Hypertension is a disease that is associated with a violation of the level of blood pressure. It can have a different etiology, be primary or secondary. There are various degrees and stages of high blood pressure, as well as risks of complications. Symptoms can vary depending on the severity of the disease and the severity of damage to so-called target organs. 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 a persistent increase in blood pressure. In a healthy person, blood pressure should be between 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 (upper) pressure, which shows the force of the contraction of the heart's walls. The second is diastolic (lowest), indicating the value with a relaxed heart.
Types of hypertension:
- Essential (primary): occurs in 90-95% of cases among all patients with arterial hypertension.
- Symptomatic - a secondary form of hypertension, observed only in 5-10% of cases.
Constant high blood pressure is formed against the background of hypertrophy of the left ventricle (LV) of the heart, an increase in its mass with thickening of cells - cardiomyocytes. Initially, the wall of the left ventricle thickens, then the heart chamber 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 progression of left ventricular dysfunction, characteristic symptoms appear.
GB (hypertension) can occur with varying degrees of severity and dynamics. There are several forms of hypertension:
- Transient. Blood pressure rises periodically, stabilizes spontaneously after a few hours or days without the use of medication.
- Labile. Manifestation is also periodic, but treatment is required to normalize blood pressure.
- steady. High blood pressure levels persist for a long time, the patient needs constant treatment.
- Evil one. Blood pressure, especially diastolic, rises to critical levels and there is low susceptibility to treatment. There is a possibility of a rapid development of the disease with the simultaneous appearance of serious complications.
- Crisis. Periodically observed hypertensive crises. They can accompany any stage of hypertension (stage 1 is rare).
Classification
High blood pressure is classified according to several criteria. The disease is divided into stages and grades, which are determined by the level of blood pressure.
There is such a thing as risk. It is determined by the probability of complications in the target organs due to their damage.
stages
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, crises are possible, but there are no symptoms of target organ damage.
- Stage 2. Signs of target organ damage are observed: the myocardium is hypertrophied, kidney function is impaired, changes in the retina are noted.
- Stage 3. Serious complications are possible: stroke, impaired visual function, myocardial infarction, atherosclerosis or aortic aneurysm.
Target organs are affected in stage 2 HE, so patients should be evaluated for potential risks. ECG, ultrasound of the heart are designed to identify the degree of hypertrophy of the heart muscles; Blood and urine samples are taken for tests (protein, creatinine) to establish indicators of kidney function.
The third stage of GB can occur with associated pathologies associated with hypertension. Among them, transient ischemic attacks, cerebrovascular accidents, angina pectoris and myocardial infarction are the most important for prognosis.
The degree of hypertension
The degree of GB is determined based on the value of blood pressure. It is important in risk and forecasting.
Hypertension is diagnosed when blood pressure exceeds 140/90 mm. rt. Art. The degrees are determined by the following relationship:
- BP within 140-159 / 90-99 mm Hg. Art. ;
- BP within 160-179 / 100-109 mm Hg. Art. ;
- Exceeding the mark of 180/110 mm Hg. Art.
In rare cases, the patient has an increase in systolic pressure with a mark of more than 140 mm. rt. Art. , and the diastolic is within the normal range. This condition is called the isolated systolic form of GB. In determining the degree of the disease, it does not matter which of the pressures (higher or lower) exceeds the normal range.
With the greatest accuracy, the degree of hypertension is established at the first detection of the disease. In the event that drugs (antihypertensives) are used, blood pressure may drop or rise sharply, which does not allow an adequate assessment of the degree of GB.
risks
With hypertension, serious complications are possible. The most dangerous conditions are cerebral hemorrhage, myocardial infarction, ischemic necrosis and renal failure. Therefore, for each patient with high blood pressure, the risk is determined from 1 to 4, with a higher value indicating the greatest risk.
With GB, the risk to patients is established on the basis of an analysis of external triggering factors, concomitant diseases, metabolic disorders, changes in internal organs involved in the pathological process.
Provoking risk factors include:
- the patient's age (for men - after 55 years and for women - 65 years);
- of smoking;
- the presence among family members under 65 (for women) and 55 (for men) of people with cardiovascular pathologies;
- violation of lipid metabolism (decrease in high-density lipid fractions, excess of the norm of low-density lipoprotein and cholesterol);
- overweight (body weight is considered excessive if the abdominal circumference exceeds 102 cm in men and 88 cm in women).
These are the main precipitating factors, but some hypertensive patients may be diabetic, sedentary, or have abnormal blood coagulation due to increased fibrinogen levels. These factors are considered additional, they increase the likelihood of complications.
To determine the risk of GB, it is necessary to take into account the transferred complications. For example, if a patient has had a stroke, she is at very 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, a moderate risk is established: 2.
Low risk means that the probability of complications does not exceed 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 a high risk, and the probability of heart attacks and strokes does not exceed 30-33%. The highest risk (4) is established when the probability of vascular accidents is greater than 35%.
