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, due to which the normal movement of blood flow is disturbed, and the blood that accumulates in the narrowed places begins to exert pressure on the walls of the blood vessels. vessels.

What is hypertension?

High blood pressure can be a symptom, but it can also be an independent disease. If a person is diagnosed with a chronic pathology of the kidneys, cardiovascular system, thyroid gland, adrenal gland, hypertension is almost inevitable as one of the manifestations of these diseases. Also, an increase in pressure can be an adaptive, adaptive reaction 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, can be 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 provide information that almost 30% of the world's population suffers from one or another stage of hypertension, and until recently, practically nothing was known about such a disease as hypertension. Disorders in the functioning of the cardiovascular system characterize only Homo sapiens, to which no representative of the animal world is susceptible. Until the 19th - 20th. century, little was known about hypertension in principle; one of the first cases of heart attack was reliably confirmed by doctors only in the 30s of the last century in one of the European countries; in the same period, there was not one clinically confirmed case of cardiovascular pathologies in African and Asian countries. Only with the development of urbanization and the penetration of modern technology in these countries, the Asian and African populations also became susceptible to hypertension, which reached its peak in the 70s of the 20th century.

Since the end of the last century, hypertension has been divided into primary and secondary.

1. Primary (essential) hypertension is a separate nosological unit, an independent disease that is not caused by organ and system dysfunction. Blood pressure rises for reasons other than, for example, kidney disease. 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 caused by an underlying disease, for example, an inflammatory process in the renal system - glomerulonephritis, polycystic kidney disease, or pituitary or pancreatic disorders. Also, secondary hypertension develops against the background of pathological changes in the vascular system - atherosclerosis, and can cause symptomatic hypertension and neurotic disease. Also, secondary hypertension is quite common in pregnancy and in gynecological diseases - cysts and neoplasms.

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

• If blood pressure is fixed between 140/90 and 159/99 mmHg, hypertension is diagnosed as stage I disease. In this case, the pressure may return to normal, but occasionally "jump" to certain limits.
• If the blood pressure is recorded in the range of 160/100 to 179/109 mmHg, hypertension is considered a stage II disease. There is practically no remission, but the pressure can be controlled with medication.
• Blood pressure that constantly remains in the range of 180/110 and above is considered a clinical symptom of stage III hypertension. In this phase, blood pressure practically does not drop to normal levels, and if it does, it is followed 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 disease development, which, however, can last for years. This form of hypertension is manifested by sinus tachycardia, unstable blood pressure when the systolic reading fluctuates, increased sweating, hyperemia of the skin, throbbing headaches and anxiety. The face and limbs often swell, the fingers become numb, and urination is difficult. There is also a more severe 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, today this form practically does not occur, because hypertension is usually 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 highest number is systole, which is an indicator of blood pressure during the contraction of the heart muscle, when blood enters the arteries. The bottom number is an indicator of blood pressure during the period of relaxation of the heart muscle. Hypertension is believed to begin when readings exceed the norm of 140/90 mmHg. This is, of course, a conditional limit, because there are conditions when the risk of developing a myocardial infarction exists even at figures of 115/75 mmHg. However, formalizing and averaging the entire variety of blood pressure conditions helps clinicians to detect deviations in time and start symptomatic and 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 cause secondary hypertension are more specific, because the cause is the underlying disease. The final diagnosis of essential hypertension is made after a comprehensive examination excluding the presence of precipitating diseases. Primary hypertension, medically speaking, is a genetic imbalance of regulatory mechanisms in the body (imbalance of the pressor and depressor systems of blood pressure).

Among the reasons described and carefully studied by clinicians are the following:

• Kidney pathologies - nephritis and most often glomerulonephritis. A factor that causes secondary hypertension.
• Stenosis (narrowing) of the renal arteries.
• Congenital pathology in which the renal artery is obstructed (coarctation).
• Neoplasms of the adrenal glands - pheochromocytosis (impaired production of norepinephrine and adrenaline).
• Increased production of aldosterone is hyperaldosteronism, which occurs during the 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 terms of disrupting normal blood pressure can be divided into nutritional, age-related and pathological:

• Age over 55 years for men and 65 years for women.
• Elevated level of cholesterol in the blood (above 6. 6 mmol).
• Hereditary predisposition, family history.
• Obesity, especially abdominal, when the waist circumference is greater than 100-15 cm in men and 88-95 in women.
• Diabetes, a change in the normal level of glucose tolerance.
• Physical inactivity, osteochondrosis.
• Chronic stress, increased anxiety.

The mechanism of development of hypertension is briefly as follows:

When arterioles - arteries of organs, most often kidneys - spasm under the influence of, for example, stress factors, the nutrition of the kidney tissue is disrupted and ischemia occurs. The kidneys try to compensate for the disturbance by producing renin, which in turn causes the activation of angiotensin, which constricts the blood vessels. As a result, blood pressure rises and hypertension develops.

