Arterial hypertension (AH, hypertension) is one of the most important socioeconomic and medical problems of our time.
This is due not only to the wide spread of this disease among different age groups of the population, but also to the high rates of serious complications, disability and death from high blood pressure if left untreated. in right time.
People prone to high blood pressure are advised to take measurements on both hands. Recent studies have shown that high blood pressure can be confirmed with a difference in reading on different hands of 10-15 mm Hg. This sign (difference in indications) has a probability of determining hypertension up to 96%.
What it is?
In simple terms, arterial hypertension is a disease of the cardiovascular system, in which the blood pressure in the arteries of the (large) systemic circulation increases steadily.
Blood pressure is divided into systolic and diastolic:
- Systolic. According to the first upper digit, the level of blood pressure is determined at the time of compression of the heart and expulsion of blood from the artery. This indicator depends on the force with which the heart contracts, the resistance of the walls of blood vessels and the frequency of contractions.
- diastolic. The second, lower number determines the blood pressure at the time the heart muscle relaxes. It indicates the level of peripheral vascular resistance.
Normally, blood pressure readings are constantly changing. They physiologically depend on the age, sex and condition of the person. During sleep, pressure decreases, physical activity or stress leads to its increase.
The average normal blood pressure in a twenty-year-old person is 120/75 mm Hg. Art. , forty years old - 130/80, over fifty years old - 135/84. With persistent numbers of 140/90, we are talking about high blood pressure. Statistics show that about 20-30% of the adult population is affected by this disease. With age, the prevalence rate increases inexorably and at age 65, 50 to 65% of the elderly suffer from this disease.
Classification
Considering the origin of the pathology, the following types are distinguished:
- Essential (primary) arterial hypertension. It is difficult to determine the exact cause of the development due to the lack of visible preconditions;
- Symptomatic (secondary). An increase in pressure is considered a consequence of the development of a certain disease, is one of its signs. The secondary type of the disease, depending on the cause of development, is divided into the following types: endocrine, renal, drug, hemodynamic, neurogenic.
If we take into account the level of blood pressure, the pathology is divided into the following types:
- Frontier. The pressure periodically rises to 140 - 149/90, then it goes down again, normalizes;
- Systolic isolated. There is an increase in the upper indicator (it reaches 140 and above). At the same time, the low remains in the 90s and below.
Considering the nature of the pathology, experts have identified the following types:
- Transient. The patient occasionally suffers from high blood pressure. This state can last for hours or days. The pressure returns to normal without the use of medication;
- Labile. It manifests itself at the initial stage of the development of pathology. This state is considered borderline, because water hammer is insignificant, unstable. The pressure usually normalizes on its own;
- Stable high blood pressure. Increased pressure is persistent, supportive therapy is needed to reduce it;
- Crisis. Periodic hypertensive crises are characteristic;
- Smart. The pressure rises to serious levels, hypertension develops rapidly, leading to serious complications. Probable death.
Risk factors
At present, the severity of the described disease directly depends on the risk facts. The risk lies in the formation of cardiovascular complications against the background of arterial hypertension. Given the presented complications, the prognosis of the consequences of arterial hypertension is diagnosed. There are the following risk factors that worsen the course of the disease and its prognosis:
- age - in men after 50 years, in women after 60 years;
- smoking;
- high cholesterol;
- hereditary factor;
- obesity;
- hypodynamia;
- Diabetes.
Presented risk factors may be eliminated (correctable) and may not be correctable. The first type of risk factors is characterized by the presence of diabetes mellitus, hypercholesterolemia, smoking, physical inactivity. Uncorrected risk factors include race, family history, and age.
Gravity
There is also an international classification of the disease, developed according to the degree of arterial hypertension:
1st degree hypertension
This stage of the disease is characterized by a mild course of the disease: the pressure during the day increases by 20-30 units and usually does not exceed 180/115 mm Hg. From Art. Hypertensive crises occur rarely and are usually triggered by a sudden change in atmospheric pressure or emotional overload. There are no complications from the work of the target organs.
2nd degree hypertension
It is characterized by an increase in blood pressure to the level of 160-179 / 100-109 mm Hg. From Art. It is with such indicators that patients most often go to the doctor for the first time, because to consider them the norm is the height of negligence. Arterial hypertension of the 2nd degree is usually manifested by severe headaches, weakness, dizziness and deterioration of well-being during episodes of increased pressure.
