Hypertension or arterial hypertension is a condition characterized by a constant increase in blood pressure, that is, it is detected as a result of repeated measurements.Accompanying many diseases, it is considered a risk factor for the development of dangerous complications from the cardiovascular system, including stroke and myocardial infarction.Hypertension, as the main cause of the pathology in question, requires taking medication, normalizing the patient's lifestyle and nutrition.
Blood pressure is the force of circulating blood on the walls of blood vessels.When the heart is contracting, this pressure is called systolic, and when the heart is relaxing, it is called diastolic.The range of normal values for these indicators is quite wide.
As a result of numerous observations, scientists have come to the conclusion that the risk of cardiovascular complications increases with each additional 10 mmHg increase in blood pressure.Art.already starting at a level of 115/75 mm Hg.Art.However, it turned out to be appropriate to reduce the pressure with drugs only above 140/90 mm.rt.Art., therefore, this value is considered as a criterion for determining arterial hypertension.
Reasons
In about 90% of cases, the cause of a constant increase in blood pressure is hypertension.This diagnosis is given to the patient if no other diseases accompanied by hypertension are detected during the examination.Among the latest:
- kidney pathologies - pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, renal artery stenosis;
- endocrine disorders - neoplasms of the adrenal glands, pancreas or pituitary gland, hyperfunction of the thyroid gland, Cushing's disease or syndrome, pheochromocytoma;
- obstructive sleep apnea syndrome;
- valvular defects or atherosclerotic lesions of the aorta.
Regular use of certain medications can also cause high blood pressure.These include oral contraceptives, non-steroidal anti-inflammatory drugs, amphetamines, corticosteroids, erythropoietin, cyclosporine, drugs containing cocaine.
The possibility of developing cardiovascular diseases, including hypertension, is closely related to the following risk factors:
- unhealthy diet, including a large amount of table salt, saturated fats and trans fats, lack of leafy greens, vegetables and fruits in the diet;
- obesity;
- heart and blood vessel pathologies in close relatives;
- Age over 65 years;
- sedentary lifestyle;
- chronic stress;
- bad habits - smoking, excessive alcohol consumption.
Classification
If it is possible to identify a disease that causes an increase in arterial pressure, arterial hypertension is called secondary or symptomatic.When the cause is unknown, hypertension is considered primary hypertension.
The latter has a gradual course:
- Stage I. There are no obvious signs of damage to target organs - heart, kidneys, arterial and venous vessels - affected by a steady increase in blood pressure.
- Stage II.There is one of the listed signs or a combination of them, for example, enlargement of the left ventricle of the heart, a significant decrease in the filtration rate in the kidneys, albumin in the urine, an increase in the thickness of the walls of the carotid arteries or the appearance of atherosclerotic plaques in their lumen.In this case, there may be no clinical manifestations of the disease.
- III stage hypertension.There are one or more pathologies associated with atherosclerotic processes in the heart and blood vessels - myocardial infarction, acute cerebrovascular accident, angina pectoris, atherosclerosis of the arteries of the lower extremities or serious kidney damage manifested by a sharp decrease in protein in the urine and / or significant protein loss.
Arterial hypertension is divided into several degrees depending on the maximum measured blood pressure:
- First degree.Systolic blood pressure is between 140 and 159 mm.rt.Art.and/or diastolic - between 90 and 99 mm.rt.Art.
- Second degree.Systolic blood pressure between 160 and 179 mm.rt.Art.and/or diastolic - between 100 and 109 mm.rt.Art.
- Third degree.Systolic blood pressure is more than 180 mm.rt.Art.and/or diastolic greater than 110 mm.rt.Art.
There is also an isolated form of arterial hypertension, in which only systolic pressure numbers increase when diastolic pressure is normal.
Symptoms
Often, an increase in blood pressure is not accompanied by a deterioration in well-being and may go unnoticed by the patient, so it is very important to measure blood pressure regularly, especially for middle-aged and elderly people.
Manifestations of hypertension may include the following symptoms:
- headache, mainly after waking up in the morning;
- nosebleeds;
- bleeding under the mucous membrane of the eye;
- heart rhythm disorder;
- blurred vision, flickering spots;
- tinnitus.
A sharp jump in blood pressure to high numbers, accompanied by a noticeable deterioration of well-being, is called a hypertensive crisis.It often occurs when systolic pressure rises above 180 mmHg.Art.and/or diastolic greater than 120 mm Hg.Art.At this time, the patient has weakness, nausea, vomiting that does not bring relief, loss of consciousness, anxiety and fear, muscle tremors, chest pains.
