Hypertension is a disease associated with a violation of the blood pressure level. It can have a different etiology, it can be primary or secondary. Arterial hypertension has several degrees and stages, as well as risks of complications. Symptoms can 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 hypertension is diagnosed, the patient is prescribed medication.
General information about hypertension
Hypertension is a disease characterized by a continuous increase in blood pressure. Blood pressure in a healthy person should be within 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 (top) pressure, which indicates the force of contraction of the walls of the heart. The second is diastolic (low), which shows the value with a relaxed heart.
Types of hypertension:
- Essential (initial) - occurs in 90-95% of all patients with arterial hypertension.
- Symptomatic - a secondary form of hypertension observed in only 5-10% of cases.
Permanent high blood pressure is formed against the background of hypertrophy of the left ventricle (LV) of the heart, increase in the mass of cells and cardiomyocytes with thickening. First, the wall of the left ventricle thickens, then the chamber of the heart expands.
It should be noted that LV hypertrophy has an unfavorable prognosis. Left ventricular enlargement increases the risk of ventricular arrhythmia, heart failure, coronary artery disease, and sudden death. Characteristic symptoms appear with the development of left ventricular dysfunction.
GB (hypertension) can occur with varying degrees of severity and dynamics. There are several forms of hypertension:
- Transient. Blood pressure rises from time to time, stabilizes spontaneously after a few hours or days without the use of drugs.
- Label. The manifestation is also periodic, but treatment is required to normalize blood pressure.
- stable. High blood pressure lasts for a long time, the patient needs constant treatment.
- Malignant. Blood pressure, especially diastolic, rises to critical levels and has low sensitivity to treatment. With the simultaneous occurrence of severe complications, there is a possibility of rapid development of the disease.
- Crisis. Periodically observed hypertensive crises. 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 determined by the level of blood pressure.
There is such a thing as risk. It is determined by the probability of complications due to damage to the target organs.
stages
Hypertension consists of 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 signs of target organ damage.
- Stage 2. Signs of damage to target organs are observed - myocardium undergoes hypertrophy, kidney function is impaired, changes in the retina are noticeable.
- Stage 3. Serious complications are possible - stroke, visual impairment, myocardial infarction, atherosclerosis or aortic aneurysm.
In stage 2 HD, target organs are affected, so patients should be screened to identify possible risks. ECG, ultrasound of the heart is designed to determine the degree of hypertrophy of the heart muscles; blood and urine are taken for tests to determine indicators of kidney function (protein, creatinine).
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 arterial 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 is within the diastolic norm. This condition is called isolated systolic form of GB. When determining the degree of the disease, it is not important which of the pressures (low or high) exceeds the normal limit.
With the greatest accuracy, the degree of hypertension is determined at the first detection of the disease. If drugs (antihypertensives) are used, blood pressure can decrease or increase sharply, which does not allow to adequately evaluate the degree of GB.
Risks
Severe complications are possible with hypertension. The most dangerous conditions are cerebral hemorrhage, myocardial infarction, ischemic necrosis and renal failure. Therefore, the risk for each patient with high blood pressure is determined from 1 to 4, where a higher value indicates the highest risk.
The risk for patients with GB is determined based on the analysis of external inciting factors, accompanying diseases, metabolic disorders, changes in internal organs involved in the pathological process.
Precipitating risk factors include:
- age of the patient (for men - after 55 years, for women - 65 years);
- to smoke;
- having relatives with cardiovascular pathology under the age of 65 (for women) and 55 (for men);
- lipid metabolism disorder (decrease of high-density lipid fractions, excess of low-density lipoproteins and cholesterol);
- overweight (body weight is considered excessive if the waist circumference is more than 102 cm in men and 88 cm in women).
These are the main predisposing factors, but some hypertensive patients may be diabetic, have a sedentary lifestyle, or have abnormal blood clotting due to increased fibrinogen levels. These factors are considered additional, increasing the likelihood of complications.
Transferred complications should be taken into account to determine the risk of GB. For example, if a patient has had a stroke, they are at very high risk (4). First- and second-degree GB with normal health (without damage to internal organs) and provoking factors such as smoking and age are assigned an average risk - 2.
Low risk means that the probability of complications is no more than 15%, indicated by the number 1. A value of 2 is medium risk with a probability of up to 20%. A value of 3 corresponds to a high risk, and the probability of a heart attack and stroke does not exceed 30-33%. The highest risk (4) is determined when the probability of vascular accidents exceeds 35%.
The reasons
The following factors can cause primary GB:
- excess body weight due to disturbed metabolism, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- regularly increasing psycho-emotional stress associated with professional activity;
- previous brain injuries (hypothermia, falls, bruises);
- hereditary tendency (at a young age, if the patient's parents suffer from arterial hypertension, the first signs of high blood pressure may appear);
- 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 years old;
- heavy consumption of caffeinated beverages, alcoholic beverages, 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 due to unilateral or bilateral narrowing of renal arteries (glomerulonephritis);
- 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 non-specific. Patients can be unaware of high blood pressure for many years, they do not feel discomfort while leading a normal life. In some cases, slight weakness and dizziness may occur, which is often associated with overwork.
