Hypertension is a disease associated with a violation of the blood pressure level. It can have different etiologies, it can be primary or secondary. Arterial hypertension has several grades and stages, as well as the risk of complications. The symptoms can vary depending on the severity of the disease and the severity of the damage to the so-called target organs. The acute course of high blood pressure is called a hypertensive crisis. It has its own characteristic symptoms and is a life-threatening condition. When diagnosing high blood pressure, the patient is prescribed medication.
General information about high blood pressure
Hypertension is a disease characterized by a persistent increase in blood pressure. A healthy person's blood pressure should be within 120/80 mm. rt. Art. Only minor deviations from this value are possible. Only in some cases are 100/65 or 135/110 mm indicators the norm. rt. Art. But for most people, such blood pressure is considered abnormal.
The BP indicator consists of two values. The first number is the systolic (top) pressure, which shows the strength of the contraction of the heart's walls. The second is diastolic (bottom), which indicates the value with a relaxed heart.
Types of hypertension:
- Essential (primary) - occurs in 90-95% of all patients with arterial hypertension.
- Symptomatic - a secondary form of hypertension, observed only in 5-10% of cases.
Constant high blood pressure develops against the background of hypertrophy of the left ventricle (LV) of the heart, as its mass increases and the cells and cardiomyocytes thicken. Initially, the wall of the left ventricle thickens, and then the heart chamber itself expands.
It should be noted that LV hypertrophy has an unfavorable prognostic sign. As the left ventricle grows, the risk of developing ventricular arrhythmias, heart failure, coronary artery disease, and sudden death increases. As left ventricular dysfunction progresses, characteristic symptoms appear.
GB (hypertension) can occur with variable severity and dynamics. High blood pressure has several forms:
- Temporary. Blood pressure rises periodically and stabilizes spontaneously after a few hours or days without the use of drugs.
- Unstable. The manifestation is also intermittent, but treatment is required to normalize blood pressure.
- stabile. High blood pressure persists for a long time, the patient needs constant treatment.
- Malicious. Blood pressure, especially diastolic, rises to a critical level and sensitivity to treatment is low. It is possible for the disease to develop rapidly, with the simultaneous occurrence of serious complications.
- Crisis. Occasionally 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 degrees, which are determined by the level of blood pressure.
There is such a thing as risk. It is determined by the probability of complications due to damage to target organs.
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There are 4 stages of high blood pressure:
- Preclinical. There are no signs of arterial hypertension, blood pressure rises without characteristic symptoms.
- Stage 1. There are signs of high blood pressure, crises are possible, but there are no symptoms of target organ damage.
- Section 2. Signs of damage to target organs can be observed - hypertrophy of the heart muscle, impaired kidney function, changes in the retina are noticeable.
- Section 3. Serious complications are possible - stroke, visual impairment, myocardial infarction, atherosclerosis or aortic aneurysm.
In stage 2 HD, target organs are involved, so patients should be screened to determine potential risks. ECG, ultrasound of the heart, is designed to determine hypertrophy of the heart muscles; blood and urine are taken for examination (protein, creatinine) to determine indicators of kidney function.
The third stage of GB can occur together with pathologies related to high blood pressure. Of these, transient ischemic attacks, stroke, angina pectoris and myocardial infarction are the most important in terms of prognosis.
The degree of high blood pressure
The degree of GB is determined based on the value of blood pressure. It is important for risk and forecasting.
High blood pressure is diagnosed when the blood pressure exceeds 140/90 mm. rt. Art. The grades are determined by the following relationship:
- BP between 140-159 / 90-99 mm Hg. Art. ;
- BP between 160-179 / 100-109 mm Hg. Art. ;
- Exceeding the 180/110 mmHg mark. Art.
In rare cases, the patient's systolic pressure increases by more than 140 mm. rt. Art. , and diastole is within the normal range. This condition is called the isolated systolic form of GB. When determining the extent of the disease, it does not matter which of the pressures (lower or upper) exceeds the normal range.
