Hypertension or arterial hypertension is a condition characterized by a stable rise in blood pressure, i.e. it can be detected by repeated measurements.Many diseases are considered a risk factor for the development of dangerous complications from the cardiovascular system, including stroke and heart attack.High blood pressure, as the main cause of the pathology in question, requires taking medications and normalizing the patient's lifestyle and diet.
Blood pressure is the force with which circulating blood acts on the walls of blood vessels.This pressure is called systolic when the heart is contracting, and diastolic when the heart is relaxing.The range of normal values for these indicators is quite wide.
Based on several observations, scientists have concluded that the risk of cardiovascular complications increases with each additional 10 mm Hg increase in blood pressure.Art.already starting from the level of 115/75 mm Hg.Art.However, drug pressure reduction has only been shown to be appropriate above 140/90 mm.rt.Art., so we consider this value as the criterion for determining arterial hypertension.
Reasons
In approximately 90% of cases, the cause of a stable increase in blood pressure is hypertension.This diagnosis is given to the patient if no other disease associated with high blood pressure is found during the examination.Among the latest:
- kidney pathologies - pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, renal artery stenosis;
- endocrine disorders - tumors of the adrenal glands, pancreas or pituitary gland, hyperthyroidism, Cushing's disease or syndrome, pheochromocytoma;
- obstructive sleep apnea syndrome;
- valvular defects or atherosclerotic lesions of the aorta.
Regular use of certain medications can also cause high blood pressure.These include oral contraceptives, non-steroidal anti-inflammatory drugs, amphetamines, corticosteroids, drugs containing erythropoietin, cyclosporine, cocaine.
The likelihood of developing cardiovascular disease, including high blood pressure, is closely related to the following risk factors:
- unhealthy diet, including an excessive amount 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
If it is possible to identify a disease that leads to increased blood pressure, arterial hypertension is called secondary or symptomatic.If the cause is unknown, high blood pressure is considered primary hypertension.
The latter has a phased course:
- Section I.There are no obvious signs of disruption of the target organs affected by a stable increase in blood pressure - the heart, kidneys, arterial and venous vessels.
- section II.One or a combination of the listed symptoms is present, such as enlargement of the left ventricle of the heart, a significant decrease in the filtration rate of the kidneys, albumin in the urine, an increase in the thickness of the wall of the carotid arteries, or the appearance of atherosclerotic plaques in the lumen.In this case, clinical manifestations of the disease may be absent.
- III.stage hypertension.Atherosclerotic processes of the heart and blood vessels are accompanied by one or more pathologies - myocardial infarction, acute cerebrovascular accident, angina pectoris, atherosclerosis of the arteries of the lower extremities or severe kidney damage, which manifests itself in a pronounced decrease in filtration and/or a significant loss of protein in the urine.
Arterial hypertension can be divided into several grades depending on the maximum blood pressure measured:
- First degree.Systolic blood pressure is 140-159 mm.rt.Art.and/or diastolic – 90-99 mm.rt.Art.
- Second degree.Systolic blood pressure is 160-179 mm.rt.Art.and/or diastolic – 100-109 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 the systolic pressure rises, while the diastolic pressure is normal.
Symptoms
An increase in blood pressure is often not accompanied by a deterioration in well-being and remains unnoticed by the patient, which is why regular blood pressure measurement is so important, especially for middle-aged and elderly people.
Manifestations of high blood pressure may include the following symptoms:
- headache, especially in the morning, after waking up;
- epistaxis;
- bleeding under the mucous membrane of the eye;
- cardiac arrhythmia;
- blurred vision, flickering spots;
- tinnitus.
A sharp jump in blood pressure to a high value, accompanied by a pronounced deterioration of well-being, is called a hypertensive crisis.It most often occurs when the systolic pressure rises above 180 mm Hg.Art.and/or diastole above 120 mm Hg.Art.In such cases, the patient experiences weakness, nausea, unrelieved vomiting, confusion, anxiety and fear, muscle fever and chest pain.
Complications
A stable increase in blood pressure during hypertension significantly increases the risk of cardiovascular pathologies, including those that threaten the patient's life.These are:
- acute cerebrovascular accident (stroke);
- angina pectoris, heart attack;
- vascular dementia (dementia);
- chronic kidney and heart failure;
- atherosclerotic changes in the vessels of the lower limbs.
