Hypertension

Hypertension is an extremely common disease, which as a collective definition unites different types of arterial hypertension. Hypertension develops against a 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 blood. vases.

What is hypertension?

Hypertension 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, adrenal glands, hypertension is almost inevitable as one of the manifestations of these diseases. In addition, an increase in pressure can be an adaptive and adaptive reaction of organs and systems to changes, both to external - excessive physical activity, and to 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 set between 100/60 and 140/90 mmHg; if the regulatory systems stop working properly, hypertension or hypotension may develop.

Statistics provide information that almost 30% of the world's population suffers from one stage or another of hypertension, yet until recently practically nothing was known about such a disease as hypertension. Only Homo sapiens is characterized by disorders in the functioning of the cardiovascular system, no representative of the animal world is susceptible to it. Until the 19th and 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 case of cardiovascular disease in African and Asian countries. It was only with the development of urbanization and the penetration of modern technology in these countries that Asian and African populations also became vulnerable to hypertension, which reached its peak in the 1970s.

Since the end of the last century, hypertension 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. For example, blood pressure increases 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 blood pressure, both systolic and diastolic. Nearly 90% of all patients with persistently high blood pressure have 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 a disorder 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 disease. In addition, secondary hypertension is quite common during pregnancy and with gynecological diseases: cysts and neoplasms.

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

• If blood pressure is set between 140/90 and 159/99 mmHg, hypertension is diagnosed as a stage I disease. In this case, the pressure can return to normal, but periodically "jump" to the specified limits.
• If blood pressure is between 160/100 and 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 consistently remains within the range of 180/110 and above is considered a clinical symptom of stage III hypertension. At this stage, blood pressure practically does not drop to normal levels, and if it drops, it is accompanied by heart 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 as sinus tachycardia, unstable blood pressure when the systolic reading fluctuates, increased sweating, skin hyperemia, throbbing headache, and anxiety. The face and limbs often swell, fingers become numb, and urination is impaired. There is also a more serious form: malignant hypertension, which progresses rapidly. Blood pressure can increase so much that there is a risk of encephalopathy, vision loss, pulmonary edema and even a risk of kidney failure. Fortunately, this form practically does not occur today, since hypertension is 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. Blood 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 indicator of blood pressure during the period of relaxation of the heart muscle. It is believed that hypertension begins when values exceed the norm of 140/90 mmHg. This, of course, is a conditional limit, since there are conditions in which there is a risk of developing a myocardial infarction even at values of 115/75 mmHg. However, formalizing and bringing to an average level the whole variety of blood pressure conditions helps doctors to notice deviations in time and begin symptomatic and therefore standard treatment.

ICD-10 code

I10 Essential hypertension [primary].

What causes hypertension?

Hypertension is considered a multi-etiological and multi-factorial disease, the real causes of which are not entirely clear. The factors that cause secondary hypertension are more specific, since the cause is the underlying disease. The definitive diagnosis of essential hypertension is made after a thorough examination excluding the presence of precipitating diseases. Primary hypertension, in medical terms, is a genetic imbalance of the body's regulatory mechanisms (imbalance of the blood pressure and blood pressure depressant systems).

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

• Kidney disorders – nephritis and very often glomerulonephritis. Factor causing secondary hypertension.
• Stenosis (narrowing) of the renal arteries.
• Congenital disorder 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.
• Impairment of the functioning of the thyroid gland.
• Alcoholism.
• Overdose or constant use of drugs, especially hormonal antidepressants.
• Dependence.

Factors considered provocative in the sense of disruption of normal blood pressure levels can be divided into nutritional, age-related and pathological:

• Age over 55 for men and 65 for women.
• Increased blood cholesterol levels (above 6. 6 mmol).
• Hereditary predisposition, family history.
• Obesity, especially abdominal, when the waist circumference is greater than 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, for example, of a stress factor, the nutrition of the kidney tissue is disrupted and ischemia develops. The kidneys try to compensate for the disorders by producing renin, which in turn causes the activation of angiotensin, which narrows the blood vessels. As a result, blood pressure rises and hypertension develops.

