Hypertension is a syndrome of persistent increase in pressure in the arteries when the systolic pressure is above 139 mm Hg. Art., and diastolic above 89 mm Hg. Art.
Normal arterial blood pressure of a healthy person is considered to be at 120 and 80 mm Hg. Art., (systolic / diastolic, respectively). There are two types of hypertension: primary (essential) hypertension and symptomatic hypertension (aka secondary).
Probably every person at least once in his life faced increased pressure, experienced it himself or found out about him through complaints from relatives and friends. Not only is hypertension dangerous in itself, it is also a catalyst and the cause of a number of other, much more dangerous diseases that are not so rarely fatal.
Studies of scientists have shown that changes in blood pressure indicators by 10 mm Hg increase the risk of serious pathologies. The heart, blood vessels, brain and kidneys are most affected. It is these organs that take the blow, therefore they are also called “target organs”. Fully cure this disease is impossible, but blood pressure can be kept under control.
Here are some statistical facts:
- Arterial hypertension was detected in 20-30% of the total adult population.
- The prevalence of pathology is growing commensurate with age: in the elderly 60-65 years old, the incidence rates reach 50-65%.
- At the age of 40 years, arterial hypertension is more common among men, whereas after 40 years it is more often diagnosed in women. This is due to the protective effect of estrogens, which cease to be actively developed during the period of menopause.
- In 90% of patients with arterial hypertension, it is not possible to identify the cause of the pathology. This form of the disease is called essential, or primary.
- In 3-4% of patients, the increased pressure is explained by problems with the kidneys, in 0.1-0.3% - by endocrine pathologies. Stress, hemodynamic, neurological factors and medication are having an active influence on the development of hypertension.
Causes of development
What is it and what are the risk factors? The causes of hypertension are various. The basis of the division of hypertension into primary and secondary is the etiology of this disease.
The primary episode occurs independently against the background of certain risk factors. These include:
- Heredity. Unfortunately, this is the most common cause of the disease. It is especially regrettable that no drugs can modify this risk factor and reduce its effect on human health.
- Floor. Often, hypertension affects women, which is explained by the corresponding hormonal background.
- Age. 55 years for women and 60 years for men are already considered risk factors for the development of hypertension.
- Obesity. Excessive body weight affects the work of the heart and leads to a rapid depletion of the energy reserves of the myocardium (heart muscle).
- Excessive exposure to stress;
- Hypodynamia. The disease of the 21st century is a disruption in the work of various organs and systems due to a sedentary lifestyle.
Risk factors increase blood pressure gradually, leading to the development of hypertension.
Blood Pressure Classification
According to this classification, adopted in 1999 by WHO, the following indicators are categorized as “standard” AD:
- Optimal - less than 120/80 mm Hg. Art.
- Normal - less than 130/85 mm Hg.
- Normal elevated - 130-139 / 85-89 mm Hg
And indicators of arterial hypertension are classified by degrees:
- 1 degree (mild hypertension) - 140-159 / 90-99 mm Hg
- 2 degree (moderate hypertension) - 160-179 / 100-109 mm Hg
- Grade 3 (severe hypertension) - 180 and higher / 110 and higher
- Borderline hypertension - 140-149 / 90 and below. (It implies an episodic increase in blood pressure followed by its spontaneous normalization).
- Isolated systolic hypertension - 140 and above / 90 and below. (Systolic blood pressure is increased, but diastolic blood pressure remains normal).
During the diagnostic examination is very difficult to determine the place of concentration of pathological factors that cause an increase in pressure. Pathogenesis also has differences in view of the types of disease. There is the following classification of arterial hypertension:
- Pulmonary essential arterial hypertension - is considered one of the types of arterial hypertension, rarely occurring, but representing a great danger to human life. Determining this ailment by symptoms is very difficult, and it is even more difficult to treat. Pulmonary arterial hypertension is formed due to the increased resistance of the pulmonary vessels and, as a result, insufficient blood flow.
- Malignant. Symptoms of such hypertension are presented in the form of high blood pressure to the level of 220/130. there is a radical change in the fundus of the eye and edema of the disc of the optic nerve. If the diagnosis was made on time, then cure this type of hypertension is real.
