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Hypertension

A cardiologist measures the blood pressure of a patient with signs of hypertension

Hypertension is an extremely common disease, which in a collective definition combines several types of high blood pressure. Hypertension develops against the background of a narrowing of the lumen of the walls of small vessels and arteries, which disrupts the normal movement of blood flow, and blood accumulating in the narrowed places begins to exert pressure onthe walls of the ship.

What is hypertension?

High blood pressure can be a symptom, but it can also be an independent disease. If a person is diagnosed with chronic pathologies of the kidneys, cardiovascular system, thyroid gland, adrenal glands, hypertension is almost inevitable as one of the manifestations of these diseases. Also, an increase in pressure can be an adaptive and adaptive reaction of organs and systems to changes, both external - excessive physical activity and internal - psycho-emotional factors, stress. Almost all types of hypertension, with timely diagnosis, are controlled both with the help of drug treatment and with the help of other non-drug methods.

Normal blood pressure in a relatively healthy person is set between 100/60 and 140/90 mmHg; if the regulatory systems no longer function properly, hypertension or hypotension can develop.

Statistics indicate that almost 30% of the world's population suffers from one stage or another of hypertension, and yet, until recently, practically nothing was known about a disease such as hypertension. Only Homo sapiens is characterized by disorders in the functioning of the cardiovascular system; no representative of the animal world is sensitive to it. Until the 19th and 20th centuries, hypertension was in principle little known; one of the first cases of heart attack was reliably confirmed by doctors only in the 30s of the last century in one of the European countries; during the same period, there has not been a single clinically confirmed case of cardiovascular pathologies in African and Asian countries. Only with the development of urbanization and the penetration of modern technologies in these countries did Asian and African populations also become vulnerable to hypertension, which peaked in the 70s of the 20th century.

Hypertension, since the end of the last century, has been divided into primary and secondary.

  1. Primary (essential) hypertension is a separate nosological unit, an independent disease that is not caused by dysfunction of organs and systems. Blood pressure rises for reasons other than kidney disease, for example. Hypertension diagnosed as primary (EG - essential hypertension or GB - essential hypertension) is characterized by a persistent clinical sign - increased pressure, both systolic and diastolic. Nearly 90% of all patients with persistently high blood pressure have primary hypertension.
  2. Symptomatic, also called secondary, hypertension is hypertension caused by an underlying disease, for example an inflammatory process in the renal system - glomerulonephritis, polycystic kidney disease or a disorder of the pituitary gland or pancreas. In addition, secondary hypertension develops against the background of pathological changes in the vascular system - atherosclerosis, and can cause symptomatic hypertension and neurotic disease. In addition, secondary hypertension is quite common during pregnancy and in gynecological diseases - cysts and neoplasms.

Hypertension is also classified into grades based on the level of increase in blood pressure.

  • If blood pressure is fixed between 140/90 and 159/99 mmHg, hypertension is diagnosed as stage I disease. In this case, the pressure may return to normal, but periodically "jump" to the specified limits.
  • If blood pressure is recorded between 160/100 and 179/109 mmHg, hypertension is considered a stage II disease. There is practically no remission, but the pressure can be controlled with medication.
  • Blood pressure that consistently remains between 180/110 and above is considered a clinical symptom of stage III hypertension. At this stage, blood pressure practically does not fall to normal levels and if it falls, it is accompanied by heart weakness up to heart failure.

Hypertension, in addition to having stages of development of the disease, is also divided into separate clinical forms. Hyperadrenergic hypertension is actually the initial stage of the development of the disease, which, however, can last for many years. This form of hypertension is manifested by sinus tachycardia, unstable blood pressure when the systolic value fluctuates, increased sweating, skin hyperemia, throbbing headaches and anxiety. The face and limbs often swell, the fingers become numb, and urination is impaired. There is also a more serious form: malignant hypertension, which progresses rapidly. Blood pressure can increase so much that there is a risk of encephalopathy, vision loss, pulmonary edema, as well as a risk of kidney failure. Fortunately, this form practically no longer exists today, because hypertension is most often diagnosed much earlier and its development can be stopped with the help of complex therapeutic measures.

Pressure indicators

Blood pressure is one of the most important indicators of human health and an indicator of the normal functioning of the cardiovascular system. Pressure has two parameters: systolic and diastolic. The highest number is systole, which is an indicator of blood pressure during the period of contraction of the heart muscle, when blood enters the arteries. The lower number is the indicator of blood pressure during the period of relaxation of the heart muscle. It is believed that hypertension begins when the readings exceed the norm of 140/90 mmHg. This is, of course, a conditional limit, since there are conditions under which the risk of developing myocardial infarction exists even at values of 115/75 mmHg. However, formalizing and bringing to an average level the set of blood pressure problems helps clinicians notice deviations over time and begin symptomatic, and then standard, treatment.

