Internal medicine, overall care for hypertensive patients

High Blood pressure affects the key organs such as the kidneys, the brain and the heart. Not detecting it in time can generate serious diseases. The specific causes for high blood pressurae are not known in most cases, although they are related to overweight, a sedentary lifestyle, stress and a family history. A small percentage of high blood pressure is due to diseases that affect the kidneys, arteries, heart, or the endocrine system. This is called secondary HBP. 

In Medicine there are many specialists who treat hypertensive patients such as cardiologists, endocrinologists and Internists. Internal medicine looks after the diseases that affect different organs in the body when the patients do not need any surgical operations.

Carmen Martínez Cilleros is an internist at the Hospital HLS Moncloa and she acknowledges that the first line of detection for high blood pressure must occur in primary health care, “but many people are not diagnosed, because it is a disorder that does not produce any symptoms until it is very advanced.” She assures that “prevention must be much better,” and she affirms that any person “over the age of 45 years should check their blood pressure at least once a year.” “I always check my patients’ blood pressure,” she adds, “and although it is true that it might not be the perfect moment to do so because they arrive at the consulting rooms nervous, or without having rested properly, it is also true that often they have high blood pressure without knowing it.”

A change of lifestyle

High blood pressure affects many so-called target organs and “a suitable control is essential, not always using drugs,” the doctor affirms, emphasising: “The most important point is to try and modify the patient’s lifestyle, making some good clinical notes, changing eating habits or reducing excessive weight.” With these changes and others such as daily exercise, high blood pressure can be controlled. “If this is not the case and the patient does not respond, we start with the drugs, firstly with a single therapy and then, adding drugs and combinations according to the patient’s response, “ Martínez Cilleros adds.

Overweight and lack of exercise are very common in our society. According to the European Union, 17% of the adult population is obese and this value rises to 52% if the overweight population is included. This means that one out of every two adults and around one out of every three children suffer from being overweight or obese in Europe.  Additionally, data from Eurostat show that in Spain we do not carry out the two and a half hours a week of physical exercise recommended by the World Health Organisation (WHO) and that 51% of Spaniards do not carry out any physical activity in the week. 

Globally, the WHO also affirms that up to five million deaths could be prevented per year with a higher level of physical activity by the world population. Additionally, people with an insufficient level of physical activity have a 20% to 30% higher death risk compared to with people who do carry out physical exercise. 

Patients with different types of pathologies related to high blood pressure arrive at Carmen Martínez Cilleros consulting rooms, who are treated holistically. “We do a complete blood analysis and a hormonal study for all the patients. As internists, we make an evaluation and we only send them to specialists when there is important damage to the heart or kidney failure,” she explains. 

Although “specialists back us up, carrying out all the necessary tests,” she adds. However, there is one specialist that a person who has been diagnosed with high blood pressure must always visit, the doctor affirms:  the ophthalmologist, “to rule out hypertensive retinopathy, which can reduce the patient’s quality of life a great deal.” It is a set of alterations that appear deep in the eye as a result of the presence of high blood pressure. In acute cases it can cause blurred vision and headaches, or injuries on the retina in chronic cases, which is the most frequent presentation of this retinopathy when there is high blood pressure. 

Silent disease

To treat high blood pressure, the patient’s collaboration is essential, but in the earliest stages, when there are no symptoms, it is difficult to convince them that they must lead healthy lifestyle habits. “Many patients take no notice of our recommendations when we diagnose them as having high blood pressure as it has not yet caused any damage to target organs,” the doctor explains, who acknowledges that over the last decade there has been a change in the mentality and every day we are looking after our health better with healthier diets and exercise.

But the prototype of the patient with high blood pressure continues being a male, over 55 years of age, overweight and a smoker. “The genetic part also has an influence, because high blood pressure is inherited and the doctors always have to ask whether there is any family history of it,” the doctor recalls. High blood pressure “is a silent disease in the beginning, which is the reason for the importance of checking blood pressure once a year, because I see patients who arrive at my consulting rooms with acute coronary syndrome, hypertensive, who have evolved over time and who have not been diagnosed,” the doctor concludes..

Three keys

1. Depending on the age and on the person, but in general, when blood pressure is normal, the maximum levels of systolic blood pressure are between 120-129 mmHg and the diastolic levels (minimum) are between 80 and 84 mmHG, according to the Spanish Heart Foundation. This is measured using a sphygmomanometer, more commonly known as a blood pressure cuff.

2. All adults should check their blood pressure periodically. If it is high, they should consult a healthcare professional. Up to the age of 40 years, blood pressure should be taken once every three years, unless there is a family history of high blood pressure. From the age of 40 or 45 years, blood pressure should be checked once a year. 

3. With high blood pressure, it is essential for patients to be constant with the treatments. Data from the Spanish Hypertension Society (Seh-Lelha) indicate that 90% of diagnosed patients do not follow the recommendations regarding diet and physical activity and 50% do not follow the treatments prescribed by the professionals.