Ischemic heart disease – risk factors
Risk factors:
HYPERCOLESTEROLEMIA, HYPERLIPIDEMIA, RAISED LDL: significantly increase the risk of developing cardiovascular diseases (CHD); VLDL cholesterol also increases risk, while HDL cholesterol decreases risk.
SMOKING: significantly increases the risk of coronary heart disease, and the risk depends on the number of cigarettes smoked per day and the time of smoking.
HIGH BLOOD PRESSURE: the risk of CHD increases with systolic pressure greater than 135mmHg and diastolic pressure greater than 85mmHg.
DIABETES (SUGAR DISEASE): 60% of all deaths in diabetes are caused by coronary heart disease.
GENETIC FACTORS: with a positive family history (angina pectoris, myocardial infarction…) the risk of developing CHD is increased.
AGE AND GENDER: the risk increases linearly with age. In men starting from the age of 30, in women starting from menopause. In men before the age of 60, the risk of developing CHD is twice as high as in women, while after the age of 60 the risk gradually equalizes.
OBESITY AND PHYSICAL INACTIVITY: regular physical activity reduces the risk of developing this disease, while a large body mass increases it (increased risk for diabetes, hypertension, hypercholesterolemia…).
PSYCHOLOGICAL CHARACTERISTICS: TYPE A PERSONALITY (competitive personality, ambitious personality…) has an increased risk for CHD.
Hypertension
Pathophysiologically, it occurs due to changes in the properties of the arterial blood vessel, and thus its adaptation to pressure, i.e. a stroke that causes a wave of blood when it is forced out (from the left ventricle) into the lumen of the aorta. Changes in the adaptation of the arterial blood vessel mean a decrease in elasticity and/or an increase in the stiffness of the arterial wall, which leads to increased pressure on it, and it is subject to further changes – it thickens and creates bag-like expansions.
What value is elevated blood pressure?
Any arterial blood pressure value that exceeds 140/90 mmHg, regardless of age.
Which blood pressure monitor is “adequate”?
Each “digital” device with a matching upper arm cuff of the appropriate size (S, M, L). Before starting use, it is advisable to check the device in the first healthcare facility and compare it with a pressure gauge of professional characteristics.
When to measure blood pressure?
In the morning hours immediately after getting out of bed, and after performing the morning toilet, before breakfast with 10-15 minutes of rest in a sitting position, as well as in the evening, immediately before going to bed. Blood pressure is measured in situations without stress and with an empty bladder. The so-called basal conditions for blood pressure measurement are listed, when all factors that can influence blood pressure are maximally excluded.
On which arm do you measure blood pressure?
Before determining the hand on which the blood pressure will be measured – the authoritative hand, it is necessary to measure the TA on both hands – the difference between them must not exceed 20 mmHg, and if this is the case, then it is advisable to contact a doctor to examine the situation in more detail. Always measure blood pressure on the arm on which more blood pressure values are measured.
Is it good to repeat the measurements several times in a short time interval and take the mean value?
Certainly not, blood pressure is measured in one attempt, unless some error is detected in the measurement technique. Arterial blood pressure is a variable value that changes during the day, so measuring blood pressure is not recommended more than 2 times a day, except in situations of deterioration of the general condition, i.e. occurrence of complaints and symptoms of increased or decreased blood pressure. Repeated measurement of tension (TA) is preferably carried out when biometerological conditions change.
How to treat high blood pressure in general?
Mildly elevated blood pressure values can often be successfully treated only by serious changes in the previous lifestyle and by introducing changes in the way of eating, reducing the intake of table salt, reducing body weight, physical activity and relaxation. Of course, in the advanced stage of hypertension, the most important thing is adequate, strictly individually selected therapy and its regular intake.
How to solve jumps or drops in arterial blood pressure and when to reduce or increase the recommended antihypertensive therapy?
Jumps in TA above 160/90mmHg require acute ie. quick intervention in the form of chewing certain tablets, repeating the measurement after 30 minutes and repeating the therapy on several occasions until TA decreases. In case of a drop in TA, it is necessary to increase the intake of liquids and salt in the form of consumption of plain or mineral water, refreshing juice, soup or salted vegetables. If these situations are repeated in the next few days, it is necessary to consult the prescribing doctor or independently correct the dose of medication by halving or increasing it, but never by canceling it! The therapy should be taken regularly even when the blood pressure is normal – in order to maintain the effective dose of the antihypertensive drug. Do not interrupt the therapy or omit it without consulting a doctor. The worst way is to take medicines according to the current level of blood pressure, because in this way sometimes you take too much, and sometimes you take insufficiently active substances, which causes potentially dangerous blood pressure oscillations.
“Doctor, but my blood pressure fluctuates hour by hour despite the therapy that other doctors have been increasing day by day?”
It is necessary to consult a psychiatrist in these cases, because in the majority of cases behind this sentence are hidden anxiety-depressive disorders that respond well to psychiatric therapy, and soon leads to a reduction in antihypertensive therapy.
Successful treatment of hypertension greatly reduces the risk of ischemic heart and brain disease, as well as brain hemorrhage and aortic wall rupture.
Dr. Miroslav Radović
spec. cardiologist internist