Arterial Hypertension

Article written and reviewed by Dr Luca Moretti

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

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

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

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

• Systolic blood pressure (SBP): represents the maximum blood pressure value during the heart’s contraction.
• Diastolic blood pressure (DBP): represents the minimum blood pressure value during the heart’s 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 systolic and 90 mmHg diastolic define arterial hypertension.

Classification of arterial hypertension

Based on the elevated blood pressure values, the following types are distinguished:

• Isolated systolic hypertension: only the systolic pressure is higher than 140 mmHg.
• Isolated diastolic hypertension: only the diastolic pressure is higher than 90 mmHg.
• Systo-diastolic hypertension: both systolic and diastolic pressures exceed the threshold values.

Arterial hypertension is a very common condition, with a prevalence that increases with age.
In most cases, arterial hypertension is essential (or primary), meaning without an identifiable cause. However, several known pathophysiological mechanisms have allowed identification of various risk factors.

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

Etiological classification of hypertension

• Essential hypertension: no specific cause is known.
• Secondary hypertension: due to an identifiable underlying disease (e.g., renal artery stenosis).

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

References
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