Hypertension or arterial hypertension is a condition characterized by a stable increase in blood pressure, which 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 medication, normalization of 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 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 each additional 10 mmHg increase in blood pressure.Art.it already starts at a level of 115/75 mm Hg.Art.However, medical lowering of blood pressure only above 140/90 mm has been shown to be advisable.rt.art., therefore, this value is accepted 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 given to the patient when no other diseases accompanied by hypertension are found during the examination.Among the latest:
- kidney pathologies - pyelonephritis, glomerulonephritis, polycystosis, 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;
- valvular defects or atherosclerotic lesions of the aorta.
Regular use of certain medications can also cause high blood pressure.These include oral contraceptives, nonsteroidal anti-inflammatory drugs, amphetamines, corticosteroids, drugs containing erythropoietin, cyclosporine, cocaine.
The likelihood of developing cardiovascular disease, including hypertension, is closely related to the following risk factors:
- unhealthy diet, including excessive amounts of table salt, saturated fat and trans fat, lack of leafy greens, vegetables and fruits in the diet;
- obesity;
- pathologies of the heart and blood vessels in close relatives;
- age over 65 years;
- 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 hypertension.
The latter has a step-by-step process:
- Stage I. There are no obvious signs of a violation 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 enlargement of the left ventricle of the heart, a significant decrease in the rate of filtration 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, the 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 serious kidney damage, manifested by a pronounced decrease in filtration and/or a significant loss of protein in the urine.
Arterial hypertension is divided into several degrees depending on the maximum measured blood pressure:
- First degree.Systolic blood pressure is from 140 to 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 more 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, an increase in blood pressure is not accompanied by a deterioration in well-being and can remain unnoticed by the patient, which is why regular blood pressure measurement is so important, especially for middle-aged and elderly people.
Manifestations of hypertension may include the following symptoms:
- headache, mainly 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 jump in blood pressure to high values, accompanied by a pronounced deterioration of well-being, is called a hypertensive crisis.Most often this happens when the systolic pressure rises to more than 180 mmHg.Art.and/or diastolic above 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, including those that threaten the patient's life.These include:
- acute cerebrovascular accident (stroke);
- angina pectoris, 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, found in at least three measurements on different days in a calm 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 observe 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 cuff of the tonometer should correspond to the thickness of the hand, and the device itself should be installed at the level of the heart;
- two measurements are performed with an interval of 1-2 minutes on each arm;if there is a large difference in the obtained figures, an additional measurement is made;
- in elderly patients, as well as people suffering from diabetes mellitus, or if there is a suspicion of a decrease in blood pressure in the event of a change in body position, measurements are performed during the first and fifth minutes in a standing position;
- In addition, the heart rate is measured for 30 seconds.
The doctor, in a conversation with the patient, clarifies at what age the pressure first began to rise, whether there are any symptoms such as snoring with pauses in breathing during sleep, attacks of muscle weakness or sudden palpitations with sweating and headache, and unusual impurities in the urine.It's also important to find out what medications and supplements he's taking.
As part of the first stage of research for hypertension, the following tests are performed:
- clinical blood test;
- general analysis of urine, detection of microalbumin in 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);
- determining the level of glycated hemoglobin;
- determining 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 gene polymorphisms associated with the development of arterial hypertension.
In order to clarify the risk factors for the development and identification of existing cardiovascular pathologies in hypertension, instrumental diagnostic methods are used:
- 24-hour blood pressure monitoring;
- electrocardiographic examination;
- echocardiography;
- 24-hour Holter monitoring;
- duplex scan of brachiocephalic, renal, or iliofemoral arteries;
- ultrasound examination of the kidneys and adrenal glands;
- fundus examination.
With hypertension, it is important to control blood pressure at home, keeping a diary in which it is necessary to record all the results of time measurements, medications taken and episodes of stress that can provoke an increase in blood pressure.In this case, measurements should be taken in a sitting position, after a few minutes of rest, keeping your hand at the same level as the heart.
Treatment
At a moderate and low risk of cardiovascular complications, the patient is only recommended to change his lifestyle, adjust his diet, reduce his weight, increase physical activity and special exercises for hypertension and give up bad habits while regularly measuring blood pressure.Often these measures are sufficient to normalize blood pressure.
A diet for hypertension includes limiting table salt, caffeine, hot, salty, smoked and spicy foods, high-fat foods, offal, confectionery with butter cream and alcoholic beverages.It is permissible to consume no more than 5 g of salt per day outside of an exacerbation of the disease.The recommended daily fluid intake is 1-1.2 liters.
In the case of unsuccessful non-drug treatment for several months, as well as in case of a high risk of complications, antihypertensive therapy with hypertension drugs is resorted to, the goal of which is to reduce blood pressure below 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 medical 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.
Most 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 compliance with all doctor's recommendations, including non-drug treatment and medication, as well as regular blood pressure measurement.