Hypertension is a disease that is associated with a violation of the blood pressure level. It can have another cause, be it primary or secondary. There are several degrees and stages of arterial hypertension, as well as risks of complications. Symptoms can vary depending on the severity of the disease and the extent of damage to the so-called target organs. An acute episode of high blood pressure is called a hypertensive crisis. It has its own characteristic symptoms and is a life-threatening condition. When hypertension is diagnosed, the patient is prescribed medication.
General information about hypertension
Hypertension is a disease characterized by persistently elevated blood pressure. In a healthy person, blood pressure should be between 120/80 mm. rt. Art. There can be only slight deviations from this value. Only in some cases are indicators like 100/65 or 135/110 mm standard. 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 (top) pressure, which indicates the strength of contraction of the heart wall. The second is diastolic (lower), indicating the value with a relaxed heart.
Types of hypertension:
- Primary (primary) - occurs in 90-95% of cases among all patients with arterial hypertension.
- Symptomatic - a secondary form of hypertension, which is observed only in 5-10% of cases.
Constantly high blood pressure is formed against the background of left ventricular (LV) hypertrophy of the heart, an increase in its volume with thickening of cells, cardiomyocytes. Initially, the wall of the left ventricle thickens, then the chambers of the heart relax on their own.
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 heart 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 several forms of hypertension:
- Temporary. Blood pressure rises cyclically, stabilizing itself after a few hours or days without medication.
- Labile. Manifestations are also cyclical, but treatment is required to return blood pressure to normal.
- stability. High blood pressure persists continuously, the patient needs continuous treatment.
- Malignant. Blood pressure, especially diastolic pressure, rises to critical levels and is less treatable. There is a possibility of rapid development of the disease with the simultaneous occurrence of severe complications.
- Crisis. Hypertensive crises are observed periodically. They can be accompanied by any stage of hypertension (stage 1 is rare).
Classify
Arterial hypertension is classified according to several criteria. The disease is divided into stages and degrees, which are determined by the degree of blood pressure.
There is such a thing as risk. It is determined by the likelihood of complications in the target organs due to their injury.
stage
Hypertension has 4 stages:
- Preclinical. There are no signs of arterial hypertension, the blood pressure rises without characteristic symptoms.
- Stage 1. Signs of high blood pressure, possibly crisis, but no symptoms of target organ damage.
- Stage 2. Signs of target organ damage are observed - myocardial hypertrophy, impaired renal function, visible retinal changes.
- Stage 3. Possible serious complications - stroke, impaired vision, heart attack, atherosclerosis or aortic aneurysm.
Target organs are affected in stage 2 HD, so patients should be screened to identify possible risks. Electrocardiogram, echocardiography designed to determine the degree of myocardial hypertrophy; Blood and urine are taken for tests (protein, creatinine) to establish indicators of kidney function.
The third stage of GB can occur with associated conditions associated with hypertension. Among them, transient ischemic attack, stroke, angina attack and myocardial infarction are the most important for prognosis.
Degree of high blood pressure
The level of GB is determined based on the value of blood pressure. What matters is risk and forecast.
Hypertension is diagnosed when blood pressure exceeds 140/90 mm. rt. Art. The degrees are determined according to the following relationship:
- BP in the range 140-159 / 90-99 mm Hg. Art. ;
- BP within 160-179 / 100-109 mm Hg. Art. ;
- Exceeded the 180/110 mm Hg mark. Art.
In rare cases, patients develop systolic hypertension with a baseline above 140 mm. rt. Art. , and diastole is within normal limits. This condition is known as the isolated extrasystoles of GB. When determining the extent of the disease, it does not matter which pressure (lower or higher) is out of the normal range.
With the greatest accuracy, the degree of hypertension is established from the first diagnosis of the disease. In the case when using drugs (antihypertensives), blood pressure can decrease or increase sharply, which does not allow to fully assess the degree of GB.
