Essential arterial hypertension treatment

Hypertension – high blood pressure – is one of the common diseases affecting the modern population. According to statistics, essential hypertension affects about 20% of adults.

Approximately 2% of patients have renovascular arterial hypertension, a disease resulting from occlusion of the renal branches.

Although this number is already quite high, it does not include people suffering from the essential form of hypertension, without going to a doctor with high rates. This means that the percentage of patients is higher.

Essential hypertension is often called a non-infectious epidemic, and is part of a group of civilizational diseases. An estimated 25% of deaths over the age of 40 are caused by hypertension.

One of the reasons for the sad statistics is that hypertension (high pressure) in the early stages has almost no signs, therefore, people are not aware of the presence of high rates, or simply ignore their insignificant symptoms, and treatment is not carried out.

Essential arterial hypertension (EAG) is a disease that is characterized by an increase in blood pressure above 140/90. This is one of the most common modern diseases. Arterial hypertension affects almost every person over 40 years old. Essential hypertension is discussed if high rates are measured repeatedly.

The etiology and pathogenesis of essential secondary arterial hypertension are well known, susceptible, and largely eliminated along with the cause of high blood pressure.

The formation of primary essential hypertension – an increase in blood pressure – is affected by the complexity of various factors: inheritance, lifestyle, and the environment.

The most important pathophysiological mechanisms and etiology factors are:

  • increased activity of the sympathetic nervous system, manifested by an increase in heart rate, minimal heart rate, and peripheral vascular resistance;
  • psychosomatics – chronic stress in genetically predisposed people causes a steady increase in TK;
  • renin-angiotensin-aldosterone system;
  • obesity;
  • physical activity;
  • inheritance;
  • salt intake;
  • alcohol.

Blood pressure values, by their nature, are constantly changing throughout the day. In the morning they are higher, in the evening they decrease, the lowest rates are during sleep. If a person changes the rhythm of the day, for example, switches to night shifts, the pressure variability “adjusts” to these changes.

The critical values ​​for people with classic biorhythm are the period in the morning and early morning, when the highest level of cardiovascular complications is observed.

A meta-analysis of the population showed a clear dependence of cerebrovascular and cardiovascular morbidity and mortality on high blood pressure – hypertension.

Symptoms of essential mild to moderate hypertension are less pronounced and nonspecific. Due to increased blood pressure on the arteries, most people have the following signs of hypertension:

  • headache;
  • cardiopalmus;
  • chest pressure
  • impaired vision;
  • irritability;
  • dizziness;
  • noise in ears;
  • fatigue;
  • insomnia;
  • bleeding from the nose;
  • swelling of the ankles;
  • excessive sweating.

These are insignificant signs that a person often does not pay attention to for a long time. Therefore, hypertension – high blood pressure – is usually diagnosed by chance. Symptoms of more advanced stages occur due to organ damage.

It must be said that systolic pressure increases with age, while diastolic pressure decreases slightly after 60 years of age in men and after 10 years in women.

At the beginning of the disease, various factors are involved (environment, endogenous regulatory systems, etc.).

But essential hypertension in adults can develop a second time, representing a consequence or manifestation of endocrine diseases, diseases of the kidneys, blood vessels, heart and other organs.

Target organs are basically the following organs:

Hypertension (high blood pressure) is manifested depending on the degree of damage to these organs.

It is possible to determine the differences between EAG and manifestations of high rates in other types of hypertension, but they are few. First of all, the following factors are taken into account:

  • age of the patient – the age of 35–45 years is characteristic for the development of essential hypertension; other types of the disease are typical for other age groups;
  • stability of indicators – with essential hypertension, pressure indicators are increased stably, they are easily amenable to therapy;
  • research results – with essential hypertension there are no characteristic findings of analyzes typical for other types of disease.
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Diagnosis of hypertension is closely related to repeated measurements of blood pressure. But here it is necessary to distinguish whether a disease occurs or the so-called. white coat syndrome. A 24-hour blood pressure measurement is also needed. However, since there are a lot of hypertensive patients, it is impossible for everyone to provide an extensive examination. Typical research methods:

  • disease history;
  • gynecological examination;
  • pulse test on large blood vessels;
  • blood pressure measurement in different positions (sitting, standing, lying), pressure is also measured on the lower extremities;
  • Analysis of urine;
  • biochemistry of blood;
  • ECG;
  • fundus studies.

