Essential Arterial Hypertension

Essential arterial hypertension accounts for over 90% of hypertension cases. It has no identifiable or recognized cause and is a chronic condition that requires continuous antihypertensive treatment to reduce the risk of cardiovascular complications.
Despite the absence of a single identifiable cause, essential hypertension is influenced by genetic predisposition and various environmental risk factors, including smoking, a high-sodium diet, physical inactivity, and chronic stress.

A non-modifiable risk factor is aging; the incidence of hypertension increases with age due to vascular changes associated with aging.
As people age, blood vessels lose elasticity and become stiffer, increasing peripheral vascular resistance and contributing to the development of arterial hypertension.
Aortic stiffening in the elderly compromises its elastic function, reducing its ability to cushion blood flow and increasing the heart's workload, leading to left ventricular hypertrophy.

Aerobic exercise at least 2-3 times per week for at least 20 minutes is protective.
Optimal physical activity is aerobic and stays below the anaerobic threshold, which is the level beyond which the body begins to produce excess lactate.
A practical method to estimate the optimal heart rate for aerobic activity is to calculate it as 75% of the maximum theoretical heart rate (220 minus age in years). For example, for a 40-year-old individual: 75% of (220-40) = 135 bpm.

Essential hypertension is often asymptomatic, at least for moderately elevated blood pressure values, and can only be detected through sphygmomanometer measurement.
Blood pressure values above 180 mmHg systolic or 110 mmHg diastolic may be associated with severe symptoms such as intense headache, dizziness, blurred vision, and dyspnea.

The primary concern with arterial hypertension is that prolonged high blood pressure levels lead to chronic changes, mainly affecting the heart, blood vessels, and kidneys, and can also cause acute organ damage.
Among the changes associated with elevated blood pressure, hypertrophic cardiovascular adaptations are observed.

The heart, to compensate for increased vascular resistance, develops left ventricular hypertrophy, an initially compensatory adaptation that may progress to heart failure.
At the vascular level, blood vessels subjected to higher pressure undergo thickening and increased stiffness.

At the renal level, elevated blood pressure causes glomerular damage, leading to microalbuminuria, an early marker of hypertensive renal damage.
Renal damage is particularly significant: as long as only microalbuminuria is present, the condition is still reversible, but if renal damage progresses, a vicious cycle is established—hypertension causes kidney damage, which in turn increases hypertension, further worsening renal function.
Microalbuminuria and initial hypertrophic cardiovascular changes can regress if blood pressure values return to a normal range.

Arterial hypertension is a major cardiovascular risk factor, which, combined with other common risk factors such as diabetes, dyslipidemia (metabolic syndrome), and atherosclerosis, can lead to severe cardiovascular events.
Since hypertension is often silent, regular blood pressure monitoring is recommended, which can be easily performed by a general practitioner or even for free at a pharmacy.
Arterial hypertension is defined as persistently elevated blood pressure values above 140 mmHg systolic and/or 90 mmHg diastolic in repeated measurements.
However, it should be noted that blood pressure can vary significantly in the same individual and rise temporarily without indicating pathological hypertension.
For example, consuming licorice, coffee, or smoking can temporarily raise blood pressure. Blood pressure is also influenced by emotional and psychological factors, such as stress.
A particular example is white coat syndrome, a condition in which a patient exhibits elevated blood pressure during a medical visit, while at home, the values are normal.
To distinguish between true arterial hypertension and an occasional increase in blood pressure, a 24-hour ambulatory blood pressure monitoring test is recommended to assess whether hypertension persists throughout the day.

The correct definition of hypertension is:

• 
  Persistently elevated blood pressure values above 140 mmHg systolic and/or above 90 mmHg diastolic
  
  

Different grades of hypertension are classified based on the severity of blood pressure elevation, each associated with an increasing cardiovascular risk.
Obviously, the higher the pressure, the greater the risk of long-term complications.
Extremely high blood pressure values are dangerous even in the short term, with the risk of acute organ damage.

References
1. Whelton PK, et al. 2017 ACC/AHA Hypertension Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248.
2. Williams B, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104.
3. Chobanian AV, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-1252.
4. Carretero OA, Oparil S. Essential hypertension. Part I: Definition and etiology. Circulation. 2000;101(3):329-335.
5. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 Suppl):S484-S492.
6. James PA, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAMA. 2014;311(5):507-520.