Main criterionarterial hypertension (or arterial hypertension)as a whole group of diseases - stable, that is, detected through repeated measurements on different days, an increase in blood pressure (BP).The question of what kind of blood pressure is considered elevated 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 blood pressure levels showed that already starting from the level of 115/75 mm Hg.Art., each additional increase in blood pressure by 10 mm Hg.Art.is accompanied by an increased risk of developing cardiovascular diseases (primarily coronary heart disease and stroke).However, the benefits of modern methods of treating arterial hypertension have been proven mainly only for those patients whose blood pressure exceeded 140/90 mmHg.Art.It is for this reason that it was agreed to consider this threshold value as a criterion for identifying arterial hypertension.
Increased blood pressure can be accompanied by dozens of different chronic diseases, and hypertension is only one of them, but the most common: approximately 9 cases out of 10. The diagnosis of hypertension is established in cases where there is a stable increase in blood pressure, but no other diseases that lead to increased blood pressure are detected.
Hypertension is a disease for which a stable increase in blood pressure is its main manifestation.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 features that accompany the modern urban lifestyle in industrialized countries.This is why hypertension is considered a lifestyle disease, and targeted changes for the better 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, more rare diseases.Regular use of medications such as glucocorticosteroids, non-steroidal anti-inflammatory drugs, and oral contraceptives can also lead to 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, ascertaining the history of the disease, examination, as well as based on the results of some, mostly simple laboratory and instrumental research methods, the diagnosis of any of the secondary arterial hypertension seems unlikely.
If you notice similar symptoms, consult your doctor.Do not self-medicate - it is dangerous for your health!
Symptoms of arterial hypertension
High blood pressure itself does not manifest itself in any subjective sensations for many people.If high blood pressure is accompanied by symptoms, this may include a feeling of heaviness in the head, headache, flashing before the eyes, nausea, dizziness, unsteadiness when walking, as well as a number of other symptoms that are rather nonspecific for high blood pressure.The symptoms listed above manifest themselves much more clearly during a hypertensive crisis - a sudden significant increase in blood pressure, leading to a clear deterioration in condition and well-being.
It would be possible to continue to list the possible symptoms of hypertension, separated by commas, but there is no particular benefit in this.Why?Firstly, all these symptoms are nonspecific for hypertension (i.e., they can occur either 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 revealed not by assessing subjective symptoms, but only by measuring blood pressure, moreover, repeatedly.This means, firstly, that “in one sitting” one should measure blood pressure twice or three times (with a short break between measurements) and take the arithmetic mean of two or three measured values as true blood pressure.Secondly, the stability of the increase in blood pressure (a 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 can be either those listed above or others, more serious - they are discussed in the “Complications” section.
Symptomatic (secondary) arterial hypertension develops as part of other diseases, and therefore their 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 (lasting hours or days) paralysis 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—leads to damage to various organs (in this context they are called “target organs”), then this can manifest itself as a decrease in memory and intelligence, stroke or transient cerebrovascular accident, an increase in the thickness of the walls of the heart, accelerated development of atherosclerotic plaques in the vessels of the heart and other organs, myocardial infarction or angina, a decrease in the rate of blood filtration in the kidneys, etc.Accordingly, clinical manifestations will 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 a number of others, mainly related to lifestyle characteristics, lead over time to disruption of the functioning of the endothelium - the inner layer of arterial vessels one cell layer thick, which is actively involved in the regulation of tone, and therefore the lumen of blood vessels.The tone of microvasculature vessels, and hence the volume of local blood flow in organs and tissues, is autonomously regulated by the endothelium, and not directly by the central nervous system.This is a system of local blood pressure regulation.However, there are other levels of blood pressure regulation - the central nervous system, the endocrine system and the kidneys (which also realize their regulatory role largely due to the ability to participate in hormonal regulation at the level of the whole organism).Violations in 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, a persistent spasm of small arteries develops, and subsequently their walls change so much that they are no longer able to return to their original state.In larger vessels, due to constantly elevated blood pressure, atherosclerosis develops at an accelerated pace.The walls of the heart become thicker, myocardial hypertrophy develops, and then the expansion of the cavities of the left atrium and left ventricle.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 supplying it, negative changes also occur - small foci of hemorrhages appear, as well as small areas of necrosis (death) of brain cells.When an atherosclerotic plaque ruptures in a sufficiently large vessel, thrombosis occurs, the lumen of the vessel is blocked, and this leads to a stroke.
