Main criterionarterial hypertension (or arterial hypertension)as a whole group of diseases - stable, that is, detected by repeated measurements on different days, an increase in blood pressure (BP).The question of what kind of blood pressure is considered elevated is not as simple as it may seem.The fact is that among practically healthy people, the range of blood pressure values is quite wide.The results of long-term monitoring of people with different levels of blood pressure showed that already starting from a level of 115/75 mm Hg.Art., each additional increase in blood pressure by 10 mm Hg.Art.is accompanied by an increased risk of developing cardiovascular diseases (primarily coronary heart disease and stroke).However, the benefits of modern methods of treating arterial hypertension have been proven mainly only in patients whose blood pressure exceeds 140/90 mmHg.Art.For this reason, it was agreed that this threshold value should be considered as a criterion for identifying arterial hypertension.
High blood pressure can be accompanied by dozens of different chronic diseases, and hypertension is only one of them, but the most common: approximately 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 that lead to an increase in blood pressure are detected.
Hypertension is a disease in which a stable increase in blood pressure is its main manifestation.Through observations of large groups of people, risk factors have been identified that increase the likelihood of its development.In addition to the genetic predisposition that some people have, these risk factors include:
- obesity;
- inaction;
- excessive consumption of table salt, alcohol;
- chronic stress;
- smoking.
In general, all these characteristics that accompany the modern urban lifestyle in industrialized countries.Therefore, hypertension is considered a lifestyle disease, and targeted changes for the better should always be considered as part of a case-by-case hypertension treatment program.
What other diseases are accompanied by high blood pressure?These are many kidney diseases (pyelonephritis, glomerulonephritis, polycystosis, 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, less common diseases.Regular use of drugs such as glucocorticosteroids, non-steroidal 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 the 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 of the secondary arterial hypertension seems unlikely.
If you notice similar symptoms, consult your doctor.Do not self-medicate - it is dangerous for your health!
Symptoms of arterial hypertension
High blood pressure itself does not manifest itself in any subjective sensations for many people.If high blood pressure is accompanied by symptoms, it can include a feeling of heaviness in the head, headache, blinking before the eyes, nausea, dizziness, unsteadiness when walking, as well as a number of other symptoms that are quite non-specific to high blood pressure.The symptoms listed above are manifested much more clearly during a hypertensive crisis - a sudden significant increase in blood pressure, leading to a clear deterioration of the condition and well-being.
It would be possible to continue listing the possible symptoms of hypertension, separated by commas, but there is little use in doing so.why First, all these symptoms are non-specific for hypertension (that is, they can appear separately 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, and repeatedly.This means, first, that "in one session" one should measure blood pressure two or three times (with a short pause between measurements) and take the arithmetic mean of two or three measured values as true blood pressure.Second, 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 definitely be symptoms, otherwise it is not a hypertensive crisis, but simply an asymptomatic increase in blood pressure.And these symptoms can be both those listed above and 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, in addition to the actual symptoms of high blood pressure (if any), depend on the underlying disease.For example, with hyperaldosteronism, this can be muscle weakness, cramps and even transient (lasting hours or days) paralysis of the muscles of the legs, arms and neck.In obstructive sleep apnea syndrome - snoring, sleep apnea, daytime sleepiness.
If hypertension over time - usually many years - leads to damage to various organs (in this context they are called "target organs"), this can manifest as a decrease in memory and intelligence, a stroke or a transient cerebrovascular accident, an increase in the 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 pectoris, a decrease in the rate of blood filtration in the kidneys, etc.Accordingly, the clinical manifestations will be caused by these complications and not by an increase in blood pressure per se.
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, lack of physical activity, excessive consumption of table salt, alcohol, chronic stress, smoking and a number of others, mainly related to lifestyle characteristics, lead over time to disruption of the functioning of the endothelium - the inner layer of arterial vessels with a thickness of one cell layer, which actively participates in the regulation of the tone and therefore the lumen of blood vessels.The tone of the microvasculature, and hence 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 for 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 realize their regulatory role largely due to their ability to participate in hormonal regulation at the level of the whole organism).Disturbances in these complex regulatory mechanisms generally lead to a reduction in the ability of the entire system to finely adapt to the ever-changing blood supply needs of organs and tissues.
