Main criterionarterial hypertension (or arterial hypertension)as a whole group of diseases - stable, that is, detected through repeated measurements on different days, increased blood pressure (BP).The question of what type of blood pressure is considered high is not as simple as it may seem.The fact is that among practically healthy people the variation in blood pressure values is quite wide.The results of long-term observation of people with different blood pressure levels showed that already from the level of 115/75 mm Hg.Art., each additional increase in blood pressure by 10 mm Hg.Art.is accompanied by an increased risk of developing cardiovascular diseases (mainly coronary heart disease and stroke).However, the benefits of modern methods of treating arterial hypertension have been proven mainly only for those patients whose blood pressure exceeded 140/90 mmHg.Art.It is for this reason that it was agreed to consider this limit value as a criterion for identifying arterial hypertension.
An increase in blood pressure can be accompanied by dozens of different chronic diseases, and hypertension is just 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 leading to an increase in blood pressure are detected.
Hypertension is a disease whose main manifestation is a stable increase in blood pressure.The risk factors that increase the likelihood of its development have been established through observations of large groups of people.In addition to the genetic predisposition that some people have, these risk factors include:
- obesity;
- inactivity;
- excessive consumption of table salt, alcohol;
- chronic stress;
- smoking.
In general, all those characteristics that accompany the modern urban lifestyle of industrialized countries.This is why hypertension is considered a lifestyle disease, and targeted changes for the better should always be considered as part of a hypertension treatment program on a case-by-case basis.
What other diseases are accompanied by increased blood pressure?These are many kidney diseases (pyelonephritis, glomerulonephritis, polycystic disease, 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 and some other more rare diseases.Regular use of medications such as glucocorticosteroids, non-steroidal anti-inflammatory drugs and oral contraceptives can also lead to a persistent increase in blood pressure.The diseases and conditions listed above lead to the development of so-called secondary or symptomatic arterial hypertension.The doctor diagnoses hypertension if, during a conversation with the patient, finding out the history of the disease, examination, as well as based on the results of some, mostly simple, laboratory and instrumental research methods, the diagnosis of any of the secondary arterial hypertension seems unlikely.
If you notice similar symptoms, see your doctor.Do not self-medicate - it is dangerous to your health!
Symptoms of high blood pressure
Hypertension itself does not manifest itself in any subjective sensations for many people.If high blood pressure is accompanied by symptoms, this may include a feeling of heaviness in the head, headache, flashes before the eyes, nausea, dizziness, unsteadiness 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 during a hypertensive crisis - a sudden and significant increase in blood pressure, leading to a clear deterioration in condition and well-being.
It would be possible to continue listing the possible symptoms of hypertension, separated by commas, but there is no particular benefit to this.Why?Firstly, all these symptoms are nonspecific to hypertension (that is, they can occur individually or in various combinations in other diseases), and secondly, to establish the presence of arterial hypertension, the very fact of a stable increase in blood pressure is important.And this is revealed not by assessing subjective symptoms, but only by measuring blood pressure, moreover, repeatedly.This means, firstly, that “at once” you should measure blood pressure two or three times (with a short interval between measurements) and take the arithmetic mean of two or three measured values as true blood pressure.Secondly, the stability of the increase in blood pressure (criterion for diagnosing hypertension as a chronic disease) must be confirmed by measurements on different days, preferably with an interval of at least one week.
If a hypertensive crisis occurs, there will definitely be symptoms, otherwise it is not a hypertensive crisis, but simply an asymptomatic increase in blood pressure.And these symptoms can be those listed above or others that are more serious - they are discussed in the “Complications” section.
Symptomatic (secondary) arterial hypertension develops as part of other diseases and therefore its manifestations, in addition to the symptoms of hypertension themselves (if any), depend on the underlying disease.For example, in hyperaldosteronism, there may be muscle weakness, cramps and even transient paralysis (lasting hours or days) in the muscles of the legs, arms and neck.With obstructive sleep apnea syndrome - snoring, sleep apnea, daytime drowsiness.
If hypertension over time - usually many years - leads to damage to various organs (in this context they are called “target organs”), then this can manifest itself as a decrease in memory and intelligence, stroke or transient stroke, an increase in the thickness of the walls of the heart, accelerated development of atherosclerotic plaques in the vessels of the heart and other organs, myocardial infarction or angina, a decrease in the rate of blood filtration in the kidneys, etc.the manifestations will be caused by these complications, and not by the increase in blood pressure as such.
