What is dangerous arterial hypertension: symptoms, causes and treatment

Arterial hypertension (AH, hypertension) is one of the most important socioeconomic and medical problems of our time.

This is not only due to the wide spread of this disease among different age groups of the population, but also to the high rates of severe complications, disability and death from arterial hypertension if left untreated. timely.

People prone to high blood pressure should measure in both arms. Recent studies have shown that arterial hypertension can be confirmed with a difference in arm measurements of 10 - 15 mm Hg. This sign (difference in indications) has a probability of identifying hypertension up to 96%.

What is it?

In a word, arterial hypertension is a disease of the cardiovascular system in which the blood pressure in the arteries of the (large) circulatory system is steadily increased.

Blood pressure is divided into systolic and diastolic:

1. Heart Autumn. According to the first number, the top number, the blood pressure level is determined at the time of compression and ejection of blood from the arteries. This number depends on the force with which the heart contracts, on the resistance of the blood vessels and on the frequency of contractions.
2. diastole. The second, lower number determines the blood pressure at the time the heart muscle relaxes. It indicates the degree of peripheral vascular obstruction.

Normally, blood pressure readings are constantly changing. Physiologically, they depend on the person's age, sex, and condition. During sleep, pressure decreases, physical activity or stress leads to its increase.

The average normal blood pressure in a twenty-year-old is 120/75 mm Hg. Art. , Forty years old - 130/80, over fifty - 135/84. With a constant number of 140/90, we are talking about arterial hypertension. Statistics show that about 20-30 percent of the adult population is affected by this disease. With age, prevalence increases dramatically, and by the age of 65, 50-65 percent of older adults have the condition.

Classify

Given the origin of the pathology, the following types are distinguished:

1. Essential (primary) arterial hypertension. It is difficult to pinpoint the exact cause of the development due to the lack of visible prerequisites;
2. Symptomatic (secondary). An increase in pressure is considered a consequence of the development of a certain disease, which is one of its signs. Secondary types of the disease, depending on the cause of development, are divided into the following types: endocrine, renal, drug, hemodynamic, and neurological.

If we take into account the degree of blood pressure, pathology is divided into the following types:

1. Border. The pressure periodically increases to 140 - 149/90, then decreases, normalizes;
2. Isolated systole. There is an increase in the above indicator (it reaches 140 and above). At the same time, the lower score is still in the 90 or less range.

Taking into account the nature of the pathology, specialists have identified the following types:

1. Temporary. The patient occasionally has high blood pressure. This state can last for hours or days. Pressure returns to normal without the use of medication;
2. Labile. It manifests itself in the early stages of the development of the pathology. This state is considered borderline, because the increase in pressure is insignificant, unstable. Pressure normally normalizes on its own;
3. Stable arterial hypertension. persistent increase in pressure, requiring supportive treatment to alleviate it;
4. Crisis. Recurring hypertensive crises are characteristic;
5. Malignant. The pressure increases to a serious level, hypertension develops rapidly, causing many serious complications. Possible death.

Risk factors

Currently, the severity of the disease described is directly dependent on the risk data. The risk lies in the development of cardiovascular complications against the background of high blood pressure. Taking into account the complications presented, the consequential prognosis of arterial hypertension is diagnosed. There are the following risk factors for exacerbation of the disease course and its prognosis:

• age - in men after 50 years, in women after 60 years;
• smoke;
• high cholesterol;
• Genetic factors;
• fat;
• motivational disorder;
• Diabetes.

The risk factors presented can be eliminated (correctable) and may not be corrected. The first type of risk factor is characterized by the presence of diabetes, high cholesterol, smoking, inactivity. Unadjusted risk factors included race, family history, and age.

Severity

There is also an international classification of the disease, which is developed depending on the degree of arterial hypertension:

Arterial hypertension grade 1

This stage of the disease is characterized by a mild course of the disease: the pressure during the day increases by 20-30 units and usually does not exceed 180/115 mm Hg. Art. Hypertensive crises occur infrequently and they are provoked, as a rule, by sharp changes in barometric pressure or emotional overload. There are no complications from the work of the target organs.

Arterial hypertension grade 2

It is characterized by an increase in blood pressure to the level of 160-179 / 100-109 mm Hg. Art. It is with such indicators that patients most often go to the doctor for the first time, since considering them the norm is the height of carelessness. Grade 2 arterial hypertension is often manifested by severe headache, weakness, dizziness, and deterioration of health during episodes of increased pressure.

