Main criterionarterial hypertension (or arterial hypertension)as a whole group of diseases - stable, i.e.h.through repeated measurements on different days, an increase in blood pressure (BP) was detected.The question of what blood pressure is considered elevated is not as simple as it seems.The fact is that in practically healthy people the range of blood pressure values is quite large.The results of long-term observation of people with different blood pressure values showed that already from the value of 115/75 mm Hg. Art., each further increase in blood pressure by 10 mm Hg. Art.Art.is associated with an increased risk of developing cardiovascular diseases (especially coronary heart disease and stroke).However, the benefit of modern methods of treating arterial hypertension has been demonstrated mainly only for patients whose blood pressure exceeded 140/90 mmHg.Art.For this reason, it was agreed to consider this threshold as a criterion for detecting arterial hypertension.
Elevated blood pressure can be accompanied by dozens of different chronic diseases, and hypertension is just one of them, but the most common: about 9 out of 10 cases.The diagnosis of hypertension is made in cases where there is a stable increase in blood pressure, but no other diseases leading to increased blood pressure are 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 identified through observations of large groups of people.In addition to the genetic predisposition that some people have, these risk factors also include:
- Obesity;
- Inactivity;
- excessive consumption of table salt, alcohol;
- chronic stress;
- Smoke.
In general, these are all those features that accompany the modern urban lifestyle in developed countries.For this reason, high blood pressure is considered a lifestyle disease and targeted changes for the better should always be considered on a case-by-case basis when treating high blood pressure.
What other diseases are associated with increased blood pressure?These include 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, less common diseases.Regular use of medications such as glucocorticosteroids, nonsteroidal 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 what is known as secondary or symptomatic arterial hypertension.The doctor makes the diagnosis of hypertension if, in conversation with the patient, collecting the history of the disease, examination, as well as based on the results of some, usually simple laboratory and instrumental research methods, the diagnosis of secondary arterial hypertension seems unlikely.
If you notice similar symptoms, contact your doctor.Do not self-medicate - it is dangerous to your health!
Symptoms of arterial hypertension
For many people, high blood pressure itself does not manifest itself in subjective feelings.When high blood pressure is accompanied by symptoms, they can include a feeling of heaviness in the head, headaches, flashes in the eyes, nausea, dizziness, unsteady gait and a number of other symptoms that are rather unspecific to high blood pressure.The symptoms listed above manifest themselves much more clearly during a hypertensive crisis - a sudden significant increase in blood pressure, which leads to a significant deterioration in the condition and well-being.
It would be possible to continue listing the possible symptoms of high blood pressure separated by commas, but this is of no particular benefit.Why?Firstly, all of these symptoms are nonspecific for hypertension (i.e. they can occur individually or in various combinations in other diseases), and secondly, for the detection of arterial hypertension, only the fact of a stable increase in blood pressure is important.And this is not shown by assessing subjective symptoms, but rather by repeatedly measuring blood pressure.This means, firstly, that you should measure blood pressure two to three times “in one session” (with a short break between measurements) and take the arithmetic mean of two or three measurements as the 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 at least a week apart.
If a hypertensive crisis occurs, there will definitely be symptoms, otherwise it is not a hypertensive crisis, but just an asymptomatic increase in blood pressure.And these symptoms can be either those listed above, or other, more serious ones - they are discussed in the “Complications” section.
Symptomatic (secondary) arterial hypertension develops in the context of other diseases and therefore its manifestations depend on the underlying disease in addition to the actual symptoms of hypertension (if any).For example, hyperaldosteronism can involve muscle weakness, cramps, and even temporary (hours or days) paralysis of the leg, arm, and neck muscles.For obstructive sleep apnea syndrome – snoring, sleep apnea, daytime sleepiness.
When hypertension over time - usually over many years - leads to damage to various organs (in this context they are called "target organs"), this can result in a decrease in memory and intelligence, a stroke or a temporary cerebrovascular accident, an increase in the thickness of the heart walls, accelerated development of atherosclerotic plaques in the vessels of the heart and other organs, myocardial infarction or angina, as well as a decreasethe blood filtration rate express kidneys, etc. Accordingly, clinical manifestations are 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, its “quintessence,” so to speak.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, over time lead to dysfunction of the endothelium - the inner layer of arterial vessels with a cell layer thickness that actively participates in regulating the tone and, therefore, the lumen of blood vessels.The tone of the microvessels 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 system for 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 perform their regulatory role largely due to the ability to participate in hormonal regulation at the level of the whole organism).Violations of these complex regulatory mechanisms generally lead to a decrease in the ability of the entire system to accurately adapt to the constantly changing needs of organs and tissues for blood supply.
