Arterial hypertension (hypertension) causes, symptoms and treatment in the article by cardiologist

Arterial hypertension is a polyetiological disease. Primary arterial hypertension occurs in more than 95% of patients. Unfortunately, the causes of its occurrence are not reliably known. Over a long study of this disease, the following risk factors that contribute to the development of arterial hypertension have been formed:

  • Hereditary factor. There are many cases of “family” arterial hypertension. The risk of contracting hypertension increases at times if two or more first-line relatives suffered from this disease.
  • Gender As already known, men are more likely to have high blood pressure than women. Women are more likely to suffer from arterial hypertension after menopause.
  • Age. People who are older than 50 are more likely to get sick.
  • Chronic stress Emotional upheaval and psychological trauma lead to increased secretion of adrenaline, which speeds up the heartbeat, increases the minute volume of blood. With chronic stress, structural changes occur in the vessels, which threatens to increase blood pressure
  • Drinking plenty of salt. Salt traps water in the tissues and circulatory system. An increase in blood volume causes an increase in blood pressure.
  • Unhealthy Lifestyle. Smoking and alcohol abuse often lead to arterial hypertension.
  • Low physical activity leads to a slow metabolism, a decrease in the body’s immune defense.
  • Excess weight. People with obesity often have hypertension, because being overweight leads to physical inactivity, heavy salt and fat intake, and hormonal disorders.

An increase in blood pressure in patients with hypertension is accompanied by the following symptoms:

  • headache that occurs through spasm of cerebral vessels. The pain has a pressing, pulsating or bursting character in the neck or temples;
  • dizziness;
  • tinnitus through the constriction of the vessels of the inner ear;
  • double vision and “flies” before the eyes;
  • nausea and vomiting, which may appear due to increased intracranial pressure;
  • shortness of breath. The reason for shortness of breath during an increase in blood pressure is ischemia of the heart muscle due to impaired coronary blood flow;
  • pains in the heart;
  • acceleration and strengthening of the heartbeat.

Before starting drug therapy, doctors recommend putting your food in order. It is necessary that the diet be varied and balanced. It is necessary to limit the consumption of animal fats, pastries and potatoes. It is necessary to exclude harmful sweets from the diet, the exception is dried fruits and nuts.

In order to prevent the development of hypertension, it is necessary to learn how to eat healthy food in optimal quantities (it is important not to overeat). Prevention is carried out using a diet in which there are a lot of vegetables, fruits, cereals, poultry, low-fat fish and lactic acid products. The main emphasis in nutrition should be on the sufficient intake of foods rich in calcium, potassium and magnesium. Of the cooking methods, it is worth choosing baking or boiling, since when frying, carcinogens are released from fats that are harmful to health.

By determining what preceded an increased diastolic and systolic blood pressure, eliminating the pathogenic factor, it is possible to productively eliminate unpleasant symptoms with conservative methods. In this case, hypertension is accompanied by the following symptoms of the disease:

  • migraine attacks that are caused by cerebrovascular spasms;
  • pain in the back of the head, which is accompanied by frequent dizziness;
  • frequent attacks of tachycardia;
  • sensation of severe pulsation in the temples after vasoconstriction;
  • decreased quality of sleep;
  • blood pressure instability.
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Syndromes

If arterial hypertension develops, the main thing is to correctly and timely differentiate the final diagnosis. For this, it is necessary to investigate a set of symptoms, to exclude similar diagnoses of manifestations in the body:

  • heart syndrome: tachycardia, angina pectoris;
  • ocular: hemorrhages and exudates in the retina, swelling of the nipples of the optic nerves;
  • renal: impaired renal circulation, paired organ dysfunction, a jump in creatinine;
  • vascular: aortic dissection, occlusive arterial pathology.

Complaints

Drug therapy does not begin after studying the patient’s complaints, but after the diagnosis of the body. However, the collection of anamnesis data significantly facilitates the diagnosis, accelerates the implementation of relevant therapeutic measures. It will not be difficult to determine symptomatic arterial hypertension – a cardiologist will tell you what it is. Patient complaints are as follows:

  1. Hypertension is characterized by a headache that gives an unpleasant feeling in the back of the head.
  2. In chronic heart failure, jumps in blood pressure are supplemented by dull pain in the sternum.
  3. In the early stages, hypertension is manifested by nausea, dizziness, a decline in performance, impaired permeability of the pulmonary vessels.

At present, the exact causes of hypertension have not been established. The main risk factor is considered to be prolonged or severe psycho-emotional stress. Other causes of pathology include:

  • overweight: with excess weight, each kilogram adds blood pressure by two mm Hg;
  • sedentary lifestyle;
  • eating canned food, smoked meats, fatty foods, hot cheese;
  • excessive use of salt in cooking;
  • frequent stress;
  • smoking – harmful substances contained in cigarettes contribute to mechanical damage to the walls of arteries;
  • busy schedule;
  • alcohol consumption;
  • very tall or too short stature in men;
  • physical and nervous overwork;
  • the use of proteins of animal origin, which is not limited.

Also, risk factors include hereditary predisposition. Increased blood pressure in first-line relatives guarantees a high risk of developing the disease.

It is worth paying attention to age, after 35 years, men have a greater chance of acquiring this disease. In women, the pathology is associated with the onset of menopause.

All these manifestations do not bother patients constantly, but arise only in a certain period of time. This is the insidiousness of the disease, so when the above symptoms appear, you should consult a doctor for advice. If therapy is not started on time, then over time the disease will begin to progress and can lead to serious complications.