Arterial hypertension grade 3

It is characterized by an increase in blood pressure to a level of 180/110 mm Hg or more. Art. Sometimes these numbers can reach completely prohibitive levels (250/160 mm Hg or more), but in this case are a real threat to human health and life. Patients with grade 3 arterial hypertension should be under the supervision of a physician, take all prescribed antihypertensive medications, and remember to have a home pressure gauge (mechanical or electronic).

Symptoms of arterial hypertension

Arterial hypertension itself has no symptoms. Most adult patients with this disease do not complain of anything, high blood pressure is discovered incidentally.

The clinical manifestations of arterial hypertension depend on which organs are affected at the present time. Adults with benign hypertension may complain of the following symptoms:

1. Headache - can be the first and main symptom. There are several types of headaches:
   • dull, not intense, characterized by a feeling of heaviness in the forehead and occipitals. It occurs most often at night or in the morning, increasing with drastic changes in the position of the head and even with mild exertion. Such pain is caused by a violation of the venous outflow of blood from the blood vessels of the skull, their overflow and irritation of pain receptors;
   • alcohol - diffuse flares all over the head, possibly vibrating. Any stress increases the pain. It occurs most often during the late stages of hypertension or when vascular hypertension is present. As a result, the blood vessels are overfilled and it is difficult for blood to flow out;
   • ischemia - spontaneous smoldering or flare-up, accompanied by dizziness and nausea. It occurs when blood pressure rises sharply. There is a strong vasospasm, as a result of which the blood supply to the brain tissues is disturbed.
2. Pain in the heart area - myocardial pain, not ischemic in nature, the coronary vessels are in order, while the pain does not stop with the use of sublingual nitrates (sublingual nitroglycerin) and can occur bothat rest and during emotional stress. Sports activities are not a trigger.
3. Shortness of breath - occurs only during sports at first, with the progression of hypertension it can also occur at rest. It characterizes the dysfunction of the heart.
4. Edema - most commonly seen in the legs due to pooling of blood in the circulatory system, sodium and water retention, or impaired kidney function. The co-occurrence in children with hematologic edema and hypertension is characteristic of glomerulonephritis, which is important to remember in the differential diagnosis.
5. Visual impairment - manifests as blurred vision, the appearance of a veil or fluttering flies. Occurs due to damage to the vessels of the retina.

Chronic arterial hypertension causes damage to the kidneys with the development of renal failure and corresponding complaints of renal origin, which will be discussed below. Chronic hypertension also leads to the development of circulatory dysfunction encephalopathy, which is characterized by decreased memory, attention and performance, sleep disturbances (more daytime somnolence, combined with loss ofsleep at night), dizziness, tinnitus, and depressed mood.

When taking the history, in the history it is necessary to record the family history and causes of arterial hypertension in immediate relatives, clarify the time when the first clinical symptoms appeared, note the diseasesat the same time.

The hypertensive crisis

This is an emergency condition, consisting of blood pressure that rises sharply to high numbers and is characterized by a severe decrease in the blood supply to all internal organs, especially the vital ones.

It occurs when the body is exposed to various, unforeseeable adverse factors, which is why uncontrolled hypertension is so dangerous. The urgency of the problem also lies in the fact that, if not treated promptly, it can lead to death. For emergency, the patient must be taken immediately to the hospital, where the blood pressure is lowered quickly with medication.

Students of medical institutions study first aid for hypertensive crises at the Department of Preventive Medicine, and therefore it is best that a bystander does not attempt to assist but calls an ambulance.

Diagnose

The three main diagnostic methods that allow you to determine the presence of hypertension in a person are:

1. Blood pressure,
2. physical examination,
3. Record electrocardiogram.

Control blood pressure

Blood pressure measurement is carried out using a special device - a manometer, which is a combination of a sphygmomanometer and a phone monitor. In addition, there are now special electronic devices that measure blood pressure and pulse rate, and at the same time allow you to enter blood pressure readings into the machine's memory.

