Hypertonic disease is the most common disease of the circulatory system around the world. About 30% of the world's population suffer from this ailment. In recent years, a significant "rejuvenation" of the disease has been noted - among the sick, more and more people of young, middle age.
Hypertension is fraught with heavy, disabled complications, often leads to death. At the same time, subject to a number of rules, the occurrence and development of the disease can be delayed by years. Each person should be familiar with the risk factors for the development of hypertension, its symptoms and principles of treatment.
What is hypertension
Hypertonic disease or arterial hypertension (synonym: essential hypertension, primary hypertension) - chronically proceeding, prone to progression, in the clinical picture of which the leading symptom is a persistent, prolonged increase in blood pressure (i. e. , arterial hypertension syndrome).
The criteria for arterial hypertension is considered to be systolic blood pressure (blood pressure) from above or equal to 140 mm Hg. Art. and/or diastolic blood pressure exceeding 90 mm Hg. Art.
Etiology of the disease
Hypertonic disease is considered an idiopathic disease, the immediate causes of its occurrence are not established.
Among the numerous theories of the emergence and development of primary hypertension, classical neurogenic theory is most widespread. This concept regards hypertension as a neurotic state of higher nervous activity. The starting mechanism is considered nervous overvoltage (acute or prolonged, chronic), which causes a violation of the trophism of the structures of the brain that are responsible for the regulation of blood pressure. Of particular importance are emotions that have not received implementation in the motor sphere, the so -called "unreacted emotions. "
In the occurrence of primary hypertension, a genetic predisposition is traced. In 35-50% of people suffering from hypertension, the family nature of the disease is observed. A specific gene, the defect of which would lead to a persistent increase in blood pressure, has not been detected. Probably, the disease has a polygenic type of inheritance.
Pathogenesis of hypertension
The pathogenesis of primary hypertension is complicated and at different stages has its own characteristics. According to neurogenic theory, under the influence of nervous overvoltage, the inhibitory effect of the cortex of the large hemispheres of the brain on subcortical (hypothalamic) vegetative centers is reduced, which causes the activation of the pressor (vasoconstrictor) sympathetic system. There is an adrenaline emission, heart ejection increases, arteries are narrowed (including renal), blood pressure increases. The spasm of the renal arteries activates another powerful pressing system-renin-angiotensin-aldosterone, which makes its significant contribution to increasing blood pressure. Other vasoconstrictive agents are also connected over time - antidiuretic hormone, prostacilla, endothelin, thromboxan. They are opposed by depressor systems-vascular prostaglandins, kallikrein-kinin, and a system of sodium-reuters. A long spasm of the arteries leads to a violation of the function of their inner shell (endothelium), restructuring the walls of blood vessels and contributes to the development of atherosclerosis.
Risk factors
The risk factors are attributed to signs, the presence of which in humans increases the likelihood of developing the disease. The variety of risk factors for primary hypertension are divided into two groups - modified and unmodified.
Unmodified risk factors (it is impossible to influence them)
These include:
- Male sex is among men of young, middle -aged incidence of hypertension higher than among women at the same age. Low incidence in women is explained by the protective effect of estrogen. The prevalence of hypertension in representatives of both sexes older than 60 years is approximately the same;
- age (more than 50-60 years)-the prevalence of hypertension increases sharply in old age;
- Heredity - the presence of cases of essential hypertension in a family increases the risk of the disease.
Modified risk factors (subject to influence)
These include:
- Smoking - nicotine has a powerful vasoconstrictor effect. Active and passive smoking lead to cramps of blood vessels, increased blood pressure;
- Obesity - i. e. The body weight index is above 30 kg/m2. Clinical studies prove that the incidence of hypertension increases as human weight grows. The deposition of subcutaneous fat in the waist area (abdominal obesity) is especially dangerous, becauseIt is associated with an extremely high risk of primary hypertension. This is due to the stimulation of the sympathetic adrenal system in fat people. A waist of a waist over 80 cm for women and over 94 cm for men is a serious risk factor for hypertension;
- A sedentary lifestyle (hypodynamia) - insufficient physical activity provokes the development of obesity;
- Excess receipt of table salt with food products (over 5 g per day);
- excessive drinking (over 30 g of ethyl alcohol per day);
- unbalanced diet (high -calorie, with an excess of saturated fats) - provokes obesity;
- stressful situations.