Therefore, it is important to control blood pressure. For this, there are now many special tonometers, from conventional mechanical devices to fully automated models. The work of tonometers with a phonendoscope is more complicated, it is not always possible to distinguish the sounds of the pulsation, but after some preparation and practice, practically everyone can learn this.

Before measuring pressure, do not smoke, drink alcohol or coffee, it is advisable to spend a few minutes at rest. The measurement is carried out in a sitting position, the cuff should be fixed slightly above the elbow, where the pulse is best felt. Most often, aneroid (lever and inflatable type) and automatic devices are used to determine the pressure. On an outpatient basis, devices are used that can monitor pressure changes for a whole day.

Each age has its own pressure standards:

  • 16-20 years – pressure 100/70 – 120/80;
  • up to forty years the norm is 120/70 – 130/80;
  • from forty to sixty – to 135/85;
  • after sixty years, up to 140/90 are cons >

During the study of the disease, many different classifications were developed with a division: by etiology, patient’s appearance, stability and level of pressure, reasons for the increase, the nature of the course. Doctors use some of them now.

The very first classification of hypertension subdivided it into red and pale. The decisive role in this division was played by the appearance of the patient. With a pale variety, the patient had cold limbs and an unhealthy complexion, due to vascular spasm. With red hypertension at the time of increasing blood pressure, the patient’s face, on the contrary, acquires a red color and becomes covered with spots.

In practice, one of the most important classifications is the separation of disease by origin. The primary or essential form is distinguished, which arises as an isolated pathology. Moreover, diseases of other organs and systems are absent.

The secondary form is a symptom of the pathology of organs that are involved in the regulation of vascular tone. These include – kidneys, endocrine and nervous systems.

There is no single systematization of hypertension, but, as a rule, doctors use the classification recommended by the World Health Organization. It is characterized by the degree of pressure increase.

  • Hypertension of the 1st degree is a mild form, which is characterized by a pressure of 140/90 to 159/99 mmHg.
  • Hypertension of the 2nd degree – moderate hypertension, pressure rises to 79/109 mm RT. Art. Sometimes doctors diagnose “hypertension 2 degree 2 risk XNUMX”, which means that there is one or two risk factors and the possibility of complications.
  • Hypertension of the 3rd degree is characterized by a severe course, the pressure rises to 180/110 mm RT. Art. and even higher. If during the examination the doctor diagnosed “hypertension 3 degree 4 risk”, then you need to immediately begin treatment and seek help at the hospital. In this case, the likelihood of developing complications increases to 30%.

The main criterion for arterial hypertension (or arterial hypertension) as a whole group of diseases is stable, that is, an increase in blood pressure (BP) detected by repeated measurements on different days. The question of which blood pressure is considered elevated is not as simple as it might 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 the level of 115/75 mm RT. Art., each additional increase in blood pressure by 10 mm RT. Art. accompanied by an increased risk of developing diseases of the cardiovascular system (primarily coronary heart disease and stroke) [1]. However, the benefit of modern methods of treating arterial hypertension was proved mainly only for those patients whose arterial pressure exceeded the value of 140/90 mm Hg. Art. It is for this reason that we agreed to consider this threshold value as a criterion for the allocation of arterial hypertension.

Dozens of various chronic diseases can be accompanied by an increase in blood pressure, and hypertension is only one of them, but the most common: approximately 9 cases out of 10. The diagnosis of hypertension is established in cases where there is a stable increase in blood pressure, but no other diseases that lead to increased blood pressure, not detected.

Hypertension is a disease for which a stable increase in blood pressure is its main manifestation. Risk factors that increase the likelihood of its development were established when observing large groups of people. In addition to the genetic predisposition of some people, these risk factors include:

  • obesity;
  • lack of mobility;
  • excessive consumption of salt, alcohol;
  • chronic stress;
  • smoking.

In general, all those features that accompany the modern urban lifestyle in industrialized countries [2]. That is why hypertension is considered a lifestyle-related disease, and its targeted changes for the better should always be considered as part of the treatment of hypertension in each individual case.

What other diseases are accompanied by an increase in 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 [3], some other, more rare diseases [4]. 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 [5]. The above diseases and conditions 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, finding out the history of the disease, examination, and also according to the results of some mostly simple laboratory and instrumental research methods, the diagnosis of any of the secondary arterial hypertension seems unlikely.

If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!

High blood pressure in itself in many people is not manifested by any subjective sensations. If high blood pressure is accompanied by symptoms, it can be a feeling of heaviness in the head, headache, flickering before the eyes, nausea, dizziness, instability when walking, as well as a number of other symptoms that are quite non-specific for high blood pressure. The symptoms listed above manifest themselves much more clearly in hypertensive crisis – a sudden significant increase in blood pressure, leading to a clear deterioration in health and well-being.

It would be possible to continue to list possible symptoms of GB through a comma, but there is no particular benefit in this. Why? Firstly, all these symptoms are nonspecific for hypertension (i.e., they can occur both individually and in various combinations and for other diseases), and secondly, the fact of a stable increase in blood pressure is important for stating the presence of arterial hypertension . And this is not revealed by an assessment of subjective symptoms, but only with measurements of blood pressure, and repeated. This means, firstly, that “in one sitting” you should measure Blood pressure twice or thrice (with a small break between measurements) and take the arithmetic mean of two or three measured values ​​as the true Blood Pressure. Secondly, the stability of increasing blood pressure (a criterion for the diagnosis of hypertension as a chronic disease) should be confirmed by measurements on different days, preferably with an interval of at least a week.

