Hypertension is a disease associated with a violation of blood pressure. It can have a different etiology, be primary or secondary. There are different degrees and stages of arterial hypertension, as well as the risks of complications. Symptoms can vary depending on the severity of the disease and the severity of damage to what are known as target organs. An acute course of high blood pressure is referred to as a hypertensive crisis. It has its own distinctive symptoms and is a life-threatening condition. When diagnosing hypertension, the patient is prescribed medication.
General information about high blood pressure
Hypertension is a disease characterized by a sustained increase in blood pressure. In a healthy person, blood pressure should be within 120/80 mm. rt. Art. Only minor deviations from this value are possible. Only in some cases, such indicators as 100/65 or 135/110 mm are the norm. rt. Art. But for most people, such blood pressure is considered pathological.
The BP indicator consists of two values. The first number is the systolic (upper) pressure, which shows the strength of the contraction of the heart's walls. The second is diastolic (lower) and shows the value when the heart is relaxed.
Types of high blood pressure:
- Essential (primary) - occurs in 90-95% of cases in all patients with arterial hypertension.
- Symptomatic - a secondary form of hypertension, observed only in 5-10% of cases.
Constant hypertension arises against the background of hypertrophy of the left ventricle (LV) of the heart, an increase in its mass with thickening of cells, cardiomyocytes. First, the wall of the left ventricle thickens, then the heart chamber itself expands.
It should be noted that LV hypertrophy has an unfavorable prognostic sign. With an increase in the left ventricle, the risk of developing ventricular arrhythmias, heart failure, coronary artery disease and sudden death increases. With the progression of left ventricular dysfunction, characteristic symptoms appear.
GB (hypertension) can occur with varying degrees of severity and dynamics. There are different forms of high blood pressure:
- In the interim. Blood pressure rises periodically, spontaneously stabilizes after a few hours or days without taking any medication.
- unstable. The manifestation is also periodic, but treatment is required to normalize blood pressure.
- stable. High blood pressure readings persist for a long time, the patient needs constant treatment.
- Malignant. Blood pressure, especially diastolic, rises to critical levels and there is little susceptibility to treatment. There is a possibility of rapid development of the disease with the simultaneous occurrence of serious complications.
- Crisis. Periodically observed hypertensive crises. They can accompany any stage of hypertension (stage 1 is rare).
classification
Arterial hypertension is classified according to several criteria. The disease is divided into stages and grades, which are determined by the level of blood pressure.
There is such a thing as risk. It is determined by the likelihood of complications in target organs due to their damage.
stages
Hypertension has 4 stages:
- preclinical. There are no signs of arterial hypertension, blood pressure increases without characteristic symptoms.
- Stage 1. There are signs of hypertension, crises are possible, but there are no symptoms of target organ damage.
- Stage 2. Signs of damage to target organs are observed - the myocardium is hypertrophied, kidney function is impaired, changes in the retina are noticeable.
- Stage 3. Serious complications are possible - stroke, visual impairment, myocardial infarction, atherosclerosis or aneurysm of the aorta.
Target organs are affected in Stage 2 HD, so patients should be evaluated to determine potential risks. ECG, ultrasound of the heart serve to identify the degree of hypertrophy of the heart muscles; Blood and urine are taken for tests (protein, creatinine) to determine indicators of kidney function.
The third GB stage can present with associated pathologies related to hypertension. Among them, transient ischemic attacks, strokes, angina pectoris and myocardial infarction are the most important for prognosis.
The degree of hypertension
The GB grade is determined based on the blood pressure value. It is important for risks and forecasts.
Hypertension is diagnosed when blood pressure exceeds 140/90 mm. rt. Art. The grades are determined by the following relationship:
- Blood pressure within 140-159 / 90-99 mm Hg. Art. ;
- Blood pressure within 160-179 / 100-109 mm Hg. Art. ;
- Exceeding the mark of 180/110 mm Hg. Art.
In rare cases, the patient has an increase in systolic pressure with a mark of more than 140 mm. rt. Art. , and the diastolic is within the normal range. This condition is called the isolated systolic form of GB. When determining the degree of disease, it does not matter which of the pressures (lower or upper) exceeds the normal range.
