Hypertension or arterial hypertension is a condition characterized by a stable increase in blood pressure, that is, it is detected by repeated measurements.Along with many diseases, it is considered a risk factor for the development of dangerous complications from 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 exerted by circulating blood 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.but starting from a level of 115/75 mm Hg.Art.However, lowering blood pressure with medication only above 140/90 mm has been shown to be advisable.capeart., therefore this value is taken 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 detected during the examination.Among the latest:
- kidney pathologies - pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, renal artery stenosis;
- endocrine disorders - neoplasms of the adrenal gland, 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.
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 excess 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 the disease that leads to increased blood pressure, arterial hypertension is called secondary or symptomatic.When the cause is unknown, hypertension is considered primary hypertension.
The latter has a staged course:
- Phase I. There are no obvious signs of disturbances in the work of the target organs affected by a stable increase in blood pressure - the heart, kidneys, arterial and venous vessels.
- Phase II.One of the above signs or a combination of them is present, such as an increase in the left heart chamber, a marked 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, clinical manifestations of the disease may be absent.
- Stage III hypertension.There is one or more pathologies associated with atherosclerotic processes in the heart and blood vessels - myocardial infarction, acute cerebrovascular infarction, angina pectoris, atherosclerosis of the arteries of the lower extremities or severe kidney damage, which is 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.capeArt.and/or diastolic – from 90 to 99 mm.capeArt.
- Second degree.Systolic blood pressure from 160 to 179 mm.capeArt.and/or diastolic – from 100 to 109 mm.capeArt.
- Third degree.Systolic blood pressure is greater than 180 mm.capeArt.and/or diastolic over 110 mm.capeArt.
There is also an isolated form of arterial hypertension, where only the systolic pressure numbers are increased, 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, which is why it is so important to measure blood pressure regularly, especially for middle-aged and elderly people.
Manifestations of hypertension may include the following symptoms:
- headache, mostly in the morning after waking up;
- nosebleeds;
- bleeding under the mucous membrane of the eye;
- heart rhythm disorder;
- blurred vision, flickering spots;
- tinnitus.
A sharp jump in blood pressure to high numbers, followed by a pronounced deterioration of well-being, is called a hypertensive crisis.It most often occurs when the systolic pressure rises to more than 180 mmHg.Art.and/or diastolic over 120 mm Hg.Art.In this case, the patient feels weakness, nausea, vomiting that does not bring relief, disturbance of 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.This includes:
- acute cerebrovascular infarction (stroke);
- angina pectoris, myocardial infarction;
- vascular dementia (dementia);
- chronic kidney and heart failure;
- atherosclerotic lesions of the blood vessels of the lower extremities.
Diagnostics
The main sign of hypertension is a stable increase in blood pressure, detected in at least three measurements on different days in a quiet environment.When measuring blood pressure for the first time in a hospital or clinic, in order 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 cuff of the tonometer must correspond to the thickness of the hand, and the device itself must be mounted at the level of the heart;
- two measurements are taken at an interval of 1-2 minutes on each arm;if there is a big difference in the obtained figures, an additional measurement is made;
- in elderly patients, as well as people suffering from diabetes mellitus or if a decrease in blood pressure is suspected in the event of a change in body position, the measurement is performed in the first and fifth minutes in a standing position;
- In addition, the pulse is measured for 30 seconds.
The doctor, in a conversation with the patient, explains at what age the pressure first started to rise, whether there are symptoms such as snoring with pauses in breathing during sleep, attacks of muscle weakness or sudden heartbeat with sweating and headache, and unusual impurities in the urine.It is also important to find out what medications and dietary supplements he is taking.
As part of the first phase of the examination for hypertension, the following tests are performed:
- clinical blood test;
- general analysis of urine, detection of microalbumin in individual and daily portions;
- biochemical blood test (cholesterol, lipoprotein level to assess the risk of atherosclerosis, blood electrolytes - potassium, sodium, chlorine, calcium, as well as glucose and creatinine);
- determining the level of glycated hemoglobin;
- determination of hormone concentration - thyroxine, triiodothyronine and thyrostimulating hormone, antibodies to thyroid peroxidase and thyroglobulin, aldosterone.
If a hereditary predisposition to the disease is suspected, it is possible to determine gene polymorphisms that are associated with the development of arterial hypertension.
In order to clarify risk factors for the 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 scan of brachiocephalic, renal or iliofemoral arteries;
- ultrasound examination of kidneys and adrenal glands;
- fund review.
With 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, the measurements must be taken in a sitting position, after a few minutes of rest, keeping the hand at the same level as the 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 give up bad habits with regular blood pressure measurements.Often these measures are sufficient to normalize blood pressure.
A hypertension diet includes limiting table salt, caffeine, hot, salty, smoked and spicy foods, high-fat foods, offal, buttercream confections, and alcoholic beverages.It is allowed not to consume more than 5 g of salt per day except for the exacerbation of the disease.The recommended daily fluid intake is 1-1.2 liters.
In the case of several months of unsuccessful non-drug treatment, as well as in the case of a high risk of complications, they resort to antihypertensive therapy with drugs for hypertension, the goal of which is to lower blood pressure to less than 140/90 mm.capeArt.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.capeArt.
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 tablets for hypertension.
Prevention
Prevention of exacerbations of hypertension involves 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 blood pressure measurement.