In the case of the development of a hypertensive crisis, symptoms will be necessary, otherwise it is not a hypertensive crisis, but simply an asymptomatic increase in blood pressure. And these symptoms can be either those listed above, or other, more serious ones – they are described in the Complications section.

Symptomatic (secondary) arterial hypertension develops as part of other diseases, and therefore their manifestations, in addition to the 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 in the muscles of the legs, arms, neck. In obstructive sleep apnea syndrome – snoring, respiratory arrest in sleep, daytime sleepiness.

If hypertension over time – usually many years – leads to damage to various organs (they are called “target organs” in this context), this can manifest itself in a decrease in memory and intelligence, stroke or transient disturbance of cerebral circulation, an increase in the thickness of the walls of the heart, the 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, clinical manifestations will result in us have these complications, rather than the increase in blood pressure as such.

What is blood pressure?

Blood pressure is the force of the blood flow that is directed to the walls of the arterial vessel.

This indicator directly depends on the functional abilities of the heart and the minute volume of blood (the amount of blood that can pump the heart in one minute).

Systolic blood pressure is formed during contraction of the myocardium (systole), and diastolic during relaxation of the heart muscle (diastole).

For different ages, there are standards for blood pressure. The ideal blood pressure figures for a young age (20-40 years) are considered to be 120/80 mm. Hg. Art ..

At a younger age from 15 to 19 years, the pressure indicators are slightly lower – 100/70 mm. Hg. Art. In people older than 40 years, blood pressure gradually rises to 140/90 mm. Hg. Art. due to irreversible structural changes in the vascular wall and heart muscle.

Classification of Arterial Hypertension

This disease develops with age, prone to a chronic course with regular exacerbations. For the successful treatment of hypertension, it is necessary to correctly determine the nature of the pathology, the prerequisites for increasing pressure in the pulmonary arteries. Especially for these purposes, conditional classification is provided according to the following evaluation criteria:

  • by pathogenic factor;
  • by the features of the pathological process;
  • according to the localization and specificity of the pathology focus

Depending on the etiology of the pathological process, doctors distinguish secondary and primary pulmonary hypertension (essential hypertension). In the first case, we are talking about complications of the main ailments of the body, as an option – renal and vascular pathologies, surgical complications and neurological conditions. If you study primary pulmonary hypertension, the causes of the pathological process for many specialists are still a mystery.

Degrees

Blood pressure in the range 135-140 / 85-90 is a borderline state between the norm and pathology, requires mandatory medical participation. As these values ​​increase, doctors distinguish four degrees of arterial hypertension, each of which reduces the quality of life of a clinical patient, bedridden. So:

  1. Easy degree. Hypertension progresses under the influence of physical and mental factors, and the pressure indicator after eliminating the pathogenic factor very soon returns to normal.
  2. Moderate. Horse racing Blood pressure prevails throughout the day, the rest of the symptoms are mild, requires medical attention. Hypertensive crises are extremely rare.
  3. Heavy. Blood pressure spikes are modified into intracranial hypertension, cerebral ischemia, increased creatinine in the blood, left ventricular hypertrophy, and narrowing of the eye arteries.
  4. Extremely heavy. May result in death for the patient. As a consequence of the pathological process, the development of malignant arterial hypertension with severe complications from the cardiovascular and nervous systems.

Hypertension, depending on the magnitude of the increased blood pressure, is divided into three degrees [9]. In addition, taking into account the increased risk of cardiovascular diseases on a scale of “years-decades” already starting from the level of blood pressure above 115/75 mm RT. Art., there are several more gradations of the level of blood pressure.

If the values ​​of systolic and diastolic blood pressure fall into different categories, then the degree of arterial hypertension is evaluated by the highest of the two values, and it does not matter – systolic or diastolic. The degree of increase Blood pressure in the diagnosis of hypertension is established with repeated measurements on different days.

In our country, the stages of hypertension continue to be distinguished [10], while in the European recommendations for the diagnosis and treatment of hypertension, no stages are mentioned. The allocation of stages is designed to reflect the staged course of hypertension from its onset to the onset of complications.

There are three stages:

  • Stage I implies that there is as yet no obvious 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 taking into account the level of creatinine in the blood, in the urine albumin protein is detected, thickening of the walls of the carotid arteries or atherosclerotic plaques in them is not detected, etc. Such damage to the internal organs is usually asymptomatic.
  • If there is at least one of the listed symptoms, stage II hypertension is diagnosed.
  • Finally, stage III hypertension is indicated when there is at least one cardiovascular disease with clinical manifestations associated with atherosclerosis (myocardial infarction, stroke, angina pectoris, atherosclerotic lesion of lower limb arteries), or, for example, serious kidney damage, manifested by a pronounced decrease in filtration and / or significant loss of protein in the urine.

Not always these stages naturally replace one another: for example, a person suffered a myocardial infarction, and after a few years the increase in blood pressure joined – it turns out that such a patient has hypertension immediately of stage III. The meaning of the stages is mainly to rank patients according to the degree of risk of cardiovascular complications. Treatment measures also depend on this: the higher the risk, the more intensive the treatment. The risk in formulating a diagnosis is assessed by four grades. In this case, the 4th gradation corresponds to the greatest risk.

