From stroke to heart attack: here are the most important risks

Answer: High blood pressure is a typical cardiovascular risk factor with an extremely significant impact on public health and healthcare costs. The most striking statistic in terms of epidemiology is the high mortality associated with hypertension, which is the leading cause of death in the world and causes the death of around 12 million patients worldwide every year, far outstripping other much feared diseases that receive far more attention and resources in terms of prevention than hypertension. As for the possible clinical consequences of hypertension, these are mainly cardiovascular complications due to the negative effect that high blood pressure values have on the heart and vascular system. In short, the most typical complication is the occurrence of a stroke, i.e. a condition in which there is a suppression of blood flow to the brain due to an arterial occlusion (ischaemic stroke) or, more rarely, a rupture of an intracranial vessel (haemorrhagic stroke).

The incidence of stroke is directly correlated to blood pressure values, which explains how reducing them through effective pharmacological treatment and non-drug treatment leads to a substantial reduction in the risk of this dreaded complication whose neurological sequelae are often disabling and can involve both motor and cognitive functions.

The great strides made in recent years by vascular neurology now make it possible to carry out a decisive arterial unblocking intervention that can limit and prevent the damage of cerebral vascular occlusion, provided that the intervention is timely and the symptoms of a possible stroke (sudden balance disorders, intense headache, speech or walking disorders, inability to move limbs or perform fine hand movements, visual disturbances, etc.) are recognised as early as possible and lead to timely hospitalisation. The second complication associated with high blood pressure is coronary artery disease and in particular myocardial infarction and angina pectoris, both of which are due to vascular damage produced by high blood pressure values in the coronary arteries where hypertension often acts in concert with hypercholesterolaemia. Coronary artery disease also has an incidence correlated with blood pressure values and can be prevented by resorting to the same therapeutic strategies described above for stroke, both on the pharmacological side and on that of coronary revascularisation, which can also be implemented in the acute phase with great possibilities of functional recovery of the heart. A third possible complication of hypertension is renal failure, also in this case resulting from the damage produced by hypertension at the level of the kidney's vascular system. The development of renal failure is proportional to blood pressure values and is amplified by the concomitant presence of diabetes mellitus. Renal damage from hypertension can be prevented by antihypertensive therapy, which can also be effective in protecting residual renal function when diagnosed late. At the cardiac level, hypertension can lead to the development of heart failure as a result of the pressure load the heart is subjected to due to high blood pressure values. The development of heart failure can occur even in the absence of coronary artery disease and is often preceded by the development of left ventricular hypertrophy, which can be easily diagnosed by electrocardiogram and echocardiogram and is a valuable tool for preventing cardiac damage. Complications of hypertension also include vascular disorders of the eye involving the retinal artery, which can undergo the same changes as the rest of the arterial system with varying symptoms but centred on the reduction-loss of visual acuity). Retinal damage from hypertension can be diagnosed with fundus analysis of the eye and can be prevented by appropriate antihypertensive therapy.

Other complications of hypertension can be: the development of cognitive impairment-dementia, atrial fibrillation and other cardiac arrhythmias, peripheral arteriopathies (in cooperation with cigarette smoking), and aneurysms of various districts of the aorta. On the other hand, epistaxis ('nosebleed') is not a common complication of hypertension, which in more than 95 per cent of cases has a venous origin and no correlation with blood pressure values, even though, paradoxically, it is considered one of the most dreaded complications!