Over time, a permanent spasm of small arteries develops, and subsequently their walls change so much that they can no longer return to their original state.In larger vessels, due to constantly increased blood pressure, atherosclerosis develops at an accelerated pace.The walls of the heart become thicker, hypertrophy of the myocardium develops, and then the expansion of the cavities of the left atrium and left ventricle.Increased pressure damages the glomeruli, their number decreases and, as a result, the kidney's ability to filter blood decreases.In the brain, due to changes in the blood vessels supplying it, negative changes also occur - small foci of hemorrhages appear, as well as small areas of necrosis (death) of brain cells.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 degree of increased blood pressure, is divided into three degrees.Moreover, taking into account the increase in the risk of cardiovascular disease on a "year-decade" scale, already starting from a blood pressure level above 115/75 mm Hg.Art., there are several more gradations of blood pressure levels.
If the values of systolic and diastolic blood pressure fall into different categories, then the degree of arterial hypertension is estimated by the higher of the two values and it does not matter - systolic or diastolic.The degree of increase in blood pressure when diagnosing hypertension is determined by repeated measurements on different days.
In some countries, stages of hypertension continue to be distinguished, while the European recommendations for the diagnosis and treatment of arterial hypertension do not mention any stages.The identification of the stages aims to reflect the stages of the course of hypertension from its onset to the appearance of complications.
There are three stages:
- Stage Isuggests that there is still no obvious 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 by taking into account the level of creatinine in the blood, the protein albumin is not detected in the urine, thickening of the walls of the carotid arteries or atherosclerosis plaques in them are not detected, etc.Such damage to internal organs is usually asymptomatic.
- If there is at least one of the listed signs, diagnoseStage IIhypertension.
- Finally, approxStage IIIWe speak of hypertension when there is at least one cardiovascular disease with clinical manifestations associated with atherosclerosis (myocardial infarction, stroke, angina pectoris, atherosclerotic damage to the arteries of the lower extremities) or, for example, serious kidney damage manifested by a marked 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 has suffered a myocardial infarction and after a few years an increase in blood pressure has occurred - it turns out that such a patient immediately has hypertension in stage III.The purpose of staging is primarily to rank patients according to their risk of cardiovascular complications.Treatment measures also depend on this: the higher the risk, the more intensive the treatment.When formulating the diagnosis, the risk is assessed in four degrees.At the same time, the 4th gradation corresponds to the greatest risk.
Complications of arterial hypertension
The goal of treating hypertension is not to "take down" high blood pressure, but to minimize the long-term risk of cardiovascular and other complications, since that risk—again, when assessed on a "year-to-decade" scale—increases with 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 and chronic heart failure, atherosclerotic vascular lesions of the lower extremities.
Most patients with hypertension are not worried about anything at the moment, so they do not have much motivation to treat themselves, regularly take a certain minimum of drugs and change their lifestyle to a healthier one.However, in the treatment of hypertension, there are no one-time measures that will allow you to forget about this disease forever, without doing anything more to treat it.
Diagnosis of arterial hypertension
With the diagnosis of arterial hypertension as such, everything is usually quite simple: it only requires 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, an increase in blood pressure can occur in a number of diseases, and hypertension is only one of them, although the most common.When conducting diagnostics, the doctor, on the one hand, must make sure that the increase in blood pressure is stable, and on the other hand, assess the probability that the increase in blood pressure is a manifestation of symptomatic (secondary) arterial hypertension.
To do this, at the first stage of the diagnostic search, the doctor finds out at what age the blood pressure first begins to rise, whether there are symptoms such as, for example, snoring withcessation of breathing during sleep, attacks of muscle weakness, unusual impurities in the urine, attacks of sudden palpitations with sweating and headache, etc.It makes sense to find out what medications and nutritional supplements the patient is taking, since in some cases they can lead to an increase in blood pressure or worsening of an already elevated one.Several routine (performed in almost all patients with high blood pressure) diagnostic tests, together with information obtained during a conversation with a doctor, help to assess the likelihood of some forms of secondary hypertension: a complete urinalysis, determination of the concentration of creatinine and glucose in the blood, and sometimes potassium and other electrolytes.In general, given the low prevalence of secondary forms of arterial hypertension (about 10% of all its cases), the further search for these diseases as a possible cause of high blood pressure should have valid reasons.Therefore, if at the first stage of the diagnostic search no significant data are found in favor of the secondary nature of arterial hypertension, then in the future it is considered that the blood pressure rises due to hypertension.This judgment can sometimes be revised subsequently when new data about the patient become available.
