Arterial hypertension (AH, hypertension) is one of the most important socio-economic and medical problems of our time.
This is not only due to the widespread spread of the disease among different age groups of the population, but also by the rate of severe complications, disability and death due to arterial hypertension without timely treatment.
People prone to high blood pressure are advised to take measurements on both hands. Recent studies show that arterial hypertension can be confirmed by different readings on different hands of 10 - 15 mm Hg. This sign (difference in indication) has a probability of determining hypertension up to 96%.
What is this?
Briefly, arterial hypertension is a disease of the cardiovascular system, in which the blood pressure in the (large) systemic circulatory arteries increases continuously.
Blood pressure is divided into systolic and diastolic:
- systolic. According to the first number, above, the level of blood pressure is determined at the moment of compression of the heart and expulsion of blood from the arteries. This indicator depends on the force with which the heart contracts, on the resistance of the blood vessel wall and the frequency of contractions.
- diastolic. The second, lower number determines the blood pressure at the time the heart muscle relaxes. It indicates the level of peripheral vascular resistance.
Usually, blood pressure readings are constantly changing. They are physiologically dependent on the age, gender and condition of the person. During sleep, stress decreases, physical activity or stress leads to its increase.
The average normal blood pressure in a person in their twenties is 120/75 mm Hg. Art. , forty years - 130/80, over fifty - 135/84. With a constant figure of 140/90, we are talking about arterial hypertension. Statistics show that about 20-30 percent of the adult population is affected by the disease. With age, the prevalence rate increases inevitably and at the age of 65, 50-65 percent of the elderly suffer from the disease.
Welding
Given the pathological origin, the following types are distinguished:
- Essential (primary) arterial hypertension. It is difficult to determine the true cause of development due to the lack of visible prerequisites;
- Symptomatic (secondary). Increased stress is considered as a result of the development of certain diseases, is one of its signs. Secondary types of the disease, depending on the cause of development, are divided into the following types: endocrine, renal, drug -induced, hemodynamic, neurogenic.
If we take into account the level of blood pressure, pathology is divided into the following types:
- border. The pressure periodically increases to 140 - 149/90, then it drops, normal;
- Systolic is isolated. There is an increase in the upper indicator (it reaches 140 and above). At the same time, the lower ones remain in the 90s and below.
Taking into account the nature of the pathology, experts have identified the following types:
- temporary. The patient has occasional high blood pressure. This condition can last for hours or days. Pressure returns to normal without the use of medications;
- labil. It manifests itself in the early stages of pathological development. The state is considered the border, because the pressure surges are insignificant, unstable. The pressure usually becomes normal on its own;
- Stable arterial hypertension. The increase in stress is constant, supportive therapy is needed to reduce it;
- Crisis. Periodic hypertensive crises are characteristic;
- malignant. Stress rises to a serious level, hypertension develops rapidly, causing severe complications. Possible death.
Risk factors
Currently, the severity of the disease described directly depends on the risk facts. The risk lies in the formation of cardiovascular complications against the background of high blood pressure. Taking into account the complications presented, the prognosis due to arterial hypertension is diagnosed. There are the following risk factors that worsen the course of the disease and its prognosis:
- age - in men after 50 years, in women after 60 years;
- smoking;
- high cholesterol;
- hereditary factors;
- obesiti;
- hypodynamics;
- diabetes.
The risk factors presented can be eliminated (can be corrected) and may not be corrected. The first type of risk factor is characterized by the presence of diabetes mellitus, high cholesterol, smoking, lack of physical activity. Uncorrected risk factors include race, family history, and age.
Severity
There is also an international classification of the disease, which is developed depending on the degree of arterial hypertension:
Arterial hypertension degree 1
The stage of the disease is characterized by mild illness: the pressure during the day increases by 20-30 units and usually does not exceed 180/115 mm Hg. Art. Hypertensive crises are rare and they are provoked, as a rule, by sudden changes in atmospheric pressure or emotional load. No complications from target organ work.
2nd degree arterial hypertension
It is characterized by an increase in blood pressure to the level of 160-179 / 100-109 mm Hg. Art. It is with such indicators that patients most often go to the doctor for the first time, because considering them as the norm is the height of negligence. Level 2 arterial hypertension is usually indicated by severe headache, weakness, dizziness and deterioration of well-being during episodes of increased stress.
