The main criterionarterial hypertension (or arterial hypertension)as a whole group of diseases - stable, i.e. detected by repeated measurements on different days, an increase in blood pressure (BP).The question of what blood pressure is considered elevated is not as simple as it seems.The fact is that among practically healthy people, the range of blood pressure values is quite wide.The results of long-term observation of people with different levels of blood pressure showed that 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 mostly only for those patients whose blood pressure is higher than 140/90 mm Hg.Art.For this reason, it was agreed that this threshold value should be considered a criterion for the identification of 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 cases out of 10. The diagnosis of hypertension is made in cases where there is a stable increase in blood pressure, but no other diseases that lead to high blood pressure are detected.
Hypertension is a disease whose main manifestation is a stable increase in blood pressure.Risk factors that increase the likelihood of its development have been determined by observing large groups of people.In addition to the genetic predisposition that some people have, these risk factors include:
- obesity;
- inactivity;
- excessive consumption of table salt, alcohol;
- chronic stress;
- smoking.
In general, all those 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, polycystic disease, diabetic nephropathy, stenosis (narrowing) of renal arteries, etc.), a number of endocrine diseases (adrenal gland tumors, hyperthyroidism, Cushing's disease and syndrome), obstructive sleep disorders and some other diseases, several syndromes.Regular use of drugs such as glucocorticosteroids, non-steroidal anti-inflammatory drugs and oral contraceptives can also lead to a permanent increase in blood pressure.The above-mentioned diseases and conditions lead to the development of so-called secondary, or symptomatic, arterial hypertension.A doctor makes a diagnosis of hypertension if, in a conversation with the patient, a medical history statement, an 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, contact your doctor.Do not self-medicate - it is dangerous for your health!
Symptoms of arterial hypertension
High blood pressure is not manifested by any subjective sensations in many people.If high blood pressure is accompanied by symptoms, it may include a feeling of heaviness in the head, headache, flashes 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 above symptoms manifest themselves much more clearly during a hypertensive crisis - a sudden significant increase in blood pressure, which leads to a clear deterioration of the condition and well-being.
One could go on listing the possible symptoms of hypertension, separated by commas, but it is of no particular use.Why?Firstly, all these symptoms are non-specific for hypertension (that is, they can occur either individually or in different combinations in other diseases), and secondly, the very fact of a stable increase in blood pressure is important for determining the presence of arterial hypertension.And this is not revealed by evaluating subjective symptoms, but only by measuring blood pressure, moreover, consecutively.This means, first, that "in one sitting" blood pressure should be measured two or three times (with a short break between measurements) and the arithmetic mean of two or three measured values should be taken as the true blood pressure.Second, the stability of the increase in blood pressure (a criterion for the diagnosis of hypertension as a chronic disease) should be confirmed by measurements on different days, preferably at an interval of at least one week.
If a hypertensive crisis develops, there will certainly be symptoms, otherwise it is not a hypertensive crisis, but simply an asymptomatic increase in blood pressure.And these symptoms can be either those mentioned above or some 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, apart from the actual symptoms of high blood pressure (if any), depend on the underlying disease.For example, with hyperaldosteronism, it can be muscle weakness, cramps, and even transient (lasting hours or days) paralysis of the muscles of the legs, arms, and neck.With obstructive sleep apnea syndrome - snoring, sleep apnea, daytime sleepiness.
If hypertension over time - usually several years - leads to damage to various organs (in this context they are called "target organs"), then this can manifest as a decrease in memory and intelligence, a stroke or a transient cerebrovascular infarction, an increase in the thickness of the heart walls, accelerated development of atherosclerotic plaques in the heart vessels and other heart vessels and other heart vessels.angina, decrease in blood filtration rate 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, vascular tone disorder and elevated blood pressure are the main content of this disease, so to speak, its "quintessence".Factors such as genetic predisposition, obesity, inactivity, excessive consumption of table salt, alcohol, chronic stress, smoking and a number of others, mostly related to lifestyle characteristics, eventually lead 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 of blood vessels, and therefore the lumen of blood vessels.The tone of microvascular vessels, and thus the volume of local blood flow in organs and tissues, is autonomously regulated by the endothelium, and not directly by the central nervous system.This is a local blood pressure regulation system.However, there are other levels of blood pressure regulation - the central nervous system, the endocrine system and the kidneys (which fulfill their regulatory role largely thanks to their ability to participate in hormonal regulation at the level of the whole organism).Violations of these complex regulatory mechanisms lead, in general, to a reduction in the ability of the entire system to fine-tune to the changing needs of organs and tissues for blood supply.