3rd degree hypertension
It is characterized by an increase in blood pressure to the level of 180/110 mm Hg or more. Art. Sometimes these figures can reach completely prohibitive (250/160 mm Hg and more), but in this case there is a real threat to human health and life. A patient with 3rd degree hypertension should be under the supervision of a physician, take all prescribed antihypertensive medications, and be sure to have a tonometer (mechanical or electronic) at home.
High Blood Pressure Symptoms
High blood pressure itself has no symptoms. Most adult patients with this disease do not complain of anything at all, high blood pressure is detected by chance.
The clinical manifestations of high blood pressure depend on the organs that are affected at the moment. Adults with mild hypertension may complain of the following symptoms:
- Headache - can be the very first and main symptom. There are several types of headaches:
- dull, not very intense, characterized by a feeling of heaviness in the forehead and occiput. It most often appears at night or in the morning, increases with a sharp change in the position of the head and even slight physical exertion. Such pain is caused by a violation of the venous outflow of blood from the vessels of the skull, their overflow and stimulation of pain receptors;
- liquor - diffuse burst throughout the head, may be pulsating. Any tension causes an increase in pain. It most often occurs in the later stages of hypertension or in the presence of pulsed hypertension. As a result, the vessels are heavily filled with blood, and its outflow is difficult.
- ischemic - dull or bright in nature, accompanied by dizziness and nausea. It occurs with a sharp increase in blood pressure. There is an acute vasospasm, as a result of which the blood supply to the brain tissues is disturbed.
- Pain in the region of the heart - cardialgia, not of an ischemic nature, the coronary vessels are in order, while the pain is not stopped by the sublingual use of nitrates (nitroglycerin under the tongue) and can occur both at therest and during emotional stress. Sports activities are not a provoking factor.
- Shortness of breath - first occurs only when playing sports, with the progression of hypertension it can also occur at rest. It characterizes the dysfunction of the heart.
- Edema - most commonly found on the legs due to stagnation of blood in the systemic circulation, retention of sodium and water, or impaired kidney function. The appearance in children simultaneously with edema of hematuria and hypertension is characteristic of glomerulonephritis, which is very important to remember in the differential diagnosis.
- Visual impairment - manifests itself in the form of blurred vision, the appearance of a veil or flickering flies. Occurs due to damage to the vessels of the retina.
Chronic arterial hypertension causes kidney damage with the development of renal failure and the corresponding complaints of renal genesis, which will be discussed below. Chronic hypertension also leads to the development of dyscirculatory encephalopathy, which is characterized by impaired memory, attention and performance, sleep disturbances (increased daytime sleepiness, associated with nocturnal insomnia), dizziness, tinnitus and depressed mood.
When collecting an anamnesis, in the medical history, it is necessary to record the family history and the causes of high blood pressure in close relatives, to clarify the time of the appearance of the first clinical symptoms, tonote concomitant illnesses.
hypertensive crisis
This is an emergency condition, which consists of a sharp increase in blood pressure to high figures and is characterized by a sharp deterioration in the blood supply to all internal organs, especially vital organs.
It occurs when the body is exposed to various adverse factors, it cannot be predicted, which is why uncontrolled hypertension is dangerous. The urgency of the problem also lies in the fact that in the absence of timely emergency care, a fatal outcome is possible. To provide emergency care, the patient must be immediately taken to the hospital, where his blood pressure is quickly reduced with medication.
Students of medical institutes study first aid for hypertensive crises in the Department of Propaedeutics of Internal Diseases, and therefore it would be better if a random passerby did not try to provide assistance, but called an ambulance.
Diagnostic
The three main diagnostic methods that allow you to determine the presence of hypertension in a person are:
- blood pressure measurement,
- physical examination,
- Recording of an electrocardiogram.
Blood pressure control
Blood pressure measurement is carried out using a special device - a tonometer, which is a combination of a sphygmomanometer with a phonendoscope. In addition, currently there are special electronic devices that measure blood pressure, pulse, and also allow you to enter blood pressure indicators into the memory of the device.
Medical background
The diagnosis of hypertension also includes an investigation of the patient by a physician. The doctor teaches the patient which diseases he has already suffered or which he currently suffers from. Risk factors are assessed (smoking, high cholesterol, diabetes), as well as the so-called. hereditary history, that is, whether the patient's parents, grandparents and other close relatives suffered from hypertension.