ICD-10 code

I10 Essential [primary] hypertension.

What are the causes of hypertension?

Hypertension is considered a multi-etiological and multi-factorial disease whose true causes are not fully understood. The factors that cause secondary hypertension are more specific, since the cause is the underlying disease. The final diagnosis of essential hypertension is made after a complete examination excluding the presence of triggering diseases. Primary hypertension, in medical terms, is a genetic imbalance of the body's regulatory mechanisms (imbalance of the vasopressor and blood pressure depressant systems).

Among the reasons that clinicians have described and carefully studied are:

  • Renal pathologies – nephritis and most often glomerulonephritis. Factor that causes secondary hypertension.
  • Stenosis (narrowing) of the renal arteries.
  • Congenital pathology in which the renal artery is blocked (coarctation).
  • Adrenal gland tumors - pheochromocytosis (impaired production of norepinephrine and adrenaline).
  • Increased production of aldosterone is hyperaldosteronism, which occurs during a tumor process in the adrenal glands.
  • Impaired functioning of the thyroid gland.
  • Alcoholism.
  • Overdose or constant use of medications, especially hormonal antidepressants.
  • Addiction.

Factors considered provocative in the sense of disruption of normal blood pressure levels can be divided into nutritional, age-related and pathological factors:

  • Age over 55 for men and 65 for women.
  • Increased blood cholesterol level (above 6. 6 mmol).
  • Hereditary predisposition, family history.
  • Obesity, especially abdominal, when the waist circumference is greater than 100-15 cm in men and 88-95 cm in women.
  • Diabetes, change in normal levels of glucose tolerance.
  • Physical inactivity, osteochondrosis.
  • Chronic stress, increased anxiety.

The mechanism of development of hypertension is briefly as follows:

When arterioles - arteries of organs, most often the kidneys - contract under the influence, for example, of a stress factor, the nutrition of the kidney tissue is disrupted and ischemia develops. The kidneys try to compensate for the disturbances by producing renin, which causes the activation of angiotensin, which constricts blood vessels. As a result, blood pressure rises and hypertension develops.

Symptoms of hypertension

The main symptom of hypertension, and sometimes the main one, is considered to be a persistent excess of 140/90 mmHg. Other signs of hypertension are directly related to blood pressure parameters. If the pressure increases slightly, the person simply does not feel well, is weak and has a headache.

If the pressure exceeds the norm by 10 units, the headache becomes intense and constant, most often it is localized on the back of the head and temples. The person feels nauseous and sometimes vomits. The face becomes red, sweating increases, tremors of the fingers are noticeable, and numbness often occurs.

If hypertension lasts a long time and is not treated, pathological processes develop in cardiac activity and the heart begins to hurt. The pain can be throbbing, sharp, it can radiate towards the arm, but most often the heart pain is localized on the left side of the chest, without spreading further. Against the background of constantly high blood pressure, anxiety and insomnia develop.

Hypertension is also characterized by dizziness and decreased vision.

Ophthalmological signs – veils or spots, "floaters" in front of the eyes. Often, when the pressure increases sharply, nosebleeds can occur.

Another symptom of hypertension is dizziness. Vision deteriorates.

The terminal stage, when hypertension reaches stage III, neurosis or depression join the typical symptoms. Hypertension in this form often occurs as part of a pathological "union" with coronary heart disease.

The most dangerous manifestation of hypertension is a crisis - a condition accompanied by a sharp increase or jump in blood pressure. A seizure state is characterized by a stroke or heart attack and is manifested by the following symptoms:

  • A sharp, sudden, or rapidly growing headache.
  • Blood pressure readings up to 260/120 mmHg.
  • Pressure in the heart region, aching pain.
  • Severe shortness of breath.
  • Vomiting, beginning with nausea.
  • Increased heart rate, tachycardia.
  • Loss of consciousness, convulsions, paralysis.

Crisis-phase hypertension is a life-threatening illness that can lead to stroke or heart attack. Therefore, at the slightest alarming sign, you must call emergency medical help. A hypertensive crisis is controlled using diuretics, cardiological and hypertensive drugs administered by injection. A hypertensive patient who knows about his problem must constantly take prescribed medications to avoid a crisis state.

Who to contact?

Cardiologist.

