Hypertension is a disease associated with a violation of the level of blood pressure. It can have a different etiology, be primary or secondary. There are different degrees and stages of arterial hypertension, as well as the 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 diagnosing hypertension, the patient is prescribed medication.
General information on hypertension
Hypertension is a disease characterized by a persistent increase in blood pressure. In a healthy person, blood pressure should be between 120/80 mm. rt. Art. Only small deviations from this value are possible. Only in some cases, gauges 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 (upper) pressure, which shows the strength of the 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 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 left ventricular hypertrophy has a poor prognostic sign. With an increase in the left ventricle, the risk of developing ventricular arrhythmias, heart failure, coronary heart 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 periodically rises, spontaneously stabilizes after a few hours or days without the use of drugs.
- Labile. The manifestation is also periodic, but treatment is required to normalize blood pressure.
- stable. High blood pressure levels persist for a long time, the patient needs constant care.
- 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 serious complications.
- Crisis. Periodically observed hypertensive crisis. 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 likelihood of complications in target organs due to their damage.
stages
Hypertension has 4 phases:
- Preclinical. There are no signs of arterial hypertension, blood pressure rises without characteristic symptoms.
- Stage 1. There are signs of hypertension, 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 hypertrophic, renal function is impaired, changes in the retina are noted.
- Stage 3. Serious complications are possible: stroke, impaired vision, myocardial infarction, atherosclerosis or aortic aneurysm.
Target organs are affected in stage 2 of HD, so patients should be screened to determine possible risks. ECG, ultrasound of the heart is 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 WBC can occur with associated pathologies associated with hypertension. Among them, transient ischemic attacks, stroke, angina pectoris and myocardial infarction are the most important for prognosis.
The degree of hypertension
The degree of WBC is determined based on the value of blood pressure. It is important in risk and prediction.
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. ;
- Exceed the mark of 180/110 mm Hg. Art.
In rare cases, the patient has an increase in systolic pressure with a mark greater 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 higher) exceeds the normal range.
With the utmost accuracy, the degree of hypertension is established at the first detection of the disease. In the event that drugs (antihypertensives) are used, blood pressure may drop or rise sharply, which does not allow for an adequate assessment of the degree of GB.
Risks
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 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.
Provocative risk factors include:
- the age of the patient (for men - after 55 years, and for women - 65 years);
- to smoke;
- the presence among relatives under the age of 65 (for women) and 55 (for men) of people with cardiovascular diseases;
- 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, they 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, she is at very high risk (4). With the first and second degree of GB with normal health (without damage to internal organs) and provocative factors such 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 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 greater than 35%.
The reasons
The following factors can result in essential WBCs:
- 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 a young age, the first symptoms of hypertension may appear if the patient's parents suffered from arterial hypertension);
- chronic diseases that adversely 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 beverages containing caffeine, 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 noradrenaline) and hyperaldosteronism (produces aldosterone) - tumors of the adrenal glands;
- consumption of wine alcohol (ethanol) more than 60 ml per day.
Symptoms
The symptoms of hypertension are not specific. Patients may be unaware of high blood pressure for many years, do not feel discomfort in leading a habitual lifestyle. In some cases, mild weakness and dizziness may occur, often attributed to overwork.
Usually, early disturbances are associated with target organ damage, which occurs in stage 2 of HD. In case of violation of cerebral circulation, a person experiences severe dizziness, noise in the head, headache, reduced performance and deterioration of memory. With the progression of the disease, flies in front of the eyes, numbness of the extremities and speech disorders are possible. Usually in the early stages, these symptoms are transient. With severe 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 gap area, which cannot be removed with analgesic drugs. With kidney damage, proteins, 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 further progression of hypertension, pain in the head persists. It has no connection with the time of day, so 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 they often cover other areas. Typically, the pain is described by patients as a "circle" sensation, due to tension in the muscles of the soft integuments of the head or the helmet tendon of the head. Such a symptom intensifies with a strong cough, tension, tilt of the head, psycho-emotional stress, it can be accompanied by a slight swelling of the eyelids and face. Prolonged headache leads to the development of short temper, irritability, increased sensitivity to external stimuli (noise, loud music). With an upright position, muscle activity or massage, the venous outflow improves, so the pain decreases or disappears for a while.
With high blood pressure, pain in the heart region has some distinctive features from angina attacks:
- located in 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 also 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 taking certain medications.
Hypertensive 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 complemented by nausea, vomiting, darkening of the eyes, sweating.
The hypertensive crisis usually lasts from a few 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 can be accompanied by profuse urination and diarrhea. As a rule, this condition is provoked by a 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 speech and sensitivity of the limbs. In some cases, the patient has pain in the heart.
Hypertensive crises appear for the following reasons:
- psychotic stress;
- inadequate drug therapy;
- ache;
- 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 high blood pressure than women. This is due to the fact that women are protected from the sex hormones, estrogen. However, such an obstacle to hypertension is short-lived. During menopause, estrogen levels drop and women are at risk for GB.
In the elderly, the main cause of hypertension is physical inactivity. With age, vascular changes occur, as a result of which hypertension can progress significantly. 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 the development of GB 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 target organ function. To do this, use drug therapy and general measures.
When establishing a diagnosis, the patient must completely reconsider the lifestyle. 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, which lead to serious and life-threatening complications.
In the treatment of hypertension, doctors use the following groups of drugs:
- ACE inhibitors.
- Angiotensin II receptor blockers.
- Diuretics.
- calcium channel blockers.
- Beta blockers.
- Imidazoline Prescription Agonists.
The above groups of medicines have their own contraindications, so 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 drug groups, nootropic drugs may be prescribed. They are used for the symptoms of dyscirculatory hypertensive encephalopathy. With changes in the myocardium, vitamins and trace elements are used to help restore the heart's muscle structure. If the patient experiences stressful loads, has an unstable emotional state, he is prescribed sedatives.