The level of high blood pressure is determined with the greatest accuracy when the disease is first detected. With the use of drugs (antihypertensive drugs), blood pressure may drop or rise sharply, which does not allow for an adequate evaluation of the degree of GB.
Risks
Serious complications are possible with high blood pressure. The most dangerous conditions are cerebral hemorrhage, myocardial infarction, ischemic necrosis and kidney failure. Therefore, for each patient with high blood pressure, the risk is determined from 1 to 4, with a higher value representing the highest risk.
In the case of GB, the patient's risk is determined based on the analysis of external provoking factors, concurrent diseases, metabolic disorders, and changes in the internal organs involved in the pathological process.
Provocative risk factors are:
- age of the patient (after 55 years for men, after 65 years for women);
- smoking;
- the presence of people with cardiovascular diseases among relatives younger than 65 years (for women) and younger than 55 years (for men);
- violation of lipid metabolism (decrease in high-density lipid fractions, exceeding the norm of low-density lipoproteins and cholesterol);
- overweight (body weight is considered excessive if the abdominal circumference exceeds 102 cm for men and 88 cm for women).
These are the main causative factors, but some hypertensive patients may be diabetic, sedentary, or have abnormal blood clotting due to increased fibrinogen levels. These factors are considered complementary and increase the likelihood of complications.
Transferred complications should be taken into account to determine the risk of GB. For example, if a patient has had a stroke, their risk is very high (4). With a normal state of health (without damage to internal organs) and with provoking factors such as smoking and age, there is a moderate risk with the first and second degree of GB - 2.
Low risk means that the probability of complications is no more than 15%, which is indicated by the number 1. A value of 2 means moderate risk, with a probability of up to 20%. A value of 3 corresponds to a high risk, the probability of heart attack and stroke does not exceed 30-33%. The highest risk (4) is established when the probability of vascular accidents is more than 35%.
The reasons
The following factors can provoke basic GB:
- overweight due to impaired metabolism, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- regular increased psycho-emotional stress related to professional activities;
- previous brain injuries (hypothermia, falls, contusions);
- hereditary predisposition (the first symptoms of hypertension may appear at a young age 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, which disrupt blood circulation;
- 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 exposure to fresh air.
Symptomatic arterial hypertension may occur against the background of:
- kidney damage (glomerulonephritis) due to unilateral or bilateral narrowing of the renal arteries;
- increased thyroid function;
- coarctation of the aorta (congenital disease);
- uncontrolled intake of hormonal drugs, antidepressants;
- pheochromocytoma (produces adrenaline and norepinephrine) and hyperaldosteronism (produces aldosterone) - tumors of the adrenal gland;
- consumption of wine alcohol (ethanol) more than 60 ml per day.
Symptoms
The symptoms of hypertension are non-specific. Patients may not know about high blood pressure for many years and may not feel uncomfortable with their usual lifestyle. In some cases, minor weakness and dizziness may occur, often attributed to overexertion.
Usually, the first complaints are related to target organ damage, which occurs in the 2nd stage of HD. In the event of a violation of cerebral circulation, a person experiences severe dizziness, noise in the head, headache, reduced performance and memory loss. As the disease progresses, flies in front of the eyes, numbness of the limbs and speech disorders are possible. Usually, in the initial stage, these symptoms are temporary. In the event of a severe exacerbation of the disease, there is a risk of cerebral infarction and cerebral hemorrhage.
If 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 the gap, which cannot be removed with painkillers. In case of kidney damage, protein and erythrocytes are found in the urine. In rare cases, high blood pressure can lead to kidney failure. Damage to the eye leads to deterioration of visual function, up to the development of blindness.