3rd degree arterial hypertension
It is characterized by an increase in blood pressure to a level of 180/110 or more mm Hg. Art. Sometimes these figures can reach too high (250/160 mm Hg and above), but in this case there is a real threat to human health and life. Patients with stage 3 arterial hypertension must be under the supervision of a physician, take all antihypertensive medications prescribed to him, and make sure you have a tonometer (mechanical or electronic) at home.
Symptoms of arterial hypertension
Arterial hypertension itself has no symptoms. Most adult patients with this disease do not complain at all about anything, high blood pressure is detected by chance.
The clinical manifestations of arterial hypertension depend on which organ is currently affected. Adults with benign hypertension may complain of the following symptoms:
- Headache - probably the first and main symptom. There are several types of headaches:
- dull, not intense, characterized by a feeling of heaviness in the forehead and occiput. It appears most often at night or in the morning, increasing with sudden changes in head position and even a little physical effort. Such pain is caused by violation of the outflow of venous blood from the cranial canal, overflow and stimulation of pain receptors;
- liquor - bursts permeate throughout the head, can be throbbing. Any tension causes an increase in pain. It occurs most often in the late stages of hypertension or in the presence of pulmonary hypertension. As a result, the blood vessels are filled abruptly and their outflow is difficult;
- ischemia - a dull or ruptured nature, accompanied by dizziness and nausea. It occurs with a sharp increase in blood pressure. There is a sharp vasospasm, as a result of which the blood supply to the brain tissue is disrupted.
- Pain in the heart area - cardialgia, non -ischemic in nature, the coronary arteries are irregular, while the pain is not stopped by sublingual application of nitrate (nitroglycerin under the tongue) and can occur both during rest and during emotional stress. Sports activities are not a provoking factor.
- Shortness of breath - initially occurs only when playing sports, with the development of hypertension, it can also occur during rest. It characterizes heart dysfunction.
- Edema - most often found on the feet due to blood stasis in the systemic circulation, sodium and water retention, or impaired kidney function. Appearance in children simultaneously with hematuria edema and hypertension is a hallmark of glomerulonephritis, which is very important to keep in mind when making a differential diagnosis.
- Visual impairment - manifests itself in the form of blurred vision, the appearance of a hood or a flickering fly. Occurs due to damage to the retinal canal.
Chronic arterial hypertension causes damage to the kidneys with the development of renal failure and complaints corresponding to renal genesis, which will be discussed below. Chronic hypertension also leads to the development of circulatory encephalopathy, which is characterized by a decrease in memory, attention and performance, sleep disturbances (increased daytime sleepiness, combined with insomnia at night), dizziness, tinnitus and depressed mood.
When collecting anamnesis, in the medical history it is necessary to record family history and the cause of arterial hypertension in close relatives, explain the time of appearance of the first clinical symptoms, note the corresponding disease.
Hypertensive crisis
This is a state of emergency, which consists of a sharp increase in blood pressure to a high volume and is characterized by a sharp decline in blood supply to all internal organs, in particular, vital ones.
It occurs when the body is exposed to various adverse factors, it is unpredictable, which is why uncontrolled hypertension is dangerous. The importance of this problem also lies in the fact that in the absence of timely emergency treatment, fatal outcomes are possible. To provide emergency care, the patient must be immediately taken to a hospital, where he or she quickly reduces blood pressure with medication.
Medical institute students study first aid for hypertensive crisis in the Department of Internal Medicine Propaedeutics, and therefore it is better for people who pass by randomly do not try to provide assistance, but call an ambulance.
Diagnostics
The three main diagnostic methods that allow you to determine the presence of hypertension in a person are:
- Blood pressure measurement,
- physical examination,
- Record an electrocardiogram.
Blood pressure control
Blood pressure measurement is performed using a special device - a tonometer, which is a combination of a sphygmomanometer with a phonendoscope. In addition, there are currently special electronic devices that measure blood pressure, pulse rate, and even allow you to insert a blood pressure indicator into the memory of the device.
Medical history
The diagnosis of hypertension also includes a review of the patient by a physician. The doctor finds out from the patient what illness he or she has had before or is currently suffering from. Risk factors are assessed (smoking, high cholesterol, diabetes), coupled with so -called. hereditary history, i. e. whether the patient’s parents, grandparents and other close relatives have hypertension.
