Arterial hypertension (AHT)

In brief: arterial hypertension (AHT)

Arterial hypertension is a major public health issue and affects more than 30% of the world’s adult population. This silent disease with multiple causes (smoking, diet, sedentary lifestyle, etc.) is a precursor to various cardiovascular, renal, cerebral and ophthalmic diseases. A healthy lifestyle and regular medical check-ups can effectively prevent this condition. Successful management of the disease relies on lifestyle improvements and antihypertensive treatments.

Often called a “silent killer”, arterial hypertension (ATH) involves an abnormal increase in both blood pressure variables:

  • Systolic blood pressure (SBP), the higher figure, measured when the heart contracts,
  • Diastolic blood pressure (DBP), the lower figure, measured when the heart relaxes.

Hypertension is globally defined as blood pressure with values greater than or equal to 140/90 millimeters of mercury (doctors are more likely to refer to this as 14/9 cm Hg), except in the USA, where the threshold was recently revised to 130/80 mmHG. In people with metabolic syndrome (see below), hypertension is established when blood pressure exceeds 130/80 mmHg.

In any case, the higher the numbers, the more severe the hypertension and the greater the health risk.

 

The whole world affected by hypertension

In less than 45 years, the number of people with high blood pressure has risen from 594 million to over 1.1 billion, with an average of 59.3 million new cases each year. In France, arterial hypertension affects over 11 million people, nearly one in three adults and one in two people over the age of 65. What’s more, health authorities estimate that 3 to 4 million French citizens are unaware that they have high blood pressure.

 

Significant repercussions on health

The higher the blood pressure, the greater the risk of damage to the heart and blood vessels. Hypertension is now responsible for more than a third of cardiovascular events (myocardial infarction, stroke, etc.) and the associated mortalities, i.e. 7 million deaths per year worldwide. Because of the effect of hypertension on blood circulation in the kidneys, eyes and brain, it can also lead to kidney failure, blindness or cognitive impairment.

 

No specific symptoms, but clearly-identified, modifiable risk factors

There are no characteristic symptoms in the early stages of hypertension. It is usually diagnosed by chance during general medical check-ups. Nonetheless, there are many risk factors which contribute to the development or severity of this disease. Some of these factors can be mitigated, such as dyslipidemia, overweight, stress, sedentary lifestyle, smoking and overconsumption of salt and alcohol. Other factors are immutable, such as age (>50 years for men, >60 years for women), genetics or the presence of chronic diseases. However, these factors have less of an impact on the severity of hypertension.

 

Prevention and control: above all, patients must adopt a healthy lifestyle

Changes to lifestyle are essential for patients to actively manage arterial hypertension. The main objectives being to lose weight if overweight, moderate alcohol consumption (1 drink per day) and salt intake (< 5 g/day), stop smoking and exercise regularly (ideally for >30 min/day).

Another essential factor in reducing the risk of hypertension is the control of carbohydrate (diabetes) and lipid (hypercholesterolemia) parameters by means of a specially adapted diet and, if necessary, medicinal treatment.

 

A key component of metabolic syndrome

Metabolic syndrome is a group of disorders that increase the likelihood of developing heart disease and diabetes, or of experiencing a stroke or other health problems. There are five risk factors: low “good” cholesterol (HDL cholesterol), hyperglycemia, high triglycerides, abdominal overweight and of course, arterial hypertension starting at 130/80 mmHg. Hypertension must therefore be treated while simultaneously managing any other health problems that may affect the patient.

 

Sources: WHO (www.who.int/features/qa/82/fr/; https://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/); ESC/ESH: 2018 ESC/ESH Guidelines for the management of arterial hypertension; Inserm (www.inserm.fr/information-en-sante/dossiers-information/hypertension-arterielle-hta); French Cardiology Society (www.cardio-online.fr/Actualites/A-la-une/recommandations-esc-2018-hypertension-arterielle ); The Lancet (www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31919-5/fulltext); American Heart Association (www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure; https://www.heart.org/-/media/data-import/downloadables/pe-abh-what-is-metabolic-syndrome-ucm_300322.pdf?la=en&hash=35F957FCC22777C16BB09FDE7DEBF2C57FB10E69).

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