Hypertension, or arterial hypertension, is a condition characterized by a steady increase in blood pressure, that is, detected through repeated measurements.Accompanying many diseases, it is considered a risk factor for the development of dangerous complications from the cardiovascular system, including stroke and myocardial infarction.Hypertension, which is the main cause of the pathology in question, requires medication, normalization of the patient's lifestyle and nutrition.
Blood pressure is the force that circulating blood exerts on the walls of blood vessels.This pressure at the time of the heart's contraction is called systole, and during its relaxation - diastole.The range of normal values of these indicators is quite wide.
Through many observations, scientists have concluded that the risk of cardiovascular complications increases when blood pressure increases by 10 mmHg.Art.started at 115/75 mm Hg.Art.However, reducing the pressure with medication just above 140/90 mm turned out to be advisable.rt.Article., therefore this value is taken as a criterion to determine arterial hypertension.
Reason
In about 90% of cases, the cause of a steady increase in blood pressure is hypertension.This diagnosis is made to the patient when no other disease accompanied by hypertension is found during the examination.In the latest issue:
- kidney pathology – pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, renal artery stenosis;
- endocrine disorders - tumors of the adrenal gland, pancreas or pituitary gland, hyperfunction of the thyroid gland, Cushing's disease or syndrome, pheochromocytoma;
- obstructive sleep apnea syndrome;
- valve defects or aortic atherosclerotic lesions.
Regular use of certain medications can also cause high blood pressure.These include oral contraceptives, nonsteroidal anti-inflammatory drugs, amphetamines, corticosteroids, drugs containing erythropoietin, cyclosporine, and cocaine.
The likelihood of developing cardiovascular diseases, including hypertension, is closely related to the following risk factors:
- unhealthy diet, including an excess of table salt, saturated and trans fats, lack of greens, vegetables and fruits in the diet;
- obesity;
- heart and blood vessel diseases in relatives;
- age over 65 years old;
- sedentary lifestyle;
- chronic stress;
- Bad habits – smoking, drinking too much alcohol.
Classify
If the disease leading to hypertension can be identified, arterial hypertension is called secondary or symptomatic.When the cause is unknown, high blood pressure is considered primary hypertension.
The latter has a phased course:
- Stage I. There are no obvious signs of disruption of target organs affected by a stable increase in blood pressure - heart, kidneys, arterial and venous blood vessels.
- Phase II.There is one of the listed signs or a combination of them, such as enlargement of the left ventricle of the heart, a marked decrease in the filtration rate in the kidneys, albumin in the urine, increased thickness of the walls 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 is one or more pathologies associated with the atherosclerotic process of the heart and blood vessels - myocardial infarction, acute cerebrovascular accident, angina pectoris, atherosclerosis of the lower limbs or severe kidney damage, manifested by a marked decrease in filtering ability and/or significant loss of protein in the urine.
Arterial hypertension is divided into several levels depending on the maximum measured blood pressure:
- First degree.Systolic blood pressure is between 140 and 159 mm.rt.Art.and/or diastolic – between 90 and 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 greater than 180 mm.rt.Art.and/or diastolic above 110 mm.rt.Art.
There is also a distinct form of arterial hypertension, in which only systolic blood pressure is increased while diastolic blood pressure is normal.
Symptom
Usually, increased blood pressure is not accompanied by deterioration of health and may not be noticed by the patient, which is why regular blood pressure measurement is so important, especially for middle-aged and elderly people.
Symptoms of high blood pressure may include the following symptoms:
- headache, mainly in the morning after waking up;
- nosebleeds;
- hemorrhage under the mucous membrane of the eye;
- arrhythmia;
- blurred vision, flashing;
- tinnitus.
