Hypertension is a disease that is associated with a violation of the blood pressure level. It can have a different etiology, be primary or secondary. There are several 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 hypertension is diagnosed, the patient is prescribed medication.
General information about hypertension
Hypertension is a disease characterized by a constant increase in blood pressure. In a healthy person, blood pressure should be within 120/80 mm. rt. Art. Only small deviations from this value are possible. Only in some cases such indicators 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 (top) pressure, which indicates the force of contraction of the walls of the heart. The second is diastolic (bottom), showing the value at 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 in only 5-10% of cases.
Permanently 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 heart chamber itself expands.
It should be noted that LV hypertrophy has an unfavorable prognostic sign. As the left ventricle enlarges, the risk of developing ventricular arrhythmias, heart failure, coronary artery disease, and sudden death increases. As the left ventricular dysfunction progresses, characteristic symptoms appear.
GB (hypertension) can appear with varying degrees of severity and dynamics. There are several forms of hypertension:
- Transitional. Blood pressure rises periodically, stabilizes spontaneously after a few hours or days without the use of drugs.
- Labile. The manifestation is also intermittent, but treatment is needed to normalize blood pressure.
- stable. High blood pressure values persist for a long time, the patient needs constant treatment.
- Malignant. Blood pressure, especially diastolic, rises to critical levels and has low sensitivity to treatment. There is a possibility of rapid development of the disease with simultaneous occurrence of severe complications.
- crisis. Periodically observed hypertensive crises. They can accompany any stage of hypertension (stage 1 is rare).
Classification
Arterial hypertension 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 probability of complications in the target organs due to their damage.
stages
Hypertension has 4 stages:
- Preclinical. There are no signs of arterial hypertension, blood pressure rises without characteristic symptoms.
- Stage 1. There are signs of high blood pressure, crises are possible, but there are no symptoms of target organ damage.
- Stage 2. Signs of damage to the target organs are observed - the myocardium is hypertrophied, kidney 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 to determine possible risks. ECG, ultrasound of the heart are 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 GB can occur with associated pathologies associated with hypertension. Among them, the most important for the prognosis are transient ischemic attacks, strokes, angina pectoris and myocardial infarction.
The degree of hypertension
The degree of GB is determined based on the blood pressure value. 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:
- BP within 140-159 / 90-99 mm Hg. Art. ;
- BP within 160-179 / 100-109 mm Hg. Art. ;
- Exceeding the mark of 180/110 mm Hg. Art.
In rare cases, the patient has an increase in systolic pressure with a mark above 140 mm. rt. Art. , and the diastolic is within normal limits. 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 upper) exceeds the normal limits.
With the greatest accuracy, the degree of hypertension is established at the first detection of the disease. 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
Severe complications are possible with hypertension. 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 assigned from 1 to 4, with the higher value indicating the highest risk.
In GB, the risk for patients is established based on the analysis of external provoking factors, concomitant diseases, metabolic disorders, changes in internal organs involved in the pathological process.
Precipitating risk factors include:
- the age of the patient (for men - after 55 years, and for women - 65 years);
- smoking;
- the presence among relatives under the age of 65 (for women) and 55 (for men) with cardiovascular pathologies;
- disorder of lipid metabolism (reduction of high-density lipid fractions, exceeding 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 elevated fibrinogen levels. These factors are considered additional, increasing the likelihood of complications.
To determine the risk of GB, it is necessary to take into account transferred complications. For example, if a patient has had a stroke, they are at very high risk (4). In the first and second degree of GB with normal health (without damage to internal organs) and such provoking factors as smoking and age, a moderate risk is established - 2.
Low risk means that the probability of complications is no more than 15%, indicated by the number 1. A value of 2 is a moderate risk with a probability of up to 20%. Value 3 corresponds to high risk, and the probability of heart attacks and strokes does not exceed 30-33%. The highest risk (4) is found when the probability of vascular accidents is more than 35%.
The reasons
The following factors can provoke essential GB:
- overweight due to impaired metabolism, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- regular increased psycho-emotional stress related to professional activities;
- previous brain injuries (hypothermia, fall, contusions);
- hereditary predisposition (the first symptoms of high blood pressure may appear at an early age if the patient's parents suffer from arterial hypertension);
- 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, which disrupt blood circulation;
- significant hormonal changes in menopause in women over 40;
- heavy consumption of caffeinated drinks, alcohol and smoking;
- prolonged mental activity;
- a sharp increase in adrenaline in the blood;
- excessive consumption of salty foods;
- sedentary way of life;
- 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 norepinephrine) and hyperaldosteronism (produces aldosterone) - tumors of the adrenal glands;
- consumption of wine alcohol (ethanol) more than 60 ml per day.
