Hypertension is a disease associated with a violation of blood pressure levels. It can have different etiologies, being primary or secondary. There are several stages and stages of arterial hypertension, as well as the risk of complications. Symptoms may vary depending on the severity of the disease and the severity of the damage to the so-called target organ. An acute course of hypertension is called a hypertensive crisis. It has its own characteristic symptoms and is a life-threatening condition. When diagnosing hypertension, 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 within 120/80 mm. rt. Art. Only small deviations from this value are possible. Only in some cases, indicators such as 100/65 or 135/110 mm are the norm. 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 the contraction of the heart wall. The second is diastolic (lower), showing the value with a relaxed heart.
Types of hypertension:
- Important (primary) - occurs in 90-95% of cases among all patients with arterial hypertension.
- Symptomatic - a secondary form of hypertension, observed in only 5-10% of cases.
Persistent high blood pressure is formed on the background of hypertrophy of the left ventricle (LV) of the heart, an increase in its mass with thickening of cells, cardiomyocytes. At first, the wall of the left ventricle thickens, then the heart chamber itself expands.
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 artery disease, and sudden death increases. With the development of left ventricular dysfunction, characteristic symptoms appear.
GB (hypertension) can occur with varying degrees of severity and dynamics. There are several forms of hypertension:
- while. Blood pressure rises periodically, stabilizes spontaneously after a few hours or days without using medication.
- labileManifestations are also periodic, but treatment is required to normalize blood pressure.
- stable. High blood pressure levels persist for a long time, patients need continuous treatment.
- Malignant. Blood pressure, especially diastolic, rises to a critical level, and there is a low susceptibility to treatment. There is a possibility of rapid development of the disease with the simultaneous occurrence of severe complications.
- Crisis. Periodically observed hypertensive crisis. 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 possibility of complications in the target organ due to its damage.
level
Hypertension has 4 stages:
- preclinical. There are no signs of arterial hypertension, blood pressure rises without characteristic symptoms.
- Stage 1. There are signs of high blood pressure, a crisis may occur, but there are no symptoms of target organ damage.
- Stage 2. Signs of damage to target organs are observed - myocardium is hypertrophied, kidney function is impaired, changes in the retina are noticeable.
- Stage 3. Serious complications are possible - stroke, impaired visual function, myocardial infarction, atherosclerosis or aortic aneurysm.
Target organs are affected in stage 2 HD, so patients should be screened to determine possible risk. ECG, cardiac ultrasound designed to identify the degree of cardiac muscle hypertrophy; blood and urine are taken for tests (protein, creatinine) to determine indicators of kidney function.
The third stage of GB can occur with pathology related to hypertension. Among them, transient ischemic attack, stroke, angina pectoris and myocardial infarction are the most important for prognosis.
Hypertension level
The degree of GB is determined based on blood pressure values. It is important in risk and prediction.
Hypertension is diagnosed when the blood pressure exceeds 140/90 mm. rt. Art. The degree is determined by the following relationship:
- BP in the range of 140-159 / 90-99 mm Hg. Art. ;
- BP in the range of 160-179 / 100-109 mm Hg. Art. ;
- Exceeds the mark of 180/110 mm Hg. Art.
In rare cases, patients have an increase in systolic pressure with a mark of more than 140 mm. rt. Art. , and diastolic is in the normal range. This condition is called the isolated systolic form of GB. When determining the level of the disease, it does not matter which pressure (lower or upper) exceeds the normal range.
With the greatest accuracy, the level of hypertension is established at the first detection of this disease. In cases when drugs (antihypertensives) are used, blood pressure can decrease or increase sharply, which does not allow an adequate assessment of the level of GB.
Risk
With hypertension, severe complications are possible. The most dangerous conditions are cerebral hemorrhage, myocardial infarction, ischemic necrosis and renal failure. Therefore, for each high blood pressure patient, the risk is determined from 1 to 4, where higher values indicate the highest risk.
With GB, the risk for the patient is established based on the analysis of external provocation factors, concomitant diseases, metabolic disorders, changes in internal organs involved in the pathological process.
Provocative risk factors include:
- age of the patient (for men - after 55 years, and for women - 65 years);
- smoking;
- the presence among relatives younger than 65 ( for women) and 55 ( for men) of people with cardiovascular pathology;
- violation of lipid metabolism (decrease in high-density lipid fraction, excess of low-density lipoprotein and cholesterol norms);
- overweight (weight is considered overweight if the abdominal circumference exceeds 102 cm in men and 88 cm in women).
This is a major precipitating factor, but some hypertensive patients may be diabetic, inactive, or have abnormal blood clotting due to increased fibrinogen levels. These factors are considered additional, increasing the likelihood of complications.
To determine the risk of GB, it is necessary to take into account the transplanted complications. For example, if a patient has had a stroke, they are at high risk (4). With the first and second degree of GB with normal health (without damage to internal organs) and provoking factors such as smoking and age, moderate risk is set - 2.
Low risk means that the probability of complications is no more than 15%, indicated by the number 1. A value of 2 is a 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) is established when the probability of a vascular accident is greater than 35%.
The reasons
The following factors can trigger significant GB:
- overweight due to impaired metabolism, inactive lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- frequently increased psycho-emotional stress related to professional activity;
- previous brain injury (hypothermia, fall, contusion);
- hereditary predisposition (at a young age, the first symptoms of high blood pressure 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 interfere with blood circulation;
- significant hormonal changes in menopause in women over 40;
- heavy consumption of caffeinated beverages, alcohol and smoking;
- prolonged mental activity;
- sudden increase in adrenaline in the blood;
- excessive consumption of salty foods;
- sedentary lifestyle;
- rarely exposed to fresh air.
