What is dangerous hypertension: symptoms, causes and treatment

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

This is due not only to the wide spread of this disease in different age groups of the population, but also to the high rate of severe complications, disability and mortality from hypertension in the absence of timely treatment.

People prone to high blood pressure are advised to take measurements in both hands. Recent studies have shown that hypertension can be confirmed by a change in readings in different arms of 10 - 15 mm Hg. This sign (change in indications) has a probability of defining hypertension up to 96%.

What is it?

Simply put, hypertension is a disease of the cardiovascular system, in which the blood pressure in the (large) circulatory arteries is constantly increasing.

Blood pressure is divided into systolic and diastolic:

1. Systolic. According to the first, upper number, the level of blood pressure is determined at the moment of compression of the heart and extraction of blood from the artery. This indicator depends on the force with which the heart contracts, the resistance of the vessel walls, and the frequency of contractions.
2. diastolic. The second number, the lowest, determines the blood pressure at the moment when the heart muscle relaxes. Indicates the level of peripheral vascular resistance.

Normally, blood pressure readings are constantly changing. They physiologically depend on the age, gender and condition of the person. During sleep, the 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 continuous figures 140/90, we are talking about hypertension. Statistics show that about 20-30 percent of the adult population is affected by this disease. With age, the prevalence rate inevitably increases and at age 65, 50-65 percent of the elderly suffer from this disease.

Distribution

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

1. Essential (primary) hypertension. It is difficult to determine the exact cause of development due to the lack of obvious preconditions;
2. Symptomatic (secondary). Increased pressure is considered as a consequence of the development of a certain disease, is one of its signs. The secondary type of disease, depending on the cause of development, is divided into the following types: endocrine, renal, drug, hemodynamic, neurogenic.

If we consider the level of blood pressure, the pathology is divided into the following types:

1. Kufiri. The pressure increases periodically to 140 - 149/90, then decreases, normalizes;
2. Isolated systolic. There is an increase in the upper indicator (reaches 140 and above). At the same time, the bottom one remains within 90 and below.

Given the nature of the pathology, experts have identified the following types:

1. Transitional. The patient occasionally has high blood pressure. This condition can last for hours or days. Blood pressure returns to normal without the use of medication;
2. Labile. It is manifested in the initial stage of pathology development. This condition is considered borderline because the pressure increases are insignificant, unstable. The pressure usually normalizes itself;
3. Stable hypertension. The increase in pressure is continuous, supportive therapy is needed to reduce it;
4. Crisis. Periodic hypertensive crises are characteristic;
5. Malinje. Pressure rises to serious levels, hypertension develops rapidly, causing severe complications. Possible death.

Risk factors

Currently, the severity of the disease described depends directly on the facts of the risk. The risk lies in the formation of cardiovascular complications against the background of high blood pressure. Considering the presented complications, the prognosis of the consequences of hypertension is diagnosed. There are the following risk factors that worsen the course of the disease and its prognosis:

• age - in men after 50 years, in women after 60 years;
• smoking;
• high cholesterol;
• hereditary factor;
• obesity;
• hypodynamics;
• diabetes.

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

Severity

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

First degree arterial hypertension

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 rarely and they are provoked, as a rule, by a sharp change of atmospheric pressure or emotional overload. There are no complications from the work of the target organs.

Second degree arterial hypertension

It is characterized by an increase in blood pressure to the level of 160-179 / 100-109 mm Hg. Art. It is with such indications that patients go to the doctor more often for the first time, as their consideration as the norm is the peak of carelessness. Second-degree hypertension usually manifests itself with severe headaches, weakness, dizziness, and deterioration of well-being during episodes of increased pressure.

Grade 3 arterial hypertension

It is characterized by an increase in blood pressure to the level of 180/110 or more mm Hg. Art. Sometimes these figures can reach completely stopping (250/160 mm Hg and above), but in this case there is a real threat to human health and life. A patient with grade 3 hypertension should be under the supervision of a physician, take all antihypertensive drugs prescribed, and have a tonometer (mechanical or electronic) at home.

Symptoms of hypertension

Hypertension itself has no symptoms. Most adult patients with this disease do not complain of anything, high blood pressure is detected by chance.

The clinical manifestations of hypertension depend on the organs 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 neck. It appears most often at night or in the morning, increases with a sharp change in head position and even a slight physical strain. Such pain is caused by a violation of venous blood flow from the vessels of the skull, their overfilling and stimulation of pain receptors;
   • Alcoholic beverages - explosives spread throughout the head, can be pulsating. Any tension causes an increase in pain. Occurs most often in the late stages of hypertension or in the presence of pulse hypertension. As a result, the vessels are heavily filled with blood and its exit is difficult;
   • ischemic - dull or explosive in nature, accompanied by dizziness and vomiting. Occurs with a sharp rise in blood pressure. There is a sharp vasospasm, as a result of which the blood supply to the brain tissue is disturbed.
2. Pain in the heart region - cardialgia, non-ischemic, coronary vessels are fine, while the pain does not stop with the sublingual use of nitrates (nitroglycerin under the tongue) and can appear both at rest and during emotional stress. . Sports activities are not a provocative factor.
3. Shortness of breath - initially appears only when playing sports, with the progression of hypertension, can also occur at rest. Characterizes heart dysfunction.
4. Edema - most often found in the legs due to stagnation of blood in the systemic circulation, retention of sodium and water, or impaired kidney function. Occurrence in children with simultaneous edema of hematuria and hypertension is characteristic of glomerulonephritis, which is very important to remember when making a differential diagnosis.
5. Visual impairment - manifests itself in the form of blurred vision, the appearance of a veil or trembling flies. Occurs due to damage to retinal vessels.

