Hypertension, or high blood pressure, is a condition characterized by a stable increase in blood pressure, that is, detected by 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 diet.
Blood pressure is the force with which circulating blood acts on the walls of blood vessels.This pressure at the time of contraction of the heart is called systolic, and during the period of 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 each additional 10 mmHg increase in blood pressure.Art.from the level of 115/75 mm Hg. Art.However, medicated pressure reduction only above 140/90 mm has been found to be recommended.art.Art., which is why this value is taken as a criterion for determining arterial hypertension.
Reasons
In about 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 noted during the examination.Among the latest:
- renal 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;
- valve defects or atherosclerotic lesions of the aorta.
Regularly taking certain medications can also cause high blood pressure.These include oral contraceptives, nonsteroidal anti-inflammatory drugs, amphetamines, corticosteroids, medications containing erythropoietin, cyclosporine, and cocaine.
The likelihood of developing cardiovascular diseases, including hypertension, is closely linked to the following risk factors:
- an unhealthy diet, including excessive amounts of table salt, saturated fats and trans fats, a lack of leafy greens, vegetables and fruits in the diet;
- obesity;
- pathologies of the heart and blood vessels in relatives;
- age over 65;
- sedentary lifestyle;
- chronic stress;
- bad habits – smoking, excessive alcohol consumption.
Ranking
If it is possible to identify a disease leading to an increase in blood pressure, high blood pressure is called secondary or symptomatic.When the cause is unknown, hypertension is considered primary hypertension.
The latter offers a step-by-step route:
- Stage I. There are no obvious signs of disruption of the target organs affected by a stable increase in blood pressure - the heart, kidneys, arterial and venous vessels.
- Stage II.One of the listed signs or a combination of them is present, such as hypertrophy of the left ventricle of the heart, a marked decrease in filtration rate in the kidneys, albumin in 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 stroke, angina pectoris, atherosclerosis of the arteries of the lower extremities or severe kidney damage, manifested by a pronounced decrease in filtration and / or significant loss of protein in urine.
High blood pressure is divided into several degrees depending on the maximum blood pressure measured:
- First degree.Systolic blood pressure is between 140 and 159 mm.art.Art.and/or diastolic – from 90 to 99 mm.art.Art.
- Second degree.Systolic blood pressure 160 to 179 mm.art.Art.and/or diastolic – from 100 to 109 mm.art.Art.
- Third degree.Systolic blood pressure is greater than 180 mm.art.Art.and/or diastolic greater than 110 mm.art.Art.
There is also an isolated form of high blood pressure, in which only the systolic pressure figures increase while the 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.This 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:
- headaches, mainly in the morning after waking up;
- nosebleeds;
- hemorrhage under the mucous membrane of the eye;
- heart rhythm disturbances;
- blurred vision, flickering spots;
- tinnitus.
A sharp increase in blood pressure to high values, accompanied by a pronounced deterioration in well-being, is called hypertensive crisis.Most often this happens when the systolic pressure exceeds 180 mmHg.Art.and/or diastolic greater than 120 mm Hg. Art.In this case, the patient experiences weakness, nausea, vomiting that does not bring relief, impaired 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, especially those that threaten the patient's life.These include:
- acute cerebrovascular accident (cerebrovascular accident);
- angina, myocardial infarction;
- vascular dementia (dementia);
- chronic kidney and heart failure;
- atherosclerotic lesions of the vessels of the lower extremities.
Diagnosis
The main sign of hypertension is a stable increase in blood pressure, detected by at least three measurements taken on different days in a calm environment.When measuring blood pressure for the first time in a hospital or clinic, to ensure the accuracy of the results obtained, it is important to follow the following rules:
- Before the examination, the patient should 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 the level of the heart;
- two measurements are taken with an interval of 1 to 2 minutes on each hand;if there is a big difference in the figures obtained, 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, specifies at what age the pressure began to increase, whether there are symptoms such as snoring with pauses in breathing during sleep, attacks of muscle weakness or sudden heartbeat with sweating and headache, as well as unusual impurities in urine.It is also important to know the medications and dietary supplements he is taking.
As part of the first stage of the examination for hypertension, the following examinations are carried out:
- clinical blood test;
- general urine analysis, 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, chlorine, calcium, as well as glucose and creatinine);
- determination of the level of glycated hemoglobin;
- 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 the 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 examination of the brachiocephalic, renal, or iliofemoral arteries;
- ultrasound examination of the kidneys and adrenal glands;
- fundus examination.
For hypertension, it is important to control blood pressure at home by keeping a diary in which it is necessary to record all the results of measurements over time, medications taken and episodes of stress that can cause an increase in blood pressure.In this case, measurements should be taken in a seated position, after several minutes of rest, keeping your hand at the same level as your heart.
Treatment
With a moderate and low risk of cardiovascular complications, the patient is only recommended to change his lifestyle, adjust his diet, lose weight, increase physical activity and special exercises for hypertension, and abandon 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, butter cream confectionery and alcoholic beverages.It is allowed to consume no more than 5 g of salt per day outside of an exacerbation of the disease.The recommended daily fluid intake is 1 to 1.2 liters.
In case of failure of non-drug treatment for several months, as well as in cases of high risk of complications, they resort to antihypertensive treatment using anti-hypertension drugs, the purpose of which is to reduce blood pressure to less than 140/90 mm.art.Art.For diabetic patients or people already suffering from pathologies of the cardiovascular system, the target pressure level is even lower - 130/80 mm.art.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 hypertension tablets.
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-drug treatment and medications, as well as regular measurement of blood pressure.