Main criterionhigh blood pressure (or high blood pressure)as a whole group of diseases: stable, that is, an increase in blood pressure (BP) detected by repeated measurements on different days.The question of what type of blood pressure is considered high is not as simple as it might seem.The fact is that among practically healthy people the range of blood pressure values is quite wide.The results of long-term observation of people with different levels of blood pressure showed that already starting from the level of 115/75 mm Hg.Art., each additional increase in blood pressure of 10 mm Hg.Art.It is accompanied by an increased risk of developing cardiovascular diseases (mainly coronary heart disease and stroke).However, the benefits of modern methods of treating high blood pressure have been demonstrated mainly only in those patients whose blood pressure exceeds 140/90 mmHg.Art.That is why it was agreed to consider this threshold value as a criterion to identify high blood pressure.
Increased blood pressure can be accompanied by dozens of different chronic diseases, and hypertension is only one of them, but the most common - about 9 cases out of 10. The diagnosis of hypertension is established in cases where there is a stable increase in blood pressure, but other diseases that lead to an increase in blood pressure are not detected.
Hypertension is a disease whose main manifestation is a stable increase in blood pressure.Risk factors that increase the likelihood of its development have been established through observations of large groups of people.In addition to the genetic predisposition that some people have, these risk factors include:
- obesity;
- inactivity;
- excessive consumption of table salt, alcohol;
- chronic stress;
- smoking.
In general, all those characteristics that accompany the modern urban lifestyle in industrialized countries.This is why hypertension is considered a lifestyle disease, and specific changes for improvement should always be considered as part of a hypertension treatment program on a case-by-case basis.
What other diseases are accompanied by increased blood pressure?These are many kidney diseases (pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, stenosis (narrowing) of the renal arteries, etc.), a number of endocrine diseases (adrenal tumors, hyperthyroidism, Cushing's disease and syndrome), obstructive sleep apnea syndrome and some other rarer diseases.Regular use of medications such as glucocorticosteroids, nonsteroidal anti-inflammatory drugs, and oral contraceptives can also cause a persistent increase in blood pressure.The diseases and conditions listed above lead to the development of so-called secondary or symptomatic arterial hypertension.The doctor makes a diagnosis of hypertension if, during a conversation with the patient, determining the history of the disease, examination, as well as based on the results of some, mostly simple, instrumental and laboratory research methods, the diagnosis of any of the secondary arterial hypertension seems unlikely.
If you notice similar symptoms, see your doctor.Do not self-medicate, it is dangerous for your health!
Symptoms of high blood pressure.
High blood pressure itself does not manifest itself in any subjective sensation for many people.If high blood pressure is accompanied by symptoms, these may include a feeling of heaviness in the head, headache, flashes before the eyes, nausea, dizziness, unsteadiness when walking, as well as a number of other symptoms that are not specific to high blood pressure.The symptoms listed above manifest themselves much more clearly during a hypertensive crisis: a sudden and significant increase in blood pressure, which leads to a clear deterioration in condition and well-being.
It would be possible to continue listing the possible symptoms of hypertension, separated by commas, but this does not bring any particular benefit.Because?Firstly, all these symptoms are not specific to hypertension (that is, they can occur individually or in various combinations in other diseases), and secondly, to establish the presence of arterial hypertension, the very fact of a stable increase in blood pressure is important.And this is not revealed by evaluating subjective symptoms, but only by measuring blood pressure, and repeatedly.This means, first of all, that "in one go" you should measure blood pressure two or three times (with a short break between measurements) and take the arithmetic mean of two or three measured values as the true blood pressure.Secondly, the stability of the increase in blood pressure (criterion for diagnosing hypertension as a chronic disease) should be confirmed by measurements on different days, preferably with an interval of at least a week.
If a hypertensive crisis develops, there will definitely be symptoms;Otherwise, it is not a hypertensive crisis, but simply an asymptomatic increase in blood pressure.And these symptoms may be those listed above or other more serious ones;They are discussed in the "Complications" section.
Symptomatic (secondary) arterial hypertension develops as part of other diseases, and therefore its manifestations, in addition to the actual symptoms of high blood pressure (if any), depend on the underlying disease.For example, with hyperaldosteronism, this can be muscle weakness, cramps, and even transient paralysis (lasting hours or days) in the muscles of the legs, arms, and neck.With obstructive sleep apnea syndrome: snoring, sleep apnea, daytime sleepiness.