Risk
With hypertension, serious complications can occur. 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, where a higher value indicates the highest risk.
With GB, the risk to the patient is established on the basis of analysis of external stimuli, comorbidities, metabolic disorders, changes in internal organs related to the disease process. physical.
Given the risk factors include:
- age of the patient (for men - after 55 years and for women - 65 years);
- smoke;
- the presence of relatives under the age of 65 (for women) and 55 (for men) of people with cardiovascular disease;
- violation of lipid metabolism (reduction of high-density lipid fractions, exceeding the norm of low-density lipoproteins and cholesterol);
- overweight (body weight is considered excessive if the waist circumference exceeds 102 cm in men and 88 cm in women).
These are the major precipitating factors, but some hypertensive patients may be diabetic, sedentary, or have abnormal blood clotting due to increased fibrinogen levels. These factors are considered complementary, increasing the likelihood of complications.
To determine the risk of GB, it is necessary to take into account the complications that are transferred. For example, if a patient has had a stroke, they are at very high risk (4). Given the first and second GB levels with normal health (no damage to internal organs) and predisposing factors such as smoking and age, a moderate risk is posed - 2.
Low risk means that the probability of a complication is no more than 15%, represented by the number 1. A value of 2 is moderate risk with a probability of up to 20%. A value of 3 corresponds to high risk, and the probability of heart attack and stroke does not exceed 30-33%. The highest risk (4) was established when the probability of a vascular accident was more than 35%.
The reasons
The following factors can stimulate essential GB:
- excess body weight due to impaired metabolism, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- frequent increase in psycho-emotional stress associated with professional activities;
- previous brain injury (hypothermia, falls, bruising);
- hereditary predisposition (in childhood, the first symptoms of hypertension may appear if the patient's parents have 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 that disrupt blood circulation;
- significant hormonal changes during menopause in women over the age of 40;
- heavy consumption of caffeinated beverages, alcohol and smoking;
- prolonged mental activity;
- a sharp increase in adrenaline in the blood;
- excessive consumption of salty foods;
- sedentary lifestyle;
- rarely exposed to fresh air.
Symptomatic arterial hypertension may occur against the background of:
- kidney damage (glomerulonephritis) due to unilateral or bilateral renal artery stenosis;
- increased thyroid function;
- coarctation of the aorta (congenital disease);
- uncontrolled intake of hormonal drugs, antidepressants;
- pheochromocytoma (producing adrenaline and norepinephrine) and hyperaldosteronism (producing aldosterone) - tumors of the adrenal gland;
- consumption of wine (ethanol) more than 60 ml per day.
Symptom
Symptoms of hypertension are not specific. Patients may not be aware of high blood pressure for many years, not feeling uncomfortable when living habits. In some cases, there may be mild weakness and dizziness, which is usually caused by overwork.
Usually, the first complaints are related to target organ damage, occurring in stage 2 HD. In case of violation of cerebral circulation, a person experiences severe dizziness, noise in the head, headache, decreased performance and memory impairment. With the progression of the disease, flies may appear in front of the eyes, numbness of the extremities, speech disorders. Usually in the early stages, these symptoms are transient. With severe disease, there is a risk of cerebral infarction, cerebral hemorrhage.
When the heart muscle is damaged, morphological changes occur in it. Atherosclerosis leads to its enlargement, dissection, and rupture. In this case, there are painful sensations in the cleft area, which cannot be eliminated with analgesics. With kidney damage, protein, red blood cells are found in the urine. In rare cases, high blood pressure can develop into kidney failure. Damage to the eye leads to impaired visual function, leading to blindness.