Classification and stages of development of arterial hypertension
Hypertension, depending on the magnitude of elevated blood pressure, is divided into three degrees.In addition, taking into account the increase in the risk of cardiovascular diseases on a “year-decade” scale, already starting from a blood pressure level above 115/75 mm Hg.Art., there are several more gradations of blood pressure levels.
If the values of systolic and diastolic blood pressure fall into different categories, then the degree of arterial hypertension is assessed by the highest 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 hypertension continue to be distinguished, while the European guidelines for the diagnosis and treatment of arterial hypertension do not mention any stages.The identification of stages is intended to reflect the phasing 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, albumin protein is not detected in the urine, thickening of the walls of the carotid arteries or atherosclerotic plaques in them is not detected, etc. Such damage to internal organs is usually asymptomatic.
- If there is at least one of the listed signs, diagnoseStage IIhypertension.
- Finally, aboutStage IIIHypertension is said 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, serious kidney damage, manifested by a pronounced decrease in filtration and/or significant loss of protein in the urine.
These stages do not always naturally replace one another: for example, a person suffered a myocardial infarction, and after a few years an increase in blood pressure occurred - it turns out that such a patient immediately has stage III hypertension.The purpose of staging is mainly to rank 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 assessed in four gradations.At the same time, the 4th gradation corresponds to the greatest risk.
Complications of arterial hypertension
The goal of treating hypertension is not to “bring down” high blood pressure, but to maximally reduce the risk of cardiovascular and other complications in the long term, since this risk—again, when assessed on a “year-decade” scale—increases for every 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 patients with hypertension do not worry about anything for the time being, so they do not have much motivation to be treated, regularly taking a certain minimum of medications and changing their lifestyle to a healthier one.However, in the treatment of hypertension there are no one-time measures that would allow you to forget about this disease forever without doing anything more to treat it.
Diagnosis of arterial hypertension
With the diagnosis of arterial hypertension as such, everything is usually quite simple: this requires only repeatedly recorded blood pressure at the level of 140/90 mm Hg.Art.and higher.But hypertension and arterial hypertension are not the same thing: as already mentioned, an increase in blood pressure can manifest itself in a number of diseases, and hypertension is only one of them, although the most common.When conducting a diagnosis, the doctor, on the one hand, must make sure 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, at the first stage of the diagnostic search, the doctor finds out at what age blood pressure first began to increase, whether there are symptoms such as,for example, snoring with pauses in breathing during sleep, attacks of muscle weakness, unusual impurities in the urine, attacks of sudden heartbeat with sweating and headache, etc.It makes sense to clarify what medications and dietary supplements the patient is taking, becausein some cases, they can lead to an increase in blood pressure or aggravation of an already elevated one.Several routine (performed in almost all patients with high blood pressure) diagnostic tests, along with information obtained during a conversation with a doctor, help 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), further search for these diseases as a possible cause of high blood pressure must 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, then in the future it is considered that blood pressure is increased due to hypertension.This judgment may sometimes be subsequently revised as new data about the patient becomes available.
In addition to searching for data on the possible secondary nature of the increase in blood pressure, the doctor determines the presence of risk factors for cardiovascular diseases (this is necessary to assess the prognosis and a more targeted search for damage to internal organs), as well as, possibly, pre-existing diseases of the cardiovascular system or their asymptomatic damage - this affects the assessment of the prognosis and stage of hypertension, the choice of therapeutic measures.For this purpose, in addition to talking with the patient and examining him, a number of diagnostic studies are performed (for example, electrocardiography, echocardiography, ultrasound examination 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 blood pressure monitoring using special compact devices allows you to assess changes in blood pressure during the patient’s usual lifestyle.This study is not necessary in all cases - mainly, if blood pressure measured at a 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 assess the effectiveness of treatment.
