Hypertension

Hypertension is an extremely common disease, which as a collective definition combines several types of high blood pressure. Hypertension develops against the background of narrowing of the lumen of the walls of small vessels and arteries, as a result of which the normal movement of blood flow is disturbed and the blood accumulating in the narrowed places begins to put pressure on the walls of the artery. glasses.

What is hypertension?

High blood pressure can be a symptom, but it can also be an independent disease. If a person is diagnosed with chronic pathologies of the kidneys, cardiovascular system, thyroid gland and adrenal glands, hypertension is almost inevitable as one of the manifestations of these diseases. In addition, an increase in pressure can be an adaptive and adaptive reaction of organs and systems to changes, both external (excessive physical activity) and internal (psycho-emotional factors, stress). Almost all types of hypertension, with timely diagnosis, are controlled both with the help of drug therapy and with the help of other non-drug methods.

Normal blood pressure in a relatively healthy person is set between 100/60 and 140/90 mmHg; If the regulatory systems stop functioning properly, hypertension or hypotension can develop.

Statistics provide information that almost 30% of the world's population suffers from one stage or another of hypertension, and yet, until recently, practically nothing was known about a disease such as hypertension. Only Homo sapiens is characterized by alterations in the functioning of the cardiovascular system; no representative of the animal world is susceptible to them. Until the 19th and 20th centuries, initially little was known about hypertension; one of the first cases of heart attack was reliably confirmed by doctors only in the 30s of the last century in one of the European countries; During the same period there was not a single clinically confirmed case of cardiovascular pathologies in African and Asian countries. It was only with the development of urbanization and the penetration of modern technology in these countries that Asian and African populations also became vulnerable to hypertension, which peaked in the 70s of the 20th century.

Hypertension, since the end of the last century, has been divided into primary and secondary.

1. Primary (essential) hypertension is a separate nosological unit, an independent disease that is not provoked by dysfunction of organs and systems. Blood pressure increases for reasons other than kidney disease, for example. Hypertension diagnosed as primary (EG - essential hypertension or GB - essential hypertension) is characterized by a persistent clinical sign: increased pressure, both systolic and diastolic. Almost 90% of all patients with persistently elevated blood pressure suffer from primary hypertension.
2. Symptomatic hypertension, also called secondary, is hypertension caused by an underlying disease, for example, an inflammatory process in the renal system: glomerulonephritis, polycystic kidney disease, or a disorder of the pituitary gland or pancreas. In addition, secondary hypertension develops against the background of pathological changes in the vascular system (atherosclerosis) and can lead to symptomatic hypertension and neurotic diseases. In addition, secondary hypertension is quite common during pregnancy and with gynecological diseases: cysts and neoplasms.

Hypertension is also classified into grades based on the level of increase in blood pressure.

• If blood pressure is set between 140/90 and 159/99 mmHg, hypertension is diagnosed as a stage I disease. In this case, the pressure can return to normal, but periodically "jump" to the specified limits.
• If blood pressure registers in the range of 160/100 to 179/109 mmHg, hypertension is considered a stage II disease. There is practically no remission, but the pressure can be controlled with the help of medications.
• Blood pressure that consistently remains within the range of 180/110 and above is considered a clinical symptom of stage III hypertension. At this stage, blood pressure practically does not drop to normal levels, and if it drops, it is accompanied by heart weakness, up to heart failure.

Hypertension, in addition to having stages of disease development, is also divided into separate clinical forms. Hyperadrenergic hypertension is actually the initial stage of the development of the disease, which, however, can last for many years. This form of hypertension manifests as sinus tachycardia, unstable blood pressure when the systolic reading fluctuates, increased sweating, skin hyperemia, throbbing headaches, and anxiety. The face and extremities often swell, the fingers become numb, and urination becomes difficult. There is also a more serious form: malignant hypertension, which progresses rapidly. Blood pressure can increase so much that there is a risk of encephalopathy, vision loss, pulmonary edema and also a risk of kidney failure. Fortunately, this form practically does not occur today, since hypertension is most often diagnosed much earlier and its development can be stopped with the help of complex therapeutic measures.

Pressure gauges

Blood pressure is one of the most important indicators of human health and an indicator of the normal functioning of the cardiovascular system. Pressure has two parameters: systolic and diastolic. The top number is systole, which is an indicator of blood pressure during the period of contraction of the heart muscle, when blood enters the arteries. The lower number is the indicator of blood pressure during the period of relaxation of the heart muscle. It is believed that hypertension begins when readings exceed the norm of 140/90 mmHg. This, of course, is a conditional limit, since there are conditions in which the risk of developing myocardial infarction exists even with figures of 115/75 mmHg. However, formalizing and bringing to an average level the entire variety of blood pressure conditions helps doctors notice deviations in time and start symptomatic and then standard treatment.

