Hypertension is a disease associated with violations of blood pressure levels. It can have different etiologies and be primary or secondary. There are several degrees and stages of arterial hypertension, as well as the risk of complications. Symptoms can vary depending on the severity of the disease and the so-called target organ damage. The acute course of hypertension is called a hypertensive crisis. It has its own characteristic symptoms and is a life-threatening disease. When high blood pressure is diagnosed, the patient is prescribed medication.
General information about high blood pressure
Hypertension is a disease characterized by persistently elevated blood pressure. A healthy person's blood pressure should be within 120/80 mm. room temperature. Art. Only minor deviations from this value are possible. Only in some cases metrics like 100/65 or 135/110 mm are standard. room temperature. Art. But for most people, such blood pressure is considered pathological.
The BP indicator consists of two values. The first number is the systolic blood pressure (upper pressure), which shows how hard the walls of the heart are contracting. The second is diastolic blood pressure (bottom), a value that indicates how relaxed the heart is.
Types of high blood pressure:
- Essential (primary) - Occurs in 90-95% of all arterial hypertension patients.
- Symptomatic - a secondary form of hypertension, observed in only 5-10% of cases.
Persistent hypertension develops against the background of cardiac left ventricular (LV) hypertrophy, which increases in mass as cells, cardiomyocytes, thicken. Initially, the wall of the left ventricle thickens, and then the chamber itself expands.
It should be noted that left ventricular hypertrophy has unfavorable prognostic signs. As the left ventricle increases, the risk of developing ventricular arrhythmias, heart failure, coronary artery disease, and sudden death increases. Characteristic symptoms appear as left ventricular dysfunction progresses.
GB (hypertension) can occur with varying degrees of severity and dynamics. High blood pressure comes in several forms:
- Short-lived. Blood pressure rises periodically and stabilizes spontaneously after a few hours or days without the use of drugs.
- unstable. Manifestations are also cyclical, but treatment is required to normalize blood pressure.
- stable. Hypertension persists for a long time, and patients require constant treatment.
- vicious. Blood pressure, especially diastolic, rises to critical levels, and sensitivity to treatment is low. The disease has the potential to progress rapidly with serious complications.
- crisis. Regular observation of hypertensive crisis. They can accompany any stage of high blood pressure (stage 1 is rare).
Classification
Arterial hypertension is classified according to several criteria. The disease is divided into stages and degrees, which are determined by blood pressure levels.
There's a risk to this kind of stuff. It depends on the likelihood of complications due to damage to the target organ.
stage
Hypertension has 4 stages:
- preclinical. No signs of arterial hypertension, elevated blood pressure without characteristic symptoms.
- The first stage. There are signs of high blood pressure and a possible crisis, but no symptoms of target organ damage.
- Phase 2. Signs of target organ damage were observed - cardiac hypertrophy, impaired renal function, marked retinal changes.
- Phase 3. Serious complications may occur - stroke, impaired visual function, myocardial infarction, atherosclerosis, or aortic aneurysm.
Target organs are affected in stage 2 HD, so patients should be screened for possible risk. Electrocardiogram, echocardiography are designed to identify the degree of cardiac hypertrophy; blood and urine are collected for tests (protein, creatinine) to determine indicators of kidney function.
Associated pathologies associated with hypertension can occur in the third stage of GB. Among them, transient ischemic attack, stroke, angina and myocardial infarction are the most important for prognosis.
degree of high blood pressure
The degree of GB is determined according to the value of blood pressure. It is important in risk and forecasting.
Hypertension is diagnosed when blood pressure exceeds 140/90 mm. room temperature. Art. Degrees are determined by the following relationship:
- Blood pressure within 140-159 / 90-99 mmHg. Art. ;
- Blood pressure within 160-179 / 100-109 mmHg. Art. ;
- Marks above 180/110 mmHg. Art.
In rare cases, the patient's systolic blood pressure increased by more than 140 mm. room temperature. Art. , the diastolic blood pressure is within the normal range. This condition is known as the orphaned shrinking form of GB. When determining the extent of the disease, it does not matter which pressure (lower or higher) is outside the normal range.
