Hypertension, or arterial hypertension, is a condition characterized by a stable 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, as the main cause of the pathology in question, requires medication, 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 during the contraction of the heart is called systolic, and during the period of its relaxation - diastolic.The range of normal values for this indicator is quite wide.
Through various observations, scientists have concluded that the risk of cardiovascular complications increases with every additional 10 mmHg increase in blood pressure.Art.already started from a level of 115/75 mm Hg.Art.However, medication pressure reduction only above 140/90 mm is apparently advisable.right.Art., Therefore this value is taken as a criterion for determining arterial hypertension.
Reason
In about 90% of cases, the cause of stable blood pressure increase is hypertension.This diagnosis is made to the patient when no other disease accompanied by hypertension is found during the examination.Among the latest:
- kidney pathology - pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, renal artery stenosis;
- endocrine disorders - neoplasm 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 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 hypertension, is closely related to the following risk factors:
- unhealthy diet, including an excess amount of table salt, saturated fat and trans fat, lack of leafy greens, vegetables and fruits in the diet;
- obesity;
- heart and blood vessel pathology in close relatives;
- age over 65 years;
- sedentary lifestyle;
- chronic stress;
- bad habits - smoking, excessive alcohol consumption.
Classification
If it is possible to identify the disease that leads to an increase in blood pressure, arterial hypertension is called secondary or symptomatic.When the cause is unknown, hypertension is considered primary hypertension.
The latter has a graded course:
- Stage I. There are no obvious signs of disorders of the target organs affected by a stable increase in blood pressure - the heart, kidneys, arteries and veins.
- Stage II.One of the listed signs or a combination of them is present, such as enlargement of the left ventricle of the heart, a significant decrease in the filtration rate in the kidneys, albumin in the urine, an increase in the thickness of the carotid artery walls or the appearance of atherosclerotic plaques in their lumen.In this case, clinical manifestations of the disease may not be present.
- Stage III hypertension.There is one or more pathologies related to the atherosclerotic process in the heart and blood vessels - myocardial infarction, acute cerebrovascular accident, angina pectoris, arterial atherosclerosis in the lower part of the legs, or serious kidney damage, which is indicated by a significant decrease in filtration and / or a significant loss of protein in the urine.
Arterial hypertension is divided into several degrees depending on the maximum measured blood pressure:
- First degree.Systolic blood pressure is from 140 to 159 mm.right.Art.and/or diastolic – from 90 to 99 mm.right.Art.
- second degree.Systolic blood pressure from 160 to 179 mm.right.Art.and/or diastolic – from 100 to 109 mm.right.Art.
- third degree.Systolic blood pressure greater than 180 mm.right.Art.and/or diastolic over 110 mm.right.Art.
There is also an isolated form of arterial hypertension, where only the systolic pressure number is increased while the diastolic pressure is normal.
symptoms
Often, an increase in blood pressure is not accompanied by a deterioration in well-being and may not be noticed by the patient, which is why it is very important to regularly measure blood pressure, especially for middle-aged and elderly people.
Manifestations of hypertension may include the following symptoms:
- headache, especially in the morning after waking up;
- nosebleeds;
- bleeding under the mucous membrane of the eye;
- heart rhythm disorders;
- blurred vision, flashing spots;
- tinnitus.
A sudden jump in blood pressure to a high figure, accompanied by a significant deterioration in well-being, is called a hypertensive crisis.It usually occurs when the systolic pressure rises to more than 180 mmHg.Art.and/or diastolic over 120 mm Hg.Art.In this case, the patient experiences weakness, nausea, vomiting that does not bring relief, impaired consciousness, anxiety and fear, muscle tremors, 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 include:
- acute cerebrovascular accident (stroke);
- angina pectoris, myocardial infarction;
- vascular dementia (dementia);
- chronic kidney and heart failure;
- atherosclerotic lesions in the vessels of the lower leg.
Diagnostics
The main sign of hypertension is a stable increase in blood pressure, detected in at least three measurements on different days in a calm environment.When measuring blood pressure for the first time in a hospital or clinic, to ensure the accuracy of the results obtained, it is important to follow the following rules:
- Before the examination, the patient should sit for a few minutes in a quiet room to calm down;
- the size of the tonometer cuff must correspond to the thickness of the arm, and the device itself must be installed at the level of the heart;
- two measurements are made with an interval of 1-2 minutes on each hand;if there is a large difference in the figures obtained, additional measurements are taken;
- in elderly patients, as well as people suffering from diabetes mellitus, or if a drop in blood pressure is suspected in the event of a change in body position, measurements are taken in the first and fifth minutes in a standing position;
- In addition, the heart rate is measured for 30 seconds.
The doctor, in conversation with the patient, explains at what age the pressure starts to increase, whether there are any symptoms such as snoring with cessation of breathing during sleep, attacks of muscle weakness or sudden heartbeat with sweating and headache, and unusual impurities in the urine.It is also important to know the medications and supplements he is taking.
As part of the first stage of screening for hypertension, the following tests are carried out:
- clinical blood tests;
- general urine analysis, detection of microalbumin in its single and daily portions;
- biochemical blood tests (cholesterol, lipoprotein levels to assess the risk of atherosclerosis, blood electrolytes - potassium, sodium, chlorine, calcium, as well as glucose and creatinine);
- determination of glycated hemoglobin level;
- determination of hormone concentrations - thyroxine, triiodothyronine and thyroid-stimulating hormone, antibodies to thyroid peroxidase and thyroglobulin, aldosterone.
If a hereditary predisposition to the disease is suspected, it is possible to determine gene polymorphisms related to the development of arterial hypertension.
To clarify risk factors for the development and identify existing cardiovascular pathology in hypertension, instrumental diagnostic methods are used:
- 24-hour blood pressure monitoring;
- electrocardiographic studies;
- echocardiography;
- 24-hour Holter monitoring;
- brachiocephalic, renal or iliofemoral artery duplex scan;
- 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, where it is necessary to record all the results of measurements over time, medications taken and episodes of stress that can trigger an increase in blood pressure.In this case, the measurement must be taken in a sitting position, after a few minutes of rest, keep your hands at the same level as your heart.
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 special exercises for hypertension, and abandon bad habits while regularly measuring blood pressure.Often these measures are enough to normalize blood pressure.
A diet for hypertension involves limiting table salt, caffeine, hot, salty, smoked and spicy foods, high-fat foods, offal, pastries with butter cream and alcoholic beverages.It is allowed to take no more than 5 g of salt per day outside the aggravation of the disease.The recommended daily fluid intake is 1-1.2 liters.
In cases of unsuccessful non-drug treatment for several months, as well as in cases of high risk of complications, they use antihypertensive therapy using drugs for hypertension, the goal of which is to reduce blood pressure to less than 140/90 mm.right.Art.For diabetic patients or people who already have cardiovascular system pathology, the target pressure level is lower - 130/80 mm.right.Art.
Modern drug 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);
- blocker b;
- alpha blockers.
Most of them are available in the form of tablets for hypertension.
Prevention
Prevention of exacerbation of hypertension includes timely diagnosis and treatment of diseases of the cardiovascular, nervous, urinary and endocrine systems, strict adherence to all doctor's recommendations, including non-drug treatment and medication, as well as regular blood pressure measurement.