ICD-10 code

I10 Essential [primary] hypertension.

What causes hypertension?

Hypertension is considered a multietiological and multifactorial disease, the real causes of which are not fully understood. The factors that cause secondary hypertension are more specific, since the cause is the underlying disease. The final diagnosis of essential hypertension is made after a complete examination that excludes the presence of precipitating diseases. Primary hypertension, in medical terms, is a genetic imbalance of the body's regulatory mechanisms (imbalance of the blood pressure pressor and depressor systems).

Among the reasons that doctors have described and carefully studied are the following:

• Kidney pathologies: nephritis and, more frequently, glomerulonephritis. Factor that causes secondary hypertension.
• Stenosis (narrowing) of the renal arteries.
• Congenital pathology in which the renal artery is obstructed (coarctation).
• Neoplasms of the adrenal glands: pheochromocytosis (impaired production of norepinephrine and adrenaline).
• Increased production of aldosterone is hyperaldosteronism, which occurs during a tumor process in the adrenal glands.
• Alteration of the functioning of the thyroid gland.
• Alcoholism.
• Overdose or constant use of medications, especially hormonal antidepressants.
• Addiction.

Factors that are considered provocative in the sense of alteration of normal blood pressure levels can be divided into nutritional, age-related and pathological:

• Age over 55 years for men and 65 years for women.
• Increased blood cholesterol levels (above 6. 6 mmol).
• Hereditary predisposition, family history.
• Obesity, especially abdominal obesity, when the waist circumference is greater than 100-15 cm in men and 88-95 cm in women.
• Diabetes, change in normal glucose tolerance levels.
• Physical inactivity, osteochondrosis.
• Chronic stress, increased anxiety.

The mechanism of development of hypertension is briefly as follows:

When the arterioles (the arteries of the organs, most often the kidneys) spasm under the influence of, for example, a stress factor, the nutrition of the kidney tissue is disturbed and ischemia develops. The kidneys try to compensate for the changes by producing renin, which in turn causes the activation of angiotensin, which constricts blood vessels. As a result, blood pressure increases and hypertension develops.

Symptoms of hypertension

The main symptom of hypertension, and sometimes the main one, is considered to be a persistent excess of 140/90 mmHg. Other signs of hypertension are directly related to blood pressure parameters. If the pressure increases slightly, the person simply feels bad, weak and has a headache.

If the pressure exceeds the norm by 10 units, the headache becomes intense and constant, most often localized in the back of the head and temples. The person feels nauseous and sometimes vomits. The face turns red, sweating increases, trembling of the fingers is noted, and numbness is often present.

If hypertension lasts a long time and is not treated, pathological processes develop in cardiac activity and the heart begins to hurt. The pain can be stabbing, sharp, it can radiate to the arm, but most often cardiac pain is localized on the left side of the chest, without spreading further. Against the background of constantly elevated blood pressure, anxiety and insomnia develop.

Hypertension is also characterized by dizziness and decreased vision.

Ophthalmological signs: veils or spots, "floaters" before the eyes. Often, when the pressure increases sharply, nosebleeds may occur.

Another symptom of hypertension is dizziness. Vision deteriorates.

The terminal stage, when hypertension reaches stage III, neurosis or depression joins the typical symptoms. Often, hypertension in this form occurs in a pathological "junction" with coronary heart disease.

The most dangerous manifestation of hypertension is a crisis, a condition with a sharp increase or increase in blood pressure. A crisis condition is fraught with a stroke or heart attack and is manifested by the following symptoms:

• A sharp, sudden, or rapidly growing headache.
• Blood pressure readings up to 260/120 mmHg.
• Pressure in the heart area, aching pain.
• Severe shortness of breath.
• Vomiting, beginning with nausea.
• Increased heart rate, tachycardia.
• Loss of consciousness, seizures, paralysis.

Hypertension in the crisis stage is a threatening condition that can provoke a stroke or heart attack, so at the slightest alarming sign, you should call emergency medical help. A hypertensive crisis is controlled with the help of diuretics, cardiological and hypertensive drugs administered by injection. A hypertensive patient who knows his problem must constantly take the prescribed medications to prevent a crisis state.

Who to contact?

Cardiologist.

