Hypertension is a disease that is associated with impaired blood pressure levels. It can have different etiology, be primary or secondary. There are several degrees and stages of arterial hypertension, as well as 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 the condition is life-threatening. 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. capeArt. Only minor deviations from this value are possible. Only in some cases such indicators as 100/65 or 135/110 mm are the norm. capeArt. 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 shows the force of contraction of the heart walls. The second is diastolic (lower), which indicates the value with a relaxed heart.
Types of hypertension:
- Essential (primary) - occurs in 90-95% of cases in all patients with arterial hypertension.
- Symptomatic - secondary form of hypertension, which is observed only in 5-10% of cases.
Constantly high blood pressure occurs on 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, and 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. Characteristic symptoms appear with the progression of left ventricular dysfunction.
GB (hypertension) can occur with different degrees of severity and dynamics. There are several forms of hypertension:
- Transient. Blood pressure occasionally rises, spontaneously stabilizes after a few hours or days without the use of medication.
- Labile. The manifestation is also periodic, but treatment is required to normalize blood pressure.
- stable. High blood pressure levels last a long time, the patient needs constant treatment.
- Malignant. Blood pressure, especially diastolic, rises to critical levels, and susceptibility to treatment is low. There is a possibility of rapid development of the disease with simultaneous occurrence of severe complications.
- Crisis. Periodically observed hypertensive crises. They can follow 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.
phases
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, possible crises, but no symptoms of target organ damage.
- Phase 2. Signs of damage to the target organs are observed - the myocardium is hypertrophied, kidney function is disturbed, changes in the retina are noticeable.
- Stage 3. Serious complications are possible - stroke, impairment of visual function, myocardial infarction, atherosclerosis or aortic aneurysm.
Target organs are involved in stage 2 HD, so patients should be screened for possible risks. ECG, ultrasound of the heart are designed to identify the degree of cardiac muscle hypertrophy; blood and urine are taken for tests (proteins, creatinine) to determine indicators of kidney function.
The third stage of GB can occur with associated pathologies related to hypertension. Among them, transient ischemic attacks, stroke, angina pectoris and myocardial infarction are the most important for the prognosis.
Degree of hypertension
The degree of GB is determined based on blood pressure values. It is important in risk and prediction.
Hypertension is diagnosed when blood pressure exceeds 140/90 mm. capeArt. 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 greater than 140 mm. capeArt. , and 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 range.
With the greatest accuracy, the degree of hypertension is determined at the first detection of the disease. In the case when drugs (antihypertensives) are used, blood pressure can suddenly 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 kidney failure. Therefore, for each patient with high blood pressure, the risk is assigned from 1 to 4, with a higher value indicating the greatest risk.
With GB, the risk for patients is determined 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:
- age of the patient (for men - after 55 years, and for women - 65 years);
- smoking;
- presence among relatives younger than 65 (for women) and 55 (for men) of persons with cardiovascular pathologies;
- violation of lipid metabolism (reduction of high-density lipid fractions, excess of low-density lipoprotein and cholesterol norms);
- overweight (body weight is considered overweight if the abdominal circumference is greater than 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, increasing the likelihood of complications.
In order to determine the risk of GB, it is necessary to take into account the transmitted complications. For example, if a patient has had a stroke, he is at very high risk (4). In the first and second degree of GB with a normal state of health (no damage to internal organs) and provoking factors such as smoking and age, a moderate risk is set - 2.
Low risk means that the probability of complications is no higher than 15%, which is indicated by the number 1. A value of 2 is a moderate risk with a probability of up to 20%. A value of 3 corresponds to high risk, and the probability of heart attack and stroke does not exceed 30-33%. The highest risk (4) is determined when the probability of vascular accidents is greater than 35%.