Chronic arterial hypertension causes kidney damage with the development of renal failure and related complaints of renal genesis, which will be discussed below. Chronic hypertension also leads to the development of circulatory encephalopathy, which is characterized by a decrease in memory, attention and performance, sleep disturbance (increased daytime sleepiness, combined with insomnia at night), dizziness, tinnitus, and depressive mood.

During the collection of a medical history, in the medical history it is necessary to record a family history and the causes of hypertension in relatives, to clarify the time of onset of the first clinical symptoms, to observe concomitant diseases.

Hypertensive crisis

This is an emergency condition, which consists of a sharp rise in blood pressure in high numbers and is characterized by a sharp deterioration of the blood supply to all internal organs, especially the vital ones.

Occurs when the body is exposed to various negative factors, can not be predicted, therefore uncontrolled hypertension is dangerous. The urgency of the problem also lies in the fact that in the absence of urgent care in time, a fatal outcome is possible. To provide urgent care, the patient should be sent immediately to the hospital, where his blood pressure is rapidly reduced with medication.

Students of medical institutes study first aid for hypertensive crisis in the Department of Internal Medicine Propeedeutics, and therefore it would be better for a casual passer-by not to try to offer help, but to call an ambulance.

Diagnosing

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

1. Blood pressure measurement,
2. physical examination,
3. Electrocardiogram recording.

Blood pressure control

Blood pressure measurement is performed using a special device - a tonometer, which is a combination of a sphygmomanometer with a phonendoscope. Moreover, there are currently special electronic devices that measure blood pressure, pulse rate, and also allow you to insert blood pressure indicators into the device memory.

Medical history

The diagnosis of hypertension also includes a study of the patient by a physician. The doctor finds out from the patient what disease he has suffered before or is currently suffering from. Risk factors are assessed (smoking, high cholesterol, diabetes), plus the so-called. hereditary history, namely whether the patient's parents, grandparents, and other close relatives have suffered from hypertension.

Physical examination

Physical examination of the patient involves, first of all, the study of the heart using a phonendoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic tones (amplification or, conversely, attenuation), as well as the appearance of uncharacteristic sounds. These data, first of all, speak of 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 the electrical potentials of the heart over time on a special tape. This is an indispensable method for diagnosing, first of all, various cardiac arrhythmias. In addition, the ECG allows you to determine the so-called. left ventricular wall hypertrophy, which is typical of arterial hypertension.

echocardiography

In addition to these diagnostic methods, other methods are used, for example, echocardiography (ultrasound examination of the heart), which allows you to determine the presence of defects in the structure of the heart, changes in the thickness of its walls and the condition of the valves.

Arteriography

Arteriography, including aortography, is an X-ray method for examining the condition of artery walls and their lumen. This method allows you to identify the presence of atheromatous plaques in the walls of the coronary arteries (coronary angiography), the presence of aortic coarctation (congenital narrowing of the aorta in a certain area), etc.

dopplerography

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

Blood chemistry

A biochemical blood test is also used to diagnose hypertension. First of all, it results in high, low and very low density cholesterol and lipoproteins, as they are indicative of the tendency for atherosclerosis. In addition the blood sugar level is determined.

In the diagnosis of hypertension is also used a study of the condition of the kidneys, for which methods such as general analysis of urine, biochemical analysis of blood (for creatinine and urea levels), as well as ultrasound of the kidneys and their. dishes are used.

Thyroid ultrasound

Thyroid ultrasound and a blood test for thyroid hormones. These research methods help to identify the role of the thyroid gland in causing high blood pressure.

How to treat high blood pressure?

Effective treatment for hypertension is chosen depending on the severity of the disease and the patient's overall risk for cardiovascular disease. To assess this risk, it takes into account several factors:

• age: 50 years for men, 60 years for women;
• family history: sudden heart attack or death of one parent (before age 55 in men, before age 65 in women) or stroke before age 45, regardless of parent's gender;
• smoking (or non-smoking within the last three years);
• diabetes;
• LDL cholesterol level above 1. 60 g / l or LDL cholesterol level below 0. 40 g / l;
• abdominal obesity, kidney failure, lack of regular exercise or excessive alcohol consumption.

