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 several degrees and stages of high blood pressure, as well as risks of complications. Symptoms can vary depending on the severity of the disease and the severity of damage to 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 disease. When diagnosing hypertension, the patient is prescribed medication.
General information about 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 minor deviations from this value are possible. Only in some cases are indicators such as 100/65 or 135/110 mm 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 indicates the strength of the contraction of the walls of the heart. The second is diastolic (lower), indicating value with a relaxed heart.
Types of hypertension:
- Essential (primary) - occurs in 90-95% of cases in all patients with arterial hypertension.
- Symptomatic - a secondary form of hypertension, observed only in 5-10% of cases.
Constant arterial hypertension 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 LV hypertrophy has an unfavorable 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 rises periodically, stabilizes spontaneously after a few hours or days without taking medication.
- Labile. The manifestation is also periodic, but treatment is necessary to normalize blood pressure.
- stable. High levels of blood pressure persist for a long time, the patient needs constant treatment.
- Smart. Blood pressure, especially diastolic, reaches critical levels and responsiveness to treatment is low. There is a possibility of rapid development of the disease with the simultaneous appearance of serious complications.
- Crisis. Periodically observed hypertensive crises. 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.
The risk exists. It is determined by the likelihood of complications in the target organs due to their damage.
steps
Hypertension has 4 stages:
- Preclinical. There are no signs of high blood pressure, blood pressure rises without characteristic symptoms.
- Stage 1. There are signs of high blood pressure, seizures are possible, but there are no symptoms of target organ damage.
- Stage 2. Signs of target organ damage are observed - the myocardium is enlarged, renal function is impaired, changes in the retina are noticeable.
- Stage 3. Serious complications are possible - stroke, impaired visual function, myocardial infarction, atherosclerosis or aortic aneurysm.
Target organs are affected in stage 2 HD, so patients should be screened for possible risks. ECG, cardiac ultrasound are designed to identify the degree of enlargement of the heart muscles; blood and urine are taken for tests (protein, creatinine) to establish indicators of kidney function.
The third stage of GB can occur with associated pathologies associated with hypertension. Among them, transient ischemic attacks, cerebrovascular accidents, angina pectoris and myocardial infarction are the most important for the 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 blood pressure exceeds 140/90 mm. rt. Art. The degrees are determined by the following relationship:
- TA between 140-159 / 90-99 mm Hg. Art. ;
- TA between 160-179 / 100-109 mm Hg. Art. ;
- Exceeding the bar 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 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 greatest accuracy, the degree of hypertension is established when the disease is first detected. In the event that drugs (antihypertensives) are used, blood pressure can sharply decrease or increase, which does not allow 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 higher risk.
With GB, the risk for patients is established on the basis of an analysis of external provocative factors, concomitant diseases, metabolic disorders, changes in internal organs involved in the pathological process.
Provoking risk factors include:
- the age of the patient (for men - after 55 years and for women - 65 years);
- smoking;
- the presence among relatives under 65 (for women) and under 55 (for men) of people with cardiovascular pathologies;
- 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, increase the risk 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, they are at very high risk (4). With the first and second degree of GB with normal health (without damage to internal organs) and provoking factors such as smoking and age, a moderate risk is defined - 2.
A low risk means that the probability of complications does not exceed 15%, indicated by the number 1. A value of 2 corresponds to a 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 cause essential WBC:
- excess weight due to impaired metabolism, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- steady increase in psycho-emotional stress associated with work activities;
- previous brain damage (hypothermia, falls, bruises);
- hereditary predisposition (at a young age, the first symptoms of high blood pressure may appear if the patient's parents suffered from high blood pressure);
- 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 at menopause in women over 40;
- high consumption of caffeinated beverages, alcohol and tobacco;
- prolonged mental activity;
- a sharp increase in adrenaline in the blood;
- excessive consumption of salty foods;
- sedentary lifestyle;
- rare exposure to fresh air.
Symptomatic high blood pressure can occur in the context 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 (product of adrenaline and noradrenaline) and hyperaldosteronism (product of aldosterone) - tumors of the adrenal glands;
- consumption of wine alcohol (ethanol) greater than 60 ml per day.
Symptoms
Symptoms of hypertension are not specific. Patients can ignore high blood pressure for many years and not feel discomfort leading a usual life. In some cases, minor weakness and dizziness may occur, often attributed to overexertion.
Usually, the first complaints are associated with target organ damage, which occurs in stage 2 HD. With a violation of cerebral circulation, a person experiences severe dizziness, noises in the head, headaches, decreased 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 a 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 eliminated with analgesic drugs. With kidney damage, proteins, erythrocytes are found in the urine. In rare cases, hypertension can develop into kidney failure. Damage to the eyes leads to a deterioration of visual function, up to the development of blindness.
Usually, with the progression of hypertension, the pain in the head persists. It has no relation to the time of day, so it can happen 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 often cover other areas. Typically, the pain is described by patients as a "hooping" sensation, due to tension in the muscles of the soft integuments of the head or the tendinous helmet of the head. Such a symptom intensifies with a strong cough, straining, tilting of the head, psycho-emotional stress, may be accompanied by slight swelling of the eyelids and face. Prolonged headaches lead to the development of irascibility, irritability, increased sensitivity to external stimuli (noise, loud music). With an upright position, muscle activity or massage, venous outflow improves, so the pain decreases or disappears for a while.
Along with high blood pressure, pain in the region of the heart has some distinctive features of angina attacks:
- localized at 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 removed with nitroglycerin;
- not caused by physical activity.
Shortness of breath, which first occurs during physical exertion, and then even 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 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 supplemented 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 feeling of fear of death. Red spots may appear on the cheeks. Attacks of a hypertensive crisis may 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 heart pain.
Hypertensive crises appear for the following reasons:
- psychotic stress;
- inadequate drug therapy;
- pain;
- the phenomenon of "rebound", which occurs in the context 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 by the sex hormones, estrogen. However, such an obstacle to hypertension is short-lived. During menopause, estrogen levels decline and women are at risk for GB.
In the elderly, the main cause of hypertension is physical inactivity. With age, vascular changes occur, due to which hypertension can dramatically progress. Usually, this group of patients has isolated systolic 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 hypertension, it is necessary to normalize blood pressure, improve lifestyle and the functioning of target organs. To do this, use drug therapy and general measures.
When establishing a diagnosis, the patient must completely reconsider his lifestyle. First of all, you need to 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, leading to serious and fatal complications.
In the treatment of hypertension, doctors use the following groups of drugs:
- 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 only be prescribed by a doctor depending on the stage of the disease, concomitant diseases. Treatment usually consists of a single drug, most often an ACE inhibitor, in the first place. 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 can be prescribed. They are used for symptoms of dyscirculatory hypertensive encephalopathy. With changes in the myocardium, vitamins and microelements are used to help restore the muscle structure of the heart. If the patient is experiencing stressful loads, has an unstable emotional state, he is prescribed sedatives.