Often, with further progression of hypertension, the pain in the head persists. It has no connection to the time of day, so it can happen at any time. Usually, the feeling of discomfort haunts the patient at night and in the morning. The patient feels heaviness or fullness in the back of the head, but usually covers other areas. Often, patients describe the pain as a "throbbing" sensation, caused by muscle tension in the soft parts of the head or the capsular tendon of the head. Such symptoms are intensified with a profuse cough, nervousness, head tilt, psycho-emotional stress, which may be accompanied by slight swelling of the eyelids and face. Prolonged headaches lead to laziness, irritability, increased sensitivity to external stimuli (noise, loud music). With an upright posture, muscular activity or massage, the outflow from the veins is improved, so the pain decreases or disappears for a while.
With arterial hypertension, pain in the heart region has several features that distinguish it from attacks of angina:
- localized at the top of the heart or to the left of the sternum;
- lasts for several minutes and hours;
- occurs at rest or during emotional stress;
- not eliminated by nitroglycerin;
- not provoked by physical activity.
Shortness of breath, occurring first with exertion and then even at rest, leg edema is also a symptom of myocardial damage and the development of heart failure. But moderate peripheral edema in hypertension may result from sodium and water retention due to impaired renal excretory function or to certain medications.
The hypertensive crisis
When there is a peak manifestation of hypertension, it is often referred to as a hypertensive crisis. In this state with a sharp increase in blood pressure, all the clinical signs described above appear. But they are replenished by nausea, vomiting, dark eyes, sweating.
A hypertensive crisis usually lasts from a few minutes to several hours. At this time, the patient complained of a rapid heartbeat and a feeling of fear of death. Red spots may appear on the cheeks. Attacks of hypertensive crisis may be accompanied by increased urination and diarrhea. As a rule, this condition is provoked by emotional overstrain.
A hypertensive crisis sometimes has a more serious course, develops gradually 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 suffered a heart attack.
Hypertensive episodes occur for the following reasons:
- mental stress;
- inadequate drug treatment;
- pain;
- the phenomenon of "rebound", which occurs against the background of drug withdrawal.
Hypertension in different age groups and sexes
Statistically, men are more susceptible to arterial hypertension than women. This is due to the fact that women are protected by the sex hormone, estrogen. However, such an obstacle to hypertension is short-lived. During menopause, estrogen levels decrease, and women are at increased risk for GB.
In the elderly, the main cause of high blood pressure is inactivity. With age, vascular changes occur, so that hypertension can progress to severe. Usually, this group of patients has isolated systolic hypertension, which is caused by decreased elasticity of blood vessels.
In children, hypertension is rare. The causes of GB development are the same as in adult patients. Treatment of diseases in children is somewhat complicated, because not all drugs can be used.
The treatment
With essential arterial hypertension, it is necessary to normalize blood pressure, improve lifestyle and function of target organs. To do this, use drug therapy and general measures.
When establishing a diagnosis, the patient needs to completely rethink his or her lifestyle. First of all, you should give up bad habits, normalize your body weight, change your diet and be physically active.
Experts note that underlying hypertension needs to be treated with systemic medication. The treatment regimen is determined by the cardiologist and the patient must fully adhere to it. If not treated promptly, the patient is at risk of a sudden increase in blood pressure, leading to dangerous, fatal complications.
In the treatment of high blood pressure, doctors use the following groups of drugs:
- ACE inhibitor.
- Angiotensin II receptor blockers.
- Diuretic.
- calcium antagonists.
- Beta blockers.
- The prescription drug imidazoline.
The above groups of drugs all have their own contraindications, so they are only prescribed by doctors based on the stage of the disease and concomitant diseases. Treatment is usually with a single drug, the first being an ACE inhibitor. With ineffective results, funds from other groups were added to the treatment regimen. This approach allows the drug to be used in small doses, thereby reducing the possibility of side effects.
In addition to the drug classes listed, nootropic drugs may be prescribed. They are used for symptoms of hypertensive encephalopathy caused by circulatory disorders. With changes in the heart muscle, vitamins and trace elements are used to help restore the muscle structure of the heart. If the patient is experiencing stress, emotional instability, he will be prescribed a sedative.