Diagnostics
The main symptom of high blood pressure is a stable increase in blood pressure, detected by at least three measurements on different days in a calm environment.When blood pressure is measured for the first time in a hospital or clinic, it is important to follow the following rules to ensure that the results obtained are correct:
- Before the examination, the patient should sit in a quiet room for a few minutes to calm down;
- the size of the cuff of the tonometer should correspond to the thickness of the arm, and the device itself should be installed at the level of the heart;
- two measurements are taken at 1-2 minute intervals on both hands;if there is a large discrepancy between the obtained data, an additional measurement must be made;
- in elderly patients and those suffering from diabetes mellitus, or if a drop in blood pressure is suspected when the body position is changed, measurements should be taken in the first and fifth minutes in a standing position;
- In addition, the heart rate is measured for 30 seconds.
During the conversation with the patient, the doctor will clarify at what age the pressure first began to rise, whether there are symptoms such as snoring with pauses in breathing during sleep, muscle weakness or sudden heartbeat, sweating and headache, as well as unusual impurities in the urine.It is also important what medicines and dietary supplements you take.
As part of the first stage of the examination of hypertension, the following tests are performed:
- clinical blood test;
- general urinalysis, detection of microalbumin in single and daily doses;
- biochemical blood test (cholesterol, lipoprotein level to assess the risk of atherosclerosis, blood electrolytes - potassium, sodium, chlorine, calcium, as well as glucose and creatinine);
- determining the level of glycated hemoglobin;
- determining the concentration of hormones - thyroxine, triiodothyronine and thyroid-stimulating hormone, antibodies against thyroid peroxidase and thyroglobulin, aldosterone.
If a hereditary predisposition to the disease is suspected, it is possible to determine the gene polymorphisms associated with the development of arterial hypertension.
In order to clarify the risk factors for the development of high blood pressure and to identify existing cardiovascular pathologies, instrumental diagnostic methods are used:
- 24-hour blood pressure monitoring;
- electrocardiographic examination;
- echocardiography;
- 24-hour Holter monitoring;
- duplex scanning of the brachiocephalic, renal, or iliofemoral arteries;
- ultrasound examination of the kidneys and adrenal glands;
- fundus examination.
In the case of high blood pressure, it is important to control your blood pressure at home by keeping a diary, in which you should record all the results of measurements over time, the medications you take and stressful episodes that cause a rise in blood pressure.In this case, the measurement should be done in a sitting position, after several minutes of rest, with your hand at the same height as your heart.
Treatment
In the case of a moderate and low risk of cardiovascular complications, the patient is only recommended to change his lifestyle, modify his diet, lose weight, increase physical activity and give up special exercises against high blood pressure, as well as bad habits, in addition to regular blood pressure measurement.Often these measures are sufficient to normalize blood pressure.
A high blood pressure diet includes limiting table salt, caffeine, hot, salty, smoked, and spicy foods, high-fat foods, offal, buttercream sweets, and alcoholic beverages.In case of exacerbation of the disease, consumption of more than 5 g of salt per day is allowed.The recommended daily fluid intake is 1-1.2 liters.
In case of unsuccessful non-pharmacological treatment lasting several months, as well as in case of a high risk of complications, antihypertensive therapy is resorted to with antihypertensive drug treatment, the aim of which is to reduce blood pressure below 140/90 mm.rt.Art.For diabetics or patients already suffering from cardiovascular pathologies, the target pressure is even lower - 130/80 mm.rt.Art.
Modern medical treatment of high blood pressure involves a combination of two or more drugs from the following groups:
- calcium antagonists;
- angiotensin-converting enzyme inhibitors;
- angiotensin II blockers;
- diuretics;
- b-blockers;
- alpha blockers.
The vast majority of these are available in the form of high blood pressure tablets.
Prevention
Prevention of exacerbation of high blood pressure includes timely diagnosis and treatment of diseases of the cardiovascular, nervous, urinary and endocrine systems, strict adherence to all the doctor's recommendations, including non-drug treatment and drug treatment, as well as regular measurement of blood pressure.