In addition to the search for data on the possible secondary nature of the increase in 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 existing diseases of the cardiovascular system or their asymptomatic damage - this affects the assessment of the prognosis and the stage of hypertension, the choice of therapeutic measures.For this purpose, in addition to the conversation with the patient and his examination, a number of 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 already obtained medical data about the patient).
Daily monitoring of blood pressure using special compact devices allows you to assess changes in blood pressure during the patient's usual lifestyle.This examination is not necessary in all cases - mainly if the blood pressure measured at the doctor's appointment differs significantly from that measured at home, if it is necessary to evaluate the blood pressure at night, if episodes of hypotension are suspected and sometimes to evaluate the effectiveness of the treatment.
Thus, 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 about the patient, to check the assumptions that the doctor made during the preliminary examination.
Treatment of arterial hypertension
Regarding the non-drug measures aimed at treating hypertension, the most convincing evidence has been accumulated for the positive role of reducing salt intake, reducing and maintaining body weight at this level, regular physical training (efforts), no more than moderate alcohol consumption, and increasing the content of vegetables and fruits in the diet.Only all these measures are effective as part of long-term changes in the unhealthy lifestyle that led to the development of hypertension.For example, reducing body weight by 5 kg leads to a decrease in blood pressure by an average of 4.4/3.6 mmHg.Art.- seems small, but combined with the other measures listed above to improve your lifestyle, the effect can be quite significant.
Lifestyle modification is warranted for almost all hypertensive patients, but drug treatment is indicated, although not always, in most cases.In 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-term benefit is provenin many clinical trials), then in stage 1 hypertension with low and moderate estimated cardiovascular risk, the benefit of such 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 the improvement of the lifestyle, the increase in blood pressure in such patients continues for several months with repeated visits to the doctor, it is necessary to reassess the need for the use of drugs.In addition, 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, they aim to achieve stabilization of blood pressure below 140/90 mmHg.Art.This does not mean that in 100% of the measurements it will be below these values, but the less often the 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 frequent than without treatment.Thanks to modern medicines, these negative processes, which in hypertension inevitably and latently destroy the internal organs over time (mainly the heart, brain and kidneys), these processes are slowed down or stopped, and in some cases they can even be reversed.
Of the drugs for the treatment of hypertension, the main ones 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 emphasized.Beta-blockers are also used, but mainly when their use is required by concomitant diseases – in these cases, beta-blockers have a dual purpose.
Nowadays, combinations of drugs are preferred because treatment with any one of them rarely leads to the desired level of blood pressure.There are also fixed drug combinations that make treatment more convenient, as the patient only takes one tablet instead of two or even three.The choice of the necessary classes of drugs for a particular patient, as well as their doses and frequency of administration, is made by the doctor, taking into account such data about the patient as the level of blood pressure, concomitant diseases, etc.
Thanks to the multifaceted positive effects of modern drugs, the treatment of hypertension includes not only lowering blood pressure as such, but also protecting internal organs from the negative effects of those processes that accompany high blood pressure.In addition, since the main goal of treatment is to minimize the risk of its 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 (which leads to myocardial infarction or stroke), etc.hypertension and slow down the growth of atherosclerotic plaques in blood vessels.Thus, the treatment of hypertension involves dealing with the disease in many ways, and achieving normal blood pressure is only one of them.
Forecast.Prevention
The general prognosis is determined not only and not so much by the fact of high blood pressure, 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;
- high blood pressure;
- obesity;
- sedentary lifestyle;
- age (with each decade lived after age 40, the risk increases);
- male and others.
In this case, not only the intensity of exposure to risk factors is important (for example, smoking 20 cigarettes per 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 estimated using special electronic calculators, one of which takes into account sex, 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 the risk assessment.At the same time, the risk obtained in most cases, which is low in absolute numbers, can give a misleading impression, since 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 according to calculator calculations: in men 3 times, and in women - even 5 times.
Regarding the prevention of hypertension, we can say that since the risk factors for its development are known (inactivity, overweight, chronic stress, regular lack of sleep, alcohol abuse, increased consumption of table salt, etc.), then 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 at all or depend a little on us: genetic characteristics, gender, age, social environment and some others.The problem is that people start thinking about hypertension prevention mostly when they are already unhealthy and the blood pressure is already elevated to one degree or another.And this is not so much a matter of prevention as of treatment.