Usually, with further progression of hypertension, the headache persists. It has nothing to do with the time of day, so it can happen at any time. Usually, discomfort haunts patients at night and in the morning. Patients feel heaviness or fullness in the back of the head, but it often covers other areas as well. The pain is typically described by patients as a "ring" sensation, which occurs due to the tension of the muscles of the soft parts of the head or the tendinous helmet of the head. Such a symptom increases with strong coughing, exertion, tilting the head, psycho-emotional stress, the eyelids and face are mildcan be accompanied by swelling. A long-lasting headache leads to 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.
Pain in the region of the heart in the case of arterial hypertension has some distinguishing features from angina attacks:
- it is localized in the apex of the heart or to the left of the sternum;
- lasts for several minutes and hours;
- occurs at rest or during emotional stress;
- not cleared with nitroglycerin;
- not provoked by physical activity.
Shortness of breath, which first appears during physical exertion and then even at rest, leg swelling is also a symptom of damage to the heart muscle and the development of heart failure. But moderate peripheral edema in high blood pressure can be the result of sodium and water retention due to impaired renal excretory function or taking certain medications.
Hypertensive crisis
At the peak of the manifestation of high blood pressure, it is customary to speak of a hypertensive crisis. In this condition, with a sharp increase in blood pressure, all the clinical symptoms described above appear. But they are accompanied by nausea, vomiting, darkening of the eyes, sweating.
A hypertensive crisis usually lasts from a few minutes to several hours. At this time, patients complain of palpitations and a feeling of fear of death. Red spots may appear on the cheeks. Attacks of hypertensive crisis can be accompanied by copious urination and diarrhea. Usually, this condition is triggered by a strong emotional overstrain.
A hypertensive crisis sometimes has a more severe course, develops gradually and lasts for a long time. This type usually occurs in the later stages of GB. It is accompanied by a violation of speech and the sensitivity of the limbs. In some cases, the patient has heart pain.
Hypertensive crises occur for the following reasons:
- psychotic stress;
- inadequate drug therapy;
- pain;
- the phenomenon of "rebound" that occurs in the background of drug withdrawal.
Hypertension in different age and gender groups
According to statistics, men are more prone to arterial hypertension than women. This is due to the fact that women are protected by sex hormones, estrogens. However, this barrier to high blood pressure is short-lived. During menopause, estrogen levels drop and women are at risk for GB.
The main cause of high blood pressure in the elderly is physical inactivity. Vascular changes occur with advancing age, which can lead to dramatic progression of high blood pressure. As a rule, in this group of patients there is isolated systolic arterial hypertension, which is caused by a decrease in the elasticity of blood vessels.
High blood pressure is rare in children. The reasons for the development of GB 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
In case of essential arterial hypertension, it is necessary to normalize the blood pressure, improve the lifestyle and the functioning of the target organs. To do this, use drug therapy and general measures.
When the diagnosis is made, the patient must completely rethink his lifestyle. First of all, you need to give up bad habits, normalize your weight, change your diet and be physically active.
Experts note that essential hypertension should be treated with systematic medication. The treatment regimen is determined by the cardiologist, and the patient must follow it in full. In the absence of timely treatment, there is a risk of sudden hypertensive crises, which lead to serious, fatal complications.
In the treatment of high blood pressure, doctors use the following drug groups:
- ACE inhibitors.
- Angiotensin II receptor blockers.
- Diuretics.
- calcium antagonists.
- Beta blockers.
- Agonists of imidazoline prescriptions.
The above drug groups have their own contraindications, so only a doctor can prescribe them based on the stage of the disease and accompanying diseases. Treatment is usually first performed with a single drug, most commonly an ACE inhibitor. Due to its insufficient effectiveness, funds from other groups are added to the regimen. This approach makes it possible to use drugs in small doses, thereby reducing the likelihood of side effects.
In addition to the listed drug groups, nootropic drugs can also be prescribed. It is used for symptoms of dyscirculatory hypertensive encephalopathy. With changes in the heart muscle, vitamins and microelements help to restore the muscle structure of the heart. If the patient experiences stress, has an unstable emotional state, then sedatives are prescribed.