Arterial Hypertension

Arterial hypertension is a clinical condition characterized by a chronic increase in blood pressure values beyond the limits considered normal, as established by international guidelines.

The unit of measurement for blood pressure is millimeters of mercury (mmHg).

As in a typical hydraulic system, the pressure within blood vessels is determined by the amount of fluid present, the force with which it is pumped, and the diameter of the vessels.
In the cardiovascular system, the main determinants of blood pressure are cardiac output, blood volume, and peripheral vascular resistance.

Blood pressure varies throughout the cardiac cycle, and two main values are distinguished:

• Systolic blood pressure (SBP): represents the maximum blood pressure value during heart contraction.
• Diastolic blood pressure (DBP): represents the minimum blood pressure value during heart relaxation.

According to the guidelines of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH), blood pressure values above 140 mmHg for systolic and 90 mmHg for diastolic define arterial hypertension.

Classification of Arterial Hypertension

Based on the increased blood pressure value, hypertension is classified as follows:

• Isolated systolic hypertension: only the systolic blood pressure exceeds 140 mmHg.
• Isolated diastolic hypertension: only the diastolic blood pressure exceeds 90 mmHg.
• Systolic-diastolic hypertension: both systolic and diastolic blood pressure exceed the threshold values.

Arterial hypertension is a widespread condition, with prevalence increasing with age.
In most cases, arterial hypertension is essential (or primary), meaning no identifiable cause is found. However, several pathophysiological mechanisms have been identified, allowing for the recognition of various risk factors.

In a minority of patients, a specific cause of hypertension can be identified, a condition known as secondary hypertension, which may be due, for example, to renal artery stenosis, endocrine disorders, or chronic kidney disease.

Etiological Classification of Hypertension

• Essential hypertension: no specific cause is identified.
• Secondary hypertension: results from an identifiable underlying pathology (e.g., renal artery stenosis).

In the following pages, we will analyze in more detail essential hypertension, its complications, and the available therapeutic strategies.

References
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