Classification of arterial hypertension
Primary hypertension is classified according to the level of arterial hypertension, by the nature of the lesion of target organs.
Classification of arterial hypertension levels (AG)
Category Systolic blood pressure, mm Hg. Art. Diastolic blood pressure, mm Hg. Art.
- Arterial hypertension I degrees 140-159 90-99
- Arterial hypertension of the II degree 160-179 100-109
- Arterial hypertension of the III degree ≥180 ≥110
Classification by the nature of the defeat of target organs
Mishenian organs are called those organs in which pathological changes arise primarily due to hypertension. For primary hypertension, targets are heart, kidneys, brain, mesh shell of the eye, blood vessels.
3 stages of primary hypertension
It is customary to distinguish 3 stages of primary hypertension:
Stage I-characterized by the absence of changes from the target organs;
Stage II-There are changes in target organs that are not manifested by any symptoms:
- heart: an increase in the left ventricle (according to the results of ECG or ultrasound of the heart);
- Vessels:signs of thickening of the walls, the presence of plaques (according to the results of ultrasound, angiography);
- kidneys:decrease in function, microalbuminuria (detection of small portions of protein in the urine);
- The retina: narrowing, impregnation of blood vessels;
Stage III-There are symptoms of changes from the target organs:
- heart: ischemic disease, heart failure;
- brain: transient disturbance of cerebral blood flow, stroke;
- kidneys:renal failure;
- Vessels: occlusion of the peripheral blood vessel, which delays the aortic aneurysm;
- Retter of the eye:edema, hemorrhages, exudates.
Symptoms of hypertension
In some cases, for a long time the only symptom of essential hypertension remains an increase in blood pressure. It can be accompanied by non -specific complaints of head pain (occurs in the morning, by the type of "heavy head", with localization in the occipital region), irritability, excessive fatigue, sleep disturbances, general weakness, dizziness, and rapid palpitations.
Hypertonic crises are considered a bright sign of the disease-short (from 1-2 hours to 2-3 days) of the exacerbation of the disease, manifested by a sudden increase in blood pressure. They occur in about a third of patients.
There are 2 types of crises for hypertension: first order (adrenal) and second order (norepinephrine).
First -order hypertensive crisis develops more often in middle -aged people. The rise of blood pressure occurs at night, accompanied by a headache, chills, cooling of the extremities, anxiety, anxiety, a rapid heartbeat.
A second -order hypertensive crisis is characteristic of the elderly. The rise in blood pressure is accompanied by a pronounced headache, impaired visual perception, inhibition, drowsiness, nausea, vomiting.
With prolonged experience of hypertension in the clinical picture, the leading place is occupied by the symptoms of diseases of the target organs: rag pain with angina pectoris, shortness of breath, swelling with heart failure, symptoms of a stroke, etc.
Diagnosis of hypertension
In order to establish a diagnosis of hypertension to a person, it is necessary to identify a persistent increase in blood pressure and exclude the presence of other diseases that are characterized by arterial hypertension syndrome.
An increase in blood pressure is determined using a conventional tonometer - hell is measured by a doctor or patient himself. An indispensable condition is to comply with the methodology of measuring blood pressure-the measurement is carried out after 3-5 minutes of rest in a comfortable environment, sitting, at rest, shoulder and heart should be located at the same level. The level of blood pressure above or equal 140/90 mm Hg. Art. He speaks of suspicion of essential hypertension. In diagnostically complex cases, the methodology of daily monitoring of blood pressure is used.