Pathogenesis of arterial hypertension
In hypertension, dysregulation of vascular tone and an increase in blood pressure are the main content of this disease, so to speak, its “quintessence”.Factors such as genetic predisposition, obesity, physical inactivity, excessive consumption of table salt, alcohol, chronic stress, smoking and a number of others, mainly related to lifestyle characteristics, over time lead to disruption of the functioning of the endothelium - the inner layer of arterial vessels with a layer of cells thick, which is actively involved in regulating the tone and, therefore, the lumen of blood vessels.The tone of the microvasculature vessels, and therefore the volume of local blood flow in organs and tissues, is regulated autonomously by the endothelium, and not directly by the central nervous system.This is a local blood pressure regulation system.However, there are other levels of blood pressure regulation - the central nervous system, the endocrine system and the kidneys (which also perform their regulatory role largely due to the ability to participate in hormonal regulation at the level of the entire organism).Violations of these complex regulatory mechanisms lead, as a rule, to a decrease in the ability of the entire system to perfectly adapt to the constantly changing needs of organs and tissues for blood supply.
Over time, a persistent spasm develops in the small arteries, and subsequently their walls change so much that they can no longer return to their original state.In larger vessels, due to constantly high blood pressure, atherosclerosis develops at an accelerated pace.The walls of the heart become thicker, myocardial hypertrophy develops, and then expansion of the cavities of the left atrium and left ventricle.Increased pressure damages the glomeruli, their number decreases and, as a result, the kidneys' ability to filter blood decreases.In the brain, due to changes in the blood vessels that irrigate it, negative changes also occur - small foci of hemorrhages appear, as well as small areas of necrosis (death) of brain cells.When an atherosclerotic plaque ruptures in a sufficiently large vessel, thrombosis occurs, the lumen of the vessel is blocked and this leads to a stroke.
Classification and stages of development of arterial hypertension
Hypertension, depending on the magnitude of high blood pressure, is divided into three degrees.Furthermore, taking into account the increased risk of cardiovascular diseases on a “year-decade” scale, starting from a blood pressure level above 115/75 mm Hg.Art., there are several other gradations of blood pressure levels.
If the values of systolic and diastolic blood pressure fall into different categories, then the degree of arterial hypertension is assessed by the higher of the two values, and it does not matter - systolic or diastolic.The degree of increase in blood pressure when diagnosing hypertension is determined by repeated measurements on different days.
In some countries, the stages of hypertension continue to be differentiated, while European guidelines for the diagnosis and treatment of high blood pressure do not mention any stage.The identification of stages aims to reflect the phasing of the course of hypertension from its onset to the appearance of complications.
There are three steps:
- Stage Iimplies that there is still no obvious damage to the 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, albumin protein is not detected in urine, thickening of the walls of the carotid arteries or atherosclerotic plaques in them is not detected, etc.asymptomatic.
- If there is at least one of the listed signs, diagnoseStage IIhypertension.
- Finally, aboutStage IIIHypertension is called when there is at least one cardiovascular disease with clinical manifestations associated with atherosclerosis (myocardial infarction, stroke, angina pectoris, atherosclerotic lesion of the arteries of the lower limbs), or, for example, severe kidney damage, manifested by a pronounced decrease in filtration and/or significant loss of proteins in the urine.
These stages do not always replace each other naturally: for example, a person suffered a myocardial infarction, and after a few years there was an increase in blood pressure - it turns out that this patient immediately has stage III hypertension.The objective of staging is mainly to classify patients according to their risk of cardiovascular complications.Treatment measures also depend on this: the greater the risk, the more intensive the treatment.When formulating a diagnosis, risk is assessed in four gradations.At the same time, the 4th grade corresponds to the greatest risk.
Complications of high blood pressure
The goal of treating hypertension is not to “reduce” high blood pressure, but to reduce the risk of cardiovascular and other long-term complications as much as possible, since this risk – again, when evaluated on a “year-decade” scale – increases with every additional 10 mm Hg.Art.already from a blood pressure level of 115/75 mm Hg.Art.This refers to complications such as stroke, coronary heart disease, vascular dementia (dementia), chronic renal and chronic heart failure, atherosclerotic vascular lesions of the lower extremities.
Most hypertension patients don't worry about anything for now, so they don't have much motivation to treat themselves, regularly taking a certain minimum of medications and changing their lifestyle to a healthier one.However, in the treatment of hypertension there are no single measures that allow you to forget about this disease forever without doing anything else to treat it.
Diagnosis of high blood pressure
With the diagnosis of arterial hypertension as such, everything is usually quite simple: this only requires repeated recording of blood pressure at the level of 140/90 mm Hg.Art.and higher.But hypertension and high blood pressure are not the same thing: as already mentioned, increased blood pressure can manifest itself in various diseases, and hypertension is just one of them, although the most common.When carrying out the diagnosis, the doctor, on the one hand, must make sure that the increase in blood pressure is stable, and on the other hand, assess the likelihood that the increase in blood pressure is a manifestation of symptomatic (secondary) arterial hypertension.