With maximum accuracy, the degree of hypertension is determined at the first detection of the disease. In the presence of drugs (antihypertensives), blood pressure can drop or rise sharply, which cannot adequately assess the extent of GB.
risk
With high blood pressure, serious complications are possible. The most dangerous conditions are cerebral hemorrhage, myocardial infarction, avascular necrosis and renal failure. Therefore, for each patient with high blood pressure, the risk is determined on a scale of 1 to 4, with higher values indicating the highest risk.
For GB, the patient's risk is determined based on an analysis of external triggers, concomitant diseases, metabolic disorders, and changes in internal organs involved in the pathological process.
Factors that give rise to risk include:
- age of the patient (men - after 55 years, women - 65 years);
- smokes;
- Have a relative with cardiovascular disease under the age of 65 (women) and under the age of 55 (men);
- Violation of lipid metabolism (partial reduction of high-density lipids, excess of low-density lipoprotein and cholesterol);
- Overweight (if the abdominal circumference exceeds 102 cm for men and 88 cm for women, it is considered overweight).
These are the main triggers, but some people with high blood pressure may have diabetes, be sedentary, or have abnormal blood clotting due to elevated fibrinogen levels. These factors are considered additional, increasing the likelihood of complications.
To determine the risk of GB, it is necessary to consider the complications of metastasis. For example, if a patient has a stroke, they are at very high risk (4). In grades 1 and 2 GB with normal health status (no internal organ damage) and predisposing factors such as smoking and age, set as intermediate risk - 2.
Low risk means that the probability of complications does not exceed 15% and is represented by the number 1. A value of 2 is medium risk, with a probability of up to 20%. A value of 3 corresponds to a high risk of a heart attack and stroke of no more than 30-33%. The highest risk is determined when the probability of a vascular accident exceeds 35% (4).
reason
The following factors can trigger the necessary GB:
- Excessive weight due to impaired metabolism, sedentary lifestyle, endocrine diseases;
- Excessive nervousness, depression, stressful situations, etc. ;
- Often increased psycho-emotional stress associated with professional activities;
- previous brain injury (hypothermia, falls, bruising);
- Genetic susceptibility (at a young age, the first symptoms of hypertension may appear if the patient's parents have arterial hypertension);
- Chronic diseases that negatively affect the cardiovascular system (rheumatoid arthritis, diabetes, gout);
- age-related changes in blood vessels;
- viruses and infectious diseases;
- Cholesterol plaques form on the walls of blood vessels that disrupt blood circulation;
- Significant changes in menopausal hormones in women over the age of 40;
- Heavy consumption of caffeinated beverages, alcohol, and smoking;
- prolonged mental activity;
- a sharp increase in adrenaline in the blood;
- Excessive consumption of salty food;
- a sedentary lifestyle;
- There is little exposure to fresh air.
Symptomatic arterial hypertension may occur in the following contexts:
- Kidney damage due to unilateral or bilateral renal artery stenosis (glomerulonephritis);
- increase thyroid function;
- Coarctation of the aorta (congenital disease);
- Uncontrolled intake of hormonal drugs, antidepressants;
- Pheochromocytoma (produces epinephrine and norepinephrine) and aldosteronism (produces aldosterone) - adrenal gland tumors;
- Drink more than 60ml of alcohol per day.
symptom
Symptoms of hypertension are nonspecific. Patients may be unaware of high blood pressure for many years and experience no discomfort with a habitual lifestyle. In some cases, mild weakness and dizziness may occur, usually due to overexertion.
Usually, the first complaint is related to target organ damage and occurs in HD stage 2. With a violation of cerebral circulation, a person experiences severe dizziness, head noises, headaches, decreased performance and memory loss. As the disease progresses, flies in the eyes, numbness of the limbs, and speech difficulties may appear. Usually in the initial stage, these symptoms are short-lived. With the severe aggravation of the condition, there is a risk of cerebral infarction and cerebral hemorrhage.
Morphological changes occur when the heart muscle is damaged. Atherosclerosis of the aorta leads to its dilation, dissection and rupture. In this case, there is pain in the interstitial area that cannot be removed with analgesics. When the kidneys are damaged, protein, red blood cells, appear in the urine. In rare cases, high blood pressure may lead to kidney failure. Damage to the eye can lead to deterioration of visual function, leading to blindness.