Symptoms of hypertension

The main 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 increases slightly, the person simply feels sick, weak and has a headache.

If the pressure exceeds the norm by 10 units, the headache becomes intense and constant, most often localized in the back of the head and temples. The person feels nauseous and sometimes vomits. The face becomes red, sweating increases, trembling of the fingers is noted, and there is often 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 excruciating, sharp, can radiate to the arm, but most often the heart pain is localized in the left side of the chest, without spreading further. Against the background of constantly high 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 increases sharply, nosebleeds may occur.

Another symptom of hypertension is dizziness. Vision deteriorates.

In the terminal stage, when hypertension reaches stage III, neurosis or depression are added to 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 increase in blood pressure. A crisis condition is fraught with stroke or heart attack and is manifested by the following symptoms:

• A sharp, sudden, or rapidly increasing 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 provoke a stroke or heart attack, therefore, at the slightest alarming signal, you need to call emergency medical help. A hypertensive crisis is controlled with the help of diuretics, cardiac and hypertensive drugs administered by injection. A hypertensive patient who knows his problem must constantly take prescribed drugs to prevent a crisis state.

Who to contact?

Cardiologist.

Treatment of hypertension

Hypertension in the initial stage, when blood pressure values often do not exceed normal levels, can be treated with non-pharmacological drugs. The first way is to control your body weight and follow a low-carb, low-fat diet. A diet for hypertension also includes limiting the intake of salty foods and controlling fluid intake, no more than 1. 5 liters per day. Psychotherapy and autogenic training are also effective, relieving anxiety and general tension. 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 involving the treatment of hypertension are prescribed according to a "gradual" 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 beta-blocker dose is calculated based on the patient's medical history, weight and condition. If blood pressure normalizes after two or 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, so as not to weaken the heart muscle. If hypertension begins to decrease, a diuretic may be prescribed once a week. There are often cases where diuretics and beta-blockers cannot be used due to possible side effects (diabetes, gout or asthma); in such situations the intake of antispasmodics is indicated. During the entire course of treatment it is necessary to monitor blood pressure levels three times a day.

Stage II hypertension is supervised by complex therapy, includingbeta-blockers, diuretics, antispasmodics, ACE inhibitors (angiotensin converting enzyme inhibitors) and potassium preparations. Among beta-blockers, effective drugs are those that can control rapid heartbeat and reduce vascular resistance in the periphery. These drugs are also effective in cases of diagnosed bradycardia, when the heart rate is reduced. Angiotensin-converting enzyme inhibitors can counteract the increase in renin production, which increases blood pressure. These drugs activate the work of the left cardiac ventricle, reducing hypertrophy, dilate the coronary vessels, thereby helping to normalize peripheral blood flow. Calcium antagonists aim to block the calcium ducts in the vascular walls, increasing their lumen. Calcium channel blockers should only be prescribed by a doctor or cardiologist, as all these drugs can cause swelling, dizziness and headaches. A set of drugs 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), 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 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 effective combined drugs. These drugs act on those patients whose body is accustomed to monotherapy and no longer responds or has significant contraindications to the use of the standard treatment used for stage I and II hypertension.

Severity III hypertension is also controlled by vasodilators. Increasingly, vasodilators have begun to be 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 drug that improves peripheral circulation and controls renin levels. The drug is taken three or four times a day, in combination with a diuretic, which allows blood pressure to return to normal after a week.

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

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 monitoring of blood pressure, 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: maintain a healthy lifestyle and physical activity, because one of the reasons that causes hypertension is physical inactivity. Hypertension can also be prevented with a normal diet, in which cholesterol and salty foods are reduced to a minimum.

Hypertension is also a bad habit, therefore, if a person does not want to join the ranks of hypertensive patients, he must 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, keep 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" .