Hypertension is a pathology of the cardiovascular system, in which persistent high blood pressure is noted, which leads to impaired functions of the corresponding target organs: heart, lungs, brain, nervous system, kidneys.
Hypertensive disease (GB) or arterial hypertension develops as a result of a malfunction in the work of higher centers that regulate the functions of the vascular system, neurohumoral and renal mechanisms.
The main clinical signs of GB:
- Dizziness, ringing and tinnitus;
- Shortness of breath, a state of suffocation;
- Darkening and “stars” in front of the eyes;
- Pain in the chest, in the heart.
There are various stages of hypertension. Determining the degree of hypertension is carried out using such methods and studies:
- Biochemical blood test and urinalysis.
- USDG of the arteries of the kidneys and neck.
- Electrocardiogram of the heart.
- Blood pressure monitoring.
Given the risk factors and the degree of damage to the target organs, a diagnosis is made and treatment is prescribed using medications and other techniques.
Hypertension – definition and description
The main clinical signs of hypertension are sharp and persistent jumps in blood pressure, while the blood pressure is stably high, even if there is no physical activity and the patient’s emotional state is normal. Pressure decreases only after the patient takes antihypertensive drugs.
WHO guidelines for blood pressure are:
- Systolic (upper) pressure – not higher than 140 mm. Hg. st .;
- Diastolic (lower) pressure – not higher than 90 mm. Hg. Art.
If during two medical examinations on different days the pressure was higher than the established norm, arterial hypertension is diagnosed and adequate treatment is selected. GB develops in both men and women with approximately the same frequency, mainly after the age of 40 years. But there are clinical signs of GB in young people.
Arterial hypertension is often accompanied by atherosclerosis. In this case, one pathology complicates the course of another. Diseases that occur against the background of hypertension are called associated or concomitant. It is the combination of atherosclerosis and GB that causes mortality among a young, able-bodied population.
According to the development mechanism, according to the WHO, I distinguish primary or essential hypertension, and secondary or symptomatic. The secondary form occurs only in 10% of cases of diseases. Essential arterial hypertension is much more often diagnosed. As a rule, secondary hypertension is a consequence of such diseases:
- Various pathologies of the kidneys, renal artery stenosis, pyelonephritis, tuberculosis hydronephrosis.
- Thyroid dysfunction – thyrotoxicosis.
- Disorders of the adrenal glands – Itsenko-Cushing’s syndrome, pheochromocytoma.
- Aortic atherosclerosis and coarctation.
Primary hypertension develops as an independent disease associated with a violation of the regulation of blood circulation in the body.
In addition, hypertension can be benign – that is, proceeding slowly, with minor deterioration of the patient’s condition over a long period of time, the pressure can remain normal and increase only occasionally. It will be important to maintain pressure and maintain proper nutrition for hypertension.
Or malignant, when the pathology develops rapidly, the pressure rises sharply and remains at the same level, it is possible to improve the patient’s condition only with the help of medications.
The pathogenesis of hypertension
An increase in pressure, which is the main cause and symptom of hypertension, occurs due to an increase in cardiac output of blood into the vascular bed and an increase in peripheral vascular resistance. Why is this happening?
There are certain stress factors that affect the higher centers of the brain – the hypothalamus and medulla oblongata. As a result, there are violations of the tone of the peripheral vessels, there is a spasm of arterioles on the periphery – including the kidneys.
Dyskinetic and dyscirculatory syndrome develops, Aldosterone production increases – it is a neurohormone that participates in water-mineral metabolism and retains water and sodium in the vascular bed. Thus, the volume of blood circulating in the vessels increases even more, which contributes to an additional increase in pressure and swelling of the internal organs.
All these factors also affect blood viscosity. It becomes thicker, the nutrition of tissues and organs is disturbed. The walls of the vessels become denser, the lumen becomes narrower – the risk of developing irreversible hypertension is significantly increased, despite the treatment. Over time, this leads to ellastofibrosis and arteriolosclerosis, which in turn provokes secondary changes in target organs.
The patient develops myocardial sclerosis, hypertensive encephalopathy, primary nephroangiosclerosis.
Classification of hypertension by stage
There are three stages of hypertension. It is this classification, according to WHO, is considered traditional and was used until 1999. It is based on the degree of damage to target targets, which, as a rule, if treatment is not carried out and the doctor’s recommendations are not followed, it becomes more and more.
At stage I of hypertension, signs and manifestations are practically absent, therefore such a diagnosis is made very rarely. Target organ lesions are not noted.
At this stage of hypertension, the patient very rarely goes to the doctor, since there is no sharp deterioration in the condition, only occasionally the blood pressure “rolls over”. However, if you do not consult a doctor and do not start treatment at this stage of hypertension, there is a risk of rapid progression of the disease.
