Hypertension is a disease that is associated with a violation of the level of blood pressure. It may have a different etiology, either primary or secondary. There are varying degrees and stages of high blood pressure, as well as the 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 within 120/80 mm. art. Art. Only small deviations from this value are possible. Only in some cases indicators like 100/65 or 135/110 mm are the norm. art. Art. But for most people, this 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 contraction of the heart walls. 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 left ventricular (LV) hypertrophy of the heart, an increase in its mass with thickening of the cells, cardiomyocytes. Initially, the wall of the left ventricle thickens, then the heart chamber itself expands.
It is noteworthy that LV hypertrophy has an unfavorable prognostic sign. As the left ventricle increases, the risk of developing ventricular arrhythmias, heart failure, coronary artery disease and sudden death increases. With 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:
- Transitional. 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 needed to normalize blood pressure.
- stable. High blood pressure levels persist for a long time, the patient needs constant treatment.
- Malignant. Blood pressure, especially diastolic, rises to critical levels and there is low susceptibility to treatment. There is a possibility of rapid development of the disease with the simultaneous occurrence of serious complications.
- Crisis. Hypertensive crises observed periodically. 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 degrees, 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 target organs due to their damage.
stages
Hypertension has 4 stages:
- preclinical. There are no signs of high blood pressure, blood pressure rises without characteristic symptoms.
- Stage 1. There are signs of high blood pressure, flare-ups are possible, but no symptoms of end-organ damage.
- Stage 2. Signs of target organ damage are observed - the myocardium is hypertrophied, renal function is impaired, retinal changes 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 potential risks. ECG, ultrasound of the heart are designed to identify the degree of hypertrophy of the heart muscles; blood and urine are collected for testing (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 blood pressure value. It is important in risk and foresight.
Hypertension is diagnosed when blood pressure exceeds 140/90 mm. art. 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 180/110 mm Hg mark. Art.
In rare cases, the patient has an increase in systolic pressure with a mark of more than 140 mm. art. Art. , and diastolic is within the normal range. This condition is called isolated systolic form of GB. When determining the degree of disease, it does not matter which of the pressures (lower or higher) exceeds the normal range.
With the greatest precision, the degree of hypertension is established at the first detection of the disease. In the case of medication (antihypertensive) use, blood pressure may decrease or increase markedly, which does not allow an adequate assessment of the degree of GB.
Scratchs
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, where a higher value indicates higher risk.
With GB, the risk for patients is established based on the analysis of external provoking factors, concomitant diseases, metabolic disorders, changes in Organs 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);
- smoke;
- the presence among family members younger than 65 (for women) and 55 (for men) of people with cardiovascular pathologies;
- violation of lipid metabolism (decrease of high-density lipid fractions, excess of the norm of low-density lipoproteins and cholesterol);
- overweight (body weight is considered excessive if the waist 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, they increase the likelihood of complications.
To determine the risk of GB, it is necessary to take into account the complications transferred. For example, if a patient has had a stroke, they are at very high risk (4). With first and second grade GBs in normal health (no damage to internal organs) and provoking factors such as smoking and age, a moderate risk is defined - 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 stroke is greater than 35%.
The reasons
The following factors can trigger essential GB:
- excess body weight due to impaired metabolism, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- regular increase in psycho-emotional stress associated with professional activities;
- previous brain injuries (hypothermia, falls, bruises);
- hereditary predisposition (at an early age, the first symptoms of high blood pressure may appear if the patient's parents suffer from high blood pressure);
- 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 interrupt blood circulation;
- significant hormonal changes at menopause in women over 40;
- heavy consumption of caffeinated beverages, 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 high blood pressure 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) greater than 60 ml per day.
Symptoms
The symptoms of hypertension are nonspecific. Patients may be unaware of hypertension for many years, feel no discomfort in leading a habitual lifestyle. In some cases, minor weakness and dizziness may occur, often attributed to overwork.
Usually, the first complaints are associated with end-organ damage, which occurs in stage 2 HD. In case of violation of cerebral circulation, a person experiences severe dizziness, head noises, headaches, decreased performance and memory deterioration. . With the progression of the disease, flies before the eyes, numbness of the extremities and speech disorders are possible. Usually in the early stages, these symptoms are transient. With a severe worsening of the disease, there is a risk of cerebral infarction and cerebral hemorrhage.
When 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 painkillers. With kidney damage, proteins and erythrocytes are found in the urine. In rare cases, hypertension can develop kidney failure. Damage to the eyes leads to a deterioration of visual function, up to the development of blindness.
Usually, with the progression of hypertension, the headache persists. It has no connection to the time of day, so it can occur at any time. Usually, the discomfort haunts patients at night and in the morning. Patients feel heaviness or fullness at the back of the head, but it usually covers other areas. Usually, the pain is described by patients as an "arching" sensation, due to tension in the muscles of the soft integuments of the head or the helmet of the tendon of the head. Such a symptom intensifies with a strong cough, exertion, tilt of the head, psycho-emotional stress, it 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, muscle activity, or massage, the venous flow improves, so the pain subsides or disappears for a while.
With high blood pressure, pain in the region of the heart has some distinguishing features from 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 eliminated with 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 damage to the heart muscle and the development of heart failure. But moderately pronounced peripheral edema in hypertension can be the result of sodium and water retention due to impaired renal excretory function or the use of certain medications.
Hypertension crisis
At the peak of the 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 the speech and sensitivity of the limbs. In some cases, the patient has heart pain.
Hypertensive crises appear for the following reasons:
- psychotic stress;
- inappropriate drug therapy;
- pain;
- the phenomenon of "rebound", which occurs in the context of drug withdrawal.
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 sex hormones, estrogens. However, such an obstacle to hypertension is 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, due to which hypertension can progress dramatically. Generally, this group of patients has isolated systolic arterial hypertension, which is caused by decreased vascular elasticity.
In children, hypertension is rare. The causes of GB development are the same as in adult patients. Treating the disease in children is a bit complicated as not all types of medication 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 establishing a diagnosis, the patient needs to completely reconsider the way of life. First of all, you must give up bad habits, normalize your body weight, change your diet and be physically active.
Experts note that essential hypertension must be treated by taking medications systematically. 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 deadly 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 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, resources from other groups are added to the treatment regimen. This approach allows for the use of drugs in small doses, thus reducing the likelihood of side effects.
In addition to the drug groups listed, nootropic drugs may be prescribed. They are used for symptoms of circulatory 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 given sedatives.