With the greatest accuracy, the degree of hypertension is established at the first detection of the disease. When taking medication (antihypertensive drugs), blood pressure can drop sharply or increase, which does not allow an adequate assessment of the extent of GB.
risks
With high blood pressure, serious complications are possible. The most dangerous conditions are cerebral hemorrhage, myocardial infarction, ischemic necrosis and renal failure. Therefore, for each patient with high blood pressure, the risk is determined from 1 to 4, with a higher value indicating the highest risk.
With GB, the risk for patients is determined on the basis of an analysis of external provoking factors, concomitant diseases, metabolic disorders, changes in the internal organs involved in the pathological process.
Provoking risk factors include:
- the age of the patient (for men - after 55 years and for women - 65 years);
- Smoking;
- the presence of people with cardiovascular disease among relatives under 65 (for women) and 55 (for men);
- Violation of lipid metabolism (decrease in high-density lipid fractions, exceeding the norm of low-density lipoproteins and cholesterol);
- Obesity (body weight is considered excessive if the waist circumference exceeds 102 cm in men and 88 cm in women).
These are the main precipitating factors, but some hypertensive patients may be diabetic, sedentary, or have abnormal blood clotting due to elevated fibrinogen levels. These factors are considered additional, increasing the likelihood of complications.
To determine the risk of GB, the complications transmitted must be taken into account. For example, if a patient has had a stroke, they are at very high risk (4). With GB of the first and second degrees, with normal health (without damage to internal organs) and provoking factors such as smoking and age, a medium risk is established - 2.
Low risk means that there is no more than a 15% chance of complications, which is indicated by the number 1. A value of 2 is a medium risk with a probability of up to 20%. A value of 3 corresponds to a high risk, and the probability of heart attacks and strokes does not exceed 30-33%. The highest risk (4) is found when the probability of vascular accidents is more than 35%.
The reasons
The following factors can provoke essential GB:
- Obesity due to metabolic disorders, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- regular increased psychoemotional stress associated with professional activities;
- previous brain injuries (hypothermia, falls, contusions);
- hereditary predisposition (at a young age the first symptoms of hypertension may appear if the patient's parents suffered from arterial hypertension);
- chronic diseases that negatively affect the cardiovascular system (rheumatoid arthritis, diabetes, gout);
- age-related changes in blood vessels;
- viral and infectious diseases;
- the formation of cholesterol plaques on the walls of blood vessels, disrupting blood flow;
- significant hormonal changes during menopause in women over 40;
- heavy consumption of caffeinated drinks, alcohol and smoking;
- prolonged mental activity;
- a sharp increase in adrenaline in the blood;
- excessive consumption of salty foods;
- sedentary lifestyle;
- rare contact with fresh air.
Symptomatic arterial hypertension can occur against the background of:
- Kidney damage (glomerulonephritis) due to unilateral or bilateral narrowing of the renal arteries;
- increased thyroid function;
- Stenosis of the coarctation (congenital disease);
- uncontrolled intake of hormonal drugs, antidepressants;
- Pheochromocytoma (producing adrenaline and noradrenaline) and hyperaldosteronism (producing aldosterone) - tumors of the adrenal glands;
- Wine alcohol (ethanol) consumption of more than 60 ml per day.
symptoms
The symptoms of high blood pressure are non-specific. Patients may be unaware of high blood pressure for many years and not feel uncomfortable if they lead a habitual lifestyle. In some cases, mild weakness and dizziness may occur, often attributed to overwork.
Most often, the first symptoms are associated with target organ damage, which occurs in stage 2 HD. In the event of a violation of the cerebral circulation, a person experiences severe dizziness, noise in the head, headache, decreased performance, and memory deteriorates. With the progression of the disease, flies before the eyes, numbness of the extremities and speech disorders are possible. Usually these symptoms are temporary in the early stages. If the disease worsens severely, there is a risk of a cerebral infarction and cerebral hemorrhage.
When the heart muscle is damaged, morphological changes occur in it. Atherosclerosis of the aorta leads to its expansion, dissection and rupture. In this case, there are painful sensations in the area of \u200b\u200bthe gap, which cannot be removed with analgesics. With kidney damage, protein, erythrocytes are found in the urine. In rare cases, high blood pressure can lead to kidney failure. Damage to the eyes leads to a deterioration in visual function and even blindness.