Symptoms of hypertension

The primary symptom of hypertension, and sometimes the main one, is considered a persistent excess of 140/90 mmHg. Other signs of hypertension are directly related to blood pressure parameters. If the pressure rises slightly, the person simply feels bad, 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, increased sweating, tremors of the fingers are noticeable, and numbness often occurs.

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

Hypertension is also characterized by dizziness and reduced vision.

Ophthalmological signs - veils or spots, "floating" in front of the eyes. Often, when the pressure rises sharply, nosebleeds can occur.

Another symptom of hypertension is dizziness. Vision is deteriorating.

Terminal stage, when hypertension reaches stage III, typical symptoms are joined by neurosis or depression. Hypertension in this form often occurs in a pathological "community" with coronary heart disease.

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

• Sharp, sudden or rapidly increasing headache.
• Blood pressure reading up to 260/120 mmHg.
• Pressure in region of heart, aching pain.
• Severe shortness of breath.
• Vomiting, beginning with nausea.
• Increased heart rate, tachycardia.
• Loss of consciousness, convulsions, paralysis.

Hypertension in the crisis phase is a threatening condition that can result in a stroke or heart attack, therefore, at the slightest alarming sign, emergency medical help should be called. A hypertensive crisis is controlled with the help of diuretics, cardiac and hypertensive drugs that are given by injection. A hypertensive patient who knows about his problem must constantly take the prescribed medication to prevent a crisis.

Who to contact?

Cardiologist.

Treatment of hypertension

Early-stage hypertension, when blood pressure readings often do not exceed normal levels, can be treated with non-drug treatments. The first way is to control your body weight and follow a low-carb, low-fat diet. 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 for stage I hypertension, although they can be used as auxiliary and additional elements in the main therapy of stage II and III hypertension.

Pharmacological means that include the treatment of hypertension are prescribed on the principle of "gradual". They are used 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 beta-blockers is calculated based on the patient's history, weight and condition. If the blood pressure normalizes after two to three days, the dose is reduced, often taken every other day. As a diuretic, a drug from the thiazide group is effective, which is prescribed once in a dose of 25 mg, in alternate doses every one or two days, so that the heart muscle does not weaken. If the hypertension begins to subside, a diuretic may be prescribed once a week. There are frequent 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 need to control your blood pressure level three times a day.

Stage II hypertension is controlled by complex therapy that includes beta-blockers, diuretics, antispasmodics, ACE inhibitors (angiotensin-converting enzyme inhibitors) and potassium preparations. Among the b-blockers, the effective drugs are those that can control rapid heart rate and reduce peripheral vascular resistance. These drugs are also effective in diagnosed bradycardia, when the heart rate is reduced. Angiotensin-converting enzyme inhibitors can neutralize the increased production of renin, which increases blood pressure. These drugs activate the work of the left heart chamber, reduce hypertrophy, expand coronary vessels, which helps to normalize peripheral blood flow. Calcium antagonists are designed to block calcium channels in vascular 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. A set of drugs is selected taking into account all possible side effects and contraindications. It should also be noted that long-term use of diuretics can cause a decrease in the level of potassium in the body (hypokalemia), so diuretics should be taken together with potassium supplements.

Stage III hypertension is a severe form of the disease 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, and the use of peripheral vasodilators is also indicated. The pharmaceutical industry today produces many combined effective drugs. These drugs work on those patients whose body is either used to monotherapy and has stopped responding to it, or has significant contraindications to the use of standard treatment of stage I and II hypertension.

Grade III hypertension is also controlled with vasodilators. Vasodilators have increasingly started to be replaced by alpha-blockers. A combination drug that combines the properties of an alpha and beta blocker 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, in combination with a diuretic, which allows you to reduce blood pressure to normal after a week.

Hypertension I and II degrees can be treated at home and does not require hospitalization. In rare cases, hospital treatment is possible for the purpose of performing analytical examinations and monitoring the health condition. Hypertension, which occurs in severe forms, is treated only in the hospital, in the cardiology department, the length of stay depends on the state of blood pressure and the functioning of organs and systems in the body.

How is hypertension prevented?

Hypertension, if it has already developed, unfortunately, remains with a person forever. In this sense, prevention refers only to the prevention of crisis situations through the regular use of prescribed medications, daily monitoring of blood pressure, feasible physical activity and weight loss.

However, if a person has a family history of a relative with hypertension, but the disease has not yet manifested itself, preventive measures can be taken. The rules are quite simple - maintaining a healthy lifestyle and physical activity, because one of the reasons that causes hypertension is physical inactivity. Hypertension is also prevented by a normal diet, where 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 hypertensives, he must 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, stay calm and take care of your nerves, then your heart and blood vessels will work "like clockwork", and the pressure will be, according to the famous saying, "like an astronaut".