Thus, some diagnostic methods when examining a patient with high blood pressure are used in all cases; 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 arterial hypertension
With regard to non-drug measures aimed at treating hypertension, the most convincing evidence has accumulated on the positive role of reducing salt intake, reducing and maintaining body weight at this level, regular physical training (exertion), no more than moderate alcohol consumption, as well as increasing the content of vegetables and fruits in the diet.Only all 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 by 5 kg led to a decrease in blood pressure by an average of 4.4/3.6 mmHg.Art.- it seems like a little, but in combination with the other measures listed above to improve your lifestyle, the effect can be quite significant.
Improving lifestyle is justified for almost all patients with hypertension, but drug 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 demonstrated in many clinical studies), then in grade 1 hypertension with low and moderate calculated cardiovascular risk, the benefit of such treatment has not been convincingly proven in large clinical trials.In such situations, the possible benefit of drug therapy is assessed individually, taking into account the patient's preferences.If, despite improving lifestyle, the increase in blood pressure in such patients persists for a number of months during repeated visits to the doctor, it is necessary to re-evaluate the need for medication use.Moreover, 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 treatment of hypertension, they strive 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, when measured under standard conditions (described in the “Diagnostics” 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 common than without treatment.Thanks to modern medications, those negative processes that, in hypertension, inevitably and latently destroy internal organs over time (primarily the heart, brain and kidneys), these processes are slowed down or suspended, and in some cases they can even be reversed.
Of the medications 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 classes of drugs 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 serve a dual purpose.
Nowadays, preference is given to combinations of drugs, since treatment with any one of them rarely leads to achieving the desired level of blood pressure.There are also fixed combinations of drugs that make treatment more convenient, since the patient takes only one tablet instead of two or even three.The selection of the necessary classes of medications for a particular patient, as well as their doses and frequency of administration, is carried out by the doctor, taking into account such data about the patient as blood pressure level, concomitant diseases, etc.
Thanks to the multifaceted positive effects of modern drugs, treatment of hypertension involves not only lowering blood pressure as such, but also protecting internal organs from the negative effects of those processes that accompany high blood pressure.In addition, since the main goal of treatment is to minimize the risk of its 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 (which leads to myocardial infarction or stroke), etc. Quitting smoking, no matter how trivial it may sound, allows you to significantly reduce the risks of stroke and myocardial infarction associated with hypertension, and slow down the growth of atheroscleroticplaques in blood vessels.Thus, treating hypertension involves addressing the disease in many ways, and achieving normal blood pressure is only one of them.
Forecast.Prevention
The overall 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 their severity and the duration of the negative impact.
These risk factors are:
- smoking;
- increased blood cholesterol levels;
- high blood pressure;
- obesity;
- sedentary lifestyle;
- age (with each decade lived after 40 years, 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 their exposure.For people who do not yet have obvious cardiovascular diseases other than hypertension, the prognosis can be assessed using special electronic calculators, one of which takes into account gender, 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 produce a misleading impression, becauseThe calculator allows you to calculate the risk of cardiovascular death.The risk of non-fatal complications (myocardial infarction, stroke, angina pectoris, etc.) is many times higher.The presence of diabetes mellitus increases the risk compared to that calculated using a calculator: for men by 3 times, and for women - even by 5 times.
With regard to 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), then all lifestyle changes that reduce the impact of these factors also reduce the risk of developing hypertension.However, it is hardly possible to reduce this risk completely to zero - there are factors that do not depend on us at all or depend little on us: genetic characteristics, gender, age, social environment, and some others.The problem is that people begin to think about the prevention of hypertension mainly when they are already unhealthy, and blood pressure is already increased to one degree or another.And this is not so much a question of prevention as of treatment.