EXPERT ADVICE: When the cause of hypertension is known, it is treated in nearly 6% of cases, explains Professor Pierre-François Plouin, of the hypertension service at the Georges Pompidou European Hospital (Paris). ).
High blood pressure(HTA) is not in itself a disease; it’s a risk factor like cholesterol. Hypertenders are statistically more likely to experience heart or brain injury than people of the same age and gender who do not have hypertension. It is these cardiovascular events that are diseases. They are severe, can be fatal or leave important sequels. Their probability increases with the level of the blood pressure (the “tension”) but is never 100%. Fortunately, we know how to prevent them: drugs that reduce blood pressure, antihypertensives, reduce their probability very significantly. To cure hypertension is to do without treatment after being hypertensive without compromising the prevention of cardiovascular events.
Antihypertensive treatment is not justified when the probability of a cardiovascular event is very low. This is particularly the case for young women (the cardiovascular risk is lower in women than in men and it increases with age) who have a normal weight, no exposure to tobacco, no diabetes or diabetes. excess of cholesterol, and whose tension does not exceed 16/10 cm of mercury. In many cases, antihypertensive treatment has been instituted during transient hypertension during stressful periods. Before starting treatment, a permanent hypertension must be confirmed by measuring the 24-hour blood pressure with an automatic monitor (blood pressure holter or ambulatory blood pressure measurement), or directly by the patient, three times in the morning and three times in the evening. for 3 to 5 days. But, even if he feels “cured”, the patient must not stop his antihypertensive treatment without a good appreciation by his doctor of the global cardiovascular risk. Monitoring is mandatory because it is not uncommon for the blood pressure to rise after a few years, justifying the term treatment.
Regular physical activity:
A better lifestyle can avoid antihypertensive treatment in cases of mild hypertension. The reduction in salt intake and alcohol, weight loss in overweight and regular physical exercise reduces tension and can “cure” hypertension to 150/100 mmHg. But these efforts and this motivation need to be supported to last by a constant surveillance, even the resumption of a drug treatment, simple to take, well tolerated, and especially more powerful, but which should not hide the benefits on the cardiovascular health of a healthy lifestyle.
When we know the cause of HTA, we can cure it in 5 to 6% of cases with support by specialized teams. This is the case, for example, in the adenoma of Conn, a benign tumor of the adrenal, a gland located above the kidney , generating hypertension by hormonal production disruption. Complete HTA healing after laparoscopic surgical ablation under general anesthesia of 40% of Conn adenomas is achieved, and a large improvement in other cases. In some cases, narrowing of the renal arteries may also explain secondary hypertension. It is then sufficient to dilate the artery by an arterially introduced balloon, often completed by the introduction of a stent, a kind of biocompatible spring that keeps the artery well open to the passage of blood from the aorta to the kidney. Finally, although it is not strictly speaking a secondary hypertension, hypertension is very common in cases of massive obesity . The use of surgery and the significant weight loss that ensues allow healing in 60% of cases.
Numerous experimental studies have shown that the control of tension depends largely on the sympathetic system, a nervous system that descends from the centers regulating tension in the brain and accompanies the arteries in most organs, including the kidneys. It is in finely regulated equilibrium with the parasympathetic system, a parallel system that has important relays in carotids. In hypertensive animals, stimulation of the renal sympathetic increases the tension, and conversely, its suppression by renal denervation can normalize it, as well as the stimulation of the parasympathetic at precise areas of the carotid arteries. These studies led to the design of probes introduced into the renal arteries to neutralize renal sympathy by the controlled emission of
The procedure involves the introduction of a transmitter probe during arteriography; it is painful and usually performed under general anesthesia. Reserved for cases of refractory HTA, uncontrollable by the usual drugs, it has not yet demonstrated its effectiveness in the medium and long term, and in all patients. A recent study did not show any difference between the radiofrequency application and a placebo procedure; the results of another controlled study should be available in the coming months. Baroreflex stimulation, which controls the tension via the parasympathetic, by the installation of a stimulator connected to the carotids by means of a small incision in the neck, could perhaps come to the rescue of these patients, but it will take a few years to optimize the probes or stimulators, to better select the candidates and to check that the drop in blood pressure will eventually lead to a reduction in cardiovascular risk. In any case, even with careful selection of candidates, these methods are still too experimental for a short-term possibility of HTA cure.