Complications
A constant increase in blood pressure during hypertension significantly increases the risk of cardiovascular pathologies, including those that threaten the patient's life.These include:
- acute cerebrovascular accident (stroke);
- angina pectoris, myocardial infarction;
- vascular dementia (dementia);
- chronic kidney and heart failure;
- atherosclerotic lesions of the vessels of the lower extremities.
Diagnostics
The main symptom of hypertension is a stable increase in blood pressure, detected in at least three measurements on different days in a quiet environment.When measuring blood pressure for the first time in a hospital or clinic, it is important to observe the following rules to ensure the accuracy of the results obtained:
- Before the examination, it is necessary to sit in a quiet room for a few minutes to calm the patient;
- the size of the tonometer cuff should correspond to the thickness of the arm, and the device itself should be installed at the level of the heart;
- two measurements are taken on each side with an interval of 1-2 minutes;if there is a big difference in the received numbers, an additional measurement is taken;
- in elderly patients, as well as in people suffering from diabetes or when a drop in blood pressure is suspected during a change in body position, measurements are taken while standing in the first and fifth minutes;
- In addition, the heart rate is measured for 30 seconds.
In the conversation with the patient, the doctor clarifies at what age the blood pressure first began to rise, whether there are symptoms such as snoring during sleep, muscle weakness or sudden heartbeat accompanied by sweating and headache, and whether there are unusual impurities in the urine.It is also important to find out what medications and dietary supplements he is taking.
As part of the first stage of examination for hypertension, the following tests are performed:
- clinical blood test;
- general urinalysis, detection of microalbumin in its single and daily portions;
- biochemical blood test (cholesterol, lipoprotein level to assess the risk of atherosclerosis, blood electrolytes - potassium, sodium, chlorine, calcium, as well as glucose and creatinine);
- determination of glycated hemoglobin level;
- determination of the concentration of hormones - thyroxine, triiodothyronine and thyroid-stimulating hormone, antibodies against thyroid peroxidase and thyroglobulin, aldosterone.
If a hereditary predisposition to the disease is suspected, it is possible to identify gene polymorphisms associated with the development of arterial hypertension.
Instrumental diagnostic methods are used to clarify risk factors for the development of hypertension and to identify existing cardiovascular pathologies:
- 24-hour blood pressure monitoring;
- electrocardiographic study;
- echocardiography;
- 24-hour Holter monitoring;
- duplex scanning of brachiocephalic, renal or iliofemoral arteries;
- ultrasound examination of kidneys and adrenal glands;
- fundus examination.
It is important to monitor blood pressure at home for hypertension, it is necessary to record all the results of measurements, medications taken and stress episodes that may cause an increase in blood pressure.In this case, measurements should be taken in a sitting position, after a few minutes of rest, keeping your hand at the same level as your heart.
Treatment
Patients with moderate and low risk of cardiovascular complications are advised to change their lifestyle, adjust their diet, lose weight, increase physical activity and special exercises for hypertension, and give up bad habits while regularly measuring blood pressure.Often these measures are enough to normalize blood pressure.
A diet for hypertension involves limiting table salt, caffeine, hot, salty, smoked and spicy foods, high-fat foods, offal, confectionery with butter cream and alcoholic beverages.It is allowed to consume no more than 5 g of salt per day, except for the exacerbation of the disease.Recommended daily fluid intake is 1-1.2 liters.
After several months of unsuccessful non-drug treatment, as well as when there is a high risk of complications, they resort to antihypertensive therapy using drugs for hypertension, the goal of which is to lower blood pressure below 140/90 mm.rt.Art.For patients with diabetes or people already suffering from pathologies of the cardiovascular system, the target pressure level is even lower - 130/80 mm.rt.Art.
Modern drug treatment of hypertension includes a combination of two or more drugs from the following groups:
- calcium antagonists;
- angiotensin-converting enzyme inhibitors;
- angiotensin II blockers;
- diuretics (diuretics);
- b-blockers;
- alpha-blockers.
Most of them are available in the form of tablets for hypertension.
Prevention
Prevention of exacerbation of hypertension includes timely diagnosis and treatment of diseases of the cardiovascular, nervous, urinary and endocrine systems, strict adherence to all doctor's recommendations, including non-drug treatment and medication, as well as regular measurement of blood pressure.