Important! If necessary, an x-ray of the chest is also performed.

Essential hypertension can be divided into 3 groups depending on the stage of development and participation of the target organ.

  • Severity 1 – an increase in pressure that does not affect organs.
  • 2 severity – a change in organs is recorded that does not cause their failure or dysfunction. For example, fundus findings, changes in arteries, ECG and echocardiography, calcification of the aorta and other arteries, microalbuminuria (protein detection in urine as a result of the study).
  • Grade 3 – serious changes in organs with functional impairments are evident. There is left heart failure, atherosclerosis, aneurysm, stroke, coronary disease, renal failure, neuroretinopathy and myocardial infarction.

Phase 3 is also referred to as malignant hypertension, which occurs mainly with essential hypertension, which is not treated or has insufficient pressure control. The pressure at this stage often exceeds 230/130. With rapid damage to organs, which was accompanied by their early failure.

ICD-10 – I10-I15 – hypertensive diseases, I10 – essential primary hypertension – Hypertensio arterialis essentialis (primaria).

The treatment of essential hypertension includes a non-pharmacological approach (i.e., without medication), regimen measures (always), pharmacological therapy and the establishment of a specific diet.

Urgently reduce blood pressure in case of essential hypertension should be if the systolic pressure (upper) exceeds 180 or the diastolic value is above 110 (lower value).

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Most often they are prescribed in combination with other antihypertensive drugs.

These are first-line drugs for the elderly, with heart weakness, isolated systolic hypertension, high blood pressure, accompanying the accumulation of water and sodium.

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Diuretics help remove water from the body. With a decrease in the volume of fluid in the vascular system, a decrease in blood pressure occurs.


These drugs may be taken alone or in combination with other medicines. The most suitable combination is a combination with calcium channel blockers.

β-blockers are prescribed for hypertension (high blood pressure), accompanied by ischemia, angina pectoris, congestive heart failure, tachycardia. After consultation with your doctor, these medicines can be taken by pregnant women.

They are not recommended for asthmatics, people with a slow heart rate, severe heart failure. This group is not suitable for people with metabolic syndrome, impaired glucose tolerance, diabetics.

ACE Inhibitors

These drugs have a positive effect on kidney and heart function. Unlike β-blockers, they do not have a negative metabolic effect. Medicines are also used in the form of so-called. single boluses in the treatment of hypertensive crisis. Nevertheless, they can be taken for a long time, as a separate medicine for high blood pressure.

In combination, they are usually taken with more severe forms of hypertension (high blood pressure). The most common combination of ACE inhibitors is with diuretics, calcium channel blockers.

Indications for the use of these drugs are high blood pressure (hypertension), heart failure, systolic dysfunction of the left ventricle, myocardial infarction, diabetes, kidney disease, proteinuria, renal failure.


These drugs for hypertension are very similar to ACE inhibitors, so they can replace drugs in this group. Sartans are very well tolerated.

A decrease in blood pressure when taking these drugs occurs through systemic vasodilation (expansion of blood vessels). Medications do not adversely affect the metabolism of fats, does not lead to a narrowing of the airways. Means have a positive effect on systolic hypertension.

In the long run, they are prescribed for older people with high blood pressure, accompanied by diabetes, left ventricular enlargement, kidney disease, and peripheral arterial disease.

They are not suitable for the treatment of high blood pressure, accompanied by heart failure, impaired AV conduction, slowing of the sino-atrial and atrioventricular lines.