Anamnesis

The diagnosis of hypertension also includes a survey of the patient by a physician. The doctor will find out for the patient what diseases he has had before or is currently suffering. Risk factors were assessed (smoking, high cholesterol, diabetes), plus so-called. genetic history, i. e. whether the patient's parents, grandparents, and other relatives have hypertension.

Physical examination

The physical examination of the patient, first of all, involves studying the heart using acoustic glasses. This method allows you to detect the presence of heart murmurs, changes in characteristic tones (amplification or, conversely, weakening), as well as the presence of non-specific sounds. These data, first of all, talk about the changes that occur in the heart tissue due to increased blood pressure, as well as the presence of defects.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a method that allows you to record changes in your heart's electrical potential over time on a special tape. This is an indispensable method for the diagnosis, first of all, of various arrhythmias. In addition, the electrocardiogram allows you to determine the so-called. left ventricular wall hypertrophy, characteristic of arterial hypertension.

echocardiography

In addition to these diagnostic methods, other methods are also used, such as echocardiography (ultrasound that examines the heart), which allows you to determine the presence of defects in the structure of the heart, changes in the thickness of the heart's walls and the condition of the valves.

Arterial Engineering

Angiography, including angiography, is an X-ray method to check the condition of the artery walls and their lumen. This method allows you to determine the presence of atherosclerotic plaques in the coronary artery wall (coronary angiogram), the presence of aortic spasm (congenital narrowing of the aorta in a single area). determined), v. v.

dopplerography

Dopplerography is an ultrasound method for diagnosing blood flow in vessels, both in arteries and in veins. With arterial hypertension, the doctor first of all checks the condition of the carotid and cerebral arteries. Ultrasound is widely used for this, as it is absolutely safe to use and does not cause complications.

Blood chemistry

Biochemical blood tests are also used in the diagnosis of hypertension. First of all, it indicates high, low and very low levels of cholesterol and lipoproteins, as they are a marker of a predisposition to atherosclerosis. In addition, blood sugar is determined.

In the diagnosis of hypertension, a study of the condition of the kidneys is also used, for such methods as a general urinalysis, biochemical blood tests (for creatinine and urea levels), as well as ultrasonography. kidney sounds and theirs. ships are used.

Thyroid ultrasound

Thyroid ultrasound and blood tests to look for thyroid hormone. These research methods help determine the role of the thyroid gland in causing high blood pressure.

How to treat arterial hypertension?

The effective treatment for hypertension is selected depending on the severity of the disease and the patient's overall cardiovascular disease risk. To assess this risk, he takes into account certain factors:

• age: 50 years old for men, 60 years old for women;
• family history: sudden heart attack or death of a parent (before age 55 in men, before age 65 in women) or stroke before age 45, regardless of parental sex;
• smoke (or have not smoked within the last three years);
• Diabetes;
• LDL cholesterol level above 1. 60 g/l or LDL cholesterol level below 0. 40 g/l;
• belly fat, kidney failure, lack of regular exercise or drinking too much alcohol.

General principles for treating arterial hypertension at home that all adults with high blood pressure should follow:

With mild, first degree of the disease, non-pharmacological methods are applied:

• limit salt intake to 5g/day (you can learn more about proper nutrition when suffering from high blood pressure in our separate article),
• normalize weight with its excess,
• moderate physical activity 3-5 times a week (walking, running, swimming, physiotherapy exercises),
• Quit smoking,
• reduce drinking,
• the use of herbal sedatives to increase emotional arousal (eg, valerian decoction).

In the case of no effect of the above methods in the treatment of grade 1 arterial hypertension as well as patients with grade 2, grade 3 hypertension, switch to drugs.

It should be noted that pharmacies now offer a wide variety of drugs for the treatment of arterial hypertension, both new and known for many years. Under different trade names, preparations with the same active ingredient may be produced. It is very difficult for a non-expert to understand them.

Diuretics are the drug of choice for the treatment of hypertension, especially in the elderly. The most common is thiazides.

In addition, in the treatment of arterial hypertension, it is important to correct for risk factors:

• antiplatelet agent - acetylsalicylic acid, used as indicated,
• statins in case of atherosclerosis - also in the absence of contraindications;
• Medicines that lower blood sugar when you have diabetes.