Physical examination
Physical examination of the patient includes, first of all, examination of the heart using a phonendoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic tone (amplification or, conversely, weakening), as well as the appearance of non -special sounds. These data, first of all, speak of changes that occur in heart tissue as a result of increased blood pressure, as well as the presence of defects.
Electrocardiogram (ECG)
An electrocardiogram (ECG) is a method that allows you to register changes in the electrical potential of the heart over time on a special tape. This is an indispensable method for diagnosing, first of all, various cardiac arrhythmias. In addition, the ECG allows you to determine what is called. left ventricular wall hypertrophy, which is typical for arterial hypertension.
echocardiography
In addition to these diagnostic methods, other methods are also used, for example, echocardiography (ultrasound examination of the heart), which allows you to determine the presence of defects in the structure of the heart, changes in its wall thickness and the condition of the valves.
Arteriography
Arteriography, including aortography, is an X-ray method of examining the condition of the walls of an artery and its lumen. This method allows you to identify the presence of atheromatous plaques in the walls of coronary arteries (coronary angiography), the presence of aortic coarctation (congenital narrowing of the aorta in certain areas), etc.
dopplerography
Dopplerography is an ultrasound method for diagnosing the state of blood flow in a duct, both in the arteries and in the veins. With arterial hypertension, first of all, the doctor checks the condition of the carotid arteries and cerebral arteries. Ultrasound is widely used for this, as it is completely safe to use and does not cause complications.
Blood chemistry
Biochemical blood tests are also used in the diagnosis of hypertension. First of all, it turns out that high, low and very low density cholesterol and lipoprotein levels, as they are indicators of predisposition to atherosclerosis. In addition, blood sugar levels were determined.
In the diagnosis of hypertension, studies of the condition of the kidneys are also used, for which methods such as general urinalysis, biochemical blood tests (for creatinine and urea levels), as well as ultrasound of the kidneys and them. ships are used.
Thyroid ultrasound
Ultrasound of the thyroid gland and blood tests for thyroid hormones. This research method helps identify the role of the thyroid gland in causing high blood pressure.
How to treat arterial hypertension?
The effective treatment for hypertension is chosen depending on the severity of the disease and the overall risk of cardiovascular disease of the patient. To assess this risk, he takes into account certain factors:
- age: 50 years for men, 60 years for women;
- family history: sudden heart attack or death of one parent (before age 55 in men, before age 65 in women) or stroke before age 45, regardless of parent’s gender;
- smoking (or not smoking in the past three years);
- diabetes;
- LDL cholesterol levels above 1. 60 g/l or LDL cholesterol levels below 0. 40 g/l;
- abdominal obesity, kidney failure, lack of regular exercise, or excessive alcohol intake.
General principles for the treatment of arterial hypertension at home, which should be followed by all adults with high blood pressure:
With the first stage of mild disease, non -drug methods are used:
- limit salt intake to 5g / day (more on proper nutrition with high blood pressure can be found in our separate article),
- weight normalization with its excess,
- moderate physical activity 3-5 times a week (walking, running, swimming, physiotherapy exercises),
- to quit smoking,
- reduction of alcohol consumption,
- the use of herbal sedatives to increase emotional pleasure (e. g. , valerian decoction).
If there is no effect of the above method in the treatment of arterial hypertension of 1 degree, as well as patients with hypertension of 2 and 3 degrees, they turn to taking medication.
It should be noted that pharmacies currently offer a wide variety of different medications for the treatment of arterial hypertension, both new and well-known for many years. Under different trade names, preparations with the same active ingredient can be produced. It is quite difficult for a non -expert to understand.
Diuretics are the drug of choice for the treatment of hypertension, especially in the elderly. The most common are thiazides.
Also, in the treatment of arterial hypertension, it is important to correct the risk factors:
- antiplatelet agent - acetylsalicylic acid, used according to instructions,
- statins in the presence of atherosclerosis - also in the absence of contraindications;
- drugs that lower blood glucose levels in the presence of diabetes.