Over time, a persistent spasm of small arteries develops, and then their walls change so much that they can no longer return to their original state.In larger vessels, due to constantly elevated blood pressure, atherosclerosis develops at an accelerated pace.The walls of the heart become thicker, myocardial hypertrophy 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 that supply it, negative changes also occur - small foci of bleeding appear, as well as small areas of necrosis (death) of brain cells.When an atherosclerotic plaque ruptures in a sufficiently large vessel, thrombosis occurs, clogging of the lumen of the vessel, which leads to a stroke.
Classification and stages of development of arterial hypertension
Hypertension, depending on the magnitude of the increased blood pressure, is divided into three degrees.In addition, taking into account the increase in the risk of cardiovascular diseases on a scale of "years-decades", already starting from blood pressure levels 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 highest 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, the stages of hypertension are still differentiated, while the European guidelines for the diagnosis and treatment of arterial hypertension do not mention any stages.The identification of phases aims to reflect the phase of the course of hypertension from its onset to the appearance of complications.
There are three stages:
- Phase Iimplies that there is still no evident damage to those organs that are most often affected by this disease: there is no increase (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, albumin protein is not detected in the urine or thickening of the artery wall, plaques in them are not detected, etc.Such damage to internal organs is usually asymptomatic.
- If there is at least one of the above signs, diagnosePhase IIhypertension.
- Finally, FrPhase IIIHypertension is referred to when there is at least one cardiovascular disease with clinical manifestations associated with atherosclerosis (myocardial infarction, stroke, angina pectoris, atherosclerotic lesions of the arteries of the lower extremities), or, for example, severe kidney damage, which is manifested by a marked decrease in filtration and/or significant urine loss.
These stages are not always replaced naturally: for example, a person suffered a myocardial infarction, and after a few years there was an increase in blood pressure - it turns out that such a patient immediately has stage III hypertension.The purpose of staging is mainly 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 a diagnosis, the risk is assessed in four gradations.At the same time, the 4th degree corresponds to the highest risk.
Complications of arterial hypertension
The goal of treating hypertension is not to "lower" high blood pressure, but to maximize the long-term risk of cardiovascular and other complications, since that risk—again, when assessed on a "year-decade" scale—increases for every additional 10 mm Hg.Art.but 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 of the patients with hypertension do not worry about anything for now, so they do not have much motivation to get treatment, they regularly take a certain minimum amount of medication and change their lifestyle to a healthier one.However, in the treatment of hypertension, there are no one-time measures that would 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 more.But hypertension and arterial hypertension are not the same thing: as already mentioned, an increase in blood pressure can manifest itself in a number of diseases, and hypertension is only one of them, although the most common.When establishing a diagnosis, the doctor must, on the one hand, 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, in the first phase of the diagnostic examination, the doctor finds out at what age the blood pressure first started to rise, whether there are symptoms such as, for example, snoring with pauses in breathing during sleep, attacks of muscle weakness, unusual impurities in the urine, attacks of rapid heartbeat with sweating and headache, etc.It makes sense to clarify what medications and dietary supplements the patient is taking, because in some cases they can lead to an increase in blood pressure or a worsening of it.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 probability of the occurrence 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, taking into account 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 must have good reasons.Therefore, if in the first phase of the diagnostic examination no significant data are found in support of secondary arterial hypertension, then in the future it is considered that the blood pressure is elevated due to hypertension.This judgment can sometimes be subsequently revised as new information about the patient becomes available.