- Renovascular arterial hypertension. The reasons for the formation of this type of disease are the presence of pathologies such as vasculitis, vascular atherosclerosis, and malignant tumors in the kidneys. The pathogenesis of the disease is reduced to the formation of characteristic pressure, which can be represented in a normal systolic and elevated diastolic blood pressure.
- Labile arterial hypertension. This type of disease is characterized by periodic normalization of pressure. Patients suffering from this form of arterial hypertension are not called sick, as this condition is not a pathology. In some cases, over a period of time, blood pressure returns to normal.
Arterial hypertension 1, 2, 3 degrees
To determine the degree of arterial hypertension, it is necessary to establish normal blood pressure values. In people over the age of 18, a pressure not exceeding 130/85 mm Hg is considered normal. St ... The pressure 135-140 / 85-90 is the borderline between the norm and pathology.
According to the level of increase in arterial pressure, the following stages of arterial hypertension are distinguished:
- Light (140-160 / 90-100 mm Hg. Art.) - pressure increases under the influence of stress and physical exertion, after which it slowly returns to normal values.
- Moderate (160-180 / 100-110 mm Hg) - BP fluctuates throughout the day; signs of damage to the internal organs and the central nervous system is not observed. Hypertensive crises are rare and mild.
- Heavy (180-210 / 110-120 mm Hg. Art.). Hypertensive crises are characteristic of this stage. When conducting a medical examination of patients reveal transient cerebral ischemia, left ventricular hypertrophy, increased serum creatinine, microalbuminuria, narrowing of the retinal arteries of the retina.
- Extremely heavy (over 210/120 mmHg). Hypertensive crises occur frequently and are difficult. Serious damage to tissues leads to dysfunction of organs (chronic renal failure, nephroangiosclerosis, dissecting aneurysm of blood vessels, edema and hemorrhage of the optic nerve, cerebral thrombosis, cardiac left ventricular failure, hypertensive encephalopathy).
The course of arterial hypertension can be benign or malignant. The malignant form is characterized by the rapid progression of symptoms, the addition of severe complications of the cardiovascular and nervous systems.
Let's talk about the common symptoms of hypertension. Many very often justify their indisposition with fatigue, and the body is already giving full signals so that people finally pay attention to their health. Day after day, by systematically destroying the human body, hypertension leads to serious complications and serious consequences. A sudden heart attack or an unexpected stroke is, alas, a sad pattern. Undiagnosed arterial hypertension can "quietly kill" a person.
The numbers below make you wonder. For people with high blood pressure:
- Vascular lesions of the legs occur 2 times more often.
- Ischemic heart disease develops 4 times more often.
- Strokes occur 7 times more often.
That is why it is very important to visit a doctor if you are concerned:
- Frequent headaches;
- Pulsating sensations in the head;
- "Flies" in the eyes and noises in the ears;
- Tachycardia (heart palpitations);
- Pain in the heart;
- Nausea and weakness;
- Puffiness of limbs and puffiness of face in the morning;
- Numbness of the limbs;
- Unexplained anxiety;
- Irritability, stubbornness, throwing from one extreme to another.
By the way, with regard to the last point, hypertension, indeed, leaves an imprint on the human psyche. There is even a special medical term "hypertensive nature", so if a person suddenly becomes difficult to communicate, do not try to change it for the better. The reason lies in the disease that needs to be treated.
It should be remembered that hypertension, which is not given due attention, can make life much shorter.
Symptoms of arterial hypertension
The clinical course of arterial hypertension is varied and is determined not only by the level of increase in blood pressure, but also by which target organs are involved in the pathological process.
For the early stage of hypertension, disorders of the nervous system are characteristic:
- transient headaches, most often localized in the occipital region;
- feeling of pulsation of blood vessels in the head;
- noise in ears;
- sleep disorders;
- fatigue, lethargy, feeling of weakness.
With the further progression of the disease in addition to the above symptoms, shortness of breath, which occurs during physical activity (climbing stairs, jogging or walking), is associated.
Increased blood pressure more than 150-160 / 90-100 mm Hg. Art. manifested by the following features:
- dull pain in the heart;
- numbness of the fingers;
- muscle tremor, like chills;
- redness of the face;
- excessive sweating.
If arterial hypertension is accompanied by fluid retention in the body, then puffiness of the eyelids and face, swelling of the fingers joins these symptoms.
