Main criterionarterial hypertension (or high blood pressure)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 type of blood pressure is considered high 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 of 10 mm Hg.Art.is accompanied by an increased risk of developing cardiovascular disease (mainly coronary heart disease and stroke).However, the benefits of modern methods of treating arterial hypertension have been demonstrated 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: about 9 out of 10 cases. The diagnosis of hypertension is established in cases where there is a stable increase in blood pressure, but no other diseases leading to an increase in 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 established through observation 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 characteristics 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, 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 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 secondary arterial hypertension seems unlikely.
If you notice similar symptoms, see your doctor.Do not self-medicate: it is dangerous for your health!
Symptoms of arterial hypertension
For many people, high blood pressure itself does not manifest itself in any subjective sensations.If hypertension is accompanied by symptoms, they may include a feeling of heaviness in the head, headache, flashes before the eyes, nausea, dizziness, unsteadiness in walking, as well as a number of other symptoms that are not specific to hypertension.The symptoms listed above manifest themselves much more clearly during a hypertensive crisis: a sudden significant increase in blood pressure, leading to a sharp deterioration in condition and well-being.
It would be possible to continue listing the possible symptoms of hypertension, separated by commas, but there is no particular advantage in this.Why?Firstly, all these symptoms are not specific to hypertension (that is, they can occur 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 evaluating subjective symptoms, but only by measuring blood pressure, moreover, repeatedly.This means, firstly, that “in one session” you should measure your blood pressure two or three times (with a short break between measurements) and take the arithmetic mean of two or three measured values as your actual 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 one week.
If a hypertensive crisis develops there will certainly be symptoms, otherwise it is not a hypertensive crisis, but simply an asymptomatic increase in blood pressure.And these symptoms can be those listed above or other more serious ones - they are discussed in the "Complications" section.
Symptomatic (secondary) arterial hypertension develops as part of other diseases, and therefore their manifestations, as well as the actual symptoms of hypertension (if any), depend on the underlying disease.For example, in the case of hyperaldosteronism, this may consist of muscle weakness, cramps, and even transient paralysis (lasting hours or days) in the muscles of the legs, arms, and neck.With obstructive sleep apnea syndrome: snoring, sleep apnea, daytime drowsiness.
If hypertension over time, usually for many years, leads to damage to various organs (in this context they are called "target organs"), this can manifest itself as a decrease in memory and intelligence, stroke or transient cerebrovascular accident, increased 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, decreased blood filtration rate in the kidneys, etc.Consequently, 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 many others, mainly related to lifestyle characteristics, lead over time to disruption of the functioning of the endothelium - the inner layer of arterial vessels often a layer of cells, which is actively involved in regulating the tone, and therefore the lumen of blood vessels.The tone of the microvascular vessels, 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 of local regulation of blood pressure.However, there are other levels of blood pressure regulation: the central nervous system, the endocrine system, and the kidneys (which also fulfill their regulatory role largely due to their ability to participate in hormonal regulation at the whole-body level).Violations of these complex regulatory mechanisms lead, in general, to a decrease in the ability of the entire system to accurately adapt to the ever-changing needs of organs and tissues for blood supply.
Over time, a persistent spasm of the 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 high blood pressure, atherosclerosis develops at an accelerated rate.The walls of the heart become thicker, myocardial hypertrophy develops, and therefore the expansion of the cavities of the left atrium and left ventricle.Increased pressure damages the glomeruli, their number decreases and, consequently, 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 hemorrhage and small areas of necrosis (death) of brain cells appear.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 extent of elevated blood pressure, is divided into three degrees.Furthermore, taking into account the increased risk of cardiovascular diseases on a "decadal" scale, starting from a blood pressure level above 115/75 mm Hg.Art., there are many other gradations of blood pressure levels.
If the systolic and diastolic blood pressure values fall into different categories, the degree of arterial hypertension is assessed by the higher of the two values and it does not matter: systolic or diastolic.The degree of increase in blood pressure during the diagnosis of hypertension is determined by repeated measurements on different days.
In some countries, the stages of hypertension continue to be distinguished, while the European guidelines for the diagnosis and treatment of arterial hypertension do not mention any stage.The identification of stages is intended to reflect the phase of the course of hypertension from its onset to the appearance of complications.
There are three phases:
- Phase Iimplies that there is still no noticeable 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, the protein albumin is not detected in the urine, no thickening of the walls of the carotid arteries or atherosclerotic plaques in them is detected, etc.Such damage to internal organs is usually asymptomatic.
- If at least one of the listed signs is present, diagnosePhase IIhypertension.
- Finally, aboutPhase IIIWe speak of hypertension 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 limbs) or, for example, severe renal damage, manifested by a pronounced decrease in filtration and/or a significant loss of protein in the urine.
These stages do not always naturally replace each other: for example, a person suffered a myocardial infarction, 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 based on the risk of cardiovascular complications.Therapeutic measures also depend on this: the higher the risk, the more intensive the treatment.When making 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 hypertension treatment is not to “lower” high blood pressure, but to maximally reduce the risk of cardiovascular and other long-term complications, since this risk – again, when assessed on a “decadal” 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 failure 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 seek treatment, regularly take a certain minimum of medications and change their lifestyle to a healthier one.However, in the treatment of hypertension there are no one-time measures that allow you to forget about this disease forever without doing anything else to cure it.
