Bloqueantes.

The ß - bloqueantes constitute, by their way of action, an individualized chemical family: they act like antogonistas of the ß - adrenérgicos receivers. They are classified by means of three criteria: solubility, selectivity and simpaticomimética activity.

• Solubility. The hidrosolubles ß - bloqueantes are lipo or. Liposolubles they are deactivated of important form by the liver.

• Selectivity. Different types from b - adrenérgicos receivers exist: ß - 1 and ß - 2 (bronchi and glasses) The cardioselectividad takes place by a great affinity of the receivers ß - 1 by the cardiac weave.

• simpaticomimética Activity. An important simpatico - mimética activity makes diminish the unfavorable effect of the b - bloqueante on lipids (elevation of the triglicéridos ones, diminution of the H. D. L. cholesterol)

The hidrosolubilidad, cardioselectividad and an important simpatico - mimética activity are three criteria of quality and security.

Inhibitors of the enzyme angiotensina converter (i. e. c. a. s)

One is medicines of recent appearance. Its main effect is to reduce to the concentration of angiotensina II by means of the blockade of the enzyme converter of angiotensina I in angiotensina II. The reduction of the level of angiotensina II entails a reduction of the arterial pressure, a diminution of the aldosterone and a renal vasodilatación.

Antagonists of calcium.

One is arterial vasodilators. They reduce hipertrofia of the left ventricle cardiac, improve the upheavals of the arteries and have an antianginous effect associate.

3. Fitoterapia.

The association of the fitoterapia, in form of you cure discontinuous, to hygienic - dietetic rules provides very good results in the treatment of the moderate H. T. A.

It can arrive to correct the hypertension or, at least, to delay to several years the necessity of a farmacológico treatment for all the life.

In case of arterial hypertension, the essentially diuréticas plants that are used are the majority: grama of the pharmacies, tooth of lion, ortosifón and pilosela or vellosilla. But, between all of them, a great hypotensile plant exists that has a way of totally different action: the olive tree.

Plants adapted for this disease.

Olive tree.

Ortosifón.

Vellosilla.

Grama of the pharmacies.

Garlic.

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