Blood pressure skyrockets to high levels, accompanied by a marked deterioration in health, called a hypertensive crisis.Usually it occurs when systolic blood pressure rises above 180 mmHg.Art.and/or diastolic blood pressure above 120 mm Hg.Art.In this case, the patient feels weakness, nausea, vomiting without relief, impaired consciousness, anxiety and fear, muscle tremors and chest pain.
complications
A steady increase in blood pressure during hypertension significantly increases the patient's risk of cardiovascular diseases, including those that threaten the patient's life.These include:
- acute cerebrovascular accident (stroke);
- angina, myocardial infarction;
- vascular dementia (memory loss);
- chronic kidney and heart failure;
- atherosclerotic lesions of the lower extremities.
Diagnose
The main sign of hypertension is a steady 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, to ensure that the results obtained are accurate, it is important to adhere to the following rules:
- Before the examination, the patient needs to sit for a few minutes in a quiet room to calm down;
- the size of the tonometer cuff should correspond to the thickness of the arm, and the device itself should be mounted at heart level;
- two measurements are taken at 1-2 minute intervals on each hand;If there is a large difference in the obtained data, perform additional measurements;
- in elderly patients, as well as people with diabetes mellitus, or if hypotension is suspected in case of changes in body position, measurements are taken during the first and fifth minutes in a standing position;
- Additionally, heart rate is measured for 30 seconds.
During a conversation with the patient, the doctor will clarify at what age the pressure begins to increase, whether there are any symptoms such as snoring and sleep apnea, attacks of muscle weakness or sudden heartbeat accompanied by sweating and headaches, as well as unusual impurities in the urine.It's also important to find out what medications and supplements he's taking.
As part of the first phase of hypertension screening, the following tests are performed:
- clinical blood tests;
- General urinalysis, detection of microalbumin in single and daily portions;
- biochemical blood tests (cholesterol, lipoprotein levels to assess the risk of atherosclerosis, blood electrolytes - potassium, sodium, chloride, calcium, as well as glucose and creatinine);
- determine the level of glycated hemoglobin;
- determination of the concentration of hormones - thyroxine, triiodothyronine and thyroid-stimulating hormone, antibodies to thyroid peroxidase and thyroglobulin, aldosterone.
If a genetic predisposition to the disease is suspected, it is possible to identify genetic polymorphisms associated with the development of arterial hypertension.
To clarify the risk factors for development and identify existing cardiovascular pathologies in hypertensive patients, instrumental diagnostic methods are used:
- 24-hour blood pressure monitoring;
- electrocardiographic studies;
- echocardiography;
- 24-hour Holter monitoring;
- duplex scanning of the brachiocephalic, renal, or iliofemoral arteries;
- Ultrasound examination of the kidneys and adrenal glands;
- fundus examination.
For hypertension, it is important to control blood pressure at home by keeping a diary, which should record all measurements over time, medications taken and periods of stress that can cause high blood pressure.In this case, the measurement must be performed in a sitting position, after a few minutes of rest, holding your hand at heart level.
Treatment
With a moderate and low risk of cardiovascular complications, patients are only recommended to change their lifestyle, adjust their diet, lose weight, increase physical activity and do special exercises for people with high blood pressure, and at the same time give up bad habits when regularly measuring blood pressure.Usually these measures are enough to normalize blood pressure.
A diet for people with high blood pressure includes limiting table salt, caffeine, hot, salty, smoked and spicy foods, fatty foods, offal, confectionery with butter cream and alcoholic beverages.It is allowed to consume no more than 5 g of salt per day except in cases where the disease becomes severe.The recommended daily fluid intake is 1-1.2 liters.
In cases where non-pharmacological treatment is unsuccessful within several months, as well as in cases where there is a high risk of complications, they use antihypertensive therapy using antihypertensive drugs, the goal of which is to reduce blood pressure below 140/90 mm.rt.Art.For patients with diabetes or those who already have pathologies of the cardiovascular system, the target pressure level is even lower - 130/80 mm.rt.Art.
Modern pharmacological 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.
Most of them are available in pill form to treat high blood pressure.
prevent
Prevention of severe hypertensive episodes includes timely diagnosis and treatment of diseases of the cardiovascular, nervous, urinary and endocrine systems, strict compliance with all doctor's recommendations, including non-pharmacological and pharmacological treatment, as well as regular blood pressure measurement.