Hypertension treatment

Hypertension in the initial stage, when blood pressure readings usually do not exceed normal levels, can be treated with non-drug medications. The first way is to control body weight and follow a diet low in carbohydrates and fats. A diet for hypertension also involves limiting the intake of salty foods and controlling fluid intake - no more than 1. 5 liters per day. Psychotherapy and autogenic training are also effective, relieving anxiety and general tension. These methods are effective for stage I hypertension, although they can be used as auxiliary and additional elements to the main treatment of stage II and III hypertension.

Pharmacological agents involving the treatment of hypertension are prescribed according to a "step" principle. They are used sequentially, targeting various organs and systems, until blood pressure is completely stabilized.

Stage I hypertension involves the use of diuretics (diuretics), beta-blockers and adrenergic receptor blockers to stop tachycardia. The beta-blocker dose is calculated based on the patient's medical history, weight, and condition. If blood pressure normalizes after two or three days, the dose is reduced and often taken every other day. As a diuretic, a drug from the thiazide group is effective, which is prescribed 25 mg once, alternating doses every one or two days, so as not to weaken the heart muscle. If hypertension begins to decrease, a diuretic may be prescribed once a week. There are often cases when diuretics and beta-blockers cannot be used due to possible side effects (diabetes, gout or asthma), in such situations taking antispasmodics is indicated. Throughout treatment, you should monitor your blood pressure levels three times a day.

Stage II hypertension is controlled by complex therapy including beta-blockers, diuretics, antispasmodics, ACE inhibitors (angiotensin-converting enzyme inhibitors) and potassium preparations. Among beta blockers, effective drugs are those that can control rapid heartbeat and reduce vascular resistance in the periphery. These medications are also effective for diagnosed bradycardia, when the heart rate is reduced. Angiotensin-converting enzyme inhibitors can neutralize the increased production of renin, which increases blood pressure. These drugs activate the work of the left cardiac ventricle, reduce hypertrophy, dilate the coronary vessels and thus help to normalize peripheral blood flow. Calcium antagonists are designed to block calcium channels in vascular walls, increasing their lumen. Calcium antagonists should only be prescribed by a doctor or cardiologist, as all of these medications can cause bloating, dizziness, and headache. A set of drugs is selected taking into account all possible side risks and contraindications. It should also be taken into account that prolonged use of diuretics can cause a decrease in potassium levels in the body (hypokalemia), so diuretics should be taken together with potassium supplements.

Stage III hypertension is a severe form of the disease, which is characterized by the body's resistance to traditional medications. Therefore, treatment should be carefully selected taking into account all the individual characteristics of the patient. The therapeutic complex includes diuretics, most often potassium-sparing, and the use of peripheral vasodilators is also indicated. The pharmaceutical industry today produces many effective combination drugs. These drugs act on those patients whose body is accustomed to monotherapy and has stopped responding to it, or has significant contraindications to the use of the standard treatment used for hypertension in stages I and II.

Severity III hypertension is also controlled by vasodilators. Increasingly, vasodilators have begun to be replaced by alpha-blockers. A drug combination that combines the properties of alpha and beta blockers may also be effective. This remedy, in combination with a diuretic, can replace three or even four less effective drugs. An ACEI is used to prescribe a drug that improves peripheral circulation and controls renin levels. The drug is taken three to four times a day, combined with a diuretic, which allows blood pressure to be reduced to normal after a week.

Hypertension of grades I and II can be treated at home and does not require hospitalization. In rare cases, hospital treatment is possible to perform analytical tests and monitor the state of health. Hypertension, which occurs in severe forms, is treated only in a hospital, in the cardiology department, the duration of the hospital stay depends on the state of blood pressure and the functioning of the organs and systems of the body.

How is hypertension prevented?

Hypertension, if it has already developed, unfortunately, remains in the person forever. Prevention in this sense only refers to the prevention of crisis situations through the regular use of prescription medications, daily monitoring of blood pressure, feasible physical activity, and weight loss.

However, if a person has a family history of relatives with hypertension, but the disease has not yet manifested itself, preventive measures can be taken. The rules are quite simple: maintain a healthy lifestyle and physical activity, because one of the reasons that causes hypertension is physical inactivity. Hypertension is also prevented by a normal diet, in which cholesterol and salty foods are kept to a minimum.

Hypertension is also a bad habit, so if a person does not want to join the ranks of hypertensive patients, he should quit smoking and limit the consumption of alcoholic beverages. In addition, a positive mood and attitude help to cope with any illness, and hypertension "loves" pessimists. The recipe is simple: enjoy life, stay calm and take care of your nerves, then your heart and blood vessels will work "like a clock" and the pressure will be, according to the well-known saying, "like an astronaut. ".