Hypertension or arterial hypertension is a disease characterized by a stable increase in blood pressure, which is determined by repeated measurements.In addition to many diseases, it is considered a risk factor for the development of dangerous complications of the cardiovascular system, including stroke and heart attack.Hypertension as the main cause of the pathology in question requires the use of medications that normalize the patient's lifestyle and diet.
Blood pressure is the force with which circulating blood acts on the walls of blood vessels.This pressure at the moment of contraction of the heart is called systolic, and during the relaxation phase it is called diastolic.The range of normal values of these indicators is quite large.
Through numerous observations, scientists have concluded that the risk of cardiovascular complications increases with every additional 10 mmHg increase in blood pressure.Art.already from the level of 115/75 mm Hg. Art.However, reducing the pressure with medication only proved advisable above 140/90 mm.rt.Art., therefore this value is used as a criterion for determining arterial hypertension.
Reasons
In about 90% of cases, high blood pressure is the cause of a stable increase in blood pressure.This diagnosis is made to the patient if the examination does not reveal other diseases associated with high blood pressure.The latest include:
- Renal diseases – pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, renal artery stenosis;
- endocrine disorders - neoplasms of the adrenal glands, pancreas or pituitary gland, hyperthyroidism, Cushing's disease or Cushing's syndrome, pheochromocytoma;
- obstructive sleep apnea syndrome;
- Valve defects or atherosclerotic lesions of the aorta.
Regular use of certain medications can also lead to high blood pressure.These include oral contraceptives, nonsteroidal anti-inflammatory drugs, amphetamines, corticosteroids, erythropoietin-containing drugs, cyclosporine and cocaine.
The likelihood of developing cardiovascular disease, including high blood pressure, is closely related to the following risk factors:
- unhealthy diet, including excessive amounts of table salt, saturated fats and trans fats, lack of leafy greens, vegetables and fruits in the diet;
- Obesity;
- Pathologies of the heart and blood vessels in close relatives;
- age over 65 years;
- sedentary lifestyle;
- chronic stress;
- bad habits – smoking, excessive alcohol consumption.
Classification
When a disease can be identified that causes increased blood pressure, it is called secondary or symptomatic arterial hypertension.When the cause is unknown, high blood pressure is considered primary hypertension.
The latter has a stepped progression:
- Stage I. There are no obvious signs of disruption of the target organs affected by a stable increase in blood pressure - heart, kidneys, arterial and venous vessels.
- Stage II. One of the listed signs or a combination of them is present, such as:B. an enlargement of the left ventricle, a significant decrease in the filtration rate in the kidneys, albumin in the urine, an increase in the wall thickness of the carotid arteries or the appearance of atherosclerotic plaques in their lumen.In this case, clinical manifestations of the disease may be absent.
- Stage III hypertension.There are one or more pathologies associated with atherosclerotic processes in the heart and blood vessels - myocardial infarction, acute stroke, angina pectoris, atherosclerosis of the arteries of the lower extremities or severe kidney damage, manifested by a significant decrease in filtration and / or significant loss of protein in the urine.
Depending on the maximum measured blood pressure, arterial hypertension is divided into several degrees:
- First degree.Systolic blood pressure is between 140 and 159 mm.rt.Art.and/or diastolic – from 90 to 99 mm.rt.Art.
- Second degree.Systolic blood pressure from 160 to 179 mm.rt.Art.and/or diastolic – from 100 to 109 mm.rt.Art.
- Third degree.Systolic blood pressure is more than 180 mm.rt.Art.and/or diastolic over 110 mm.rt.Art.
There is also an isolated form of arterial hypertension, in which only systolic pressure values are increased, while diastolic pressure is normal.
Symptoms
An increase in blood pressure is often not accompanied by a deterioration in well-being and can go unnoticed by the patient, which is why regular blood pressure measurement is so important, especially for middle-aged and older people.
Manifestations of hypertension may include the following symptoms:
- Headache, mainly in the morning after waking up;
- nosebleeds;
- bleeding under the mucous membrane of the eye;
- cardiac arrhythmia;
- blurred vision, flickering spots;
- Tinnitus.
A sharp increase in blood pressure to high values, accompanied by a significant deterioration in well-being, is called a hypertensive crisis.It most commonly occurs when systolic pressure rises to more than 180 mmHg.Art.and/or diastolic over 120 mm Hg. Art.In this case, the patient feels weakness, nausea, vomiting that does not bring relief, impaired consciousness, anxiety and fear, muscle tremors and chest pain.
