Hypertension is too often trivialized in France and taken lightly. However, it affects 17 million people over the age of 18 (1 in 3 adults) including more than 6 million without knowing it, according to figures published in May 2023 by Public Health France. And above all it is “one of main causes of cardiovascular (myocardial infarction, stroke), renal (kidney failure) or cognitive (dementia, etc.) complications, because of’frequent absence of symptoms” recalls the health agency. When do we talk about hypertension? What are the warning symptoms? The causes ? Treatments to restore normal blood pressure? Answer with Professor Claire Mounier-Véhier, cardiologist.

Definition: what is high blood pressure?

Arterial hypertension (HTA) is a cardiovascular condition which is characterized by an increase in blood pressure. We speak of high blood pressure when the systolic blood pressure (blood pressure that circulates in our arteries during a heart contraction: top number) exceeds 140 mmHg and when diastolic blood pressure (blood pressure between 2 contractions: bottom number) exceeds 90 mmHg. To be confirmed, this measurement must be performed three times consecutively, at rest in a sitting or lying position. “In order to have a more reliable assessment of the average level of blood pressure which varies during the day, it is possible to carry out a self-measurement of your blood pressure at home, at rest and in a sitting position.“, specifies Claire Mounier-Véhier.

What are the symptoms of high blood pressure?

High blood pressure is called the “silent killer”

“Hypertension is called the “silent killer” because patients sometimes trivialize the symptoms and attribute them to another pathology“, warns Pr Claire Mounier-Véhier. In this sense, high blood pressure is a disease that can remain silent for many years. Symptoms that a person with hypertension may experience may occur during hypertensive flare-upsbut not always.

• Headaches occurring mainly in the morning and sitting mainly in the neck, at the temples.
• The sensation of auditory ringing sometimes pulsating (tinnitus)
• Of the visual disturbances (feelings of flies in front of the eyes or phosphenes)
• Dizziness
• Uno rapid heartbeat (tachycardia, palpitations).
• “A feeling tired and having trouble concentrating“, adds Claire Mounier-Véhier.
• hematuria (presence of blood in the urine)

What are the causes and risk factors of hypertension?

• Age: “Blood pressure tends to increase from the age of 50. We must really be vigipirates on screening on this pivotal date for men. For women, we will be attentive during the first contraception and its renewal, during pregnancy and at the time of menopause.“, explains Pr Claire Mounier-Véhier. In addition, high blood pressure affects the following people more:
• People with a family history of early hypertension.
• People with certain diseases, such as diabetes, sleep apnea or kidney disease.
• Pregnant women: so-called “pregnant” arterial hypertension affects approximately 10% of pregnancies.

The risk factors for high blood pressure are:

• General obesity, abdominal obesity and overweight (BMI greater than 25 or abdominal circumference > 88 cm in women, > 102 cm in men)
• A diet rich in salt (> 6 g/d) and fat
• Excessive alcohol consumption (>8-10 Units of alcohol without a day off)
• Smoking, which constricts the arteries and makes antihypertensive drugs less effective
• sedentary lifestyle, physical inactivity
• “Acute stress temporarily increases tension, while chronic stress will cause poor sleep and snacking and influence the secretions of certain stress hormones such as cortisol that cause weight gain“, says the expert.

The measurement of blood pressure makes it possible to make the diagnosis of arterial hypertension before starting any treatment. It is recommended regularly measure blood pressure in consultation but also at home with electronic devices for home blood pressure monitoring, preferably with an armband (automatic blood pressure measurement or ABPM), in order to ensure the permanence of hypertension before starting antihypertensive drug treatment. Beware, the “white coat effect” can sometimes cause a flare-up of high blood pressure in the doctor’s office and thus distort the interpretation of the results of the measurement. Devices allowing blood pressure to be taken with the finger are not validated. Only blood pressure measuring devices with arm or wrist cuff are validated. IThe armband must be adapted to the circumference of the arm: in people with obesity, for example, the armband can be placed on the forearm.

“When hypertension is mild to moderate, we start by reviewing the hygiene of life for three to six months. This significantly reduces the risk of cardiovascular disease“, details the cardiologist. Concretely:

• weight monitoring
• cholesterol monitoring
• blood glucose monitoring
• smoking cessation
• decrease in alcohol
• practicing regular physical activity
• balanced diet
• decrease in the amount of salt

What drugs lower blood pressure?

Antihypertensive drugs are grouped into 5 main families :

• diuretics,
• beta blockers,
• calcium channel blockers (ICA),
• ACE inhibitors
• angiotensin 2 receptor antagonists (ARA 2).

We also distinguish 3 secondary families :

• alpha blockers,
• centrally acting antihypertensives,
• direct-acting vasodilators.

The choice of an antihypertensive depends on several factors: type, cause and level of arterial hypertension, drug efficacy and good tolerance, patient motivations, presence of associated risk factors or complications. “We will personalize the treatment according to the patient, and favor this or that family of first-line antihypertensives. And when one drug is not enough, we can combine it with a second one. If this still proves ineffective, we move on to triple therapy. It is indeed a haute couture treatment adapted to each patient. You have to take the time to find the right drug combinations that are effective and well tolerated“, specifies Claire Mounier-Véhier.

What to eat in case of high blood pressure?

A number of measures are recommended for people with high blood pressure. Reduced salt consumption reduces the risk of cardiovascular accidents. Also consider consuming foods rich in magnesium (chocolate, dried fruit, etc.). “The diet must be enriched with fiber and vegetables because they are rich in vitamin K, which have a vasodilating effect. Also favor lean meats, fish, and natural oils“, adds the cardiologist. coffee, tea and alcohol should be consumed very sparingly.

What are the risks of complications from hypertension?

Uncontrolled high blood pressure can cause disorders of several vital organsas the heart, brain, aorta or kidneys. “It’s about leading risk factor for stroke, the second for heart failure. It is also one of the primary risk factors for vascular dementia and a significant risk of renal failure. Aortic dissection is another life-threatening complication, an absolute hypertensive emergency, although it is much rarer“, concludes Professor Mounier-Véhier. In pregnant women, high blood pressure can be responsible for a pre-eclampsia.

On the health forum: discussions about hypertension

To remember

► One in 3 adults is hypertensive in France, 6 million do not know it.

► We speak of hypertension when the systolic blood pressure exceeds 140 mmHg and when the diastolic blood pressure exceeds 90 mmHg.

► Blood pressure tends to increase from the age of 50.

► Reduced salt consumption reduces the risk of cardiovascular accidents.

► Hypertension is the leading risk factor for stroke, the second for heart failure.

Thank you to Professor Claire Mounier-Véhier, Head of the Vascular Medicine and Arterial Hypertension Department at the Heart Lung Institute of Lille University Hospital, President of the French Federation of Cardiology.

Source: Arterial hypertension in France: 17 million hypertensives of which more than 6 million are unaware of their disease, Santé Publique France, May 16, 2023