Symptomatic arterial hypertension can occur against the background of:
- kidney damage (glomerulonephritis) caused by 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
Symptoms of hypertension are non-specific. Patients may not be aware of high blood pressure for years, not feeling discomfort in leading a normal lifestyle. In some cases, minor weakness and dizziness may occur, which are often associated with overwork.
Usually, the first complaint is associated with target organ damage, which occurs in stage 2 HD. If there is a violation of cerebral circulation, a person experiences severe dizziness, noise in the head, headaches, decreased performance and impaired memory. With the development of the disease, flies in front of the eyes, numbness of the legs, and speech disorders are possible. Usually in the early stages, these symptoms are temporary. With serious disease severity, there is a risk of cerebral infarction and cerebral hemorrhage.
When the heart muscle is damaged, morphological changes occur in it. Atherosclerosis of the aorta leads to expansion, dissection and rupture. In this case, there is a painful sensation in the gap area, which cannot be removed with analgesic drugs. With kidney damage, protein, erythrocytes are found in the urine. In rare cases, hypertension may lead to kidney failure. Damage to the eye leads to deterioration in visual function, until the development of blindness.
Usually, with the further development of hypertension, the headache continues. It has nothing to do with the time of day, so it can happen at any time. Usually, discomfort haunts the patient at night and in the morning. The patient feels heaviness or fullness in the back of the head, but often covers other areas. Usually, the pain is described by the patient as a "loop" sensation, caused by tension in the soft integumentary muscles of the head or the head tendon helmet. Such symptoms intensify with a strong, straining cough, head tilt, psycho-emotional stress, may be accompanied by slight swelling of the eyelids and face. Prolonged headaches lead to the development of irritability, irritability, increased sensitivity to external stimuli (noise, loud music). With vertical position, muscle activity or massage, venous outflow improves, so the pain decreases or disappears for a while.
With arterial hypertension, pain in the heart area has several features that distinguish it from an angina attack:
- localized at the top of the heart or on the left side of the sternum;
- lasts for several minutes and hours;
- occurs at rest or during emotional stress;
- not eliminated with nitroglycerin;
- not provoked by physical activity.
Shortness of breath, which occurs first during physical exercise, and then even at rest, swelling of the legs is also a symptom of damage to the heart muscle and the development of heart failure. But moderate peripheral edema in hypertension may be caused by sodium and water retention due to impaired renal excretory function or taking certain medications.
Hypertensive crisis
At the peak manifestation of hypertension, it is customary to speak of a hypertensive crisis. In this situation with a sudden increase in blood pressure, all the clinical signs described above appear. But they are accompanied by nausea, vomiting, darkness in the eyes, sweating.
A hypertensive crisis usually lasts from a few minutes to a few hours. At this time, the patient complained of heart palpitations and the fear of death. Red spots may appear on the cheeks. An attack of hypertensive crisis may be accompanied by excessive urination and diarrhea. As a rule, this condition is provoked by strong emotional overstrain.
Hypertensive crises sometimes have a more severe course, develop gradually and last a long time. This type usually occurs in the late stages of GB. It is accompanied by a violation of speech and the sensitivity of the limbs. In some cases, patients experience heart pain.
A hypertensive crisis appears for the following reasons:
- psychotic stress;
- inadequate drug therapy;
- sick;
- "rebound" phenomenon, which occurs against the background of drug withdrawal.
Hypertension in different age groups and sexes
According to statistics, men are more prone to arterial hypertension than women. This is due to the fact that women are protected by the sex hormone, estrogen. However, such barriers to hypertension are short-lived. During menopause, estrogen levels decrease, and women are at risk for GB.
In the elderly, the main cause of hypertension is physical inactivity. With age, vascular changes occur, as hypertension can develop dramatically. Usually, this group of patients has isolated systolic arterial hypertension, which is caused by a decrease in vascular elasticity.
In children, hypertension is rare. The causes of GB development are the same as in adult patients. Treatment of diseases in children is quite complicated, because not all types of medicine can be used.
Treatment
With essential arterial hypertension, it is necessary to normalize blood pressure, improve lifestyle and target organ function. To do this, use drug therapy and general measures.
When making a diagnosis, the patient needs to completely reconsider the way of life. First of all, you should abandon bad habits, normalize your weight, change your diet and be physically active.
Experts note that essential hypertension should be treated by taking medication systematically. The treatment regimen is determined by the cardiologist and must be fully observed by the patient. If there is no timely treatment, there is a risk of a sudden hypertensive crisis, which leads to serious and fatal complications.
In the treatment of hypertension, doctors use the following groups of drugs:
- ACE inhibitors.
- Angiotensin II receptor blockers.
- Diuretic.
- calcium antagonists.
- Beta blockers.
- A prescription imidazoline agonist.
The above groups of drugs have their own contraindications, therefore they should be prescribed only by a doctor based on the stage of the disease, concomitant diseases. Treatment is usually with one drug, usually an ACE inhibitor, first. With its insufficient effectiveness, funds from other groups are added to the treatment regimen. This approach allows the use of drugs in small doses, thus reducing the possibility of side effects.
In addition to the listed group of drugs, nootropic drugs can be prescribed. It is used for symptoms of circulatory hypertensive encephalopathy. With changes in the myocardium, vitamins and microelements are used to help restore the structure of the heart muscle. If the patient is under stress, has an unstable emotional state, then he is prescribed a sedative.