hypertension

Hypertension is an extremely common disease that, as a collective definition, includes several forms of arterial hypertension. Hypertension develops against the background of a 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 and arteries.

What is high blood pressure?

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

Normal blood pressure for a relatively healthy person is between 100/60 and 140/90 mmHg; When the regulatory systems stop functioning properly, high blood pressure or hypotension can occur.

Statistics show 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 dysfunctions of the cardiovascular system; no representative of the animal world is susceptible to this. Until the 19th and 20th centuries, little was known about high blood pressure; one of the first cases of myocardial infarction 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. Only with the development of urbanization and the penetration of modern technology into these countries did Asian and African populations also become susceptible to hypertension, which reached its peak in the 1970s.

Since the end of the last century, hypertension has been divided into primary and secondary hypertension.

1. Primary (essential) hypertension is an independent nosological unit, an independent disease that is not caused by dysfunctions of organs and systems. For example, blood pressure rises for reasons other than kidney disease. 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 disease of the pituitary gland or pancreas. In addition, secondary hypertension develops against the background of pathological changes in the vascular system - atherosclerosis - and can provoke symptomatic hypertension and neurotic diseases. Secondary hypertension is also quite common during pregnancy and with gynecological diseases - cysts and neoplasms.

Depending on the level of increase in blood pressure, hypertension is also classified into degrees.

• When blood pressure is 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 "jumps" to the specified limits.
• If blood pressure is measured 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 medication.
• Blood pressure that remains consistently in 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 values, and when it falls, it is accompanied by heart weakness up to heart failure.

Hypertension not only has stages of disease development, but is also divided into various clinical forms. Hyperadrenergic hypertension is actually the initial stage of the disease's development, but it can last for many years. This form of hypertension is manifested by sinus tachycardia, unstable blood pressure with fluctuating systolic values, increased sweating, skin hyperemia, throbbing headaches and anxiety. Often the face and limbs swell, the fingers become numb, and urination is impaired. There is also a more serious form - malignant hypertension, which progresses rapidly. Blood pressure can rise so much that there is a risk of encephalopathy, loss of vision, pulmonary edema and also a risk of kidney failure. Fortunately, this form practically no longer occurs today, as high blood pressure is usually 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, an indicator of blood pressure during the contraction phase of the heart muscle, when blood enters the arteries. The lower number is the blood pressure indicator during the relaxation phase of the heart muscle. It is believed that hypertension begins when the readings exceed the norm of 140/90 mmHg. Of course, this is a conditional limit, since there are conditions in which there is a risk of a heart attack even at values of 115/75 mmHg. However, formalizing and presenting the full range of blood pressure conditions helps physicians to timely identify deviations and begin symptomatic and subsequent standard treatment.

ICD-10 code

I10 Essential [primary] hypertension.

What causes high blood pressure?

High blood pressure is considered a multietiological and multifactorial disease, the true causes of which are not fully understood. The factors that cause secondary hypertension are more specific because the cause lies in the underlying disease. The final diagnosis of essential hypertension is made after a comprehensive examination in which the presence of causative diseases is ruled out. From a medical point of view, primary hypertension is a genetically caused imbalance of the regulatory mechanisms in the body (imbalance of the pressor and depressive blood pressure systems).

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

• Kidney diseases – nephritis and most commonly glomerulonephritis. Factor causing secondary hypertension.
• Stenosis (narrowing) of the renal arteries.
• Congenital pathology in which the renal artery is blocked (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.
• Thyroid dysfunction.
• Alcoholism.
• Overdose or constant use of medications, especially hormonal antidepressants.
• Seeks.

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

• Age over 55 years for men and 65 years for women.
• Increased blood cholesterol level (above 6. 6 mmol).
• Hereditary predisposition, family history.
• Obesity, especially abdominal obesity, when the waist circumference is over 100-15 cm in men and over 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 arterioles - the arteries of organs, most often the kidneys - spasm under the influence, for example, of a stress factor, the nutrition of the kidney tissue is disrupted and ischemia develops. The kidneys try to compensate for the disturbances by producing renin, which in turn triggers the activation of angiotensin, which constricts blood vessels. This causes blood pressure to rise and high blood pressure develops.

Symptoms of high blood pressure

A persistent excess of 140/90 mmHg is considered the primary and sometimes most important symptom of high blood pressure. Other signs of hypertension are directly related to blood pressure parameters. If the pressure increases slightly, the person simply feels uncomfortable, 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 becomes red, sweating increases, the fingers tremble and numbness often occurs.