If hypertension over time (usually many years) causes damage to various organs (in this context they are called "target organs"), then this can manifest itself as a decrease in memory and intelligence, a stroke or a transient cerebrovascular accident, an increase in the thickness of the walls of the heart, an accelerated development of atherosclerotic plaques in the vessels of the heart and other organs, a myocardial infarction or angina pectoris, a decrease in the rate of blood filtration in the kidneys,etc.be caused by these complications, and not by an increase in blood pressure as such.
Pathogenesis of arterial hypertension.
In hypertension, dysregulation of vascular tone and increased blood pressure are the main content of this disease, so to speak, its "quintessence".Factors such as genetic predisposition, obesity, inactivity, excessive consumption of table salt, alcohol, chronic stress, smoking and many others, mainly related to lifestyle characteristics, lead over time to a disturbance in the functioning of the endothelium, the inner layer of arterial vessels of a layer of thick cells, which is actively involved in regulating the tone and, therefore, the lumen of blood vessels.The tone of the vessels of the microvasculature and, therefore, the volume of local blood flow in organs and tissues, is regulated autonomously by the endothelium and not directly by the central nervous system.This is a local blood pressure regulation system.However, there are other levels of blood pressure regulation: the central nervous system, the endocrine system, and the kidneys (which also play their regulatory role largely due to their ability to participate in hormone regulation at the whole-body level).Violations of these complex regulatory mechanisms lead, in general, to a decrease in the ability of the entire system to finely adapt to the constantly changing needs of organs and tissues for blood supply.
Over time, persistent spasm of small arteries develops, and subsequently their walls change so much that they can no longer return to their original state.In larger vessels, due to the constant increase in blood pressure, atherosclerosis develops at an accelerated rate.The walls of the heart become thicker, myocardial hypertrophy develops, and then the chambers of the left atrium and left ventricle expand.The increased pressure damages the glomeruli, their number decreases and, as a result, the ability of the kidneys to filter blood decreases.In the brain, due to changes in the blood vessels that supply it, negative changes also occur: small foci of hemorrhage appear, as well as small areas of necrosis (death) of brain cells.When an atherosclerotic plaque ruptures into a sufficiently large vessel, thrombosis occurs, the lumen of the vessel is blocked, and this causes a stroke.
Classification and stages of development of arterial hypertension.
Hypertension, depending on the magnitude of elevated blood pressure, is divided into three degrees.Furthermore, taking into account the increased risk of cardiovascular diseases on a “year-decade” scale, starting from a blood pressure level higher than 115/75 mm Hg.Art., There are several more gradations of blood pressure levels.
If the values of systolic and diastolic blood pressure are divided into different categories, then the degree of arterial hypertension is assessed by the greater of the two values, and it does not matter: systolic or diastolic.The degree of increase in blood pressure when diagnosing hypertension is determined by repeated measurements on different days.
In some countries, stages of high blood pressure continue to be distinguished, while the European guidelines for the diagnosis and treatment of high blood pressure do not mention any stage.The identification of stages is intended to reflect the phases of the course of hypertension from its onset to the appearance of complications.
There are three stages:
- Stage Iimplies that there is still no obvious damage to those organs that are most often affected by this disease: there is no enlargement (hypertrophy) of the left ventricle of the heart, there is no significant decrease in the filtration rate in the kidneys, which is determined taking into account the level of creatinine in the blood, no albumin protein is detected in the urine, no thickening of the walls of the carotid arteries or atherosclerotic plaques in them is detected, etc.generally asymptomatic.
- If there is at least one of the listed signs, diagnoseStage IIhypertension.
- Finally, aboutStage IIIHypertension is said to occur when there is at least one cardiovascular disease with clinical manifestations associated with atherosclerosis (myocardial infarction, stroke, angina pectoris, atherosclerotic lesion of the arteries of the lower extremities), or, for example, severe kidney damage, manifested by a pronounced decrease in filtration and/or a significant loss of protein in the urine.
These stages do not always naturally replace each other: for example, a person suffered a myocardial infarction, and after a few years an increase in blood pressure occurred;It turns out that this patient immediately has stage III hypertension.The goal of staging is primarily to classify patients according to their risk of cardiovascular complications.Treatment measures also depend on this: the higher the risk, the more intensive the treatment.When formulating a diagnosis, risk is evaluated in four gradations.At the same time, the 4th gradation corresponds to the highest risk.
Complications of high blood pressure.