General principles for treating hypertension at home, which should be followed by all adults with high blood pressure:

With a mild, first stage of the disease, non-drug methods are used:

• limiting salt intake to 5 g / day (more on proper nutrition with high blood pressure can be found in our special article),
• normalization of weight with its excess,
• moderate physical activity 3-5 times a week (walking, running, swimming, physiotherapy exercises),
• to quit smoking,
• reduction of alcohol consumption,
• use of herbal sedatives to increase emotional arousal (e. g. , a decoction of valerian).

In the absence of the effect of the above methods in the treatment of grade 1 arterial hypertension, as well as patients with grade 2 and 3 hypertension, switch to taking medication.

It should be noted that pharmacies currently offer a wide range of different medications for the treatment of hypertension, new and known for many years. Under different trade names, preparations with the same active substance may be produced. It is quite difficult for a non-specialist to understand them.

Diuretics are the drugs of choice for treating hypertension, especially in the elderly. The most common are thiazides.

Also, in the treatment of hypertension, it is important to correct the risk factors:

• Antiplatelet agents - acetylsalicylic acid, used as indicated,
• statins in the presence of atherosclerosis - also in the absence of contraindications;
• drugs that lower blood glucose levels in the presence of diabetes.

If the effect is insufficient, it may be necessary to add a second or third medicine. Rational combinations:

• diuretic + beta-blocker
• diuretic + ACE inhibitor (or sartan)
• diuretic + calcium antagonist
• calcium dihydropyridine + beta-blocker antagonist
• calcium antagonist + ACE inhibitor (or sartan)

Invalid combinations:

• non-dihydropyridine + beta-blocker calcium antagonist (potential development of heart block to death)
• ACE inhibitor + sartan

For the treatment and examination of hypertension, you should see a doctor. Only a specialist after a thorough examination and analysis of the results of examinations will be able to accurately diagnose and prescribe competent treatment.

Why is hypertension dangerous?

Hypertension is one of the leading causes of severe CVS pathologies.

Despite the fact that there are currently a large number of antihypertensive drugs that allow you to keep your blood pressure at an adequate level, the incidence of hypertensive crises and complications such as heart failure (HF) and kidney failure (RF), aortaand mitral valve regurgitation, heart and aortic aneurysm, MI (heart attacks), strokes, etc. in patients with hypertension remains extremely high.

This is mainly due to the fact that many patients do not want to receive antihypertensive therapy systematically, believing that the hypertensive crisis that developed in them was the only one and this will not happen again.

According to statistics, of the patients who are aware that they have hypertension, only about 40% of women and 35% of men receive drug treatment. At the same time, only 15% of women and about five percent of men achieve the required pressure levels due to the systematic use of antihypertensive therapy, monitoring of blood pressure indicators and regular visits to the doctor and following the recommendations ofhis.

Despite the fact that hypertension is one of the controllable risk factors for the formation of cardiovascular pathologies, such unfortunate indicators are due to the banal misunderstanding of the patient about the seriousness of his diagnosis and, consequently, the lack of a serious and responsible approach to treatment. .

The most common serious complications that develop due to crises of hypertensive origin 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);
• dissecting aortic aneurysm (2. 5%) etc.

It should be noted that in the absence of adequate and systematic treatment of hypertension, from heart and kidney failure within three years after suffering a severe (complicated) hypertension crisis, 30 to 40% of patients die.

Comprehensive treatment, responsible health approach, systematic use of antihypertensive drugs and pressure control, allow these frightening figures to be reduced to a minimum.

Prevention of hypertension

For people with an inherited predisposition to hypertension and aggravated by risk factors, disease prevention is of paramount importance.

1. First of all, this is a regular examination by a cardiologist and adherence to the rules of a proper lifestyle, which will help delay and often eliminate the disease of hypertension. If you have a history of relatives with hypertension, you need to review your lifestyle and radically change many of the habits and lifestyle that are risk factors.
2. You need to review your dietary principles, stop eating salty and fatty foods, switch to a low calorie diet that includes lots of fish, seafood, fruits and vegetables. Do not confuse with alcoholic beverages and, especially, beer. They contribute to obesity, uncontrolled consumption of table salt, adversely affect the heart, blood vessels, liver and kidneys.
3. It is necessary to lead an active lifestyle, to move more, depending on age, it is ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually, without overloading the body. Outdoor exercises are especially helpful. 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 conflicts, remember that a broken nervous system very often triggers the mechanism for the development of hypertension.
5. Quit smoking, nicotine-containing substances provoke changes in the walls of arteries, increase their stiffness, therefore may be the culprits of high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.

Thus, we can briefly say that the prevention of hypertension includes regular examinations by a cardiologist, proper lifestyle and a favorable emotional background for your environment.

Prediction for life

The prognosis for 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;
• Stage III and IV of hypertension;
• severe vascular damage.

Extremely unfavorable course of hypertension is observed in young people. They have a high risk for stroke, myocardial infarction, heart failure, sudden death.

With early treatment of hypertension and subject to careful adherence by the patient to all the recommendations of the attending physician, it is possible to slow the progression of the disease, improve the quality of life of patients, and sometimes achieve long-term remission. .