Complications
A stable increase in blood pressure with hypertension significantly increases the risk of cardiovascular diseases, including those that threaten the patient's life.This includes:
- acute cerebrovascular accident (stroke);
- angina pectoris, myocardial infarction;
- vascular dementia (dementia);
- chronic kidney and heart failure;
- atherosclerotic lesions of the vessels of the lower extremities.
diagnosis
The main sign of hypertension is a stable increase in blood pressure, detected in at least three measurements on different days in a quiet environment.When measuring blood pressure for the first time in a hospital or clinic, it is important to adhere to the following rules to ensure the accuracy of the results obtained:
- Before the examination, the patient must sit in a quiet room for a few minutes to calm down;
- the size of the tonometer cuff must correspond to the thickness of the arm, and the device itself must be mounted at the level of the heart;
- two measurements are taken on each hand with an interval of 1-2 minutes;If there are large deviations between the obtained values, an additional measurement is carried out.
- For older patients and people with diabetes mellitus or if there is a suspicion of a drop in blood pressure when changing posture, the measurement is taken in the first and fifth minutes while standing;
- In addition, the heart rate is measured for 30 seconds.
When talking to the patient, the doctor clarifies at what age the pressure first began to rise, whether there are symptoms such as snoring with pauses in breathing during sleep, attacks of muscle weakness or sudden heartbeat with sweats and headaches, as well as unusual impurities in the urine.It is also important to find out what medications and supplements he is taking.
As part of the first stage of testing for high blood pressure, the following tests are carried out:
- clinical blood test;
- general urine analysis, detection of microalbumin in single and daily portions;
- biochemical blood test (cholesterol, lipoprotein levels to assess the risk of atherosclerosis, blood electrolytes - potassium, sodium, chlorine, calcium, as well as glucose and creatinine);
- Determination of glycated hemoglobin level;
- Determination of the concentration of hormones - thyroxine, triiodothyronine and thyroid-stimulating hormone, antibodies to thyroid peroxidase and thyroglobulin, aldosterone.
If a hereditary predisposition to the disease is suspected, it is possible to determine gene polymorphisms that are associated with the development of arterial hypertension.
To clarify the risk factors for its development and identify existing cardiovascular pathologies in hypertension, instrumental diagnostic methods are used:
- 24-hour blood pressure monitoring;
- electrocardiographic study;
- echocardiography;
- 24-hour Holter monitoring;
- Duplex scanning of the brachiocephalic, renal or iliofemoral arteries;
- Ultrasound examination of the kidneys and adrenal glands;
- Fundus examination.
With hypertension, it is important to control blood pressure at home by keeping a diary in which all measurements over time, medications taken and stress episodes that can cause an increase in blood pressure must be recorded.In this case, the measurements must be taken after a few minutes of rest while sitting, keeping the hand at heart level.
Treatment
With a moderate and low risk of cardiovascular complications, the patient is only recommended to change his lifestyle, adjust his diet, lose weight, increase physical activity and special exercises for hypertension, and abandon bad habits with regular measurement of blood pressure.These measures are often enough to normalize blood pressure.
A diet for high blood pressure involves limiting table salt, caffeine, spicy, salty, smoked and spicy foods, fatty foods, offal, confectionery with butter cream and alcoholic beverages.Unless the disease worsens, it is permissible to consume no more than 5 g of salt per day.The recommended daily fluid intake is 1-1.2 liters.
If non-drug treatment over several months is unsuccessful and there is a high risk of complications, they resort to antihypertensive therapy with high blood pressure medication, the aim of which is to reduce blood pressure to below 140/90 mm.rt.Art.For patients with diabetes or people who already suffer from diseases of the cardiovascular system, the target pressure is even lower - 130/80 mm.rt.Art.
Modern drug treatment of hypertension includes a combination of two or more drugs from the following groups:
- calcium antagonists;
- angiotensin-converting enzyme inhibitors;
- angiotensin II blockers;
- diuretics (diuretics);
- B blockers;
- Alpha blockers.
The vast majority of them are available in the form of tablets for high blood pressure.
Prevention
Prevention of hypertension exacerbations includes timely diagnosis and treatment of diseases of the cardiovascular, nervous, urinary and endocrine systems, strict adherence to all medical recommendations, including non-drug and drug treatment, and regular measurement of blood pressure.