Diagnosis of arterial hypertension
With the diagnosis of arterial hypertension as such, usually everything is quite simple: this requires only a 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, increased blood pressure can manifest itself in numerous diseases, and hypertension is only one of them, although the most common.When making 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 diagnostic research, the doctor finds out at what age blood pressure first began to increase, whether there are symptoms such as, for example, snoringwith breathing pauses during sleep, attacks of muscle weakness, unusual impurities in the urine, attacks of sudden heartbeat with sweating and headache, etc.It is advisable to clarify which drugs and food supplements the patient is taking, because in some cases they can lead to an increase in blood pressure or a worsening of an already high one.Numerous routine diagnostic tests (performed in almost all patients with high blood pressure), together with information obtained during an interview with a doctor, help to assess the likelihood of some forms of secondary hypertension: a complete analysis of urine, determination of blood concentrations of creatinine and glucose, and sometimes of potassium and other electrolytes.In general, taking into account the low prevalence of secondary forms of arterial hypertension (about 10% of all cases), further research into these diseases as a possible cause of arterial hypertension must have good reasons.Therefore, if at the first stage of diagnostic research no significant data are found in favor of the secondary nature of arterial hypertension, in the future it is believed that blood pressure is increased due to hypertension.This judgment can sometimes be subsequently revised as new patient data becomes available.
In addition to searching for data on the possible secondary nature of increased blood pressure, the doctor determines the presence of risk factors for cardiovascular diseases (this is necessary for assessing 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, numerous 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 on the patient).
Daily monitoring of blood pressure using special compact devices allows you to evaluate changes in blood pressure during the patient's usual lifestyle.This study is not necessary in all cases, especially if the blood pressure measured during the medical examination differs significantly from that measured at home, if it is necessary to evaluate night blood pressure, if episodes of hypotension are suspected, and sometimes to evaluate the effectiveness of treatment.
Therefore, in all cases some diagnostic methods are used when examining a patient with high blood pressure;the use of other methods is more selective, depending on the data already obtained on the patient, to verify the hypotheses formulated by the doctor during the preliminary examination.
Treatment of arterial hypertension
As for non-pharmacological 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), moderate alcohol consumption and increasing the content of fruits and vegetables in the diet.Only all of 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 of 5 kg led to a decrease in blood pressure by an average of 4.4/3.6 mmHg.Art.- it seems like little, but in combination with the other measures listed above to improve your lifestyle, the effect can be quite significant.
Lifestyle improvement is warranted for almost all patients with hypertension, but pharmacological 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 provenin many clinical trials), therefore in grade 1 hypertension with a calculated low and moderate cardiovascular risk, the benefit of this treatment has not been convincingly demonstrated 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 improvements in lifestyle, the increase in blood pressure in these patients persists for several months during repeated visits to the doctor, it is necessary to reassess the need for the use of drugs.Furthermore, 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 hypertension treatment, an attempt is made to achieve stabilization of blood pressure below 140/90 mmHg.Art.This does not mean that in 100% of measurements it will be lower than these values, but the less often blood pressure, 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 drugs, those negative processes which, in hypertension, inevitably and latently destroy the internal organs over time (heart, brain and kidneys first and foremost), these processes are slowed down or suspended, and in some cases can even be reversed.
Among drugs for the treatment of hypertension, the main 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 particularly highlighted.Beta blockers are also used, but especially when their use is required by concomitant diseases: in these cases beta blockers have a dual purpose.
Nowadays, preference is given to combinations of drugs, since treatment with any one of them rarely leads to achieving the desired blood pressure level.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 classes of drugs necessary for a particular patient, as well as doses and frequency of administration, is carried out by the doctor, taking into account data about the patient such as blood pressure level, concomitant diseases, etc.
Thanks to the multiple positive effects of modern drugs, the 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 hypertension.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 the level of cholesterol in the blood, take drugs that reduce the risk of blood clots (leading to myocardial infarction or stroke), etc.Quitting smoking, as trivial as it may seem, allows you to significantly reduce the risks of stroke and myocardial infarction associated with hypertension and slow the growth of atherosclerotic plaques in blood vessels.Therefore, treating hypertension involves addressing 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 diseases, the degree of their severity and the duration of the negative impact.
These risk factors are:
- smoking;
- increased blood cholesterol levels;
- hypertension;
- obesity;
- sedentary lifestyle;
- age (with every decade lived after the age of 40 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 disease 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 disease 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 terms, can produce a misleading impression, because The 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 with the calculator: for men by 3 times and for women even by 5 times.
Regarding the prevention of hypertension, we can say that since the risk factors for its development are known (inactivity, excess weight, chronic stress, lack of regular sleep, alcohol abuse, increased consumption of table salt and others), all lifestyle changes that reduce the impact of these factors also reduce the risk of developing hypertension.However, it is hardly possible to completely reduce this risk to zero: there are factors that do not depend on us at all or depend little on us: genetic characteristics, sex, age, social environment and some others.The problem is that people start thinking about hypertension prevention especially when they are already unhealthy and their blood pressure has already increased in one way or another.And it's not so much a question of prevention as of cure.