If the effect is not enough, it may be necessary to add a second or third drug. Rational combination:
- diuretics + beta blockers
- diuretics + ACE inhibitors (or sartan)
- diuretics + calcium antagonists
- dihydropyridine calcium antagonist + beta blocker
- calcium antagonists + ACE inhibitors (or sartan)
Invalid combination:
- non-dihydropyridine calcium antagonists + beta-blockers (possible development of heart block to death)
- ACE inhibitor + sartan
For the treatment and examination of hypertension, you need to see a doctor. Only a specialist after a full examination and analysis of examination results will be able to correctly diagnose and prescribe competent treatment.
Why is hypertension dangerous?
Arterial hypertension is one of the leading causes of severe CVS pathology.
Despite the fact that currently there are a large number of antihypertensive drugs that allow you to maintain blood pressure at an adequate level, the occurrence of hypertensive crises and complications such as heart failure (HF) and renal failure (RF), aortic and mitral valve regurgitation, cardiac aneurysms andaorta, MI (heart attack), stroke, etc. in patients with persistent hypertension is very high.
This is mainly due to the fact that many patients do not want to systematically take antihypertensive therapy, believing that the hypertensive crisis that develops in them is the only one and this will never happen again.
According to statistics, of patients who are aware that they have arterial hypertension, only about 40% of women and 35% of men receive drug treatment. At the same time, only 15% of women and about five percent of men reach the required level of stress due to the systematic use of antihypertensive therapy, monitoring of blood pressure indicators and periodic visits to the doctor and following his recommendations.
Despite the fact that arterial hypertension is one of the controllable risk factors for the formation of cardiovascular pathology, the unfortunate indicator is due to the patient's unclear misunderstanding of the seriousness of his diagnosis, and, consequently, lack of a serious and responsible approach to treatment.
The most common severe complications that occur as a result of a hypertensive crisis are:
- stroke (about thirty percent of patients);
- pulmonary edema (twenty -three percent);
- hypertensive encephalopathy (16%);
- acute heart failure (fourteen percent);
- cerebral hemorrhage (five percent of cases);
- dissecting aortic aneurysms (2. 5%), etc.
It should be noted that in the absence of adequate and systematic treatment of hypertension, from heart and kidney failure within three years after experiencing a severe (complicated) hypertensive crisis, 30 to 40% of patients die.
Comprehensive treatment, a responsible approach to one’s health, systematic use of medications against arterial hypertension and control of one’s pressure, allow this frightening figure to be reduced to a minimum.
Prevention of arterial hypertension
For people who have a hereditary predisposition to arterial hypertension and are burdened by risk factors, disease prevention is very important.
- First of all, this is a regular examination by a cardiologist and adherence to proper lifestyle rules, which will help to delay, and often eliminate the disease of arterial hypertension. If you have a history of relatives with hypertension, you should reconsider your lifestyle and radically change many of the habits and lifestyles that are risk factors.
- You should reconsider your dietary principles, stop eating salty and fatty foods, switch to a low-calorie diet that includes large amounts of fish, seafood, fruits and vegetables. Don’t get carried away with alcoholic beverages and, especially, beer. They contribute to obesity, uncontrolled consumption of table salt, adversely affect the heart, blood vessels, liver and kidneys.
- It is necessary to lead an active lifestyle, move more, depending on age, this is ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually, without straining the body. Outdoor exercise is very beneficial. Physical exercise strengthens the heart muscle and nervous system and helps prevent stress.
- Try to have a supportive psycho-emotional environment around you. If possible, avoid conflicts, remember that a destroyed nervous system very often triggers a mechanism for the development of arterial hypertension.
- Quitting smoking, the substances contained in nicotine cause changes in the walls of arteries, increase their rigidity, therefore, they can be a cause of high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.
Therefore, we can briefly say that the prevention of arterial hypertension includes regular checkups by a cardiologist, a proper lifestyle and a favorable emotional background for your surroundings.
Lifetime forecast
The prognosis for arterial hypertension is determined by the nature of the course (malignant or benign) and the stage of the disease. Factors that worsen the prognosis are:
- rapid development of signs of damage to target organs;
- Stage III and IV arterial hypertension;
- severe damage to blood vessels.
A very unfavorable course of arterial hypertension is observed in young people. They have a high risk of stroke, myocardial infarction, heart failure, sudden death.
With early treatment of arterial hypertension and subject to careful compliance by the patient with all recommendations of the attending physician, it is possible to slow the progression of the disease, improve the patient’s quality of life, and sometimes achieve long-term remission. .