The “silent killer” is among us all. This is not an exaggeration. Arterial hypertension (AH) – a chronic, lifelong disease – sneaks up gradually, without revealing itself with acute symptoms. It is all the more important to know how to protect yourself from high blood pressure, which causes complications that end in death.

The vessels through which blood flows have the property of expanding and narrowing, that is, changing their tone. This regulates the pressure set by the heart.

Complications of the disease

If you do not control this disease, then it will certainly lead to a hypertensive crisis. This condition can last from several hours to several days, and high pressure will be difficult to normalize. Crisis is characterized by severe headache, vomiting, nausea, dizziness, shortness of breath, heart pain, and redness of the face. With such symptoms, it is urgent to take a tablet of Nifedipine or Captopril. After that, you should call the ambulance team.

During the crisis period, other symptoms may occur that will develop into chronic diseases. A person will have diseases inherent in the ǀ and ǀǀ degrees of essential hypertension. Each of these conditions is severe and requires immediate hospitalization.

Prospects and possible consequences of the development of hypertension

With regular use of a complex of drugs, the patient has a great chance to protect himself from the negative consequences of the disease, reducing the effect of high pressure on the target organs and helping himself to create conditions for normal life. All medications will have to be taken for a very long time, most likely, all life.

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The consequences of developing and progressing hypertension for a patient can be very sad:

  • acute myocardial infarction;
  • stroke (cerebral hemorrhage);
  • chronic heart failure;
  • pulmonary edema;
  • kidney disease.

Constant medication, an improvement in lifestyle, and a reduction in the likelihood of stress will help the patient avoid such complications.

Degrees of hypertension

Consider the development of a disease such as essential hypertension. The pathogenesis of the disease involves 3 degrees, which differ in combinations of numbers. Blood pressure with some risk factors for possible complications.

Severity of hypertension

Upper blood pressure, mmHg

Lower blood pressure, mmHg

When determining the degree, the stage of the disease and the risks of complications are also specified. For an accurate diagnosis, the increase in blood pressure is taken into account, that is, several times during the month. Essential severity I-II severity at risk group 1 is usually accompanied by a small stable increase in blood pressure without sudden jumps. At risk group 2, the onset of a hypertensive crisis is already possible.

Third stage (heavy)

In the initial stage of the disease, the patient often does not notice his hypertension, the symptoms of the disease are invisible to him. The only signs of trouble are a feeling of weakness, headaches, dizziness, and darkening in the eyes. These symptoms appear due to strong physical or emotional stress, in case of malnutrition and abuse of coffee or alcohol.

At the 2nd stage, the symptoms of the disease manifest themselves more significantly and may be accompanied by hypertensive crises. A crisis is a sharp jump in blood pressure, in which there is a change in blood flow in the internal organs, as well as a violation of the psychoemotional background. Provoke a hypertensive crisis can:

  • improper nutrition, including a lot of salt in the patient’s diet;
  • a sharp change in weather conditions.

Symptoms of a hypertensive crisis in case of hypertension 2 degrees 2 risk levels are as follows:

  • pain in the sternum, extending to the scapula;
  • Strong headache;
  • dizziness;
  • possible loss of consciousness.

At this stage, of course, it is already impossible not to notice the disease. Therefore, it is precisely when such symptoms appear that the patient often comes to the doctor, and he is diagnosed with essential hypertension. What is it – the patient learns from the attending physician, who will prescribe the necessary examination and recommend treatment. At the 2nd stage of the disease, a separate administration of drugs that lower the pressure will no longer have the desired effect. A comprehensive treatment is needed that can guarantee constant monitoring of blood pressure.

In patients with the 3rd (most severe) stage of the disease, various signs of the disease are already observed in other organs:

  • vascular encephalopathy, which manifests itself in a gradual decrease in intellectual capabilities, impaired attention and memory, negative changes in behavior (apathy and depression);
  • symptoms of heart failure;
  • impaired renal function, which leads to metabolic disorders (the presence of protein in the urine, an increase in creatinine in the blood test).

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Detonic for pressure normalization

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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.