Hypertension

Hypertension is an extremely common disease, which as a collective definition combines several types of arterial hypertension. 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 disrupted, and the blood accumulating in the narrowed places begins to put pressure on the walls of the vessels.

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, adrenal glands, hypertension is almost inevitable as one of the manifestations of these diseases. Also, an increase in pressure can be an adaptive, 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 fixed between 100/60 and 140/90 mmHg; if the regulatory systems stop working correctly, hypertension or hypotension may develop.

Statistics provide information that almost 30% of the world's population suffer from one stage or another of hypertension, and yet until recently, practically nothing was known about such a disease as hypertension. Only Homo sapiens are characterized by disturbances in the functioning of the cardiovascular system; no representative of the animal world is susceptible to them. Until the 19th-20th centuries, little was known about hypertension in principle; 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 casecardiovascular pathologies in African and Asian countries. It was only with the development of urbanization and the penetration of modern technology into these countries that the 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, which is also called secondary, is hypertension provoked 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. Also, secondary hypertension develops against the background of pathological changes in the vascular system - atherosclerosis, and can provoke symptomatic hypertension and neurotic disease. Also, secondary hypertension is quite common during pregnancy and with gynecological diseases - cysts and neoplasms.

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

• If blood pressure is fixed between 140/90 and 159/99 mmHg, hypertension is diagnosed as a stage I disease. In this case, the pressure may return to normal, but periodically "jump" to the specified limits.
• If blood pressure is recorded in the range from 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 constantly remains within the range of 180/110 and higher is considered a clinical symptom of stage III hypertension. At this stage, blood pressure practically does not fall to normal levels, and if it does drop, it is accompanied by cardiac 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 itself as sinus tachycardia, unstable blood pressure when the systolic reading fluctuates, increased sweating, skin hyperemia, throbbing headaches, and anxiety. The face and limbs often swell, fingers go numb, and urination is impaired. There is also a more serious form - malignant hypertension, which rapidly progresses. Blood pressure can increase so much that there is a risk of encephalopathy, vision loss, pulmonary edema, and there is 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 indicators

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 blood pressure indicator during the period of relaxation of the heart muscle. It is believed that hypertension begins when the readings exceed the norm of 140/90 mmHg. This, of course, is a conditional limit, since there are conditions when the risk of developing myocardial infarction exists even at figures of 115/75 mmHg. However, formalizing and bringing to an average level the entire variety of blood pressure conditions helps clinicians to notice deviations in time and begin symptomatic, and then standard treatment.

ICD-10 code

I10 Essential [primary] hypertension.

What causes hypertension?

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

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

• Kidney pathologies – nephritis and most often glomerulonephritis. Factor that provokes 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.
• Impaired 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 disruption 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 waist circumference is above 100-15 cm in men and 88-95 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 arterioles—the arteries of organs, most often the kidneys—spasm under the influence of, for example, a stress factor, the nutrition of the renal tissue is disrupted and ischemia develops. The kidneys try to compensate for the disturbances by producing renin, which in turn provokes the activation of angiotensin, which constricts blood vessels. As a result, blood pressure rises and hypertension develops.

Symptoms of hypertension

The primary 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 rises slightly, the person simply feels unwell, weak, and has a headache.

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

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 the heart 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 rises sharply, there may be nosebleeds.

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 "union" with coronary heart disease.

The most dangerous manifestation of hypertension is a crisis - a condition with a sharp increase or jump 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, starting with nausea.
• Increased heart rate, tachycardia.
• Loss of consciousness, convulsions, paralysis.

Hypertension in the crisis stage is a threatening condition that can result in a stroke or heart attack, therefore, 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 about his problem must constantly take prescribed medications to prevent a crisis state.

Who to contact?

Cardiologist.

Treatment of hypertension

Hypertension in the initial stage, when blood pressure readings do not often exceed normal levels, can be treated with non-drug medications. The first way is to control your body weight and follow a low-carb, low-fat diet. 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, which relieve general anxiety and tension, are also effective. These methods are effective for stage I hypertension, although they can be used as auxiliary and additional elements to the main therapy of stage II and III hypertension.

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

Hypertension in stage I involves the use of diuretics (diuretics), beta-blockers, adrenergic receptor blockers to stop tachycardia. The dose of beta-blocker is calculated based on the patient's medical history, weight and condition. If blood pressure normalizes after two to three days, the dose is reduced, often taking it 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, in order not to weaken the heart muscle. If hypertension begins to subside, a diuretic can 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. During the entire course of treatment, you need to monitor your blood pressure levels three times a day.

Stage II hypertension is supervised by complex therapy, including beta-blockers, diuretics, antispasmodics, ACE inhibitors (angiotensin-converting enzyme inhibitors) and potassium preparations. Among b-blockers, effective drugs are those that can control rapid heartbeat and reduce vascular resistance in the periphery. These drugs 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, reducing hypertrophy, dilate coronary vessels, thereby helping to normalize peripheral blood flow. Calcium antagonists are designed to block calcium ducts in the vascular walls, increasing their lumen. Calcium antagonists should only be prescribed by a physician or cardiologist, since all of these drugs can cause swelling, dizziness and headache. A set of medications is selected taking into account all possible side risks and contraindications. It should also be noted that long-term 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 drugs. Therefore, treatment must 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 combined effective drugs. These drugs act on those patients whose body is either accustomed to monotherapy and has stopped responding to it, or has significant contraindications to the use of standard treatment used for stage I and II hypertension.

Hypertension of III severity is also supervised by vasodilators. Increasingly, vasodilators have begun to be replaced by alpha-blockers. A combination drug combining the properties of alpha and beta blockers may also be effective. This remedy, in combination with a diuretic, can replace three or even four other 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 you to reduce blood pressure to normal after a week.

Hypertension of degrees I and II can be treated at home and does not require hospitalization. In rare cases, inpatient treatment is possible in order to conduct analytical examinations and monitor health status. Hypertension, which occurs in severe forms, is treated only in a hospital, in the cardiology department; the length of stay depends on the state of blood pressure and the performance of organs and systems of the body.

How is hypertension prevented?

Hypertension, if it has already developed, unfortunately, remains with a person forever. Prevention in this sense only concerns the prevention of crisis situations through regular use of prescribed medications, daily blood pressure monitoring, 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 - maintaining a healthy lifestyle and physical activity, because one of the reasons that provokes hypertension is physical inactivity. Hypertension is also prevented by a normal diet, where cholesterol and salty foods are kept to a minimum.

Hypertension is also a bad habit, therefore, if a person does not want to join the ranks of hypertensive patients, he needs to stop smoking and limit the consumption of alcoholic beverages. In addition, a positive mood and attitude help to cope with any disease, and hypertension "loves" pessimists. The recipe is simple - enjoy life, remain 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".