Often, head pain persists as hypertension progresses further. It is independent of the time of day, so it can happen at any time. Often, discomfort plagues patients at night and in the morning. The patient feels heaviness or fullness in the back of the head, but other areas are usually covered. Often, patients describe the pain as a "hoop" feeling due to muscle tension in the soft outer skin of the head or the tendon helmet of the head. This symptom is exacerbated by severe coughing, nervousness, head tilt, psycho-emotional stress, and may be accompanied by mild swelling of the eyelids and face. Chronic headaches can lead to increased irritability, irritability, and increased sensitivity to external stimuli (noise, loud music). Through vertical position, muscle activity, or massage, venous outflow is improved, so the pain lessens or disappears for a while.
With arterial hypertension, pain in the heart area is associated with an angina attack with some distinguishing features:
- at the apex of the heart or on the left side of the sternum;
- for minutes and hours;
- Occurs during rest or emotional stress;
- Cannot be eliminated with nitroglycerin;
- Not caused by physical activity.
Shortness of breath, which occurs first during physical activity, followed by swelling of the legs even at rest, is a symptom of myocardial damage and the development of heart failure. However, moderately marked hypertensive peripheral edema may be the result of sodium and water retention due to impaired renal excretion or certain medications.
Hypertensive crisis
During the peak of high blood pressure, people are used to talking about hypertensive crisis. In this state of sharply elevated blood pressure, all of the above-mentioned clinical symptoms appear. But they are also accompanied by nausea, vomiting, darkened eyes, and sweating.
Hypertensive crisis usually lasts from minutes to hours. At this point, the patient complained of palpitations and fear of death. Red spots may appear on the cheeks. The onset of hypertensive crisis may be accompanied by profuse urination and diarrhea. Usually, this condition is caused by strong emotional overstretching.
Hypertensive crisis is sometimes more severe, develops gradually and lasts for a long time. This type usually occurs late in the GB. It is accompanied by aggression of speech and sensitivity of the limbs. In some cases, patients experience heart pain.
Hypertensive crisis occurs for the following reasons:
- mental stress;
- Inadequate drug treatment;
- pain;
- The phenomenon of "rebound" in the context of drug withdrawal.
Hypertension in people of different ages and genders
According to statistics, men are more likely to suffer from high blood pressure than women. This is because women are protected by sex hormones, estrogen. However, this barrier to high blood pressure is short-lived. During menopause, estrogen levels drop and women are at risk of developing GB.
In older adults, the main cause of high blood pressure is physical inactivity. As you age, blood vessels change, so high blood pressure develops dramatically. Typically, this group of patients has isolated systolic arterial hypertension, which is caused by decreased vascular elasticity.
In children, high blood pressure is rare. GB develops for the same reasons as in adult patients. Treatment of childhood illnesses is somewhat complicated because not all types of medicines are available.
treat
For primary arterial hypertension, it is necessary to normalize blood pressure, improve lifestyle and target organ function. To do this, use medication and general measures.
When establishing a diagnosis, patients need to completely reconsider their lifestyle. First, you should break bad habits, normalize your weight, change your diet, and exercise more.
Experts point out that essential hypertension should be treated with systemic medication. The treatment regimen is determined by the cardiologist, and the patient must follow it adequately. If left untreated, there is a risk of developing a sudden hypertensive crisis that can lead to serious and life-threatening complications.
When treating high blood pressure, doctors use the following groups of drugs:
- ACE inhibitors.
- Angiotensin II receptor blockers.
- Diuretics.
- Calcium antagonists.
- beta-blockers.
- Imidazoline-prescribed agonists.
The above groups of drugs have their own contraindications, so they can only be prescribed by doctors according to the stage of the disease and accompanying diseases. Treatment usually begins with a single agent, most commonly an ACE inhibitor. Funding from other groups was added to the treatment regimen due to insufficient efficacy. This approach allows the drug to be used in small doses, thereby reducing the likelihood of side effects.
In addition to the listed drug groups, nootropics may also be prescribed. They are used to treat symptoms of circulatory hypertensive encephalopathy. As the heart muscle changes, vitamins and trace elements are used to help restore the muscle structure of the heart. If the patient is under stressful load and emotionally unstable, sedatives may be required.