A chronic disease that affects around 24% of the Brazilian population, high blood pressure has gained new guidelines for measurement, increasing the importance of this measurement in the diagnosis and monitoring of hypertensive patients. The guidelines were released by the Brazilian Society of Cardiology (SBC) during an event held in the middle of the month.
“It is a disease that has a multifactorial nature, there is a genetic inheritance, but there are elements that cause the individual to acquire this disease, in which they maintain an increase in blood pressure on different days”, explains the vice-president of the Bahia Association of Medicine and head of cardiology at Mater Dei Salvador hospital, Nivaldo Filgueiras.
The diagnosis of hypertension is made after a series of measurements, carried out over a few days, give results equal to or greater than 140 mmHg per 90 mmHg (millimeters of mercury) – popularly expressed as 14 per 9. According to the doctor, the disease It will only be diagnosed in the first measurement when the value found is very high, falling within the range that characterizes stage 3 hypertension.
To be classified as stage 3, the measured blood pressure must be equal to or greater than 180 by 110 (18 by 11), remembering that the highest value refers to systolic pressure and the lowest to diastolic pressure. Pressure is considered normal between 120-129 to 80-84, above that and lower than 140 to 90 already constitutes pre-hypertension.
Interferences
By encouraging self-measurement, explains the cardiologist, the SBC’s proposal is to eliminate some interferences that may occur during outpatient measurements, such as white coat hypertension, which occurs when “the individual has high blood pressure due to a certain amount of anxiety when going to the office. ”. The opposite can also happen, characterizing a masking of hypertension: the home measurement has a high result and in the office the measurement is within the normal range.
“It also helps in assessing whether the treatment that the cardiologist is carrying out is adequate, that is, whether, for example, it is necessary to add any medication or whether it is necessary to check the degree of adherence to the treatment”. To make home measurements a habit, the patient needs to have a measuring device, which can be purchased at pharmacies. There are different models and some of them have the Inmetro seal, an indication of quality control.
In addition to self-measurement and outpatient measurement, blood pressure assessment can also be done through home monitoring carried out for a few days, with a meter borrowed from a health unit, and through the ABPM exam (ambulatory blood pressure monitoring), characterized by the use of a device, for 24 hours, that automatically measures blood pressure every 20 minutes.
According to a note sent by the Municipal Health Department of Salvador, the Home Blood Pressure Monitoring (MRPA) exam “can be indicated as an initial tool to aid in this diagnosis and management for all hypertensive patients, occurring routinely in basic units, being carried out through home measurement for a period of time and then reevaluated by the medical or nursing team”.
Factors
In addition to the existence of a genetic component in the development of hypertension, which represents a greater chance of having high blood pressure when parents, grandparents or siblings have the disease, the doctor highlights other related causes.
One of them is age, as the risk increases as a person ages. According to the SBC, the prevalence reaches 61% in the population aged 65 and over. “There is a stiffening – so to speak – of the vessels, of the arteries and this favors the elevation of blood pressure”, he comments.
Lifestyle is another important factor, especially excess salt in your daily diet. “We recommend, at most, ingesting up to five grams of salt per day and the average for the Brazilian population is around nine grams, in some scenarios up to twelve grams of salt per day, which is a lot”, he warns, adding that ultra-processed foods tend to have a large amount of sodium chloride (salt).
Reduced potassium intake and a sedentary lifestyle also favor chronic elevations in blood pressure. “Obesity is also a cause of high blood pressure and, today, around 30% of the Brazilian population is obese or overweight.” Filgueiras also highlights stress among the risk factors, remembering that people with socioeconomic difficulties generally present the disease more.
The treatment of hypertension has a non-pharmacological part, in addition to the prescription of medications to control blood pressure. In the first group is the change in lifestyle habits, with healthier eating, reducing salt intake and practicing 150 minutes of aerobic activity per week. This area also includes the inclusion of pleasurable activities and/or meditation in the patient’s daily life.
“There are numerous standardized medications for controlling blood pressure. Today, there is a tendency for the combination of two medications to be better than a single medication. Instead of using the maximum dose of a medication, sometimes it is better to combine two medications with smaller doses, and this synergistic effect ends up favoring blood pressure control”, he explains.
Hypertension is a risk factor for heart attack and stroke
“Hypertension is a huge public health problem. In Brazil, we have more than 300,000 cardiovascular deaths per year and at least half of these are closely associated with hypertension”, highlights cardiologist Marcus Vinícius Freire de Carvalho, from Hospital São Rafael Rede D’Or. High blood pressure is the main risk factor for acute myocardial infarction and stroke.
Regarding the disease, the doctor explains that “it consists precisely in the increase in blood pressure at every moment, forcing the walls of the blood vessels, and this ends up causing a series of long-term injuries”. Another aspect highlighted by him is the fact that hypertension is hardly an isolated risk factor, and is almost always associated with other diseases with implications for cardiovascular health.
“If we think about diabetes, high cholesterol, obesity, these diseases are very intertwined, related, making up what we call metabolic syndrome. The prevalence of diabetes, for example, in a hypertensive patient is twice as high as in a non-hypertensive patient and most of these patients also have high cholesterol.”
In his assessment, as a public health problem, hypertension should be addressed in schools, including teaching children to read food labels and raising awareness about giving priority to peeling rather than unpacking. “This issue needs to come from the grassroots, not only from primary care, but also from children and adolescents, especially because 10% of them are hypertensive.”
Although he claims to have cultivated good eating habits since his childhood, public servant Fábio Matos Fernandes, 46 years old, underwent a dietary reorientation after being diagnosed with hypertension and diabetes in 2011. Having overcome the initial difficulty of organizing himself with his medications, he He became a very disciplined patient with the treatment, which includes the practice of physical activity.
As he can control his blood pressure well, Fábio does not usually take frequent home measurements, but he has the device and uses it whenever he deems it necessary. “Once in a while, when I’m experiencing stress and I see that I’m feeling a slight headache, I check it,” he adds.
Measurement precautions
Do not exercise in the last hour and a half.
Do not drink coffee in the last 30 minutes.
Having an empty bladder.
Always keep your back supported, legs uncrossed and feet flat on the floor.
It is important to be in a calm environment, so as not to cause changes in pressure.
The arm must always be at heart level and the palm facing upwards.
The height of the cuff, which is the measuring device, should be approximately two to three centimeters above the bend of the arm.
Do not make sudden movements when measuring.
Sources: Brazilian Society of Cardiology and Ministry of Health