In 1999, specialists of the World Health Organization developed the following classification of blood pressure indicators:

  • optimal performance – not higher than 120/80 mm RT. st .;
  • normal indicators – up to 130/85 mm Hg;
  • normal elevated rates – 130-139 / 85-89 mm Hg;
  • arterial hypertension of the first degree – 140-159 / 90-99 mm Hg;
  • arterial hypertension of the second degree – 160-179 / 100-109 mm Hg;
  • arterial hypertension of the third degree – above 180/110 mm. Hg. st .;
  • isolated systolic hypertension – when only the upper blood pressure rises, and the lower is within normal limits.

There are 3 stages of arterial hypertension:

  1. The first stage (I century). For this stage, an insignificant episodic increase in blood pressure is characteristic without damage to vital organs (“target organs”).
  2. The second stage (Art. II) There is a persistent increase in blood pressure to high numbers, and also “target organs” are affected – the heart muscle of the left ventricle is thickened, the vessels of the retina of the eyes, kidneys, and brain are sclerotic.
  3. The third stage (III art.). At this stage, complications arise from the “target organs” in the form of cardiovascular failure, necrosis of the walls of the heart, angina pectoris, renal failure, strokes, hypertensive encephalopathy, retinal hemorrhage, optic nerve edema, aortic aneurysm and others.

Important! Mandatory for all patients with arterial hypertension, the risk of cardiovascular complications is determined.

There are four risk groups:

  1. Patients with arterial hypertension of the first stage up to 55 years old without a concomitant pathology of the cardiovascular system have a low risk. The risk of complications is not more than 15%.
  2. The medium-risk group consists of patients with risk factors for complications, namely: high blood pressure, hypercholesterolemia, impaired glucose tolerance, women over 65 years old, men over 55 years old, burdened by heredity. The risk is in the range of 15-20%.
  3. The high-risk group is formed by persons with hypertension of the second and third stages.
  4. A very high risk group includes patients with arterial hypertension, which is combined with coronary heart disease, diabetes mellitus, chronic renal failure, acute history of cerebral and coronary circulation.

There is also an etiological classification, according to which distinguish between essential and symptomatic hypertension. Essential hypertension occurs primarily, and the cause of its development cannot be established.

Symptomatic or secondary hypertension is a symptom of a number of diseases, among which are:

  • chronic kidney disease (glomerulonephritis, pyelonephritis, polycystic);
  • systemic kidney diseases (diabetes mellitus, amyloidosis, etc.);
  • endocrine pathology (primary hyperaldosteronism; Itsenko-Cushing’s disease and syndrome, pheochromocytoma, hyperthyroidism, insulin resistance);
  • some physiological conditions (menopause, menopause);
  • tumors, injuries and inflammatory diseases of the brain and nervous system;
  • coarctation of the aorta;
  • systemic atherosclerosis;
  • alcoholism;
  • eclampsia of pregnant women;
  • against the background of oral contraceptives, glucocorticoids, sympathomimetics, analgesics, monoamine oxidase inhibitors;
  • poisoning with lead and salts of heavy metals.

Diagnosis of hypertension

This is the main pathological condition of the body, which creates all the necessary conditions for the development of disorders in the work of the heart muscle and neurocirculatory dysfunctions.

The term “Hypertension” was first coined by the Soviet academician F.G. Langom. The significance of this diagnosis has a general meaning with the term widely used abroad, “essential hypertension” and means an increase in the level of blood pressure above the norm for no apparent reason.

Symptoms of pathology

Signs of high blood pressure often cannot be fixed, which makes the disease a hidden threat. Persistent hypertension is manifested by headaches, fatigue, compression in the back of the head and temples, nosebleeds, and nausea.

Stage HypertensionPressure during systolePressure during diastole
Initial hypertension of 1 degree.From 140 to 159 mmHg90-99 mmHg
Persistent hypertension 2 degrees160-179 mmHg100-109 mmHg
Severe grade 3 hypertensiongt; Or = 180 mmHggt; Or = 110 mmHg
Isolated AGgt; 140lt; 90 mmHg

The arterial pressure within the normal range for a healthy person should be at the level of 120-129 mm Hg, and the normal DA blood pressure should be 80-84 mm Hg. Systolic pressure from 130 to 139 mm Hg is called highly normal, and diastolic pressure is from 85 to 89 mm Hg. Art.

Diseases characterized by high blood pressure I10-I15

I10Essential (primary) hypertension.
I11Hypertension with heart damage.
I12Hypertension with kidney damage.
I13Hypertension with predominant damage to the heart and kidneys.
I15Secondary hypertension.

There is a scale for assessing cardiovascular risk (SSR), which affects the further course and development of the disease. To determine the SSR, it is important to consider not only the level of blood pressure, but also concomitant dysfunctions of other organs. Thus, the risk is low, medium, high and very high.

Complications after arterial hypertension

The causes of arterial hypertension are very diverse. This can be a difficult or emotional profession, or a pathology that has been inherited from the parents.

Risk factors for arterial hypertension, which I take into account when diagnosing and the degree of SSR:

  1. The male sex is more prone to the occurrence of disorders of the heart and blood vessels at the age of more than 55 years;
  2. Cases of arterial hypertension are more common at the age of over 65;
  3. Smoking helps to reduce the tone of the vascular walls and increase blood pressure on them;
  4. Violations of the lipid composition of the blood (an increase in the number of low density lipoproteins and a decrease in the number of high density lipoproteins);
  5. Increased blood glucose;
  6. Obese people almost always suffer from hypertension;
  7. Adverse family history of heart and vascular disease.