If the effect is not sufficient, a second or third drug may be added. Reasonable combination:

• diuretics + beta blockers
• diuretic + ACE inhibitor (or sartan)
• diuretic + calcium antagonist
• dihydropyridine calcium antagonists + beta-blockers
• calcium antagonists + ACE inhibitors (or sartan)

Invalid combinations:

• non-dihydropyridine calcium antagonists + beta-blockers (may develop heart block to death)
• ACE inhibitors + sartan

To treat and check for high blood pressure, you need to see a doctor. Only a specialist doctor after a complete examination and analysis of the results of the examination can make an accurate diagnosis and prescribe competent treatment.

Why is high blood pressure dangerous?

Arterial hypertension is one of the leading causes of severe CVS.

Despite the fact that there are now a large number of antihypertensive drugs that allow you to maintain your blood pressure at an appropriate level, the incidence of hypertensive episodes and complications such as heart failure (HF) and kidney failure(RF), aortic and mitral regurgitation, cardiac and aortic aneurysms, MI (heart attack), stroke, etc. v. in hypertensive patients remains very high.

This is mainly because many patients do not want to systematically treat their hypertension, believing that the hypertensive crisis that develops in them is just one and this will not happen again.

According to statistics, among patients who are known to have arterial hypertension, only about 40% of women and 35% of men are treated with drugs. At the same time, only 15% of women and about 5% of men achieve the necessary blood pressure levels due to the application of systemic antihypertensive therapy, monitoring of blood pressure readings, and regular visits to the doctor and adherence to the guidelines. according to the doctor's recommendations.

Despite the fact that arterial hypertension is one of the controllable risk factors for the development of cardiovascular diseases, such unfortunate indicators are due to the trivial misinterpretation of the patient'sthe severity of his diagnosis, and therefore, the lack of a serious and responsible approach to treatment.

The most common serious complications that develop as a result of hypertensive crises are:

• stroke (about thirty percent of patients);
• pulmonary edema (twenty-three percent);
• hypertensive encephalopathy (16%);
• acute heart failure (fourteen percent);
• cerebral hemorrhage (five percent of cases);
• dissection of aortic aneurysm (2. 5%), v. v.

It should be noted that without adequate and systematic treatment of hypertension, due to heart and kidney failure within three years of severe (complex) hypertension, 30 to 40% of patients die.

Comprehensive treatment, a responsible approach to one's health, the systematic use of antihypertensive drugs and the control of one's pressure, allowing to reduce the frightening numbersthis down to the minimum.

Prevention of arterial hypertension

For people who have a genetic predisposition to arterial hypertension and are weighed down by risk factors, prevention is extremely important.

1. First of all, this is a regular examination by a cardiologist and observance of the rules of a reasonable lifestyle, which will help to delay, and often eliminate, arterial hypertension. If you have a family history of hypertension, you should review your lifestyle and radically change many of the habits and lifestyles that are risk factors.
2. You should reconsider your eating principles, stop eating salty and fatty foods, switch to a low-calorie diet that includes large amounts of fish, seafood, fruits and vegetables. Do not bring alcoholic beverages and especially beer. They contribute to obesity, uncontrolled consumption of salt, adverse effects on the heart, blood vessels, liver and kidneys.
3. A more active lifestyle is required, depending on age, making it ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually, without overloading the body. Outdoor exercise is especially beneficial. Exercise strengthens the heart muscle and nervous system, and helps prevent stress.
4. Try to have a favorable psycho-emotional environment around you. If possible, avoid conflict, keeping in mind that a ruptured nervous system very often triggers the development of arterial hypertension.
5. Quit smoking, the substances in nicotine cause changes in the artery walls, increasing their stiffness, so they can be the culprit of high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.

Thus, we can say succinctly that the prevention of arterial hypertension includes regular visits by a cardiologist, a suitable lifestyle and an emotional background favorable to your environment.

Forecast for life

The prognosis for arterial hypertension is determined by the nature of the course (malignant or benign) and the stage of the disease. Factors that worsen the prognosis are:

• rapid progression of signs of target organ damage;
• Stages III and IV of arterial hypertension;
• Severe damage to blood vessels.

An extremely adverse course of arterial hypertension is observed in young adults. They are at high risk of stroke, heart attack, heart failure, and sudden death.

With early treatment of arterial hypertension and the patient's careful observance of all recommendations of the attending physician, it is possible to slow disease progression, improve the patient's quality of life, and sometimeswhen long-term remission is achieved. .