Hypertension, or arterial hypertension, is a disease characterized by a steady increase in blood pressure that is detected by repeated measurements.Along with many diseases, it is considered a risk factor for the development of dangerous complications of the cardiovascular system, including stroke and myocardial infarction.Hypertension, as the main cause of associated pathologies, requires medication, normalization of the patient's lifestyle and nutrition.
Blood pressure is the force of circulating blood acting on the walls of blood vessels.The pressure when the heart contracts is called systolic blood pressure, and the pressure when the heart relaxes is called diastolic blood pressure.The range of normal values for these indicators is quite wide.
Through extensive observations, scientists concluded that for every 10 mm Hg increase in blood pressure, the risk of cardiovascular complications increases.Art.Already starting from a level of 115/75 mmHg.Art.However, it turns out that only a reduction in drug pressure above 140/90 mm is desirable.RT.Therefore, this value is used as the standard for determining arterial hypertension.
reason
In about 90% of cases, the cause of a steady increase in blood pressure is hypertension.This diagnosis can be made in a patient when no other diseases associated with high blood pressure are found during the examination.Among the latest:
- Renal pathology - pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, renal artery stenosis;
- Endocrine disorders - adrenal, pancreatic or pituitary tumors, hyperthyroidism, Cushing's disease or syndrome, pheochromocytoma;
- obstructive sleep apnea syndrome;
- Aortic valve defects or atherosclerotic lesions.
Regular use of certain medications can also cause high blood pressure.These include oral contraceptives, nonsteroidal anti-inflammatory drugs, amphetamines, corticosteroids, medications containing erythropoietin, cyclosporine, and cocaine.
The likelihood of developing cardiovascular disease, including high blood pressure, is closely related to the following risk factors:
- Unhealthy diet, including excess salt, saturated fat, and trans fat, and a diet lacking in leafy green vegetables, vegetables, and fruits;
- obesity;
- Heart and blood vessel disease in close relatives;
- Aged over 65 years old;
- sedentary lifestyle;
- chronic stress;
- Bad habits - smoking, excessive drinking.
Classification
If the disease causing the increase in blood pressure can be identified, arterial hypertension is called secondary or symptomatic hypertension.When the cause is unknown, high blood pressure is considered essential hypertension.
The latter has a staged course:
- Stage one.The target organs affected by the steady increase in blood pressure—the heart, kidneys, arterial and venous blood vessels—show no obvious signs of destruction.
- The second stage.The presence of one or a combination of the listed symptoms, such as enlargement of the heart's left ventricle, significantly reduced kidney filtration rate, presence of albumin in urine, increased carotid artery wall thickness, or presence of atherosclerotic plaque within the lumen.In this case, clinical manifestations of the disease may not be present.
- Stage III hypertension.Presence of one or more conditions associated with atherosclerotic processes in the heart and blood vessels - myocardial infarction, acute cerebrovascular accident, angina pectoris, atherosclerosis of the lower limbs or severe kidney damage, manifested by a significant reduction in filtration and/or a significant loss of protein in the urine.
Arterial hypertension is divided into several levels based on the highest blood pressure measured:
- First degree.Systolic blood pressure was 140 to 159 mm.RT.Art.and/or diastolic blood pressure – from 90 to 99 mm.RT.Art.
- Second degree.Systolic blood pressure 160 to 179 mm.RT.Art.and/or diastolic blood pressure – from 100 to 109 mm.RT.Art.
- Level three.Systolic blood pressure greater than 180 mm.RT.Art.and/or diastolic blood pressure exceeds 110 mm.RT.Art.
There is also an isolated form of arterial hypertension in which only systolic blood pressure values are elevated, while diastolic blood pressure is normal.
symptom
Often, elevated blood pressure is not accompanied by worsening health conditions and may go unnoticed by patients, which is why regular blood pressure measurements are so important, especially for middle-aged and older adults.
Signs of high blood pressure may include the following symptoms:
- Headache, which mainly occurs after getting up in the morning;
- nosebleed;
- Bleeding under the mucosa of the eye;
- heart rhythm disturbance;
- Blurred vision, flashing spots;
- tinnitus.