Over time, a persistent spasm of small arteries develops, the walls of which subsequently change to such an extent that they can no longer return to their original state.In larger vessels, arteriosclerosis develops more rapidly due to the constantly increased blood pressure.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.Negative changes also occur in the brain due to changes in the blood vessels that supply it - small foci of bleeding 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 becomes blocked, which leads to a stroke.
Classification and stages of development of arterial hypertension
Depending on the extent of the increased blood pressure, hypertension is divided into three degrees.In addition, the increase in the risk of cardiovascular diseases on a “year-decade” scale must be taken into account from a blood pressure value above 115/75 mm Hg.There are several other gradations of blood pressure.
If the values of systolic and diastolic blood pressure fall into different categories, the degree of arterial hypertension is judged 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 European guidelines for the diagnosis and treatment of arterial hypertension do not mention stages.The identification of the stages should reflect the course of high blood pressure from the onset to the appearance of complications.
There are three phases:
- Stage Imeans that there is still no obvious damage to the organs 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 internal damage is not detected in the organsUsually asymptomatic.
- If at least one of the listed signs is present, make a diagnosisStage IIHigh blood pressure.
- Finally, approximatelyStage IIIHypertension is referred to 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 significant decrease in filtration and / or a significant loss of protein in the urine.
These stages do not always replace each other naturally: for example, a person suffered a heart attack and after a few years there was an increase in blood pressure - it turns out that such a patient immediately has stage III hypertension.The purpose 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 making a diagnosis, the risk is assessed in four gradations.At the same time, the 4th level corresponds to the greatest risk.
Complications of arterial hypertension
The goal of treating hypertension is not to “lower” high blood pressure, but to maximally reduce the risk of cardiovascular and other complications in the long term, since this risk – again assessed on a “year-decade” scale – increases with each additional 10 mm Hg.Art.from a blood pressure value 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 have anything to worry about for the time being, so they do not have much motivation to seek treatment, regularly take a certain minimum of medication and change their lifestyle to a healthier one.However, in the treatment of high blood pressure, there are no one-time measures that would allow you to forget about this disease forever without doing something more about it.
Diagnosis of arterial hypertension
When diagnosing arterial hypertension as such, everything is usually very simple: all that is required is repeated measurement of blood pressure at the level of 140/90 mm Hg. Art.and higher.But high blood pressure 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 just one of them, albeit the most common.When making a diagnosis, the doctor must, on the one hand, ensure that the increase in blood pressure is stable and, on the other hand, assess the probability that the increase in blood pressure is a manifestation of symptomatic (secondary) arterial hypertension.
In the first step of the diagnostic search, the doctor determines at what age blood pressure first increases and whether symptoms are present, such as snoringwith pauses in breathing during sleep, attacks of muscle weakness, unusual impurities in the urine, attacks of sudden heartbeat with sweating and headaches, etc. It is useful to clarify which medications and nutritional supplements the patient is taking, as in some cases these can lead to an increase in blood pressure or a worsening of an already high blood pressure.Several routine diagnostic tests (carried out in almost all patients with hypertension), as well as information from a conversation with a doctor, help assess the likelihood of some forms of secondary hypertension: a complete urinalysis, determining blood concentrations of creatinine and glucose, and sometimes potassium and other electrolytes.In general, there must be good reasons for further searching for these diseases as a possible cause of high blood pressure, given the low prevalence of secondary forms of arterial hypertension (approx. 10% of all cases).Therefore, if significant data on the secondary nature of arterial hypertension are not found at the first stage of the diagnostic search, in the future it is assumed that blood pressure is increased due to hypertension.This judgment can sometimes be revised later 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 for a more targeted search for damage to internal organs), as well as possibly already existing diseases of the cardiovascular system or their asymptomatic damage - this influences the assessment of the prognosis and stage of hypertension, as well as the choice of therapeutic measures.For this purpose, in addition to the conversation with the patient and his examination, a number of diagnostic examinations are carried out (e.g. electrocardiography, echocardiography, ultrasound examination of the neck vessels and, if necessary, some other examinations, the type of which is determined by the patient's already collected medical data).
Daily blood pressure monitoring using special compact devices allows you to assess changes in blood pressure during the patient's usual lifestyle.This test is not necessary in all cases - especially when the blood pressure measured at a doctor's appointment differs significantly from that measured at home, when an assessment of nocturnal blood pressure is required, when episodes of hypotension are suspected and sometimes also to assess the effectiveness of treatment.
Therefore, when examining a patient with hypertension, some diagnostic methods are used in all cases;The use of other methods is more selective, depending on the data already collected about the patient, in order to verify the assumptions made by the doctor during the preliminary examination.
