Hypertension is the most common cardiovascular disease whose symptoms after 60-65 years affect a large part of the population. The diagnosis has many names, including essential hypertension (AH), arterial hypertension (AH). The disease is chronic, the main task of each patient is to avoid exacerbations and prolong the period of remission (disappearance of symptoms) using drugs and non-drug methods.
What is hypertension
Arterial hypertension is a constant increase in blood pressure above an acceptable level (from 140/90 mm Hg) under the influence of provoking factors. This diagnosis is called the "silent killer". The pathological process proceeds for a long time in an asymptomatic form, but during an attack it significantly increases the risk of stroke, myocardial infarction and other dangerous diseases. The potential complications of GB can threaten the life of the patient, so the disease requires prompt diagnosis and adequate treatment.
Hypertensive disease develops as a result of dysfunction of the higher centers of neurohumoral regulation, kidneys, blood vessels. In the absence of timely treatment, the pathological process leads to organic and functional disorders of the heart, organs of the central nervous system and kidneys. Incorrectly chosen therapy can lead to the progression of the disease with increased pain.
Classification of hypertension
In 2003, a unified classification of hypertension was defined according to the severity of the disease. The determining factor in this division is considered the true indicator of blood pressure, determined by the tonometer in a particular clinical case. Hypertension is also classified according to its origin (primary, secondary), its stages (transient, stable, sclerotic) and the level of risk of cardiovascular pathologies. This classification simplifies the diagnosis, helps to more accurately determine the treatment regimen for each hypertensive patient.
Degrees of high blood pressure
With an increase in blood pressure (BP), it is suspected that high blood pressure is progressing, especially if it is not possible to solve this health problem with non-drug methods. It is important to know that the optimal blood pressure is 120/80 mm Hg. Art. , normal - 120-129 mm Hg. From Art. (systolic pressure - SBP) and 80-84 mm Hg. From Art. (diastolic - DBP), high normal - 130-139 mm. rt. Art. (SAD) and 85-89mm. rt. Art. (DAD). A deviation from these figures indicates serious pathologies of the body. Doctors distinguish 3 degrees of GB:
- Hypertensive disease of the 1st degree (mild) is characterized by unstable pressure, which for several days varies from 140/90 to 159/99 mm Hg. Art The risk of developing a hypertensive crisis is minimal, there is nosymptom of organic damage to internal organs and central nervous system. To suppress a painful attack, in addition to taking medication, the patient needs a good rest, excluding stressful situations. Positive emotions, walks in the fresh air are especially useful.
- Arterial hypertension of the 2nd degree develops rapidly. The blood pressure index ranges from 160/100 to 179/109 mm Hg. Art. , there are symptoms of hypertensive crisis (cold sweat, goosebumps, flushing of the face). The patient is concerned about migraine attacks, dizziness, lack of sleep, shortness of breath. Clinical manifestations of arterial hypertension: transient cerebral ischemia (decreased blood flow in the organ), increased creatinine in the blood, narrowing of the retinal arteries, hypertrophy (increase in size) of the left ventricle, microalbuminuria (detection ofprotein in urinalysis). It is not possible to normalize the condition without medication.
- Hypertensive disease of the 3rd degree (severe) is accompanied by a sharp drop in visual acuity, poor memory, attacks of tachycardia (increased heart rate). A hypertensive crisis develops. Blood pressure indicator - from 180/110 mm Hg. From Art. and higher. Possible complications include hypertensive encephalopathy, cerebral vascular thrombosis and aneurysm (pathological expansion of the vessel), heart and kidney failure of the left ventricle, hemorrhage (bruising) and swelling of the optic nerve. Pathological changes are irreversible.
Degree of cardiovascular risk
To predict the likelihood of complications in progressive hypertension, the first step is to determine the cardiovascular risk index. This requires specialized advice, complex diagnostics. The degree of hypertension, the circumstances provoking the relapse (physiological and pathological) are taken into account. Common risk factors are:
- smoking, other bad habits;
- high cholesterol in the blood;
- sedentary lifestyle;
- obesity, especially abdominal (most fat is deposited in the abdomen);
- age (women over 65, men over 55);
- fasting sugar index 5. 6-7. 0 mmol/l;
- impaired glucose tolerance, determined using a special test;
- the presence of diseases of the cardiovascular system in relatives;
- Male.
The patient is at high cardiovascular risk if, in addition to hypertension, there are concomitant chronic diseases:
- Diabetes;
- cardiac arrest;
- violation of lipid (fat) metabolism;
- bronchial asthma;
- significant damage to the retina;
- coronary artery disease;
- stage 4 renal failure;
- suffered a stroke;
- cerebrovascular diseases (damage to the vessels of the brain);
- signs of obliterating diseases of the peripheral arteries of the lower extremities (atherosclerosis);
- damage to other internal organs.
This information helps the doctor to predict the clinical course of the disease. To determine the cardiovascular risk indicator for each degree of hypertension, you should familiarize yourself with the table below:
| General Risk Factors (RFR) | Arterial pressure | Risk of hypertension 1 degree | 2nd degree hypertension, risk | Risk of grade 3 hypertension |
|---|---|---|---|---|
| no risk factors | ordinary risk | short | moderate | high |
| 1-2 | short | moderate | moderately high | high |
| more than 3 | low-moderate | moderately high | high | high |
| damage to other internal organs, stage 3 kidney disease, diabetes mellitus | moderately high | high | high | very large |
| CVD, stage 4 chronic kidney disease with involvement of other organs or common risk factors | very large | very large | very large | very large |
Hypertension Treatment
The classification of GB according to stages and risks makes it possible to correctly determine the drug treatment regimen, quickly stop a painful attack and prolong the period of remission. If primary arterial hypertension develops (isolated), subject to medical recommendations, the prognosis is favorable. The secondary form of the disease often occurs with complications.
If the disease is not cured in time, it is difficult to stabilize high blood pressure even with medication. The general recommendations of specialists, if grade 1, 2 or 3 hypertension is diagnosed, are presented below. . Must be completed by taking medication as prescribed by the attending physician:
- Compliance with a therapeutic diet. It is important to reduce the servings of table salt, enrich the daily diet with foods containing potassium and magnesium to strengthen the heart muscle (seeds, nuts, legumes and cereals, green vegetables).
- Rejection of bad habits. This applies not only to alcohol and smoking, but also to the need to increase physical activity, abandon a "sedentary" lifestyle and take walks in the fresh air.
- Weight control. If a patient with arterial hypertension is obese, it is necessary to abandon fatty, fried and smoked foods and regularly arrange fasting days.
- Physiotherapy. In order to prevent and prolong the period of remission of GB, it is recommended to perform physical exercises of moderate intensity for 30 minutes 5 times a week.
- Reception of multivitamin complexes. The composition of such drugs should contain potassium, magnesium, iron and other trace elements important for the body.
medical therapy
Oral medications depend on the degree of hypertension and associated symptoms. Here are the optimal regimens for the conservative treatment of arterial hypertension:
- In the mild stage of the disease, the patient is prescribed angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers.
- If arterial hypertension of the 2nd degree of risk 4 develops, an integrated approach to the problem is necessary, which combines several representatives of different pharmacological groups in a conservative treatment regimen. These are the above drugs in combination with thiazide diuretics.
- In the complicated course of this disease, in addition to the above drugs, doctors recommend alpha or beta blockers. This is necessary if high doses of diuretics are poorly tolerated by a weakened body).