Against the background of arterial hypertension, a spasm of retinal arteries occurs in patients, which is accompanied by deterioration of vision, the appearance of spots in the form of lightning, flies before the eyes. With a significant increase in blood pressure, retinal hemorrhage can occur, resulting in blindness.
When to visit a doctor?
It is very important to make an appointment with a doctor if you are concerned about this symptom:
- frequent headaches;
- throbbing sensations in the head;
- "flies" in the eyes and tinnitus;
- tachycardia (heart palpitations);
- pain in the heart;
- nausea and weakness;
- swelling of limbs and puffiness of face in the morning;
- numbness of the limbs;
- unexplained anxiety;
- irritability, stubbornness, throwing from one extreme to another.
It should be remembered that hypertension, which is not given due attention, can make life much shorter.
Arterial hypertension grade 3 risk 3 - what is it?
When formulating the diagnosis, in addition to the degree of hypertension, the degree of risk is also indicated. Under the risk in this situation refers to the likelihood of cardiovascular diseases in the patient within 10 years. In assessing the degree of risk, many factors are taken into account: the age and sex of the patient, heredity, lifestyle, the presence of comorbidities, and the state of target organs.
Patients with arterial hypertension are divided into four main risk groups:
- The chances of developing cardiovascular disease is less than 15%.
- The incidence of disease for such patients is 15-20%.
- The frequency of development reaches 20-30%.
- The risk in this group of patients is above 30%.
Patients diagnosed with grade 3 arterial hypertension belong to 3 or 4 risk groups, since this stage of the disease is characterized by damage to the internal organs of the target. Group 4 is also called a very high risk group.
This dictates the need for diagnosis of hypertension grade 3 risk 4 urgently conduct intensive treatment. This means that for patients with risk groups 1 and 2, patient monitoring and the use of non-drug treatment methods are acceptable, patients with risk groups 3 and 4 require the immediate prescription of antihypertensive therapy immediately after the diagnosis.
Arterial hypertension grade 2 risk 2 - what is it?
With grade 2, risk factors may be absent or only one or two similar signs will be available. At risk 2, the likelihood of an irreversible change in organs after 10 years, fraught with heart attacks and strokes, is 20%.
Consequently, the diagnosis of “arterial hypertension of 2 degrees, risk 2” is made when this pressure holds for a long time, there are no endocrine disorders, but one or two internal target organs have already begun to undergo changes, atherosclerotic plaques have appeared.
Prophylactic measures should be taken to reduce the risk of hypertension. Mainly:
- Preventing bad habits: drinking alcohol, drugs, smoking, overeating.
- Active lifestyle. Hardening. Dosed physical exertion (skates, skis, swimming, jogging, biking, walking, rhythm, dancing). For boys 5-18 years old, the rate of physical activity is 7-12 hours per week, for girls - 4-9 hours.
- Rational nutrition, preventing overweight. Limiting salt intake.
- Increased resistance to stress, a favorable psychological climate in the family.
- Mandatory measurement of blood pressure at different periods of life.
Diagnosis of arterial hypertension
When collecting anamnesis, the duration of arterial hypertension and the highest figures of blood pressure, which were previously registered, are specified; any indication of the presence or manifestation of PVA, HF, or other comorbidities (for example, stroke, renal failure, peripheral arterial disease, dyslipidemia, diabetes mellitus, gout), and a family history of these diseases.
The history of life includes the level of physical activity, smoking, alcohol and stimulants (prescribed by a doctor and taken independently). Nutrition specifies in terms of the amount of salt consumed and stimulants (for example, tea, coffee).
The main objectives of the diagnosis of this pathological process is the determination of a stable and elevated degree of blood pressure, the elimination or detection of symptomatic arterial hypertension, and the assessment of the overall risk.
It is necessary:
- conduct a biochemical analysis to determine the concentration of glucose, creatinine, potassium ions and cholesterol.
- be sure to pass the ECG, echo cg.
- undergo a kidney ultrasound.
- check renal arteries, peripheral vessels.
- explore the fundus of the eye.
Also an important diagnostic method of examination is pressure monitoring throughout the day, providing the necessary information about the mechanisms of cardiovascular regulation with daily blood pressure variability, nighttime hypertension or hypotension, and uniformity of the antihypertensive effect of drugs.
Treatment of hypertension
In the case of arterial hypertension, treatment should begin with changing your lifestyle and non-drug therapy. (The exception is secondary hypertension syndrome. In such cases, treatment of the disease, the symptom of which is hypertension, is also prescribed).
