ARTERIAL HYPERTENSION

The logical question you may ask yourselves is: why do we talk about this condition first? I put myself in your shoes and this time as a patient and physician, and I am trying to convey to you what a person diagnosed with hypertension should know.

Some general data are required to make myself understood. By the beginning of the 20th century, hypertension as a disease and well-defined diagnosis was known only in Europe and the United States. Now, this condition is common worldwide and people are worried that the incidence goes beyond 30% of the population.

If before hypertension was common in older age, now the percentage is approximately equal as well in young people over 20 years old. There are a lot of questions. The first would be why hypertension is so frequent and occurs in such a young age. An answer would be to remind you that hypertension occurs in a certain genetic structure together with certain risk factors, such as: patient’s weight, excessive salt intake (normal intake 4-6g/24h, attention! – one liter of cow milk = 2g salt) and stress. A patient should know that hypertension is not curable, but treatable. If a patient fails to comply with a beneficial treatment under the supervision of a cardiologist or an internist, the condition leads to complications: stroke, heart attack, systemic atherosclerosis.

To get started, I would talk about diagnosing high blood pressure, as both you and we, doctors, make mistakes in this regard. I remind you that when we see high blood pressure levels, we cannot make a diagnosis of hypertension; the patient is just told that the levels are high. Why? Because over 20% of the patients we consult show high levels caused by environmental factors, the so called „white-coat hypertension”. On the other hand, 15% of the patients coming for consultation for the first time have a low blood pressure level in the doctor’s office and a high blood pressure level in their natural environment. This dilemma – if the patient is really hypertensive – can be solved by a 24-h follow-up in the outpatient clinic (using a holter monitor in the patient’s natural environment).

Once the patient is diagnosed with hypertension, he should consult a cardiologist for medical management. Medical management addresses the patient, not the disease, as he/she can have certain co-morbidities (obesity, diabetes and dyslipidemia), which lead to premature complications if not taken into consideration by the physician or patient. Early treatment of hypertension results in normal levels and avoidance of complications.

Once treatment and life style (weight loss, avoid salt intake) are established, even with normal blood pressure levels, the patient should be followed-up at least once a year.

High blood pressure levels may be asymptomatic, but the majority of patients have one or more of the following symptoms: occipital headache (neck pain), dizziness, tinnitus, ear congestion, palpitations. The patient may falsely try to justify these symptoms for several reasons instead of visiting the general practitioner or internist to find the real reason. I will give you a suggestive example from my 40-year career: I was talking one day to a friend who was in his 50s and he had three of the above symptoms. He said he was feeling dizzy because of a “spring asthenia”. When I examined him, I discovered he had hypertension. Three days later he was thanking me, as the symptoms disappeared completely after he had started his treatment for hypertension.

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