The goal of hypertension treatment is not to "lower" high blood pressure, but rather to minimize the risk of long-term cardiovascular and other complications, since this risk (again, when assessed on a "decades of years" scale) increases for each additional 10 mm Hg.Art.already from a blood pressure level of 115/75 mm Hg.Art.This refers to complications such as stroke, coronary heart disease, vascular dementia (dementia), chronic renal and chronic heart failure, atherosclerotic vascular lesions of the lower extremities.
Most hypertensive patients do not worry about anything at the moment, so they do not have much motivation to receive treatment, they regularly take a minimum of medications and change their lifestyle to a healthier one.However, in the treatment of hypertension there are no single measures that allow you to forget about this disease forever without doing anything else to treat it.
Diagnosis of high blood pressure.
For the diagnosis of arterial hypertension as such, everything is usually quite simple: for this it is enough to repeatedly record blood pressure at the level of 140/90 mm Hg.Art.and higher.But hypertension and high blood pressure are not the same: as already mentioned, an increase in blood pressure can manifest itself in various diseases, and hypertension is only one of them, although the most common.When making a diagnosis, the doctor, on the one hand, must ensure that the increase in blood pressure is stable, and on the other hand, assess the likelihood that the increase in blood pressure is a manifestation of symptomatic (secondary) arterial hypertension.
To do this, in the first stage of the diagnostic search, the doctor finds out at what age blood pressure began to increase and whether symptoms appear, such as snoring with pauses.in breathing during sleep, attacks of muscle weakness, unusual impurities in urine, attacks of tachycardia with sweating and headache, etc.It makes sense to clarify what medications and dietary supplements the patient is taking, because in some cases they can cause an increase in blood pressure or aggravation of an already elevated one.Various routine diagnostic tests (carried out on almost all patients with high blood pressure), together with information obtained during a conversation with a doctor, help to assess the likelihood of some forms of secondary hypertension: a complete urinalysis, determination of blood concentrations of creatinine and glucose, and sometimes potassium and other electrolytes.In general, taking into account the low prevalence of secondary forms of arterial hypertension (about 10% of all its cases), an increased search for these diseases as a possible cause of arterial hypertension should have good reasons.Therefore, if at the first stage of the diagnostic search no significant data are found in favor of the secondary nature of arterial hypertension, in the future it is considered that blood pressure increases due to hypertension.Sometimes this judgment may be revised later as new data about the patient become available.
In addition to searching for data on the possible secondary nature of increased blood pressure, the doctor determines the presence of risk factors for cardiovascular diseases (this is necessary to assess the prognosis and a more specific search for damage to internal organs), as well as, possibly, pre-existing diseases of the cardiovascular system or its asymptomatic damage;This affects the assessment of the prognosis and stage of hypertension, the choice of therapeutic measures.To do this, in addition to talking with the patient and examining him, a number of diagnostic studies are performed (for example, electrocardiography, echocardiography, ultrasound of the vessels of the neck and, if necessary, some other studies, the nature of which is determined by the medical data already obtained about the patient).
Daily monitoring of blood pressure using special compact devices makes it possible to evaluate changes in blood pressure during the patient's usual lifestyle.This study is not necessary in all cases, mainly if the blood pressure measured at the doctor's appointment differs significantly from that measured at home, if it is necessary to evaluate nighttime blood pressure, if episodes of hypotension are suspected, and sometimes to evaluate the effectiveness of the treatment.
Thus, in all cases, some diagnostic methods are used when examining a patient with arterial hypertension;the use of other methods is more selective, depending on the data already obtained about the patient, to check the assumptions that the doctor made during the preliminary examination.
Treatment of high blood pressure.
As for non-pharmacological measures aimed at treating hypertension, the most convincing evidence has been accumulated about the positive role of reducing salt intake, reducing and maintaining body weight at this level, engaging in regular physical exercise (exertion), no more than moderate alcohol consumption, as well as increasing the content of vegetables and fruits in the diet.Only all of these measures are effective as part of long-term changes in the unhealthy lifestyle that led to the development of hypertension.For example, a decrease in body weight of 5 kg caused a decrease in blood pressure of an average of 4.4/3.6 mmHg.Art.- It seems little, but in combination with the other measures listed above to improve lifestyle, the effect can be quite significant.