The treatment regimen includes therapeutic nutrition (with limited intake of fluid and table salt, with obesity - with limited daily calories); restriction of alcohol intake, smoking cessation, adherence to work and rest, physical therapy, physical therapy (electrosleep, medicinal electrophoresis, warm — coniferous or fresh, radon, carbonic, hydrosulphuric baths, circular and fan douche, etc.).
Recommendations include regular exercise in the open air, at least 30 minutes a day, 3-5 times a week; weight loss to achieve a BMI of 18.5 to 24.9; a high-pressure diet rich in fruits, vegetables, low-fat foods with a reduced amount of saturated and total fat; sodium intake.
According to the recommendations of the Moscow Association of Cardiologists, it is necessary to treat hypertension with medications in the following cases:
- With an increase in blood pressure to 160/100 mm Hg. Art. and higher;
- When blood pressure is less than 160/100 mm Hg. Art. in case of ineffectiveness of non-drug treatment;
- With the involvement of target organs (left ventricular hypertrophy of the heart, changes in the fundus of the eye, changes in urinary sediment and / or an increase in blood creatinine levels);
- If there are two or more risk factors for coronary heart disease (dyslipidemia, smoking, etc.).
The following groups of drugs can be used for treatment:
- Diuretics (diuretics);
- Alpha blockers;
- Angiotensin converting enzyme (ACE) inhibitors;
- Angiotensin II antagonists;
- Calcium antagonists;
The choice of a particular agent for the treatment of hypertension depends on the degree of increase in blood pressure and the risk of developing coronary artery disease, as well as age, sex, associated diseases and the individual characteristics of the patient.
Diuretics recommended for hypertension include:
- Indapamide retard;
These medicines have proven to be highly effective drugs that have a positive effect on the cardiovascular system and are easily tolerated by patients. Most often, it is with them that hypertension begins to be treated, provided that there are no contraindications in the form of diabetes and gout.
They increase the amount of urine excreted by the body, which removes excess water and sodium. Diuretics are often prescribed in combination with other drugs that reduce blood pressure.
Calcium channel blockers
Through the blockade, the influx of calcium into the sarcoplasm of smooth myocytes of the blood vessels prevents vasospasm, due to which the hypotensive effect is achieved. They also affect the vessels of the brain, and therefore are used to prevent disorders of cerebral circulation. They are also the drugs of choice for bronchial asthma, combined with arterial hypertension. The most frequent side effects are headache and swelling of the legs.
- Amlodipine, s-amlodipine;
- Verapamil - slows heart rate, and therefore not recommended for use with beta-blockers.
Angiotensin-converting enzyme (ACE) inhibitors
These drugs have a high degree of effectiveness. They are well tolerated by patients. ACE inhibitors prevent the formation of angiotensin II, a hormone that causes vasoconstriction. Due to this, peripheral blood vessels expand, the heart becomes lighter and blood pressure decreases. When taking these drugs reduces the risk of nephropathy on the background of diabetes mellitus, morphofunctional changes, as well as death in people suffering from heart failure.
Angiotensin II Antagonists
This group of drugs is aimed at blocking the above-mentioned angiotensin II. They are prescribed in cases where it is impossible to treat with an angiotensin-converting enzyme inhibitor, because the drugs have similar characteristics. They also neutralize the effect of angiotensin II on blood vessels, promote their expansion and lower blood pressure. It is worth noting that these drugs in some cases exceed the effectiveness of ACE inhibitors.
All drugs in this group expand the vessels, increasing their diameter, prevent the development of stroke. They are very effective and easily tolerated by patients. They have a wide enough positive range of properties with a small list of contraindications, which makes it possible to actively use them in the treatment of hypertension in patients of different clinical categories and age groups. In the treatment of hypertension, calcium antagonists are most in demand in combination therapy.