To determine the SSR, the following factors are taken into account:

  1. Increased pulse pressure;
  2. Signs of hypertrophy of the left chambers of the heart, in particular the ventricle, on the echocardiography and on the ECG;
  3. The presence of chronic kidney disease and concomitant microalbuminuria;
  4. The formation of atherosclerotic plaques on the walls of the carotid arteries;
  5. Diabetes;
  6. Pathology of the vessels of the brain;
  7. Coronary heart disease;
  8. Pathological changes in the retina.

How to measure blood pressure? Various devices are used to measure the level of blood pressure in the arterial bed. A doctor or nurse measures the pressure. The patient can also take measurements on his own using an automatic blood pressure monitor.

The patient should be in a sitting position, with a raised hand to the level of the heart, in a relaxed state. Excluded a few minutes before measuring the intake of coffee or tea, sympathomimetics, physical activity.

A special cuff is superimposed on the arm so that its lower edge is 2 cm above the elbow joint. Cuffs are different in size! People with obesity need to measure pressure only with a cuff of 20 * 42cm. or 16 * 38cm.

Using a phonendoscope, you need to register Korotkov’s tones. When the first tone is heard, the SBP is recorded, and when the last is the DBP level. Measurement is carried out twice.

In the future, the pressure is determined on the hand on which more was recorded.

Self-monitoring of blood pressure is actively used, which helps to establish dynamic changes in pressure level. Often, in combination with it, it is recommended that an ABPM be performed.

SMA blood pressure is a XNUMX-hour monitoring of the patient’s blood pressure.

For this method, a special portable device with a cuff is used, which the patient carries with him for a day. The device constantly records changes in arterial blood pressure in the bloodstream. The patient is recommended to keep a diary, recording his actions and the time of taking certain drugs during monitoring.

Indications for SMA Blood pressure and SCAD:

  1. Suspicions that the pressure rises at the sight of a doctor (psychological factor);
  2. The presence of damage to the heart, kidneys or other organs without a clear increase in blood pressure;
  3. If blood pressure fluctuates in its values ​​with several visits to the doctor;
  4. With a decrease in blood pressure during the change of horizontal position to vertical (standing);
  5. With a significant drop in blood pressure during sleep during the daytime;
  6. If suspected of hypertension at night.

By using the results of the sphygmogram and the pressure measurement data on the shoulder, the level of central blood pressure can be calculated. First, a collection of complaints and anamnesis of life, disease. Then measure the growth and body weight in order to calculate the patient’s body mass index.

Diagnosis of arterial hypertension is the most important stage in the treatment and prevention of chronic disease. A timely diagnosis can help the patient quickly normalize blood pressure and avoid serious complications. It is also important to consult an experienced doctor who will quickly select the optimal treatment regimen for hypertension individually.

  1. Complete blood count and urinalysis;
  2. Determination of cholesterol;
  3. Glomerular filtration rate and creatinine;
  4. ECG.
  1. The level of uric acid and potassium in the blood;
  2. The presence of protein in the urine;
  3. Ultrasound of the kidneys and blood vessels, adrenal glands;
  4. The amount of sugar in the blood, glycemic profile;
  5. Echocardioscopy (echocardiography);
  6. SMA blood pressure and blood pressure self-monitoring;
  7. Pulse wave velocity measurement in the aorta;
  8. Ultrasound of the vessels of the kidneys and vessels of the head and neck.
  9. X-ray analysis of OGK;
  10. Consultation of an ophthalmologist.

The treatment of hypertension begins with a lifestyle change that has affected pressure spikes. The patient should change the fuss for peace of mind and joy from life. Patients are advised to visit a psychologist, take a vacation at work, go on vacation to nature.

The main goal of antihypertensive therapy is to lower the level of arterial blood pressure to the target numbers. Target blood pressure is 140/90 mm. Hg

If hypertension is diagnosed, treatment also involves a change in diet. It is proper nutrition that helps to quickly replenish the supply of useful vitamins and minerals for the cardiovascular system.

A person can reduce his own pressure, it is enough to follow the basic rules of prevention and lead an active lifestyle.

  1. Normalization of nutrition. An increase in the amount of food of plant origin, a decrease in the amount of salt intake to 5 g per day, limitation of fatty foods
  2. Exclusion of alcoholic beverages;
  3. It is recommended to refuse cigarettes. Smoking adversely affects the cardiovascular system;
  4. Dosed physical activity (30 minutes every other day, aerobic exercise). It is advisable not to engage in power sports;
  5. Slimming in case of obesity.

Pressure pills should be prescribed by a doctor. Self-medication for hypertension is not only ineffective, but can also cause the development of a hypertensive crisis.

Types of drugs for pressure:

  1. Angiotensin-converting enzyme inhibitors and drugs that block angiotensin receptors 11. The drugs in these groups are very often used in the treatment of hypertension. They are especially effective if there is a hyperfunction of the angiotensin-aldosterone system of the kidneys in a patient. Sometimes when using an ACE inhibitor, the phenomenon of “slipping” effect may occur, since the angiotensin enzyme changes its synthesis pathway. This effect is not observed when taking BAP.
  2. Calcium antagonists (AK) reduce the peripheral resistance of the walls of blood vessels, which reduces blood pressure. There are three groups of AK: – Dihydropyridines (Amlodipine, Nifedipine); – Phenylalkylamines (Verapamil);

Preparations of this series protect the vascular wall from the application of thrombotic masses, prevent the occurrence of atherosclerosis, and provide a protective function for the kidneys and brain.