Treatment of hypertension

Hypertension in the initial stage, when blood pressure values do not often exceed normal levels, can be treated with non-drug medications. The first is to control your weight and follow a low-carb, low-fat diet. A diet for hypertension also involves limiting the consumption of salty foods and controlling fluid intake - no more than 1. 5 liters per day. Psychotherapy and autogenic training, which relieve general anxiety and tension, are also effective. These methods are effective for stage I hypertension, although they can be used as auxiliary and additional elements to the main treatment of stage II and III hypertension.

Pharmacological agents that involve the treatment of hypertension are prescribed according to a "stepped" principle. They are used sequentially, targeting various organs and systems, until blood pressure is completely stabilized.

Stage I hypertension involves the use of diuretics (diuretics), beta-blockers and adrenergic receptor blockers to stop tachycardia. The dose of beta blocker is calculated based on the patient's medical history, weight and condition. If blood pressure normalizes after two to three days, the dose is reduced, often every other day. As a diuretic, a drug from the thiazide group is effective, it is prescribed in the amount of 25 mg once, alternating doses every one or two days, so as not to weaken the heart muscle. If hypertension begins to subside, a diuretic may be prescribed once a week. Often diuretics and beta blockers cannot be used due to possible side effects (diabetes, gout or asthma); in such situations, taking antispasmodics is indicated. During the entire treatment period, you should monitor your blood pressure three times a day.

Stage II hypertension is managed by complex treatment including beta-blockers, diuretics, antispasmodics, ACE inhibitors (angiotensin converting enzyme inhibitors) and potassium preparations. Among beta blockers, effective drugs are those that can control rapid heart rate and reduce peripheral vascular resistance. These drugs are also effective in cases of diagnosed bradycardia, when the heart rate is reduced. Angiotensin-converting enzyme inhibitors can counteract the increased production of renin, which increases blood pressure. These drugs activate the work of the left ventricle of the heart, reduce hypertrophy, dilate the coronary vessels, thereby helping to normalize peripheral blood flow. Calcium antagonists are designed to block calcium channels in the vessel walls, thereby increasing their lumen. Calcium antagonists should only be prescribed by a doctor or cardiologist, as all of these medications can cause swelling, dizziness and headaches. A set of drugs is selected taking into account all possible side risks and contraindications. It should also be noted that long-term use of diuretics can lead to a decrease in potassium levels in the body (hypokalemia). Diuretics should therefore be taken with potassium supplements.

Stage III hypertension is a severe form of the disease, characterized by the body's resistance to traditional drugs. Therefore, treatment should be carefully selected taking into account all individual characteristics of the patient. The therapeutic complex includes diuretics, most often potassium-sparing, and the use of peripheral vasodilators is also indicated. The pharmaceutical industry today produces many drugs with combined effectiveness. These drugs act on patients whose body is either accustomed to monotherapy and has stopped responding to it, or has significant contraindications to the use of standard treatment used for stage I and II hypertension.

Severity III hypertension is also monitored with vasodilators. Increasingly, vasodilators began to be replaced by alpha-blockers. A combination medication combining the properties of alpha and beta blockers may also be effective. This remedy, combined with a diuretic, can replace three or even four other less effective medications. An ACE inhibitor is used to prescribe a medication that improves peripheral circulation and controls renin levels. The drug is taken three to four times a day, in combination with a diuretic, which allows blood pressure to return to normal after a week.

Hypertension of degrees I and II can be treated at home and does not require hospitalization. In rare cases, hospital treatment is possible in order to carry out analytical examinations and monitor the state of health. Hypertension, which occurs in severe forms, is only treated in the hospital, in the cardiology department; the length of stay depends on the state of blood pressure and the functioning of the body's organs and systems.

How to prevent hypertension?

Hypertension, if it has already developed, unfortunately stays with a person forever. Prevention in this sense only concerns the prevention of crisis situations through regular use of prescribed medications, daily monitoring of blood pressure, feasible physical activity and weight loss.

However, if a person has a family history of relatives suffering from hypertension, but the disease has not yet manifested itself, preventive measures can be taken. The rules are quite simple: maintain a healthy lifestyle and physical activity, because one of the reasons that causes hypertension is physical inactivity. Hypertension can also be prevented by a normal diet, in which cholesterol and salty foods are kept to a minimum.

High blood pressure is also a bad habit. Therefore, if a person does not want to join the ranks of hypertensive patients, he should quit smoking and limit his consumption of alcoholic beverages. In addition, a positive mood and attitude help to cope with any illness, and hypertension "loves" pessimists. The recipe is simple: enjoy life, stay calm and take care of your nerves, then your heart and blood vessels will work "like a clock", and the pressure will be, according to the well-known saying, "like an astronaut". .