Pain in the head usually persists as the high blood pressure progresses. It is not related to the time of day, so it can occur at any time. Patients are usually plagued by symptoms at night and in the morning. Patients feel heaviness or fullness at the back of the head but often covers other areas. Typically, pain is described by patients as a "tired" sensation due to tension in the muscles of the soft skin of the head or the tendon-helmet of the head. Such a symptom intensifies with a strong cough, exertion, head tilt, psycho-emotional stress, and may be accompanied by a slight swelling of the eyelids and face. Prolonged headache leads to the development of irritability, irritability, increased sensitivity to external stimuli (noise, loud music). With a vertical position, muscle activity or massage, the venous outflow improves, so the pain decreases or disappears for a while.
With arterial hypertension, pain in the heart area differs from attacks of angina in several respects:
- localized in the apex of the heart or to the left of the sternum;
- lasts several minutes and hours;
- occurs at rest or during emotional stress;
- not eliminated with nitroglycerin;
- not provoked by physical activity.
Shortness of breath, which occurs first with physical exertion and later also at rest, swelling of the legs are also a symptom of damage to the heart muscle and the development of heart failure. But moderate peripheral edema in hypertension can be the result of sodium and water retention due to impaired renal excretory function or use of certain medications.
Hypertensive Crisis
The peak of hypertension is usually referred to as a hypertensive crisis. In this condition with a sharp increase in blood pressure, all the clinical signs described above appear. But they are complemented by nausea, vomiting, darkening of the eyes, sweating.
A hypertensive crisis usually lasts from a few minutes to several hours. At this point, patients complain of palpitations and fear of death. Red spots may appear on the cheeks. Attacks of hypertensive crisis may be accompanied by profuse urination and diarrhea. As a rule, this condition is provoked by strong emotional overstrain.
A hypertensive crisis is sometimes more severe, develops insidiously and lasts a long time. This type usually occurs in the later stages of GB. It is accompanied by a violation of speech and sensitivity of the limbs. In some cases, the patient has heart pain.
Hypertensive crises occur for the following reasons:
- psychotic stress;
- insufficient drug therapy;
- Pains;
- the phenomenon of "rebound" that occurs against the background of drug withdrawal.
Hypertension in different age and sex groups
According to statistics, men are more prone to arterial hypertension than women. This is because women are protected by sex hormones, estrogens. However, such an obstacle to hypertension is short-lived. During menopause, estrogen levels drop and women are at risk of GB.
In the elderly, physical inactivity is the main cause of high blood pressure. With age, vascular changes occur, due to which hypertension can progress dramatically. Usually this group of patients has isolated systolic arterial hypertension caused by a decrease in vascular elasticity.
Hypertension is rare in children. The causes of GB development are the same as in adult patients. Treatment of the disease in children is somewhat complicated, since not all types of drugs can be used.
treatment
With essential arterial hypertension, it is necessary to normalize blood pressure, improve lifestyle and the functioning of target organs. To do this, use drug therapy and general measures.
When making the diagnosis, the patient has to completely rethink their lifestyle. First of all, you should give up bad habits, normalize your body weight, change your diet and be physically active.
Experts note that essential hypertension should be treated by systematically taking medication. The treatment regimen is determined by the cardiologist and must be fully observed by the patient. Without timely treatment, there is a risk of sudden hypertensive crises leading to serious, fatal complications.
In the treatment of hypertension, doctors use the following groups of drugs:
- ACE inhibitors.
- Angiotensin II receptor blockers.
- diuretics.
- calcium channel blockers.
- beta blockers.
- Agonists of imidazoline prescriptions.
The above groups of drugs have their own contraindications, so they should only be prescribed by a doctor based on the stage of the disease and concomitant diseases. Treatment is usually first with a single drug, most commonly an ACE inhibitor. With insufficient effectiveness, funds from other groups are added to the treatment regimen. This approach allows the use of drugs in small doses, which reduces the likelihood of side effects.
In addition to the listed groups of drugs, nootropics can be prescribed. They are used for symptoms of dyscirculatory hypertensive encephalopathy. With changes in the myocardium, vitamins and trace elements are used to help restore the muscular structure of the heart. If the patient experiences stress loads, has an unstable emotional state, he is prescribed tranquilizers.