  • Thiazide diuretics (hydrochlorothiazide) enhance the excretion of chlorine and sodium in the urine, reduce the volume of circulating blood, thereby lowering blood pressure. However, when using such drugs in high doses, metabolic disturbances in the body may occur. Most often they are combined with an ACE inhibitor or BAT. Aldosterone receptor antagonists (spironolactone) lower blood pressure by binding to aldosterone receptors. This drug reduces the excretion of potassium and magnesium in the urine.
  • Beta-blockers (bisoprolol, nebivolol, carvedilol). Assign in the event that the patient suffered a myocardial infarction, heart failure. The effect is to reduce the frequency and strength of contractions of the heart muscle. However, beta-blockers adversely affect the metabolism of the body. They prevent the development of pathology of the vessels of the brain, prevent the occurrence of strokes.
  • The patient can take both 1 prescribed drug, and carry out combined treatment (2-3 drugs).

    There are other classes of anti-hypertension drugs:

    1. Imidazoline receptor agonists (rilmenidine, moxonidine). Affect the carbohydrate metabolism of the body positively, contribute to reducing the weight of the patient;
    2. Alpha-adrenergic blocking agents (prazosin). Also positively affect metabolic processes in the body. Use in combination with other antihypertensive drugs.
    3. Renin inhibitors (direct). Aliskiren is used, which reduces the amount of renin in the blood and angiotensin.

    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 RT. Art. and higher. But hypertension and arterial hypertension are not the same thing: as already mentioned, an increase in blood pressure can manifest a number of diseases, and hypertension is only one of them, although the most common. The doctor, when diagnosing, on the one hand, must verify the stability of the increase in blood pressure, and on the other, assess the likelihood that the increase in blood pressure is not 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 blood pressure began to rise for the first time, are there any symptoms such as snoring with respiratory arrest in sleep, muscle weakness, unusual impurities in the urine, sudden heartbeat with sweating and headache pain, etc. It makes sense to clarify which medications and dietary supplements the patient is taking, because in some cases, it is they that can lead to an increase in blood pressure or to aggravation of an already elevated one. Several routine (performed for almost all patients with high blood pressure) diagnostic tests, along with information obtained during a conversation with a doctor, help to assess the likelihood of some forms of secondary hypertension: a general urinalysis, determination 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), to further search for these diseases as a possible cause of high blood pressure, one must have good reason. 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 it is further believed that blood pressure is elevated due to hypertension. This judgment may sometimes be subsequently revised as new patient data 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 to assess the prognosis and more targeted search for damage to internal organs), as well as, possibly, existing diseases of the cardiovascular system or their asymptomatic lesion – it affects the assessment of the prognosis and stage of hypertension, the choice of therapeutic measures. For this purpose, in addition to talking with the patient and examining him, a number of diagnostic studies are performed (for example, electrocardiography, echocardiography, ultrasound examination of the neck vessels, if necessary, some other studies, the nature of which is determined by the medical data already received about the patient).

    Daily monitoring Blood pressure using special compact devices allows you to assess changes in blood pressure in the course of the patient’s usual lifestyle. This study is not necessary in all cases – mainly, if the blood pressure measured at the doctor’s appointment differs significantly from the measured blood pressure at home, if necessary, to evaluate nighttime blood pressure, suspected episodes of hypotension, and sometimes to evaluate the effectiveness of the treatment.

    Thus, some diagnostic methods for examining a patient with high blood pressure are used in all cases, other methods are used more selectively, depending on the data already received about the patient, to check the assumptions that a doctor had during the preliminary examination.

    Definition of the disease. Causes of the disease

    Concerning non-pharmacological measures aimed at the treatment of hypertension, the most convincing evidence has been accumulated about the positive role of reducing salt intake, reducing and maintaining body weight at this level, regular physical training (loads), no more than moderate alcohol consumption, and also about increasing the content of vegetables and fruits in the diet. Only all of these measures are effective as part of the long-term changes in the unhealthy lifestyle that led to the development of hypertension. For example, a decrease in body weight of 5 kg led to a decrease in blood pressure by an average of 4,4 / 3,6 mm RT. Art. [9] – it seems to be a little, but in combination with the other measures to improve the lifestyle of the above, the effect can be very significant.

    Improving the lifestyle is justified for almost all patients with hypertension, but drug treatment is indicated, although not always, but in most cases. If 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 has been demonstrated in many clinical studies), then with hypertension of 1 degree with low and medium calculated cardiovascular risk, the benefits of such treatment have not been conclusively proven in serious clinical trials. In such situations, the possible benefits of prescribing drug therapy are evaluated individually, taking into account the preferences of the patient. If, despite a healthy lifestyle, increased blood pressure in these patients persists for several months with repeated visits to the doctor, it is necessary to re-evaluate the need for medication. Moreover, the magnitude of the estimated risk often depends on the completeness of the patient’s examination and may turn out to be significantly higher than it initially seemed. In almost all cases of treatment of hypertension, stabilization is sought to achieve blood pressure below 140/90 mm Hg. Art. This does not mean that it will be lower than these values ​​in 100% of the measurements, but the less often the Blood Pressure, when measured under standard conditions (described in the Diagnostics section), will exceed this threshold, the better. Thanks to this treatment, the risk of cardiovascular complications is significantly reduced, and if hypertensive crises occur, then much less often than without treatment. Thanks to modern medicines, those negative processes that, with hypertension, inevitably and implicitly destroy internal organs (primarily the heart, brain and kidneys) over time, these processes slow down or stop, and in some cases they can even be reversed.

