Hypertension

Hypertension is an extremely common disease, which as a collective definition unites several types of arterial hypertension. Hypertension develops against the 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 disturbed and the blood accumulated in the narrowed places begins to exert pressure on the walls of the blood. dishes.

What is hypertension?

High blood pressure can be a symptom, but it can also be a disease on its own. If a person is diagnosed with chronic pathologies of the kidneys, cardiovascular system, thyroid gland, adrenal glands, hypertension is almost inevitable as one of the manifestations of these diseases. Also, an increase in pressure can be an adaptive, adaptive response of organs and systems to changes, both external - excessive physical activity, and 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 fixed between 100/60 and 140/90 mmHg; if the regulatory systems stop working properly, hypertension or hypotension can develop.

Statistics show that almost 30% of the world's population suffers from one or another stage of hypertension, but until recently, almost nothing was known about such a disease as hypertension. Only Homo sapiens is characterized by disorders in the work of the cardiovascular system, no representative of the animal world is susceptible to them. Until the 19th and 20th centuries, little was known about hypertension in general; one of the first cases of heart attack was reliably confirmed by doctors only in the 1930s in one of the European countries; during the same period there was not a single clinically confirmed case of cardiovascular pathologies in African and Asian countries. Only with the development of urbanization and the introduction of modern technology in these countries did the Asian and African populations also become vulnerable to hypertension, the peak of which was in the 1970s.

Hypertension since the end of the last century is 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. Blood pressure rises for reasons other than kidney disease, for example. Hypertension, diagnosed as primary (EG - essential hypertension or GB - essential hypertension), is characterized by a persistent clinical sign - increased pressure, both systolic and diastolic. Almost 90% of all patients with persistently elevated blood pressure suffer from primary hypertension.
2. Symptomatic hypertension, which is also called secondary, is hypertension provoked 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. Also, secondary hypertension develops against the background of pathological changes in the vascular system - atherosclerosis and can provoke symptomatic hypertension and neurotic diseases. Also, secondary hypertension is quite common during pregnancy and in gynecological diseases - cysts and neoplasms.

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

• If the blood pressure is fixed between 140/90 and 159/99 mmHg, hypertension is diagnosed as a disease in stage I. In this case, the pressure may normalize, but periodically "jump" to the specified limits.
• If blood pressure is recorded in the range of 160/100 to 179/109 mmHg, hypertension is considered a second-stage disease. There is practically no remission, but the pressure can be controlled with the help of drugs.
• Blood pressure that consistently remains within 180/110 and higher is considered a clinical symptom of stage III hypertension. At this stage, blood pressure practically does not fall to normal levels, and if it falls, 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 itself as sinus tachycardia, unstable blood pressure with fluctuations in the systolic reading, increased sweating, hyperemia of the skin, throbbing headache and anxiety. The face and limbs often swell, the fingers go numb, urination is disturbed. There is also a more serious form - malignant hypertension, which progresses rapidly. Blood pressure can rise so much that there is a risk of encephalopathy, vision loss, pulmonary edema, and there is also a risk of kidney failure. Fortunately, this form practically does not occur today, since hypertension is most 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. 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 blood pressure indicator during the relaxation period of the heart muscle. Hypertension is considered to begin when readings 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 averaging the entire variety of blood pressure conditions helps clinicians spot abnormalities early and initiate symptomatic, then standard, treatment.

ICD-10 code

I10 Essential [primary] hypertension.

What causes hypertension?

Hypertension is considered a multietiological, multifactorial disease, the true causes of which are not fully understood. The factors that provoke secondary hypertension are more specific, since the cause is the underlying disease. The final diagnosis of essential hypertension is made after a comprehensive examination, excluding the presence of provoking diseases. Primary hypertension, from a medical point of view, is a genetic imbalance of regulatory mechanisms in the body (imbalance of the pressor and depressor systems of blood pressure).

Among the causes that clinicians have described and carefully studied are the following:

• Kidney pathologies - nephritis and most often glomerulonephritis. A factor that provokes secondary hypertension.
• Stenosis (narrowing) of the renal arteries.
• Congenital pathology 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.
• Dysfunction of the thyroid gland.
• Alcoholism.
• Overdose or constant use of drugs, especially hormonal antidepressants.
• Addiction.

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

• Age above 55 years for men and 65 years for women.
• Increased levels of cholesterol in the blood (over 6. 6 mmol).
• Hereditary predisposition, family burden.
• Obesity, especially abdominal obesity, when the waist circumference is over 100-15 cm in men and 88-95 in women.
• Diabetes, change in normal levels of glucose tolerance.
• Lack of physical activity, osteochondrosis.
• Chronic stress, increased anxiety.

The mechanism of development of hypertension is briefly as follows:

With spasm of the arterioles - the arteries of organs, most often of the kidneys - under the influence of, for example, a stress factor, the nutrition of the kidney tissue is disturbed and ischemia develops. The kidneys try to compensate for the disturbances by producing renin, which in turn provokes the activation of angiotensin, which constricts 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 constant increase of 140/90 mmHg. Other signs of hypertension are directly related to blood pressure parameters. If the pressure rises slightly, a person simply feels unwell, 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 turns red, sweating increases, tremors of the fingers are noticed, there is often numbness.