Usually, the first complaints are related to target organ damage that occurs in stage 2 HD. In the case of a violation of cerebral blood circulation, a person experiences severe dizziness, noise in the head, headaches, decreased performance and memory deterioration. With the progression of the disease, the eyes fly before the eyes, numbness of the extremities, speech disorders are possible. Usually, these symptoms are transient in the initial stages. With serious complications of the disease, there is a risk of cerebral infarction and cerebral hemorrhage.
When the heart muscle is damaged, morphological changes occur. Atherosclerosis of the aorta leads to its expansion, fragmentation and rupture. In this case, there are painful sensations in the cavity area that cannot be eliminated by analgesic drugs. With kidney damage, protein and erythrocytes are detected in the urine. In rare cases, hypertension can develop kidney failure. Damage to the eyes leads to the deterioration of visual function, up to the development of blindness.
Usually, as the hypertension progresses, the headache continues. It has nothing to do with the time of day, so it can happen at any time. Usually, anxiety haunts patients at night and in the morning. Patients feel heaviness or fullness in the back of the head, but it often involves other areas. Typically, the pain is described by patients as a "ring" sensation due to tension in the muscles of the soft integuments of the head or the tendon helmet of the head. Such a symptom is intensified by a strong cough, tension, tilting the head, psycho-emotional stress, and may be accompanied by slight swelling of the eyelids and face. Long-lasting headaches lead to the development of nervousness, nervousness, increased sensitivity to external stimuli (noise, loud music). With the vertical position, muscle activity or massage, the venous outflow improves, so the pain decreases or disappears for a while.
Pain in the heart region with arterial hypertension has some distinguishing features from angina attacks:
- localized in the upper part of the heart or to the left of the sternum;
- lasts several minutes and hours;
- occurs at rest or during emotional stress;
- not eliminated by nitroglycerin;
- not provoked by physical activity.
Shortness of breath, swelling of the legs, which first appears during physical exertion, and then even at rest, is also a sign of damage to the heart muscle and the development of heart failure. However, moderately pronounced peripheral edema in hypertension may be the result of sodium and water retention due to impaired renal excretory function or the administration of certain drugs.
Hypertensive crisis
At the peak manifestation of hypertension, it is customary to speak of a hypertensive crisis. With a sharp increase in blood pressure, in this case, all the clinical signs described above appear. But these are completed with nausea, vomiting, darkening of the eyes, sweating.
A hypertensive crisis usually lasts from a few minutes to a few 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 hypertensive crisis can be accompanied by profuse urination and diarrhea. As a rule, this condition is provoked by strong emotional overstrain.
Hypertensive crisis sometimes has a more severe course, develops gradually and lasts for a long time. This type usually occurs in the later stages of GB. This is accompanied by a violation of speech and sensitivity of the limbs. In some cases, the patient has heart pain.
Hypertensive crises occur for the following reasons:
- psychotic stress;
- inadequate drug treatment;
- pain;
- the "rebound" phenomenon that occurs against the background of drug withdrawal.
Hypertension in different age and gender groups
According to statistics, men are more susceptible to arterial hypertension than women. This is due to the protection of women by sex hormones, estrogens. However, such an obstacle for hypertension is short-lived. Estrogen levels decrease during menopause and women are at risk for GB.
The main cause of hypertension in the elderly is physical inactivity. With age, vascular changes occur, so hypertension can develop sharply. Usually, this group of patients has isolated systolic arterial hypertension caused by a decrease in vascular elasticity.
Hypertension is rare in children. The causes of GB development are the same as in adult patients. Treatment of the disease in children is somewhat complicated, because not all types of drugs can be used.
Treatment
With essential arterial hypertension, it is necessary to normalize blood pressure, improve lifestyle and function of target organs. For this, use drug treatment and general measures.
When making a diagnosis, the patient should completely reconsider his lifestyle. First of all, you should give up bad habits, normalize your body weight, change your diet and be physically active.
Experts note that essential hypertension should be treated with systematic 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, which lead to serious, fatal complications.
In the treatment of hypertension, doctors use the following drug groups:
- ACE inhibitors.
- Angiotensin II receptor blockers.
- Diuretics.
- calcium antagonists.
- Beta blockers.
- Agonists of imidazoline prescriptions.
The above groups of drugs have their own contraindications, so they should be prescribed by a doctor only depending on the stage of the disease and concomitant diseases. Treatment is usually with one drug, primarily an ACE inhibitor. 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 possibility of side effects.
In addition to the listed drug groups, nootropic drugs can also be prescribed. They are used for symptoms of dyscirculatory hypertensive encephalopathy. With the changes in the myocardium, vitamins and trace elements are used that help to restore the muscle structure of the heart. If the patient experiences stressful loads, has an unstable emotional state, sedatives are prescribed.