The reasons
The following factors can cause essential GB:
- excess body weight due to impaired metabolism, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stress situations, etc. ;
- regular increase in psychoemotional stress associated with professional activities;
- previous brain injuries (hypothermia, falls, contusions);
- hereditary predisposition (at a young age, the first symptoms of high blood pressure may appear 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 the blood vessels;
- viral and infectious diseases;
- the formation of cholesterol plaques on the walls of blood vessels that disrupt blood circulation;
- significant hormonal changes at menopause in women over 40 years of age;
- high consumption of caffeinated beverages, alcohol and tobacco;
- 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 can occur in the context 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 glands;
- consumption of wine alcohol (ethanol) greater than 60 ml per day.
Symptoms
The symptoms of hypertension are nonspecific. Patients may not be aware of high blood pressure for many years, not feeling discomfort when leading a usual lifestyle. In some cases, minor weakness and dizziness may occur, which is often attributed to overwork.
The first complaints are usually associated with target organ damage, which occurs in stage 2 HD. In case of violation of cerebral circulation, a person experiences severe dizziness, noise in the head, headaches, decreased performance and memory impairment. With the progression of the disease, flies before the eyes, numbness of the limbs, and speech disorders are possible. In the early stages, these symptoms are usually transient. With severe aggravation of the disease, 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 its expansion, dissection and rupture. In this case, there are painful sensations in the area of \u200b\u200bthe gap, which can not be eliminated with painkillers. With kidney damage, protein, erythrocytes are found in the urine. In rare cases, hypertension can lead to kidney failure. Damage to the eyes leads to impaired visual function, up to the development of blindness.
Usually, with further progression of hypertension, pain in the head persists. It has no connection to 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. Typically, patients describe the pain as a "hoop" sensation, due to tension in the muscles of the soft teguments of the head or the tendon hoof. Such a symptom is intensified by a strong cough, straining, head tilt, psycho-emotional stress, may be accompanied by a slight swelling of the eyelids and face. Prolonged headaches lead to the development of irascibility, irritability, increased sensitivity to external stimuli (noise, loud music). With an upright position, muscular activity or massage, the venous flow improves, so the pain decreases or disappears for a while.
With arterial hypertension, pain in the region of the heart has some distinctive features of angina attacks:
- located at the apex of the heart or to the left of the sternum;
- lasts several minutes and hours;
- occurs at rest or during emotional stress;
- not removed by nitroglycerin;
- not caused by physical activity.
Shortness of breath, which occurs first during physical exertion, and later, even at rest, swelling of the legs, is also a symptom of heart muscle damage and the development of heart failure. But moderately pronounced peripheral edema in hypertension may be the result of sodium and water retention due to impaired renal excretory function or when taking certain medications.
Hypertensive crisis
At the maximum manifestation of hypertension, it is customary to speak of a hypertensive crisis. In this state with a sharp increase in blood pressure, all the clinical signs described above appear. But they are supplemented by nausea, vomiting, darkening of the eyes, sweating.
The hypertensive crisis usually lasts from several minutes to several hours. At this time, patients complain of heart palpitations and a feeling of fear of death. Red spots may appear on the cheeks. Attacks of a hypertensive crisis may be accompanied by profuse urination and diarrhea. As a rule, this condition is provoked by strong emotional overload.
A hypertensive crisis sometimes has a more severe course, develops gradually and lasts a long time. This type usually occurs in the later stages of GB. It is accompanied by a violation of speech and sensitivity of the extremities. In some cases, the patient has heart pain.
Hypertensive crises appear for the following reasons:
- psychotic stress;
- inadequate drug therapy;
- pain;
- the phenomenon of "rebound", which occurs in the context of drug withdrawal.
Arterial hypertension in different age groups and sex
According to statistics, men are more susceptible to high blood pressure than women. This is due to the fact that women are protected by the sex hormones - estrogens. However, such a hindrance to hypertension is short-lived. During menopause, estrogen levels drop and women are at risk for GB.
In the elderly, the main cause of hypertension is physical inactivity. With age, vascular changes occur, so hypertension can progress dramatically. In general, this group of patients presents with isolated systolic arterial hypertension, which is caused by a decrease in vascular elasticity.
In children, hypertension is rare. The causes of 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
With essential arterial hypertension, it is necessary to normalize blood pressure, improve lifestyle and the function of target organs. To do this, use drug therapy and general measures.
When establishing a diagnosis, the patient needs to completely reconsider the way of life. First of all, he must give up bad habits, normalize body weight, change his diet and be physically active.
Experts point out that essential hypertension should be treated by systematically taking medication. The treatment regimen is determined by the cardiologist and must be fully observed by the patient. In the absence of timely treatment, there is a risk of sudden hypertensive crises, leading to serious and fatal complications.
In the treatment of hypertension, doctors use the following groups of drugs:
- ACE inhibitors.
- Angiotensin II receptor blockers.
- diuretics
- calcium antagonists
- beta blockers.
- Prescription imidazoline agonists.
The above groups of drugs have their own contraindications, therefore they should only be prescribed by a doctor depending on the stage of the disease, concomitant diseases. Treatment is usually with a single drug, most commonly 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, which reduces the likelihood of side effects.
In addition to the listed drug groups, nootropic drugs can be prescribed. They are used for symptoms of dyscirculatory hypertensive encephalopathy. With changes in the myocardium, vitamins and microelements are used to help restore the muscular structure of the heart. If the patient experiences stressful loads, has an unstable emotional state, then sedatives are prescribed.