Physical examination
The physical examination of the patient includes, first of all, the study of the heart using a phonendoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic tones (amplification or, conversely, weakening), as well as the appearance of uncharacteristic sounds. These data, first of all, speak of changes occurring in the heart tissue due to increased blood pressure, as well as the presence of defects.
Electrocardiogram (ECG)
An electrocardiogram (ECG) is a method that allows you to record changes in the electrical potentials of the heart over time on a special tape. It is an indispensable method for diagnosing, first of all, various cardiac arrhythmias. In addition, the ECG allows you to determine the so-called. hypertrophy of the wall of the left ventricle, typical of arterial hypertension.
echocardiography
In addition to these diagnostic methods, other methods are also used, for example, echocardiography (ultrasound examination of the heart), which allows to determine the presence of defects in the structure of the heart, changes in the thickness of itswalls and the condition of the valves.
Arteriography
Arteriography, including aortography, is an x-ray method for examining the condition of the walls of the arteries and their lumen. This method allows you to identify the presence of atheromatous plaques in the wall of the coronary arteries (coronary angiography), the presence of coarctation of the aorta (congenital narrowing of the aorta in a certain area), etc.
dopplerography
Dopplerography is an ultrasound method for diagnosing the state of blood flow in the vessels, both in the arteries and in the veins. With high blood pressure, the doctor first of all checks the condition of the carotid and cerebral arteries. Ultrasound is widely used for this, since its use is absolutely safe and does not cause complications.
blood chemistry
A biochemical blood test is also used in the diagnosis of hypertension. First of all, it turns out the level of cholesterol and high, low and very low density lipoproteins, since they are an indicator of a tendency to atherosclerosis. In addition, the blood sugar level is determined.
In the diagnosis of hypertension, a study of the condition of the kidneys is also used, for which such methods as a general urine analysis, a biochemical blood test (for the level of creatinine and urea), as well as an ultrasound of the kidneys and their vessels are used.
Thyroid ultrasound
Ultrasound of the thyroid gland and blood test for thyroid hormones. These research methods help identify the role of the thyroid gland in high blood pressure.
How to treat high blood pressure?
Effective treatment for hypertension is chosen based on the severity of the disease and the patient's overall risk of cardiovascular disease. To assess this risk, it takes into account certain factors:
- age: 50 for men, 60 for women;
- family history: sudden heart attack or death of one of the parents (before age 55 in men, before age 65 in women) or stroke before age 45, regardless of the sex of the parent;
- smoke (or have not smoked in the last three years);
- Diabetes;
- LDL cholesterol level above 1. 60 g/l or LDL cholesterol level below 0. 40 g/l;
- abdominal obesity, kidney failure, lack of regular exercise or excessive alcohol consumption.
General principles for treating high blood pressure at home, which should be followed by all adults with high blood pressure:
With a mild first degree of the disease, non-drug methods are used:
- limit salt intake to 5 g / day (more information on proper nutrition with high blood pressure can be found in our separate article),
- normalization of weight with its excess,
- moderate physical activity 3 to 5 times a week (walking, running, swimming, physiotherapy exercises),
- stop smoking,
- reduction in alcohol consumption,
- the use of herbal sedatives to increase emotional excitability (for example, a decoction of valerian).
In the absence of the effect of the above methods in the treatment of arterial hypertension of 1 degree, as well as patients with hypertension of 2 and 3 degrees, they switch to taking medication.
It should be noted that pharmacies currently offer a wide range of different drugs for the treatment of arterial hypertension, both new and known for many years. Under different trade names, preparations with the same active substance can be produced. It is quite difficult for a non-specialist to understand them.
Diuretics are the drugs of choice for the treatment of hypertension, especially in the elderly. The most common are thiazides.
Also, in the treatment of high blood pressure, it is important to correct the risk factors:
- antiplatelet agents - acetylsalicylic acid, are used according to indications,
- statins in the presence of atherosclerosis - also in the absence of contraindications;
- drugs that lower blood sugar in the presence of diabetes.
