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 several degrees and stages of arterial hypertension, as well as the risks of complications. Symptoms may vary depending on the severity of the disease and the severity of damage to the 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 within 120/80 mm. rt. Art. Only minor deviations from this value are possible. Only in some cases, such indicators 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 systolic (upper) pressure, which shows the strength of the contraction of the walls of the heart. The second is diastolic (lower), 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 chamber of the heart 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 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 medications.
- Labile. The manifestation is also periodic, but treatment is required to normalize blood pressure.
- stable. High levels of blood pressure persist for a long time, the patient needs constant treatment.
- Malignant. Blood pressure, especially diastolic, rises to critical levels, 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. Hypertensive crises are periodically observed. 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 likelihood of complications in 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 damage to target organs are observed - the myocardium is hypertrophied, kidney function is impaired, changes in the retina of the eyes 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 risks. ECG, ultrasound of the heart are designed to identify the degree of hypertrophy of the heart muscles; blood and urine 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, strokes, 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. When determining the degree of the disease, it does not matter which of the pressures (lower or upper) exceeds the normal range.
With the greatest accuracy, the degree of hypertension is established at the first detection of the disease. In the case when medications (antihypertensives) are used, blood pressure can sharply decrease or increase, which does not allow an adequate assessment of the degree of GB.
Risks
With hypertension, severe 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, where a higher value indicates the highest risk.
With GB, the risk for patients is established on the basis of an analysis of external provoking factors, concomitant diseases, metabolic disorders, changes in the internal organs involved in the pathological process.
Provoking risk factors include:
- the 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 pathologies;
- violation of lipid metabolism (decrease in high-density lipid fractions, excess of the norm of low-density lipoproteins 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 clotting due to increased fibrinogen levels. These factors are considered additional, 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, they are at very high risk (4). With the first and second degree of GB with normal health ( without damage to internal organs) and such provoking factors as smoking and age, a 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 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 more than 35%.
The reasons
The following factors can provoke essential GB:
- excess body weight due to impaired metabolism, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- regular increased psycho-emotional stress associated with professional activities;
- previous brain injuries (hypothermia, falls, bruises);
- 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 blood vessels;
- viral and infectious diseases;
- the formation of cholesterol plaques on the walls of blood vessels that disrupt blood circulation;
- significant hormonal changes in menopause in women over 40;
- heavy consumption of caffeinated drinks, alcohol and smoking;
- 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 against the background 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) more than 60 ml per day.
Symptoms
Symptoms of hypertension are nonspecific. Patients may be unaware of high blood pressure for many years, not feel discomfort in leading a habitual lifestyle. In some cases, slight weakness and dizziness may occur, which are often attributed to overwork.
Usually, the first complaints are 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 deteriorates. With the progression of the disease, flies before the eyes, numbness of the extremities, and speech disorders are possible. Usually in the initial stages, these symptoms are transient. With a serious 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 the gap, which cannot be removed with analgesic drugs. With kidney damage, protein, erythrocytes are found in the urine. In rare cases, hypertension may develop renal failure. Damage to the eyes leads to a deterioration in visual function, up to the development of blindness.
Usually, with further progression of hypertension, pain in the head persists. It has no connection with the time of day, therefore it can occur 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 often covers other areas. Typically, pain is described by patients as a "hoop" sensation, due to tension in the muscles of the soft integuments of the head or the tendon helmet of the head. Such a symptom intensifies with a strong cough, straining, head tilt, psycho-emotional stress, may be accompanied by 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 a vertical position, muscle activity or massage, venous outflow improves, so the pain decreases or disappears for a while.
With arterial hypertension, pain in the region of the heart has some distinguishing features from angina attacks:
- localized in the apex of the heart or to the left 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 exertion, and subsequently even at rest, swelling of the legs is also a symptom of damage to the heart muscle 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 taking certain medications.
Hypertensive crisis
At the peak 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 in the eyes, sweating.
Hypertensive crisis usually lasts from several minutes to several hours. At this time, patients complain of heart palpitations and a sense 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 overstrain.
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 limbs. 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 against the background of drug withdrawal.
Hypertension in different age and sex groups
According to statistics, men are more susceptible to arterial hypertension than women. This is due to the fact that women are protected by sex hormones, estrogens. However, such an obstacle to hypertension is short-lived. During menopause, estrogen levels decrease, and women are at risk for HD.
In the elderly, the main cause of hypertension is physical inactivity. With age, vascular changes occur, due to which hypertension can progress 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 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, you should give up bad habits, normalize body weight, change your diet and be physically active.
Experts note that essential hypertension should be treated by systematically taking medications. 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, deadly complications.
In the treatment of hypertension, doctors use the following groups of medications:
- ACE inhibitors.
- Angiotensin II receptor blockers.
- Diuretics.
- calcium antagonists.
- Beta blockers.
- Agonists of imidazoline prescriptions.
The above groups of medicines 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 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, thereby reducing the likelihood of side effects.
In addition to the listed groups of drugs, 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 he is prescribed sedatives.