Treatment of arterial hypertension
With regard to non-drug measures for the treatment of hypertension, the most convincing evidence is available for the beneficial effects of reducing salt intake, reducing and maintaining body weight at this level, regular physical activity (exertion), at most moderate alcohol consumption, and increasing the proportion of vegetables and fruits in the diet.Only all of these measures are effective as part of a long-term change in the unhealthy lifestyle that led to the development of high blood pressure.For example, a 5 kg reduction in body weight resulted in a reduction in blood pressure of an average of 4.4/3.6 mmHg.Art.– it seems a little, but when combined with the other measures listed above to improve your lifestyle, the effect can be quite significant.
Lifestyle improvement is warranted in almost all patients with hypertension, but drug treatment is indicated in most cases, although not always.In 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 (long-term) is mandatoryAlthoughthe benefit of such treatment has been demonstrated in many clinical trials), the benefit of such treatment in grade 1 hypertension with low and intermediate calculated cardiovascular risk has not been convincingly demonstrated in large clinical trials.In such situations, the potential benefit of drug therapy is assessed individually, taking into account the patient's preferences.If the increase in blood pressure in such patients persists over several months despite improved lifestyle and repeated visits to the doctor, the need for medication must be reassessed.In addition, the level of the calculated risk often depends on the completeness of the patient's examination and can be significantly higher than initially assumed.In almost all cases of treating high blood pressure, the aim is to stabilize blood pressure below 140/90 mmHg.Art.This does not mean that it will be below these values in 100% of measurements, but the less often blood pressure exceeds this threshold when measured under standard conditions (described in the “Diagnostics” section), the better.Thanks to this treatment, the risk of cardiovascular complications is significantly reduced and hypertensive crises, if they occur, are significantly less frequent than without treatment.Thanks to modern drugs, the negative processes that inevitably and latently destroy the internal organs (mainly the heart, brain and kidneys) in high blood pressure over time are slowed down or suspended, and in some cases they can even be reversed.
Of the drugs used to treat high blood pressure, the main 5 drug classes are:
- 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 particularly highlighted.Beta blockers are also used, but primarily when their use is necessary due to comorbidities - in these cases, beta blockers serve a dual purpose.
Nowadays, combinations of medications are preferred because treatment with one of these medications rarely results in achieving the desired blood pressure level.There are also fixed drug combinations that make treatment more comfortable because the patient only takes one tablet instead of two or even three.The selection of the drug classes necessary for a particular patient as well as their dosage and frequency of administration is made by the doctor, taking into account patient data such as blood pressure, concomitant diseases, etc.
Thanks to the wide range of positive effects of modern drugs, the treatment of high blood pressure is not only about lowering the actual blood pressure, but also about protecting the internal organs from the negative effects of the processes associated with 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 blood cholesterol levels, take medications that reduce the risk of blood clots (leading to myocardial infarction or stroke), etc. Quitting smoking, as trivial as it may sound, can significantly reduce the risk of strokes and myocardial infarctions associated with hypertension and the growth of atheroscleroticPlaques in the blood slow down blood vessels.Therefore, treating high blood pressure involves fighting the disease in many ways, and achieving normal blood pressure is just one of them.
Forecast.Prevention
The overall prognosis is determined not only and not so much by the fact of hypertension, but by the number of risk factors for cardiovascular disease, the severity of their severity and the duration of negative effects.
These risk factors are:
- Smoke;
- increased blood cholesterol levels;
- high blood pressure;
- Obesity;
- sedentary lifestyle;
- age (the risk increases with each decade of life after 40 years);
- 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 smoking 5 cigarettes, although both are associated with a worse prognosis), but also the duration of their exposure.For people who do not have any obvious cardiovascular diseases other than high blood pressure, the prognosis can be assessed using special electronic calculators that take into account, among other things, gender, age, blood cholesterol level, blood pressure and smoking.The electronic calculator SCORE is suitable for estimating the risk of death from cardiovascular diseases in the next 10 years from the date of the risk assessment.At the same time, the risk, which is low in absolute terms in most cases, can give a misleading impression, because the calculator can be used to calculate the risk of cardiovascular death.The risk of non-fatal complications (heart attack, stroke, angina pectoris, etc.) is many times higher.The presence of diabetes mellitus increases the risk compared to the risk calculated using the calculator: three times in men and five times in women.
With regard to the prevention of high blood pressure, since the risk factors for the development of high blood pressure are known (inactivity, obesity, chronic stress, regular lack of sleep, alcohol abuse, increased consumption of table salt, and others), any lifestyle changes that reduce the impact of these factors also reduce the risk of developing high blood pressure.However, it is hardly possible to completely reduce this risk to zero - there are factors that do not depend at all or only slightly on us: genetic characteristics, gender, age, social environment and some others.The problem is that people only think about preventing high blood pressure when they are already sick and blood pressure is already elevated in one way or another.It's less about prevention and more about treatment.