If the effect is insufficient, it may be necessary to add a second or third drug. Rational combinations:
- diuretic + beta-blocker
- diuretic + ACE inhibitor (or sartan)
- diuretic + calcium antagonist
- dihydropyridine calcium antagonist + beta-blocker
- calcium antagonist + ACE inhibitor (or sartan)
Invalid combinations:
- non-dihydropyridine calcium antagonist + beta-blocker (possible development of heart blocks until death)
- ACE inhibitor + sartan
For the treatment and examination of hypertension, you need to consult a doctor. Only a specialist after a comprehensive examination and analysis of the results of examinations will be able to correctly diagnose and prescribe competent treatment.
Why is hypertension dangerous?
High blood pressure is one of the main causes of severe CVS pathologies.
Despite the fact that there are currently a large number of antihypertensive drugs that help maintain blood pressure at an adequate level, the incidence of hypertensive crises and complications such as heart failure (HF) and renal failure (RF), aortic and mitral valve regurgitation, cardiac and aortic aneurysm, MI (heart attack), stroke, etc. in hypertensive patients remains extremely high.
This is mainly due to the fact that many patients do not want to systematically take antihypertensive therapy, believing that the hypertensive crisis that has developed in them was unique and it will not happen again.
According to statistics, among patients who know that they have high blood pressure, only about 40% of women and 35% of men receive drug treatment. At the same time, only 15% of women and about 5% of men achieve the required levels of pressure due to the systematic use of antihypertensive therapy, monitoring of blood pressure indicators and regular visits to the doctor andfollowing his recommendations.
Although arterial hypertension is one of the controllable risk factors for the formation of cardiovascular pathologies, such unfortunate indicators are due to the patient's banal misunderstanding of the seriousness of his diagnosis and, therefore, theabsence of a serious and responsible approach to treatment.
The most common serious complications that develop due to crises of hypertensive origin are:
- stroke (about thirty percent of patients);
- pulmonary edema (twenty-three percent);
- hypertensive encephalopathy (16%);
- acute heart failure (fourteen percent);
- cerebral hemorrhage (five percent of cases);
- dissect an aortic aneurysm (2. 5%), etc.
It should be noted that in the absence of adequate and systematic treatment of hypertension, which arises from heart and kidney failure within three years after suffering a severe (complicated) hypertensive crisis, 30-40% of patients die.
Comprehensive care, a responsible approach to one's health, the systematic use of medication for high blood pressure and the control of one's pressure, make it possible to reduce these frightening figures to a minimum.
Prevention of high blood pressure
For people with a hereditary predisposition to high blood pressure and burdened by risk factors, the prevention of the disease is of great importance.
- First of all, it is a regular examination by a cardiologist and compliance with the rules of a proper lifestyle, which will help to delay and often eliminate the disease of high blood pressure. If you have a history of parents with hypertension, you should reconsider your lifestyle and drastically change many of the habits and lifestyle that are risk factors.
- You should reconsider your dietary principles, stop eating salty and fatty foods, switch to a low-calorie diet that includes a large amount of fish, seafood, fruits and vegetables. Do not get carried away with alcoholic beverages and, above all, beer. They contribute to obesity, uncontrolled consumption of table salt, adversely affect the heart, blood vessels, liver and kidneys.
- It is necessary to lead an active lifestyle, to move more, depending on age, it is ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually, without overloading the body. Outdoor exercise is particularly beneficial. Physical exercise strengthens the heart muscle and the nervous system and helps prevent stress.
- Try to have a favorable psycho-emotional environment around you. If possible, avoid conflicts, remember that a broken nervous system very often triggers the mechanism of the development of high blood pressure.
- Quit smoking, the substances contained in nicotine cause changes in the walls of the arteries, increase their stiffness, therefore, they can be the culprits of high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.
Thus, we can briefly say that the prevention of high blood pressure requires regular examinations by a cardiologist, a healthy lifestyle and a favorable emotional background in your environment.
forecast for life
The prognosis of arterial hypertension is determined by the nature of the course (malignant or benign) and the stage of the disease. The factors that worsen the prognosis are:
- rapid progression of signs of target organ damage;
- stage III and IV of arterial hypertension;
- severe damage to blood vessels.
An extremely unfavorable course of arterial hypertension is observed in young people. They have a high risk of stroke, myocardial infarction, heart failure, sudden death.
With early treatment of arterial hypertension and provided that the patient strictly follows all the recommendations of the attending physician, it is possible to slow the progression of the disease, improve the quality of life of patients and sometimes achieve along-term remission. .