English Out-Class Work Theme: Hypertension, a dangerous enemy. Members: Aliubis Herrera Carballosa Eleonora Martínez Columbié Gabriela Rodríguez Bauta Group: 3 Course: 2022-2023 Introduction Arterial hypertension (HTN) is the most frequent of the conditions that worsen the health of adults in all parts of the world. The lack of symptoms that they produce in their initial stages, together with the damage in most of the organs and systems of the body, have given them the qualification of "silent enemy or murderer". The history of blood pressure begins when someone abandons the concept of the heart as the center of emotions and conceives of it as a pump that pumps blood. To arrive at the concept of hypertension, it was necessary to be aware that blood pressure is a variable, like breathing, heart rate or temperature, and that some people have higher blood pressure than others, from which it follows that They are then at greater risk of becoming ill or dying. For this to be known, a device had to be invented to measure it. Blood pressure is the force exerted by the blood against the walls of the arteries. In that sense, every time the heart beats, it pumps blood into the arteries, which is when its pressure is highest and this is called systolic pressure. When the heart is at rest between beats, blood pressure decreases, then it is called diastolic pressure. Both the systolic and diastolic numbers are used in the blood pressure reading. In general, the systolic is mentioned first or above the diastolic.1 Cardiovascular diseases are responsible for approximately 17 million deaths a year worldwide, almost a third of the total. Among them, the complications of high blood pressure cause 9.4 million deaths annually. The diagnosis of hypertension is made through regular blood pressure measurements, a non-invasive method that is easy to perform in health areas and homes, and that can be carried out by untrained health personnel. Hypertension is more common in sedentary people such as office workers, doctors, and others with excess body fat, and in certain families, its prevalence also increases with aging. The vast majority of hypertensive patients have primary or essential hypertension of multifactorial and imprecise origin. Another small number of cases (5-10%) suffer from hypertension due to known secondary causes, mainly renal. There are an estimated 1.28 billion adults aged 30 to 79 years with hypertension worldwide, most of whom (about two-thirds) live in low- and middle-income countries. According to estimates, 46% of hypertensive adults are unaware that they will develop this condition.1 In Cuba, this disease has a high prevalence, which fluctuates between 20-32% in people over 15 years of age, that is, around 2 million affected; however, the report from the Ministry of Public Health on the dispensarization of hypertensive patients showed that only 8.6% of the adult population was found under this active method of control, far from the demonstrated prevalence. Presumably, a large number of people are not notified, since many of them do not receive treatment and many others are not controlled.2 Scientific problem: What are the clinical characteristics of arterial hypertension as a chronic disease? Objective Characterize arterial hypertension taking into account the clinical picture, risk factors, treatment and prevention. Method A descriptive study was carried out regarding the clinical characteristics of hypertension as a chronic disease. Development Risk factors for high blood pressure Although the specific causes of high blood pressure are not yet known, it has been related to a number of factors that are usually present in most people who suffer from it, such as: a diet high in salt, fat or cholesterol , in addition to chronic conditions (renal and hormonal problems, diabetes mellitus and high cholesterol), family history of the disease, lack of physical activity, old age (the older the person, the more likely they are to suffer from it), overweight, obesity, color of the skin, some contraceptive medications, stress and excessive consumption of tobacco or alcohol.2 Clinical picture In the majority of patients, arterial hypertension occurs without symptoms and, therefore, goes unnoticed, with the risk that this entails, but there are clinical manifestations such as headache, sweating, rapid pulse, shortness of breath, dizziness, visual disturbances, buzzing in the the ears, facial flushing and eye spots as flying dark objects. According to data from the Spanish Society of Arterial Hypertension-Spanish League for the Fight against Arterial Hypertension, hypertensive patients who have been undiagnosed for a long time may suffer a complication at a given moment, such as angina pectoris, which is a symptom derived from this. The excess pressure in the arteries maintained for years and not treated, can lead to a high number of complications such as atherosclerosis, hypertensive heart disease, kidney disease and stroke.1 Treatment The goal of treatment is to decrease cardiovascular morbidity and mortality. This is achieved by normalizing blood pressure and controlling other cardiovascular risk factors, without causing other physical, mental or social illnesses. If the patient presents risk factors such as hypercholesterolemia, smoking, obesity, diabetes mellitus and a sedentary lifestyle, then it is necessary to correct them if cardiovascular risk is to be significantly reduced. The fundamental premise to treat patients with arterial hypertension must be to individualize the treatment. In some cases, the normalization of blood pressure is obtained only by modifying the lifestyle; in others, it is necessary to indicate drug therapy, but in both situations, patient education is essential. The most important impediment to achieving the proposed