Diseases accompanying high blood pressure
In addition to hypertension, there are still a number of diseases accompanied by an increase in blood pressure: kidney pathology (chronic pyelo-/glomerulonephritis), vasorenal hypertension (caused by narrowing of the renal artery), adrenal tumor-pheochromocytoma, aortic coarctation (congenital defect of the vessel), endocrine disorders (conn syndrome, disease syndrome, disease. Itsenko-Kushing). To exclude the presence of these pathologies, the doctor prescribes a comprehensive examination.
An additional examination is aimed at detecting pathologies of target organs. It allows you to clarify the stage of hypertension, prescribe appropriate treatment.
Diagnostic measures include:
- ECG: There may be signs of an increase in the left ventricle (hypertrophy), ischemic changes, signs of an acute myocardial infarction.
- X -ray of the chest organs: Changes in the contour of the heart (manifestation of hypertrophy of the left ventricle) can be detected;
- Echocardiography (ultrasound of the heart): can be detected by hypertrophy of the left ventricle, expansion of the heart cavities, a decrease in its work;
- Study of the fundus: the narrowed arteries of the retina, dilated veins, in the later stages - hemorrhages, exudates, swelling are determined;
- Blood test: the amount of cholesterol, the indicators of the kidneys (creatinine, urea) are determined;
- Urine analysis: Disorders of the functioning of the kidneys, microalbuminuria, etc. are detected.
Treatment of hypertension
In the treatment of primary hypertension, non -drug and drug methods that complement each other are successfully used.
Non -drug methods of treating arterial hypertension
They are prescribed to absolutely all patients with hypertension, even if a person receives drugs to control blood pressure. These measures imply the elimination of risk factors by modifying the established lifestyle and human habits. Scientists have proved that non -drug treatment in certain cases is not inferior to treatment with drugs.
The main directions:
- Limiting the amount of table salt coming from food (up to 5-6 g per day). This implies a complete rejection of foods such as sausages, sausages, salty cheeses, canned foods, salted fish. It should also be taken into account that a significant amount of salt is contained in bakery products;
- The fight against overweight - people suffering from primary hypertension, it is recommended to reduce the calorie content of the food diet by limiting the use of fats;
- restriction of the use of alcohol -containing drinks - up to 30 g of ethyl alcohol per day;
- a complete and strict refusal of smoking-if necessary, resort to the help of an narcologist;
- Regular physical activity is moderate, preferably daily, lasting at least half an hour. Events in the fresh air are preferred: jogging, walking at an accelerated pace, cycling.
Drug treatment of arterial hypertension
Implies the use of drugs.
For effective treatment of primary hypertension, several classes of drugs are recommended by experts, they reduce blood pressure, affecting different stages of the pathogenesis of the disease.
Main classes of drugs:
- angiotenzinzinoproding enzyme inhibitors - IAC;
- angiotensin receptors - sartans;
- calcium antagonists;
- diuretics;
- blockers;
- Renin inhibitors;
- drugs of central (brain) action;
- Alpha-blockers.
Combinations of drugs for the treatment of arterial hypertension
In the treatment of hypertension, combinations of drugs from various groups are widely used, for example, IACD + diuretic, calcium antagonist + IACF, -block + sartan + diuretic. The modern pharmaceutical industry produces a large number of ready -made combined drugs, which greatly simplifies medication.
It should be noted that the treatment of hypertension is carried out under the continuous control of a doctor-therapist or a cardiologist. The doctor determines the volume of medical measures, the moment of prescribing drugs, dosage, etc.
The independent prescription of antihypertensive drugs is unacceptable. With the development of malignant hypertension, which is not amenable to the effects of drugs, surgical treatment of hypertension can be performed (stimulation of carotide sinus baroreceptors, kidney denervation, etc. ).
Prevention of hypertension
Primary prevention of hypertension must be carried out from childhood. Children, adolescents, young people should regularly undergo medical examinations with the measurement of blood pressure. Prevention should affect the risk factors of the disease. Children are shown a rational muscle load, overfeeding, excessive consumption of salt food is unacceptable. Secondary prevention is aimed at preventing the progression of the disease. People suffering from hypertension are contraindicated at night, overtime work, as well as conjugated with nervous overloads.