Reasons
The following factors can cause essential GB:
- excess body weight due to disturbed metabolism, sedentary lifestyle, endocrine diseases;
- excessive nervous tension, depression, stressful situations, etc. ;
- regular increased psycho-emotional stress associated with professional activities;
- previous brain injuries (hypothermia, falls, bruises);
- hereditary predisposition (the first symptoms of high blood pressure may appear at a young age if the patient's parents suffered 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 that hinder blood circulation;
- significant hormonal changes in menopause in women over 40 years old;
- high consumption of caffeinated drinks, alcohol and smoking;
- prolonged mental activity;
- sudden increase of adrenaline in the blood;
- excessive consumption of salty food;
- sedentary lifestyle;
- 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 function of the thyroid gland;
- 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 can be unaware of high blood pressure for many years, they do not feel discomfort in leading a normal lifestyle. In some cases, minor weakness and dizziness may occur, which are often attributed to overwork.
Usually, the first complaints are related to target organ damage, which occurs in stage 2 HD. In the case of a violation of cerebral circulation, a person experiences severe dizziness, noise in the head, headaches, a decrease in performance and deterioration of memory. With the progression of the disease, flies before the eyes, numbness of the extremities, speech disorders are possible. Usually in the initial stages these symptoms are transient. With a 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 area of the gap, which cannot be removed with analgesic drugs. In case of kidney damage, proteins and erythrocytes are found in the urine. In rare cases, hypertension can develop kidney failure. Damage to the eyes leads to deterioration of visual function, up to the development of blindness.
Usually, with further progression of hypertension, the headache persists. It has nothing to do with 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 covers other areas as well. Patients usually describe the pain as a "hoop" feeling, due to tension in the muscles of the soft integuments of the head or the tendinous helmet of the head. Such a symptom is intensified by strong coughing, straining, tilting the head, psycho-emotional stress, and may be accompanied by slight swelling of the eyelids and face. Long-term headaches lead to the development of irritability, irritability, increased sensitivity to external stimuli (noise, loud music). With a vertical position, muscle activity or massage, the venous outflow improves, so the pain decreases or disappears for a while.
With arterial hypertension, pain in the heart area has some characteristics of an angina attack:
- localized in 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 induced by physical activity.
Shortness of breath, which occurs first during physical exertion, and then at rest, swelling of the legs is also a symptom of damage to the heart muscle and the development of heart failure. However, moderately pronounced peripheral edema in hypertension may be the result of sodium and water retention due to impaired kidney function or taking certain medications.
Hypertensive crisis
At the peak of the manifestation of hypertension, it is common to speak of a hypertensive crisis. In this condition with a sudden 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 caused by strong emotional overstrain.
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 impaired speech and tenderness 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 "rebound" phenomenon, which 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 for GB.
In the elderly, the main cause of hypertension is physical inactivity. Vascular changes occur with age, due to which hypertension can progress dramatically. Usually, this group of patients has isolated systolic arterial hypertension, which is caused by a decrease in vascular elasticity.
Hypertension is rare in children. The causes of GB development are the same as in adult patients. Treatment of diseases in children is somewhat complicated, because not all types of drugs can be used.
Treatment
In case of essential arterial hypertension, it is necessary to normalize blood pressure, improve lifestyle and target organ function. To do this, use drug therapy and general measures.
When making a diagnosis, the patient should completely reconsider his lifestyle. First of all, you should 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 the patient must follow it completely. In the absence of timely treatment, there is a risk of sudden hypertensive crises that lead to serious, 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.
- Imidazoline prescription agonists.
The above-mentioned groups of drugs have their own contraindications, so they should only be prescribed by a doctor based on the stage of the disease, accompanying diseases. Treatment is usually with a single drug first, most often an ACE inhibitor. With its insufficient effectiveness, agents from other groups are added to the treatment regimen. This approach allows the use of drugs in small doses, which reduces the likelihood of side effects.
In addition to the mentioned groups of drugs, nootropic drugs can also be prescribed. They are used for symptoms of dyscirculatory hypertensive encephalopathy. In the case of changes in the myocardium, vitamins and microelements 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.