Stage II hypertension is characterized by a steady increase in pressure. Irregularities appear on the part of the heart and other target organs: the left ventricle becomes larger and thicker, and lesions of the retina are sometimes noted. Treatment at this stage is almost always successful with the assistance of a patient with a doctor.
In stage III hypertension, lesions of all target organs occur. The pressure is consistently high, the risk of myocardial infarction, stroke, coronary heart disease is very high. If such a diagnosis is made, then, as a rule, angina pectoris, renal failure, aneurysm, hemorrhage on the fundus are already noted in the anamnesis.
The risk of a sudden deterioration in the patient’s condition is increased if treatment is not carried out properly, the patient has stopped taking medication, is abusing alcohol and cigarettes, or is experiencing psycho-emotional stress. In this case, hypertensive crisis may develop.
Classification of hypertension by degree
Such a classification is currently considered more relevant and appropriate than by stage. The main indicator is the patient’s pressure, its level and stability.
- Optimum – 120/80 mm. Hg. Art. or lower.
- Normal – no more than 10 units may be added to the upper indicator, no more than 5 to the lower indicator.
- Close to normal – indicators range from 130 to 140 mm. Hg. Art. and from 85 to 90 mm. Hg. Art.
- Hypertension of the I degree – 140-159 / 90-99 mm. Hg. Art.
- Hypertension of the II degree – 160 – 179 / 100-109 mm. Hg. Art.
- Hypertension of the III degree – 180/110 mm. Hg. Art. and higher.
Hypertension of the III degree, as a rule, is accompanied by lesions of other organs, such indicators are characteristic of hypertensive crisis and require hospitalization of the patient in order to conduct emergency treatment.
Hypertension risk stratification
There are risk factors that can lead to increased blood pressure and the development of pathology. The main ones are:
- Age indicators: for men it is over 55 years old, for women – 65 years old.
- Dyslip >Risk factors are always taken into account by a physician when examining a patient in order to correctly diagnose. It was noted that most often the cause of jumps in blood pressure is nervous overstrain, increased intellectual work, especially at night, and chronic overwork. This is the main negative factor according to WHO.
Second is salt abuse. WHO notes – if you consume more than 5 grams daily. salt, the risk of developing hypertension increases several times. The risk level increases if the family has relatives suffering from high blood pressure.
If more than two close relatives undergo treatment of hypertension, the risk becomes even higher, which means that the potential patient must strictly comply with all the doctor’s recommendations, avoid worries, abandon bad habits and monitor the diet.
Other risk factors, according to WHO, are:
- Chronic thyroid disease;
- Infectious diseases of a chronic course – for example, tonsillitis;
- Menopause period in women;
- Pathology of the kidneys and adrenal glands.
Comparing the factors listed above, indicators of patient pressure and their stability, a risk is stratified for the development of such a pathology as arterial hypertension. If 1-2 unfavorable factors are identified with first-degree hypertension, then risk 1 is put, according to the WHO recommendation.
If the adverse factors are the same, but AH is already of the second degree, then the risk from low becomes moderate and is designated as risk 2. Further, according to the WHO recommendation, if third-degree AH is diagnosed and 2-3 adverse factors are noted, risk 3 is established. Risk 4 implies a diagnosis of hypertension of the third degree and the presence of more than three adverse factors.
Complications and risks of hypertension
The main danger of the disease is the serious complications on the heart that it gives. For hypertension, combined with severe damage to the heart muscle and left ventricle, there is a WHO definition – headless hypertension. The treatment is complex and lengthy, headless hypertension is always difficult, with frequent attacks, with this form of the disease, irreversible changes in blood vessels have already occurred.
Ignoring pressure surges, patients put themselves at risk of developing such pathologies:
- Angina pectoris;
- Myocardial infarction;
- Ischemic stroke;
- Hemorrhagic stroke;
- Pulmonary edema;
- Exfoliating aortic aneurysm;
- Retinal detachment;
If a hypertensive crisis occurs, the patient needs urgent help, otherwise he may die – according to WHO, it is this condition with hypertension that in most cases leads to death. The risk is especially great for those people who live alone, and in case of an attack there is no one next to them.
It should be noted that it is impossible to completely cure arterial hypertension. If hypertension of the first degree at the very initial stage begins to strictly control pressure and adjust the lifestyle, you can prevent the development of the disease and stop it.
But in other cases, especially if associated pathologies have joined hypertension, a full recovery is no longer possible. This does not mean that the patient should put an end to himself and abandon the treatment. The main measures are aimed at preventing sharp jumps in blood pressure and the development of a hypertensive crisis.
It is also important to cure all concomitant or associative diseases – this will significantly improve the patient’s quality of life, help to keep him active and working until his old age. Almost all forms of arterial hypertension allow you to play sports, lead a personal life and have a good rest.
The exception is 2-3 degrees at a risk of 3-4. But the patient is able to prevent such a serious condition with the help of medicines, folk remedies and the revision of his habits. A specialist will popularly discuss the classification of hypertension in the video in this article.Ask a Question