    Of the drugs for the treatment of hypertension, the main are 5 classes of drugs [9]:

    • diuretics (diuretics);
    • calcium antagonists;
    • angiotensin converting enzyme inhibitors (names end with -pril);
    • angiotensin II receptor antagonists (names end with -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 requires concomitant diseases – in these cases, beta-blockers serve a dual purpose.

    Nowadays, preference is given to combinations of drugs, since treatment with one of them rarely leads to the achievement of the desired level of blood pressure. There are also fixed combinations of drugs that make treatment more convenient, as the patient takes only one tablet instead of two or even three. The selection of the necessary classes of drugs for a particular patient, as well as their doses and frequency of administration, is carried out by the doctor, taking into account such data about the patient as blood pressure, concomitant diseases, etc.

    Thanks to the multifaceted positive effect of modern drugs, 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 increase life expectancy, it may be necessary to correct blood cholesterol, taking drugs that reduce the risk of thrombosis (which leads to myocardial infarction or stroke), etc. smoking, no matter how trivial it may sound, can significantly reduce the risks of stroke and myocardial infarction in hypertension, and inhibit the growth of atherosclerotic plaques in the vessels. Thus, the treatment of hypertension involves the impact on the disease in many ways, and achieving normal blood pressure is only one of them.

    The total 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, their severity and duration of the negative impact.

    These risk factors are:

    1. smoking;
    2. high blood cholesterol;
    3. high blood pressure;
    4. obesity;
    5. sedentary lifestyle;
    6. age (with every decade lived after 40 years, the risk increases);
    7. male gender and others.

    At the same time, 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 worsening prognosis), but also the duration of their exposure. For people who do not yet have obvious cardiovascular diseases, in addition to hypertension, the prognosis can be estimated using special electronic calculators, one of which takes into account gender, age, blood cholesterol, blood pressure and smoking. The SCORE electronic calculator is suitable for assessing the risk of death from cardiovascular disease in the next 10 years from the moment of risk assessment. At the same time, the risk obtained in most cases is not high in absolute numbers and can make a misleading impression, since the calculator allows you to calculate exactly the risk of cardiovascular death. The risk of non-fatal complications (myocardial infarction, stroke, angina pectoris, etc.) is several times higher. The presence of diabetes increases the risk compared to that calculated using a calculator: for men, 3 times, and for women, even 5 times.

    With regard to the prevention of hypertension, we can say that, since the risk factors for its development are known (immobility, excess weight, chronic stress, regular lack of sleep, alcohol abuse, increased consumption of sodium chloride and others), all lifestyle changes that reduce the impact of these factors reduce the risk of hypertension. However, it is hardly possible to reduce this risk entirely to zero – there are factors that do not depend on us at all or depend a little: genetic characteristics, gender, age, social environment, and some others. The problem is that people begin to think about the prevention of hypertension mainly when they are already unhealthy, and blood pressure is already increased to one degree or another. And this is already a question not so much of prevention as of treatment.

    Both pathologies are characterized by sustained high blood pressure under the influence of external and internal provoking factors. In the case of hypertension, it is a permanent diagnosis that can be temporarily stopped, but not cured. Arterial hypertension is a more alarming symptom that manifests itself in heart failure, chronic renal failure, and other pathologies. In both cases, treatment is required. By hypertension is meant a sharp jump in pressure, which reaches a mark above 140 and 90 units.

    A characteristic pathology develops with an increase in the resistance of peripheral blood vessels and an increase in cardiac output. Due to emotional instability, the regulation of the tone of peripheral vessels by the medulla oblongata and hypothalamus is disrupted. As a result of the pathological process, spasm of arterioles, exacerbation of dyscirculatory and dyskinetic syndromes are observed. With arterial hypertension, an increase in blood viscosity occurs with a further decrease in blood flow velocity, metabolic decline, and irregular blood pressure.

    Causes

    Patients with atherosclerosis of the vessels often suffer from acute attacks of hypertension. This proves that a characteristic symptom occurs with extensive pathologies of the vascular system, myocardium, and kidneys. The main causes of the disease to this day remain unclear, there is a genetic predisposition, age-related changes in the body, weather conditions, weight category and the presence of chronic diseases.

    Risk Factors

    The condition progresses with mental and physical fatigue, severe nervous shocks. The development of secondary signs is due to a violation of the regulatory function of the higher departments of the central nervous system. Pathogenic factors are the following diagnoses and clinical pictures:

    • diabetes;
    • develops more often in the elderly;
    • past stresses, emotional upheavals;
    • heart attacks, strokes;
    • one form of obesity;
    • pathology in the work of the adrenal glands, the presence of endocrine pathologies;
    • exposure to toxic substances;
    • the presence of bad habits (alcoholism, smoking);
    • chronic kidney disease;
    • passive way of life;
    • excess salt in the daily diet;
    • gender (women are more likely to have hypertension);
    • lipid metabolism disorders;
    • one of the cardiovascular complications.

    When the first symptoms appear, the attending physician explains in detail what arterial hypertension is and why it occurs. The diagnosis is confirmed under the following condition: the jump Blood pressure is fixed and does not fall after repeating three measurements. Measurement is required at different times of the day, without the influence of drugs that correct blood pressure.

