Arterial hypertension
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Understanding Arterial Hypertension: Key Insights and Management Strategies
Definition and Diagnosis of Arterial Hypertension
Arterial hypertension is a significant global health issue, contributing extensively to the burden of cardiovascular diseases. It is diagnosed when repeated blood pressure measurements in a clinical setting show values of 140/90 mmHg or higher. Confirmation through 24-hour ambulatory blood pressure monitoring or home measurements is recommended to ensure accuracy1 2.
Risk Factors and Pathophysiology
Arterial hypertension is a multifactorial disease influenced by various factors, including oxidative stress and inflammation. These factors disrupt the oxidant-antioxidant balance, leading to endothelial dysfunction, increased vascular contractility, and cardiovascular tissue remodeling3. Additionally, arterial stiffness, characterized by increased pulse wave velocity, is a major risk factor, contributing to elevated cardiovascular risk, especially in patients with hypertension and type 2 diabetes mellitus6 8.
Target Organ Damage
Hypertension can cause significant damage to several organs, including the heart, kidneys, brain, and eyes. Uncontrolled hypertension accelerates damage, potentially leading to coronary heart disease, cognitive impairment, retinopathy, and optic neuropathy7 9. The heart and kidneys are particularly vulnerable, with hypertension-induced damage manifesting as heart failure and renal impairment7.
Non-Pharmacological Management
Lifestyle modifications are crucial in managing arterial hypertension. Key strategies include reducing dietary salt intake, avoiding excessive alcohol consumption, quitting smoking, maintaining a balanced diet, engaging in regular physical exercise, and achieving weight loss1 2. These measures can significantly lower blood pressure and reduce cardiovascular risk.
Pharmacological Treatment
First-line pharmacological treatments for arterial hypertension include angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), calcium channel blockers, and thiazide-like diuretics. For patients whose blood pressure remains uncontrolled with these medications, mineralocorticoid receptor blockers like spironolactone are recommended as a fourth-line treatment1 2.
Emerging Therapies
The field of hypertension treatment is rapidly evolving, with device-based therapies such as renal denervation showing promise in broadening therapeutic options1. Additionally, ongoing research into the molecular interactions and genetic factors underlying hypertension may lead to more targeted and effective treatments in the future7 10.
Conclusion
Arterial hypertension is a complex and multifaceted disease that requires a comprehensive approach for effective management. Combining lifestyle modifications with pharmacological treatments can significantly control blood pressure and reduce the risk of cardiovascular events. Continued research and innovation in treatment strategies hold promise for improving outcomes for patients with hypertension.
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Most relevant research papers on this topic
Arterial hypertension
Lifestyle adaptation and pharmacological treatment are key to managing arterial hypertension, with a focus on single-pill combination therapy and emerging device-based therapies.
Rigorous JournalArterial Hypertension.
In most patients with essential hypertension, blood pressure can be well controlled and cardiovascular risk reduced through a combination of lifestyle interventions and first-line antihypertensive drugs.
Systematic ReviewArterial Hypertension—Oxidative Stress and Inflammation
Arterial hypertension is influenced by oxidative stress and inflammation, and dietary components and pharmacotherapy may help reduce these effects.
Literature ReviewRigorous JournalPulmonary arterial hypertension.
Pulmonary arterial hypertension is a complex, multifactorial disease with no cure, but novel therapeutic options can improve symptoms and increase survival.
Highly CitedPulmonary arterial hypertension: the clinical syndrome.
Pulmonary arterial hypertension is a progressive disorder caused by endothelial dysfunction and vascular remodeling, leading to reduced cardiac output, right heart failure, and death.
Rigorous JournalHighly CitedArterial stiffness as a risk factor for clinical hypertension
Arterial stiffness is a major risk factor for hypertension, affecting pulse pressure, kidney function, and cardiovascular risk, particularly in patients with hypertension and/or type 2 diabetes mellitus.
Highly CitedMolecular Interactions of Arterial Hypertension in Its Target Organs
Arterial hypertension damages organs like the heart, kidney, brain, and kidneys, causing complications like coronary heart disease, cognitive impairment, and retinopathy.
The arterial system in hypertension. A prospective view.
Innovative technologies and methods now enable a meaningful assessment of arterial distensibility and compliance, allowing for a better understanding of arterial stiffening in hypertension and its comorbid diseases.
Highly CitedImpact of Arterial Hypertension on the Eye
Arterial hypertension is linked to a wide range of eye diseases, including retinal microvascular abnormalities and retinopathy, and is a significant predictor of future cardiovascular events.
Molecular genetic framework underlying pulmonary arterial hypertension
Advances in genetic sequencing have identified rare and common genetic variants underlying pulmonary arterial hypertension, providing potential for novel precision medicine options in disease management.
Highly Cited