A sharp increase in blood pressure accompanied by a significant deterioration in health is called a hypertensive crisis.It most commonly occurs when systolic blood pressure rises above 180 mmHg.Art.and/or diastolic blood pressure greater than 120 mm Hg.Art.In this condition, patients experience weakness, nausea, vomiting without relief, confusion, anxiety and fear, muscle tremors, and chest pain.
complication
The steady increase in blood pressure during hypertension significantly increases the risk of cardiovascular diseases, including those that threaten the patient's life.These include:
- Acute cerebrovascular accident (stroke);
- Angina pectoris, myocardial infarction;
- Vascular dementia (dementia);
- chronic renal failure and heart failure;
- Atherosclerotic lesions of the blood vessels of the lower extremities.
diagnosis
The main symptom of hypertension is a steady increase in blood pressure, which can be detected by taking at least three measurements on different days in a quiet environment.When measuring your blood pressure for the first time in a hospital or clinic, be sure to follow the following rules to ensure the accuracy of the results obtained:
- Before the examination, the patient needs to sit quietly in a quiet room for a few minutes to calm down;
- The size of the tonometer cuff must correspond to the thickness of the arm, and the device itself must be mounted at heart level;
- Two measurements were taken on each hand, 1-2 minutes apart; if the numbers obtained differed significantly, additional measurements were taken;
- In elderly patients and those with diabetes, or if a drop in blood pressure due to a change in body position is suspected, take measurements within the first and fifth minutes of standing;
- In addition, heart rate is measured for 30 seconds.
Doctors talk to patients to determine the age at which blood pressure first began to rise and whether there are any symptoms, such as snoring during sleep, pauses in breathing, muscle weakness or sudden heartbeats, sweating and headaches, and unusual impurities in the urine.It's also important to know what medications and dietary supplements he's taking.
As part of the first phase of checking for high blood pressure, the following tests are done:
- clinical blood tests;
- General urinalysis, detection of microalbumin in single and daily portions;
- Blood chemistry tests (cholesterol, lipoprotein levels, blood electrolytes - potassium, sodium, chloride, calcium, as well as glucose and creatinine to assess atherosclerosis risk);
- Determination of glycosylated hemoglobin levels;
- Determination of hormone concentrations - thyroxine, triiodothyronine and thyroid-stimulating hormone, thyroid peroxidase and thyroglobulin antibodies, aldosterone.
If a genetic predisposition to the disease is suspected, genetic polymorphisms associated with the development of arterial hypertension can be identified.
In order to elucidate the risk factors for the development of hypertension and to determine the existing cardiovascular pathology of hypertension, instrumental diagnostic methods are used:
- 24-hour blood pressure monitoring;
- EKG studies;
- echocardiography;
- 24-hour dynamic electrocardiogram monitoring;
- Dual scan of the brachiocephalic, renal, or iliofemoral arteries;
- Ultrasound examination of the kidneys and adrenal glands;
- Fundus examination.
For high blood pressure, it is very important to control blood pressure at home by keeping a diary, in which it is necessary to record all measurements taken over a period of time, medications taken, and stress episodes that may cause an increase in blood pressure.In this case, the measurement must be taken in a sitting position, with the hands at the same level as the heart, after a few minutes of rest.
treat
For patients with medium to low risk of cardiovascular complications, patients are only advised to change their lifestyle, adjust their diet, lose weight, increase physical activity and special exercises for high blood pressure, give up bad habits, and measure their blood pressure regularly.Usually these measures are enough to normalize blood pressure.
The hypertensive diet includes restriction of salt, caffeine, hot, salty, smoked and spicy foods, fatty foods, offal, butterscotch and alcoholic beverages.Unless the condition worsens, daily salt intake should not exceed 5 grams.The recommended daily fluid intake is 1-1.2 liters.
If several months of non-pharmacological treatment are unsuccessful and the risk of complications is high, they resort to antihypertensive medications for antihypertensive treatment, with the goal of lowering blood pressure to less than 140/90 mm.RT.Art.For patients with diabetes or those who already suffer from cardiovascular disease, the target pressure level is even lower - 130/80 mm.RT.Art.
Modern drug treatment of hypertension includes a combination of two or more drugs from the following groups:
- Calcium antagonists;
- angiotensin-converting enzyme inhibitors;
- Angiotensin II blockers;
- diuretics (diuretics);
- b-blockers;
- Alpha-blockers.
The vast majority of these are available in tablet form to treat high blood pressure.
prevention
Preventing the exacerbation of hypertension includes promptly diagnosing and treating diseases of the cardiovascular, neurological, urinary and endocrine systems, strictly adhering to all recommendations from your doctor, including non-pharmacological and pharmacological treatments, and regularly measuring blood pressure.