objective is non-compliance with the therapeutic plan indicated by the physician.3 Non-pharmacological treatment: lifestyle modifications All patients must be duly stimulated and convinced of the importance of nonpharmacological treatment, since it is the main measure to undertake and often turns out to be the appropriate therapy; Likewise, the health personnel in charge must have knowledge of such a procedure. It is considered that all hypertensive patients need to modify their lifestyle and among the main measures to comply with are the following: control body weight, reduce salt in food, perform physical exercises, increase the consumption of fruits and vegetables, eliminate smoking and limit the intake of alcoholic beverages. It should start with all patients with grade I hypertension and maintain it for 3 months as the only therapeutic measure, if some of the conditions considered as cardiovascular risk do not exist. Pharmacotherapy This will be indicated from the beginning together with non-pharmacological treatment in all patients classified as grade II, as well as in those grade I with cardiovascular risk. The use of antihypertensive drugs should always be accompanied by measures that contribute to changing the patient's lifestyle. The main requirements for starting and maintaining pharmacological treatment include: age of the patient, individual needs and dose, response to treatment, diseases or comorbid factors that may influence the latter (alcoholism and chronic obstructive pulmonary disease, among others), as well as formulations Therapeutic drugs that are easy to administer and have optimal efficacy to guarantee better adherence to treatment. The most appropriate are those that reduce blood pressure figures for 24 hours. Ideally, you want to maintain more than 50% of your maximum effect levels throughout the day. To achieve this, in the event that 2 or more drugs are combined, it is recommended to divide the doses and distribute them at different times of the day, for example: if a diuretic is combined with a beta-blocker, the diuretic should be administered in the morning and the another medicine in the afternoon or evening.4 Main drugs used in patients with arterial hypertension The most universally used hypotensive medications for having withstood therapeutic tests, according to multicenter studies, and considered first-line are diuretics, betablockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and more recently , angiotensin II receptor antagonists. Other medications, such as alpha-blockers, central sympatholytics, peripheral adrenergic antagonists, and direct vasodilators, are considered second or third line and some are reserved for very specific situations. Prevention Although arterial hypertension cannot be definitively cured, there are a series of lifestyle habits that, together with the action of antihypertensive drugs, can substantially control it and thus avoid its consequences. Among these are the following: -Every adult over 40 years of age should periodically monitor her blood pressure, especially if her parents or grandparents have suffered from it. - Perform physical exercises and avoid obesity. - Reduce the level of salt in the preparation of meals. - Minimize animal fat and eat a diet rich in vegetables, legumes, fruits and fiber. - Limit the amount of processed and fried foods. - Do not smoke and avoid environments contaminated by tobacco smoke. - Moderate the consumption of alcoholic beverages. - Do not drink excessively exciting drinks such as coffee and tea, to name a few. Hypertension is a powerful cardiovascular risk factor that worsens when associated with high cholesterol, diabetes mellitus or uric acid.5 Conclusions Preventing hypertension is the most important and least expensive universal measure to avoid its appearance. Improving the prevention and control of blood pressure is a major challenge for all health institutions, the population, and governments. The adequate perception of the danger that having the disease means, requires the execution of strategies to detect and monitor with specific measures individuals exposed to high levels of one or several risk factors and who have a high probability of suffering from it, so that the modification of lifestyles is essential to obtain these benefits. Bibliographic references 1. Miguel Soca Pedro Enrique, Sarmiento Teruel Yamilé. Arterial hypertension, a dangerous enemy. ACIMED [Internet]. 2009 Sep [cited 2022 Nov 09] ; 20(3): 92-100. Available at: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1024- 94352009000900007&lng=es. 2. Berenguer Guarnaluses Lazaro Jorge. Some considerations on arterial hypertension. MEDISAN [Internet]. 2016 Nov [cited 2022 Nov 09] ; 20(11): 2434-2438. Available at: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S102930192016001100015&lng=es. 3. Vidalon Fernandez Armando. Arterial hypertension: a general introduction. medical certificate Peruvian [Internet]. 2006 May [cited 2022 Nov 09] ; 23(2): 67-68. Available at: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1728- 59172006000200004&lng=es. 4. Alfonso Prínce José Claro, Salabert Tortoló Idalmi, Alfonso Salabert Iria, Morales Díaz Mariuska, García Cruz David, Acosta Bouso Anilexys. Arterial hypertension: an international health problem. Rev.Med.Electron. [Internet]. 2017 Aug [cited 2022 Nov 09] ; 39(4): 987-994. Available at: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S168418242017000400013&lng=es. 5. Weschenfelder Magrini D., Gue Martini J.. Arterial hypertension: main modifiable risk factors in the family health strategy. sick glob. [Internet]. 2012 Apr [cited 2022 Nov 09] ; 11(26): 344-353. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S169561412012000200022&lng=es. 61412012000200022. https://dx.doi.org/10.4321/S1695- Annexes