    Medication

    • Reduce salt intake. Since sodium traps water in the body, the volume of circulating blood increases, which affects the increase in pressure. The norm of salt will be about 4 grams. Ideally, you no longer need to add salt to the food during cooking.
    • To normalize the metabolism, it is necessary to drink a sufficient amount of liquid, about 1,5 liters per day. It is necessary to give preference to clean water, a rosehip broth, as well as “healthy” soups.
    • Exclude coffee, strong tea and alcohol from the diet.
    • Fractional nutrition. It is important to distribute the diet in such a way as to eat in even portions five to eight times a day.
    • Reduce the amount of meat and animal fats consumed. Patients are advised to choose lean meat – turkey, veal, chicken, rabbit. It is best to cook without oil, if the meat seems fresh, you can add greens and lemon juice, which will replace salt. As little as possible, it is worth including smoked meats, sausages, butter in the diet.
    • It is important to increase the amount of vegetables and foods rich in potassium and magnesium: cereals, beets, carrots, dried apricots, cabbage.
    • It is recommended to abandon the use of confectionery products with a high amount of sugar, preference is given to dried fruits, honey, whole grain products.
    • With hypertension, patients should not starve. Strict fasting and dieting are contraindicated.

    Symptoms of pathology

    Description of antihypertensive drug groups

    Beta blockers

    The effectiveness of this group has been proven by numerous randomized trials, they are also the “gold standard” in the treatment of hypertension.

    Beta-blockers block the beta receptors of the endothelium and myocardium, thereby lowering blood pressure, slowing the heartbeat, improving oxygenation of the heart muscle, and reducing the severity of left ventricular hypertrophy.

    The drugs are used both in the form of monotherapy, and in combination with other antihypertensive agents.

    Beta-blockers are contraindicated in cases of hypersensitivity to them, bronchial asthma, obstruction of the lungs, bradycardia, heart block, sinus node weakness, cardiogenic shock, hypotension, severe atherosclerosis.

    The most effective representatives of beta-blockers are Bisoprolol, Metoprolol, Carvedilol, Nebivolol and Propranolol.

    Diuretics increase the excretion of excess fluid by the kidneys, which leads to a decrease in the volume of circulating blood and normalization of blood pressure. Unfortunately, this group of drugs is only suitable for symptomatic treatment, since the cause of arterial hypertension is not eliminated.

    Diuretics along with urine remove potassium, so heart rhythm disturbances can occur.

    The main representatives of diuretics are Furosemide, Torasemide, Hypothiazide, Indapamide, Spironolactone (does not remove potassium).

    For long-term treatment of arterial hypertension, slow calcium channel blockers in retard forms are more often used.

    The mechanism of action of drugs is to relax the muscle cells of the heart and blood vessels, due to which the blood flow slows down and blood pressure decreases.

    When taking calcium channel blockers, adverse reactions often occur, such as dizziness, facial flushing, hypotension, arrhythmia, dry mouth, headaches, general weakness, swelling of the lower extremities.

    Drugs are best taken with meals or washed down with milk.

    The following calcium channel blockers are used in the treatment of arterial hypertension: Nifedipine, Verapamil, Diltiazem and Felodipine.

    This group of drugs is considered the newest. The mechanism of action is based on the blockade of angiotensin and a decrease in the secretion of aldosterone, which retains sodium and water in the body.

    Angiotensin 2 receptor blockers are well tolerated by patients and have a small number of adverse reactions of the body.

    Treatment with drugs of this class may be accompanied by dizziness, nausea, vomiting, weakness, arrhythmia, diarrhea, and insomnia.

    Today there are several representatives of this group – Valsartan, Lozartan, Irbesartan, Candesartan.

    ACE inhibitors block the secretion of angiotensin in the kidneys and thereby dilate blood vessels, remove water and sodium from the body, reduce the sympathetic nervous system in the heart and blood vessels, and thus normalize blood pressure.

    During treatment with ACE inhibitors, free side effects often occur in the form of cough, flushing of the skin, dizziness, a taste of metal in the mouth, tachycardia, Quincke’s edema, vomiting, diarrhea, and others.

    Among the widely used ACE inhibitors are drugs such as Enalapril, Lisinopril, Captopril, Ramipril, Perindopril.

    Breathing exercises

    Among other principles of primary prevention of hypertension, physical activity occupies a special place. Physical therapy (LFK) is designed to work to strengthen the body as a whole, normalize the work of the cardiovascular, central nervous and respiratory systems. In addition, the correct implementation of exercises helps to normalize vascular tone, leading to improved metabolism. A set of exercises is developed relative to the stage of the disease and severe symptoms. Classes should be affordable and regular.

    In most cases, patients with a diagnosis of hypertension need to avoid certain types of exercises:

    • rhythmic gymnastics at a fast pace;
    • lifting heavy objects;
    • exercises with sharp lowering the head down;
    • classes on individual muscle contractions (with a stable trunk and / or limbs);
    • climb uphill (with and without load);
    • classes at low or high ambient temperatures, in insufficiently ventilated rooms.

    Exercises to reduce pressure positively affect the work of the heart, normalizing the number of contractions and reducing the load. Especially popular was respiratory gymnastics according to Strelnikova’s system. Exercises can be performed at home, gradually increasing the load. This breathing system is based on fast noisy breaths and slow full exhalations.

    Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

    Detonic