If hypertension persists for a long time and is not treated, pathological processes develop in cardiac activity and the heart begins to hurt. The pain can be piercing, sharp, can radiate to the arm, but most often heart pain is localized on the left side of the chest, without spreading further. Against the background of constantly increased blood pressure, anxiety and insomnia develop.

Hypertension is also characterized by dizziness and reduced vision.

Ophthalmological signs - veils or spots, "floaters" in front of the eyes. Often, when the pressure rises sharply, there may be nosebleeds.

Another symptom of hypertension is dizziness. Vision is deteriorating.

The terminal stage, when hypertension reaches stage III, neurosis or depression joins the typical symptoms. Hypertension in this form often occurs in a pathological "union" with coronary heart disease.

The most dangerous manifestation of hypertension is the crisis - a condition with a sharp increase or jump in blood pressure. The crisis state is filled with stroke or heart attack and is manifested by the following symptoms:

• Sharp, sudden, or rapidly increasing headache.
• Blood pressure up to 260/120 mmHg.
• Pressure in region of heart, aching pain.
• Strong 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 lead to a stroke or heart attack, so at the slightest alarming sign you should call emergency medical help. Hypertensive crisis is managed with the help of diuretics, cardiac and hypertensive drugs administered by injection. A hypertensive patient who is aware of his problem must constantly take prescribed medication to prevent a crisis condition.

Who should I contact?

Cardiologist.

Treatment of hypertension

Hypertension in the initial stage, when blood pressure indicators often do not exceed normal values, can be treated with non-pharmacological drugs. The first way is to control your body weight and follow a low-carb and low-fat diet. The 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 in relieving general anxiety and tension. These methods are effective in hypertension in stage I, although they can be used as auxiliary and additional elements to the main therapy of hypertension in stages II and III.

Pharmacological means, which include the treatment of hypertension, are prescribed on the "step" principle. They are applied sequentially, targeting different organs and systems, until the blood pressure is completely stabilized.

Hypertension in stage I includes the use of diuretics (diuretics), beta-blockers, blockers of adrenergic receptors to stop tachycardia. The dose of the beta-blocker is calculated based on the patient's medical history, weight, and condition. If the blood pressure normalizes after two to 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 the hypertension begins to decrease, a diuretic may be prescribed once a week. There are often cases when diuretics and beta-blockers cannot be used due to possible side effects (diabetes, gout or asthma); in such situations, taking antispasmodics is indicated. During the entire course of treatment, you should monitor your blood pressure level three times a day.

Hypertension in stage II is controlled by complex therapy, including beta-blockers, diuretics, antispasmodics, ACEinhibitors (angiotensin-converting enzyme inhibitors) and potassium preparations. Among the b-blockers, effective drugs are those that can control the accelerated heart rate and reduce vascular resistance in the periphery. These drugs are also effective in diagnosed bradycardia, when the heart rate is reduced. Angiotensin-converting enzyme inhibitors can counteract the increased production of renin that raises blood pressure. These drugs activate the work of the left heart chamber, reduce hypertrophy, expand coronary vessels, thereby helping to normalize peripheral blood flow. Calcium antagonists are designed to block calcium channels in the vessel walls, increasing their lumen. Calcium antagonists should only be prescribed by a doctor or cardiologist, as all these drugs can cause swelling, dizziness and headache. The 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), so diuretics should be taken together with potassium supplements.

Hypertension in the third stage is a severe form of the disease, which is characterized by the body's resistance to traditional drugs. Therefore, the treatment must be carefully selected, taking into account all the individual characteristics of the patient. The therapeutic complex includes diuretics, most often potassium-sparing, as well as the use of peripheral vasodilators. The pharmaceutical industry today produces many combined effective drugs. These drugs work on those patients whose body is either used to monotherapy and stopped responding to it, or there are significant contraindications to the use of standard treatment used for hypertension in stages I and II.

Grade III hypertension is also controlled by vasodilators. Increasingly, vasodilators began to be replaced by alpha-blockers. A combination drug combining the properties of alpha and beta blockers may also be effective. This drug, in combination with a diuretic, can replace three or even four other less effective drugs. ACEI is used to prescribe a drug that improves peripheral circulation and controls renin levels. The drug is taken three to four times a day, combined with a diuretic, which allows you to reduce blood pressure to normal after a week.

Hypertension of the I and II degrees can be treated at home and does not require hospitalization. In rare cases, inpatient treatment is possible for the purpose of conducting analytical studies and monitoring the state of health. Hypertension, which occurs in severe forms, is treated only in a hospital, in the cardiology department, the length of stay depends on the state of blood pressure and the work 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 refers only to preventing crisis situations through regular use of prescribed medications, daily monitoring of blood pressure, attainable physical activity and weight loss.

However, if a person has a family history of relatives with hypertension, but the disease has not yet manifested, preventive measures can be taken. The rules are quite simple - maintaining a healthy lifestyle and physical activity, since one of the reasons that provoke hypertension is the lack of physical activity. Hypertension is also prevented by a normal diet in which cholesterol and salty foods are kept to a minimum.

Hypertension is also a bad habit, therefore, if a person does not want to join the ranks of patients with hypertension, he should 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 "asclock", and the pressure will be, according to the famous saying, "like that of an astronaut".