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

High blood pressure is also characterized by dizziness and reduced vision.

Ophthalmological signs – haze or spots, "floaters" in front of the eyes. If the pressure increases sharply, nosebleeds may occur frequently.

Another symptom of high blood pressure is dizziness. Vision worsens.

In the final stage, when high blood pressure reaches stage III, the typical symptoms are joined by neurosis or depression. High blood pressure in this form often occurs in a pathological "association" 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 state is accompanied by a stroke or heart attack and is manifested by the following symptoms:

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

Crisis stage high blood pressure is a threatening condition that can lead to a stroke or heart attack. Therefore, at the slightest alarming sign, you should call an emergency doctor. Hypertensive crisis is controlled with the help of diuretics, cardiological and antihypertensive drugs administered by injection. A hypertensive patient, aware of his problem, needs to constantly take prescribed medications to prevent a crisis state.

Whom can I contact?

Cardiologist.

Treatment of high blood pressure

Hypertension in the early stages, when blood pressure values do not often exceed normal, can be treated with non-drug medications. The first option is to control your body weight and follow a low-carbohydrate and 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, but can be used as auxiliary and additional elements to the main therapy for stage II and III hypertension.

Pharmacological agents for the treatment of hypertension are prescribed according to the "stepwise" principle. They are used sequentially, targeting different 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 dose of the 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 and often taken every two days. A drug from the thiazide group is effective as a diuretic and is prescribed as a one-time dose of 25 mg, alternating every one or two days, so as not to weaken the heart muscle. When high blood pressure subsides, a diuretic may be prescribed once a week. It often happens that diuretics and beta-blockers cannot be used due to possible side effects (diabetes, gout or asthma); In such situations, the use of antispasmodics is indicated. You must monitor your blood pressure three times a day throughout the treatment period.

Stage II hypertension is monitored by complex therapy, which includes beta blockers, diuretics, antispasmodics, ACE inhibitors (angiotensin converting enzyme inhibitors) and potassium supplements. The effective drugs among B-blockers include those that can control rapid heartbeat and reduce vascular resistance in the periphery. These drugs are also effective in 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 ventricle, reduce hypertrophy, expand the coronary vessels, thereby contributing to the normalization of peripheral blood flow. Calcium antagonists are intended to block calcium channels in the vessel walls and thus increase their lumen. Calcium antagonists should only be prescribed by a doctor or cardiologist because all of these medications can cause swelling, dizziness, and headaches. A set of drugs is selected taking into account all possible side effects and contraindications. It should also be noted that long-term use of diuretics can lead to a decrease in potassium levels in the body (hypokalemia). Therefore, diuretics should be taken together with potassium supplements.

Stage III hypertension is a severe form of the disease characterized by the body's resistance to conventional medications. Therefore, treatment must be carefully selected, taking into account all the individual characteristics of the patient. The therapeutic complex includes diuretics, usually potassium-sparing, and the use of peripheral vasodilators is also indicated. Today, the pharmaceutical industry produces many combined effective medicines. These drugs work in patients whose bodies are either used to monotherapy and no longer respond to it, or who have significant contraindications to the use of standard treatment for stage I and II hypertension.

Grade III hypertension is also monitored with vasodilators. Vasodilators are increasingly being replaced by alpha-blockers. A combination drug 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 other, less effective drugs. An ACEI is used to prescribe a medication that improves peripheral blood flow and controls renin levels. The drug is taken three to four times a day in combination with a diuretic, which allows you to reduce blood pressure to normal after a week.

Grades I and II hypertension can be treated at home and does not require hospitalization. In rare cases, inpatient treatment is possible to carry out analytical examinations and monitor the state of health. Hypertension, which occurs in severe forms, is treated only in the hospital in the cardiology department; the duration of the stay depends on the state of blood pressure and the performance of the body's organs and systems.

How is high blood pressure prevented?

Unfortunately, hypertension, once it has already developed, remains with a person forever. Prevention in this sense only concerns the prevention of crisis situations by regularly taking prescribed medication, daily blood pressure monitoring, feasible physical activity and weight loss.

However, if hypertension has been diagnosed in a person's family, but the disease has not yet manifested itself, preventive measures can be taken. The rules are very simple: maintain a healthy lifestyle and physical activity, because one of the reasons that provoke high blood pressure is physical inactivity. High blood pressure is also prevented by a normal diet that minimizes cholesterol and salty foods.

High blood pressure is also a bad habit. Therefore, if a person does not want to be among those suffering from hypertension, he must stop 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, as a well-known saying goes, "like an astronaut". .