In addition to searching 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 more targeted search for damage to internal organs), as well as, possibly, already existing diseases of the cardiovascular system or their asymptomatic assessment of damage, prognostication of hypergnosis and assessment of damage, therapeutic measures.For this purpose, in addition to talking to the patient and examining him, numerous diagnostic studies are carried out (eg electrocardiography, echocardiography, ultrasound examination of the neck veins, 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 enables assessment of changes in blood pressure during the patient's usual lifestyle.This study is not necessary in all cases - mainly, if the blood pressure measured at the doctor's appointment is significantly different from the one 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 treatment.
Thus, in all cases, some diagnostic methods are used during the examination of patients with elevated blood pressure;the use of other methods is more selective, depending on the already obtained data about the patient, to check the assumptions made by the doctor during the preliminary examination.
Treatment of arterial hypertension
As for non-drug measures for the treatment of hypertension, the most convincing evidence has been accumulated on the positive role of reducing salt intake, reducing and maintaining body weight at this level, regular physical training (exertion), no more than moderate alcohol consumption, as well as increasing the content of vegetables and fruits in the diet.Only all these measures are effective as part of long-term changes in an unhealthy lifestyle that led to the development of hypertension.For example, a 5 kg reduction in body weight led to an average drop in blood pressure 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 patients with hypertension, but drug treatment is indicated, although not always, in most cases.If in patients with elevated 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 has been provenin many clinical studies), then in stage 1 hypertension with low and moderate calculated 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 evaluated individually, taking into account the patient's preferences.If, despite the improvement of lifestyle, the increase in blood pressure in such patients lasts for several months during repeated visits to the doctor, it is necessary to reconsider the need for medication.Moreover, the magnitude of the calculated risk often depends on the completeness of the patient's examination and may turn out to be significantly greater than initially thought.In almost all cases of hypertension treatment, they aim to stabilize blood pressure below 140/90 mmHg.Art.This does not mean that 100% of the measurements will be below these values, but the less often the blood pressure, when 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 drugs, those negative processes that in hypertension inevitably and latently destroy internal organs (primarily heart, brain and kidneys) are slowed down or stopped, and in some cases they can be reversed.
Of the drugs for the treatment of hypertension, there are 5 main 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 necessary due to accompanying diseases - in these cases, beta blockers have a dual purpose.
Today, the preference is given to combinations of drugs, because treatment with any one of them rarely leads to the achievement of the desired blood pressure level.There are also fixed combinations of drugs that make the treatment more convenient, because the patient takes only one tablet instead of two or even three.The selection of the necessary classes of drugs for a specific patient, as well as their dosages and frequency of administration, is made by the doctor, taking into account the patient's data such as the level of blood pressure, concomitant diseases, etc.
Thanks to the multiple positive effects of modern drugs, the treatment of hypertension involves 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 prolong life, it may be necessary to correct blood cholesterol levels, take drugs that reduce the risk of blood clots (which lead to myocardial infarction or stroke), etc.hypertension, and slow down the growth of atherosclerotic plaques in blood vessels.Therefore, treating hypertension involves addressing the disease in many ways, and achieving normal blood pressure is only one of them.
Forecast.Prevention
The overall 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 level of cholesterol in the blood;
- high blood pressure;
- obesity;
- sedentary lifestyle;
- age (with each decade after age 40, the risk increases);
- masculine gender and others.
In this case, not only the intensity of exposure to risk factors is important (eg, smoking 20 cigarettes a 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, prognosis can be estimated using special electronic calculators, one of which takes into account gender, 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 risk assessment.At the same time, the obtained risk in most cases, which is low in absolute numbers, can give a wrong impression, because 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 compared to the one calculated using the calculator: for men 3 times, and for women - as much as 5 times.
Regarding the prevention of hypertension, we can say that since the risk factors for its development are known (inactivity, excess weight, chronic stress, regular lack of sleep, alcohol abuse, increased consumption of table salt, etc.), then all lifestyle changes that reduce the influence 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 on us 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 it is not so much a question of prevention as of treatment.