Combinations of two antihypertensive drugs are divided into rational (proven), possible and irrational. Rational combinations: IAPF + diuretic, ARB + diuretic, ACC + diuretic, ARB + ACC, IAPP + ACC, β-AB + diuretic. There are fixed combinations (in one tablet) in the form of ready-made dosage forms that have significant ease of use and increase patient adherence to treatment:
- ACE inhibitor diuretic (Noliprel A, Korenitek, Enap N, Fozikard N, Berlipril plus, Rami Hexal compositum, Liprasid, Enalozide, Co-Dyroton)
- ACE Inhibitor + Calcium Antagonist (Equator, Gipril A, Prestanz, Rami-Azomeks)
- ARB + diuretic (Gizaar, Lozarel Plus, Co-Diovan, Lozap +, Walz (Vazar) H, Diocor, Mikardis plus)
- ARA + Calcium Antagonist (Amzaar, Exforge, Lo-Azomex)
- Calcium antagonist (dihydropyridine) + β-AB (Beta-Azomex)
- Calcium antagonist (non-dihydropyridine) + ACE inhibitor (Tarka)
- Calcium antagonist (dihydropyridine) + diuretic (Azomex N)
- β-AB + diuretic (Lodoz)
One of the most used is the combination of ACE inhibitors and diuretics. Indications for use of this combination: diabetic and non-diabetic nephropathy, microalbuminuria, left ventricular hypertrophy, diabetes mellitus, metabolic syndrome, advanced age, isolated systolic hypertension.
Studies are also carried out on minimally invasive treatment with partial renal sympathetic denervation that is resistant to conventional non-drug and drug therapy with at least three antihypertensive drugs, one of which is a diuretic, with a systolic blood pressure under treatment conditions of at least 160 mmHg, including malignant, arterial hypertension36. Such an intervention will be sufficient to hold once, and the patient over time will no longer need an ineffective in these patients a strict schedule of daily medication, switching to a course of treatment with them.
It is possible that interruptions in the administration of drugs in the future will allow conceiving and carrying out a child without affecting the fetus by antihypertensive therapy. There are no foreign objects in the human body. All manipulation is performed by the endovascular method using a special catheter inserted into the renal arteries. A group of 530 people was selected to study the long-term effects of such denervation in the United States. According to 2,000 such surgeries outside the United States, over two years, 84% of patients managed to achieve a decrease in systolic pressure of not less than 30 mm Hg, and diastolic pressure - not less than 12 mm Hg.
In due time, similar treatment of arterial hypertension and most other diseases of the visceral organs was proposed by F. I. Inozemtsev, but in his time there was no necessary medication and minimally invasive procedures. The effectiveness of treatment with this method of resistant arterial hypertension in patients with severe and moderate chronic renal failure has been shown37. In the absence of long-term dangerous effects in patients with resistant arterial hypertension, it is planned to widely use this method specifically for the treatment of many other diseases and resistant, especially malignant, arterial hypertension, it is unlikely to be widely used for the treatment of the usual drug-resistant arterial hypertension.
Invasive treatment and before this study was widely used according to indications in the treatment of diseases manifested by secondary hypertension, and symptomatic components of hypertension. For example, it is used in the treatment of pathological tortuosity of arteries (kink and coiling), which can be congenital, occur with a combination of atherosclerosis and arterial hypertension, be a consequence of arterial hypertension and contribute to its strengthening and progression. Most often localized in the internal carotid artery, usually - before entering the skull.
In addition, vertebral, subclavian arteries and brachiocephalic trunk may be affected. In the arteries of the lower extremities, this type of circulatory disorders is much less common and has less clinical significance than in the brachiocephalic vessels. Invasive treatment for pathological tortuosity, which can occur in nearly a third of people and is not always the cause of hypertension, consists in resection of the affected segment followed by a direct end-to-end anastomosis.
Hypertension is a danger in terms of the likelihood of severe complications. Many people do not realize that with hypertension symptoms may be absent for a long time, and signs of deviations appear only when the disease has affected the vital organs.
- an increase in the size of the heart;
- angina attacks;
- progressive disorders of the heart;
- heart attack;
- intermittent claudication;
- stratifying aortic aneurysm.
Pathological changes in the kidneys:
- signs of impaired renal function;
- decrease in visual function;
- neurological disorders;
- transient ischemic attack;
The described changes are often irreversible, and further treatment is aimed at maintaining the life of the patient. Without adequate therapy, high blood pressure can have fatal consequences.
The prognosis of 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 progression of signs of target organ damage;
- Stage III and IV hypertension;
- severe damage to blood vessels.
The extremely 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 initiation of arterial hypertension treatment and with the patient carefully following all recommendations of the attending physician, it is possible to slow the progression of the disease, improve the quality of life of patients, and sometimes achieve long-term remission.