Symptoms
Symptoms of hypertension are non-specific. Patients may not know about high blood pressure for many years, not experience discomfort while leading a normal lifestyle. In some cases, slight weakness and dizziness may occur, which are often due to overexertion.
Typically, the first complaints are related to target organ damage, which occurs in stage 2 HD. In the event of a violation of cerebral blood circulation, a person experiences severe dizziness, noise in the head, headache, reduced working capacity and memory deteriorates. As the disease progresses, flies before the eyes, numbness of the limbs and speech disorders are possible. Usually, in the initial stages, these symptoms are transient. With serious worsening 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 that cannot be removed with analgesic drugs. In case of kidney damage, proteins and erythrocytes are detected in the urine. In rare cases, hypertension can develop kidney failure. Damage to the eyes leads to deterioration of visual function, to the development of blindness.
Usually, with further progression of hypertension, the headache continues. It has no relation to the time of day, so it can appear 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 it often involves other areas. Usually, the pain is described by patients as a "hoop" feeling due to tension in the muscles of the soft coverings of the head or the helmet of the tendons of the head. Such a symptom intensifies with a strong cough, tension, head tilt, psycho-emotional stress, may be accompanied by 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 a vertical position, muscle activity or massage, venous outflow improves, so the pain decreases or disappears for a while.
With arterial hypertension, pain in the heart area has some distinctive features from angina attacks:
- located 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 eliminated by nitroglycerin;
- not provoked by physical activity.
A symptom of damage to the heart muscle and the development of heart failure is shortness of breath, which first appears during physical exertion, and subsequently at rest, swelling of the legs. But moderate peripheral edema in hypertension may be the result of sodium and water retention due to impaired renal excretory function or the intake of certain drugs.
Hypertensive crisis
At the peak manifestations of hypertension, it is accepted to speak of a hypertensive crisis. In this condition, 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.
A hypertensive crisis usually lasts from a few minutes to a few hours. At this time, patients complain of palpitations and a feeling of fear of death. Red spots may appear on the cheeks. Attacks of hypertensive crisis can be accompanied by copious urination and diarrhea. As a rule, this condition is provoked by strong emotional overstrain.
Hypertensive crisis is sometimes more severe, develops gradually and lasts for a long time. This type is usually found in the later stages of GB. It is accompanied by a speech disorder and the sensitivity of the limbs. In some cases, the patient has pain in the heart.
Hypertensive crises occur for the following reasons:
- psychotic stress;
- inadequate drug therapy;
- pain;
- the phenomenon of "rebound" that occurs against the background of drug withdrawal.
Hypertension in different age and gender groups
According to statistics, men are more susceptible to arterial hypertension than women. This is due to the fact that women are protected by sex hormones, estrogens. However, such an obstacle to hypertension is short-lived. During menopause, estrogen levels decrease and women are at risk of GB.
In the elderly, the main cause of hypertension is lack of physical activity. Vascular changes occur with age, due to which hypertension can progress dramatically. Usually, this group of patients has isolated systolic arterial hypertension, which is due to a decrease in vascular elasticity.
In children, hypertension is rare. The reasons for 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
In essential arterial hypertension, normalization of blood pressure, improvement of lifestyle and function of target organs is necessary. To do this, use drug therapy and general measures.
When the diagnosis is established, the patient must completely revise 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 followed by the patient. In the absence of timely treatment, there is a risk of sudden hypertensive crises leading to serious, deadly complications.
In the treatment of hypertension, doctors use the following groups of drugs:
- ACE inhibitors.
- Angiotensin II receptor blockers.
- Diuretics.
- calcium antagonists.
- Beta blockers.
- Imidazoline agonist prescriptions.
The above groups of drugs have their own contraindications, therefore they should be prescribed only by a doctor based on the stage of the disease, concomitant diseases. Treatment is usually first with a single drug, most commonly an ACE inhibitor. In case of insufficient effectiveness, agents 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 groups of drugs, nootropic drugs can be prescribed. They are used for symptoms of dyscirculatory hypertensive encephalopathy. With changes in the myocardium, vitamins and trace elements are used to help restore the muscle structure of the heart. If the patient experiences stressful loads, has an unstable emotional state, then sedatives are prescribed.