Hypertension, or arterial hypertension, is a condition characterized by a stable increase in blood pressure, detected through repeated measurements.Accompanying many diseases, it is considered a risk factor for the development of dangerous complications of the cardiovascular system, including stroke and myocardial infarction.Hypertension, as the main cause of the pathology in question, requires taking medications, normalizing the patient's lifestyle and nutrition.
Blood pressure is the force with which circulating blood acts on the walls of blood vessels.This pressure at the moment of contraction of the heart is called systolic, and during the period of its relaxation - diastolic.The range of normal values for these indicators is quite wide.
Through numerous observations, scientists have concluded that the risk of cardiovascular complications increases with every additional 10 mmHg increase in blood pressure.Art.already starting from the level of 115/75 mm Hg.Art.However, reducing the pharmacological pressure only above 140/90 mm proved advisable.rt.Art., therefore this value is taken as a criterion for determining arterial hypertension.
Reasons
In approximately 90% of cases the cause of a stable increase in blood pressure is hypertension.This diagnosis is made to the patient when no other diseases accompanied by hypertension are found during the examination.Among the latest:
- kidney disease – pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, renal artery stenosis;
- endocrine disorders - neoplasms of the adrenal glands, pancreas or pituitary gland, hyperfunction of the thyroid, Cushing's disease or syndrome, pheochromocytoma;
- obstructive sleep apnea syndrome;
- valve defects or atherosclerotic lesions of the aorta.
Regular use of some medications can also cause hypertension.These include oral contraceptives, nonsteroidal anti-inflammatory drugs, amphetamines, corticosteroids, drugs containing erythropoietin, cyclosporine, cocaine.
The probability of developing cardiovascular diseases, including hypertension, is closely related to the following risk factors:
- unhealthy diet, including excessive amounts of table salt, saturated fats and trans fats, lack of leafy greens, vegetables and fruits in the diet;
- obesity;
- pathologies of the heart and blood vessels in close relatives;
- age over 65;
- sedentary lifestyle;
- chronic stress;
- bad habits – smoking, excessive alcohol consumption.
Classification
If it is possible to identify a disease that leads to an increase in blood pressure, arterial hypertension is called secondary or symptomatic.When the cause is unknown, hypertension is considered primary.
The latter has a path in stages:
- Stage I. There are no obvious signs of disruption of the target organs affected by a stable increase in blood pressure: heart, kidneys, arterial and venous vessels.
- Phase II.One of the listed signs or a combination of them is present, such as an enlargement of the left ventricle of the heart, a marked 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, clinical manifestations of the disease may be absent.
- Stage III 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 severe renal damage, manifested by a pronounced decrease in filtration and/or a significant loss of protein in the urine.
Arterial hypertension is divided into different grades depending on the maximum blood pressure measured:
- First degree.Systolic blood pressure is between 140 and 159 mm.rt.Art.and/or diastolic – from 90 to 99 mm.rt.Art.
- Second degree.Systolic blood pressure from 160 to 179 mm.rt.Art.and/or diastolic – from 100 to 109 mm.rt.Art.
- Third degree.Systolic blood pressure is greater than 180 mm.rt.Art.and/or diastolic over 110 mm.rt.Art.
There is also an isolated form of arterial hypertension, in which only the systolic pressure values increase while the diastolic pressure is normal.
Symptoms
Often the increase in blood pressure is not accompanied by a worsening of well-being and can go unnoticed by the patient, which is why it is so important to measure blood pressure regularly, especially in middle-aged and elderly people.
Manifestations of hypertension may include the following symptoms:
- headache, especially in the morning after waking up;
- nosebleeds;
- hemorrhage under the mucous membrane of the eye;
- heart rhythm disorder;
- blurred vision, flickering spots;
- tinnitus.
A sharp increase in blood pressure to high numbers, accompanied by a pronounced deterioration in well-being, is called hypertensive crisis.Most often it occurs when systolic blood pressure exceeds 180 mmHg.Art.and/or diastolic above 120 mm Hg.Art.In this case, the patient feels weakness, nausea, vomiting that does not bring relief, disturbances in consciousness, anxiety and fear, muscle tremors and chest pain.
Complications
A stable 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 renal and cardiac failure;
- atherosclerotic lesions of the vessels of the lower limbs.
Diagnostics
The main sign 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, to ensure the correctness of the results obtained, it is important to follow the following rules:
- Before the examination, the patient needs to sit for a few minutes in a quiet room to calm down;
- the size of the tonometer cuff should correspond to the thickness of the arm, and the device itself should be mounted at heart level;
- two measurements are taken with an interval of 1-2 minutes on each hand;if there is a large difference between the obtained values, an additional measurement is taken;
- in elderly patients, as well as people suffering from diabetes mellitus, or if a decrease in blood pressure is suspected in case of a change in body position, measurements are taken in the first and fifth minutes in a standing position;
- Additionally, heart rate is measured for 30 seconds.
The doctor, in a conversation with the patient, clarifies at what age the pressure began to increase, whether there are symptoms such as snoring with breathing pauses during sleep, attacks of muscle weakness or sudden heartbeat with sweating and headaches and unusual impurities in the urine.It is also important to find out what medications and dietary supplements you are taking.
As part of the first stage of the 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 levels to assess the risk of atherosclerosis, blood electrolytes - potassium, sodium, chloride, 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 determine genetic polymorphisms associated with the development of arterial hypertension.
In order to clarify risk factors for development and identify existing cardiovascular pathologies in hypertension, instrumental diagnostic methods are used:
- 24-hour blood pressure monitoring;
- electrocardiographic study;
- echocardiography;
- 24-hour Holter monitoring;
- duplex scan of the brachiocephalic, renal or iliofemoral arteries;
- ultrasound examination of the kidneys and adrenal glands;
- fundus examination.
In case of hypertension it is important to check blood pressure at home by keeping a diary, in which it is necessary to record all the results of the measurements over time, the medications taken and the episodes of stress that can cause an increase in blood pressure.In this case the measurement must be carried out in a sitting position, after a few minutes of rest, keeping the hand at heart level.
Treatment
With a moderate and low risk of cardiovascular complications, the patient is only advised to change lifestyle, adjust diet, lose weight, increase physical activity and special exercises for hypertension, and abandon bad habits by regularly measuring blood pressure.Often these measures are sufficient to normalize blood pressure.
A diet for hypertension involves limiting table salt, caffeine, hot, salty, smoked and spicy foods, high-fat foods, organ meats, buttercream confections and alcoholic beverages.It is allowed to consume no more than 5 g of salt per day outside of a flare-up of the disease.The recommended daily fluid intake is 1-1.2 liters.
In case of unsuccessful non-drug treatment for several months, as well as in case of high risk of complications, antihypertensive therapy with hypertension drugs is resorted to, the goal of which is to reduce blood pressure to less than 140/90 mm.rt.Art.For patients with diabetes or people who already suffer 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.
The vast majority of them are available in the form of tablets for hypertension.
Prevention
Prevention of exacerbations 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-pharmacological treatments and medications, as well as regular measurement of blood pressure.