Lifestyle improvement is justified in almost all patients with hypertension, but pharmacological treatment is indicated, although not always, in most cases.If patients with an increase in blood pressure of 2 and 3 degrees, as well as with hypertension of any degree with a high calculated cardiovascular risk, drug treatment is mandatory (its long-termbenefit has been proven in manyclinical studies), then in grade 1 hypertension with calculated low and moderate cardiovascular risk, the benefit of such treatment has not been convincingly demonstrated in large clinical trials.In such situations, the possible benefit of drug therapy is evaluated individually, taking into account the patient's preferences.If, despite improving lifestyle, the increase in blood pressure in these patients persists for several months during repeated visits to the doctor, the need for medication needs to be reassessed.Furthermore, the magnitude of the calculated risk often depends on the completeness of the patient's examination and may turn out to be significantly higher than initially thought.In almost all cases of hypertension treatment, efforts are made to achieve stabilization of blood pressure below 140/90 mmHg.Art.This does not mean that in 100% of measurements it will be below these values, but the less often the blood pressure, measured under standard conditions (described in the "Diagnosis" section), exceeds this threshold, the better.Thanks to this treatment, the risk of cardiovascular complications is significantly reduced and hypertensive crises, if they occur, are much less frequent than without treatment.Thanks to modern medications, those negative processes that, in hypertension, inevitably and latently destroy the internal organs (mainly the heart, brain and kidneys) over time, these processes are slowed down or suspended and, in some cases, can even be reversed.
Of the drugs for the treatment of hypertension, the main ones are 5 classes of drugs:
- diuretics (diuretics);
- calcium antagonists;
- angiotensin-converting enzyme inhibitors (names ending in -adj);
- angiotensin II receptor antagonists (names ending in -sartan);
- beta blockers.
Recently, the role of the first four drug classes in the treatment of hypertension has been especially emphasized.Beta-blockers are also used, but mainly when their use is required by concomitant diseases;In these cases, beta blockers have a dual purpose.
Today, preference is given to combinations of drugs, since treatment with any of them rarely leads to achieving the desired level of blood pressure.There are also fixed combinations of drugs that make the treatment more comfortable, since the patient takes only one tablet instead of two or even three.The selection of the classes of drugs necessary for a particular patient, as well as their doses and frequency of administration, is carried out by the doctor, taking into account data about the patient such as the level of blood pressure, concomitant diseases, etc.
Thanks to the many positive effects of modern drugs, the treatment of hypertension involves not only reducing blood pressure as such, but also protecting internal organs from the negative effects of the processes accompanying high blood pressure.In addition, since the main goal of treatment is to minimize the risk of complications and increase life expectancy, it may be necessary to correct the level of cholesterol in the blood, take medications that reduce the risk of blood clots (leading to myocardial infarction or stroke), etc.Quitting smoking, no matter how trivial it may seem, allows you to significantly reduce the risks of stroke and myocardial infarction associated with hypertension and slow down the growth of atherosclerotic plaques in blood vessels.Therefore, treating hypertension involves addressing the disease in many ways, and achieving normal blood pressure is just one of them.
Forecast.Prevention
The general prognosis is determined not only and not so much by the fact of high blood pressure, but by the number of risk factors for cardiovascular diseases, the degree of severity and the duration of the negative impact.
These risk factors are:
- smoke;
- increased blood cholesterol levels;
- hypertension;
- obesity;
- sedentary lifestyle;
- age (with each decade lived after age 40, the risk increases);
- male gender and others.
In this case, not only the intensity of exposure to risk factors is important (for example, smoking 20 cigarettes a day is undoubtedly worse than 5 cigarettes, although both are associated with a worse prognosis), but also the duration of your exposure.For people who do not yet suffer from obvious cardiovascular diseases other than hypertension, the prognosis can be assessed using special electronic calculators, one of which takes into account sex, age, blood cholesterol level, blood pressure and smoking.The SCORE electronic calculator is suitable for estimating the risk of death from cardiovascular diseases in the next 10 years from the date of risk assessment.At the same time, the risk obtained in most cases, which is low in absolute numbers, can give a misleading impression, because the calculator allows the risk of cardiovascular death to be calculated.The risk of non-fatal complications (myocardial infarction, stroke, angina, etc.) is many times higher.The presence of diabetes mellitus increases the risk compared to that calculated with a calculator: for men 3 times and for women even 5 times.
Regarding the prevention of hypertension, we can say that since the risk factors for its development are known (inactivity, excess weight, chronic stress, regular lack of sleep, alcohol abuse, increased consumption of table salt and others), all lifestyle changes that reduce the impact of these factors also reduce the risk of developing hypertension.However, it is almost impossible to completely reduce this risk to zero: there are factors that do not depend on us at all or depend little on us: genetic characteristics, sex, age, social environment and some others.The problem is that people start thinking about the prevention of hypertension mainly when they are no longer healthy and blood pressure is already increased to one degree or another.And it's not so much about prevention as it is about treatment.