To do this, in the first stage of the diagnostic search, the doctor finds out at what age the blood pressure started to rise, if there are symptoms such as, for example, snoring with pauses in breathing duringsleep, attacks of muscular weakness, unusual impurities in the urine, attacks of sudden heartbeat with sweating and headache, etc.It makes sense to clarify which medications and dietary supplements the patient is taking, as in some cases they can lead to an increase in blood pressure or worsening an already high one.Several routine diagnostic tests (performed on almost all patients with high blood pressure), along with information obtained during a conversation with a doctor, help assess the likelihood of some forms of secondary hypertension: a complete urinalysis, determination of blood concentrations of creatinine and glucose, and sometimes potassium and other electrolytes.In general, given the low prevalence of secondary forms of arterial hypertension (about 10% of all its cases), the continued search for these diseases as a possible cause of arterial hypertension should have good reasons.Therefore, if in the first stage of the diagnostic search no significant data are found in favor of the secondary nature of arterial hypertension, in the future it will be considered that blood pressure is increased due to hypertension.This judgment can sometimes be later revised as new data about the patient becomes available.
In addition to searching for data on the possible secondary nature of increased blood pressure, the doctor determines the presence of risk factors for cardiovascular diseases (this is necessary to assess the prognosis and a more targeted search for damage to internal organs), as well as, possibly, pre-existing diseases of the cardiovascular system or its asymptomatic damage - this affects the assessment of the prognosis and stage of hypertension, the choice of therapeutic measures.To this end, in addition to talking to the patient and examining him, a number of diagnostic studies are carried out (for example, electrocardiography, echocardiography, ultrasound examination of the neck vessels and, if necessary, some other studies, the nature of which is determined by the medical data already obtained about the patient).
Daily monitoring of blood pressure using special compact devices makes it possible to assess changes in blood pressure during the patient's usual lifestyle.This study is not necessary in all cases - in particular, if the blood pressure measured at the doctor's appointment differs significantly from that measured at home, if it is necessary to assess nighttime blood pressure, if episodes of hypotension are suspected, and sometimes to assess the effectiveness of treatment.
Thus, some diagnostic methods when examining a patient with hypertension are used in all cases;the use of other methods is more selective, depending on the data already obtained about the patient, to verify the assumptions that the doctor made during the preliminary examination.
Treatment of high blood pressure
With regard to non-drug measures aimed at treating hypertension, the most convincing evidence has accumulated about the positive role of reducing salt intake, reducing and maintaining body weight at this level, regular physical exercise (exertion), no more than moderate alcohol consumption, as well as increasing the content of vegetables and fruits in the diet.Only all of these measures are effective as part of long-term unhealthy lifestyle changes that led to the development of hypertension.For example, a decrease in body weight by 5 kg led to a decrease in blood pressure by an average of 4.4/3.6 mmHg.Art.- it seems a little, but in combination with the other measures listed above to improve your lifestyle, the effect can be quite significant.
Lifestyle improvement is warranted for almost all patients with hypertension, but drug treatment is indicated, although not always, 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 durationhas been demonstrated in many clinical studies),Therefore, in grade 1 hypertension with calculated low and moderate cardiovascular risk, the benefit of such treatment has not been convincingly proven in large clinical trials.In these situations, the possible benefit of drug therapy is assessed individually, taking into account the patient's preferences.If, despite improvements in lifestyle, the increase in blood pressure in these patients persists for several months during repeated medical visits, it is necessary to reevaluate the need for medication.Furthermore, the magnitude of the calculated risk often depends on the completeness of the patient examination and may turn out to be significantly higher than initially thought.In almost all cases of hypertension treatment, the aim is to stabilize blood pressure below 140/90 mmHg.Art.This does not mean that in 100% of measurements it will be below these values, but the less frequently blood pressure, when measured under standard conditions (described in the “Diagnosis” section), exceeds this limit, the better.Thanks to this treatment, the risk of cardiovascular complications is significantly reduced and hypertensive crises, if they occur, are much less common than without treatment.Thanks to modern medicines, those negative processes that, in hypertension, inevitably and latently destroy the internal organs over time (mainly the heart, brain and kidneys), these processes are slowed down or suspended, and in some cases they can even be reversed.
Of the medications for treating hypertension, the main ones are 5 classes of medications:
- diuretics (diuretics);
- calcium antagonists;
- angiotensin-converting enzyme inhibitors (names ending in -adj);
- angiotensin II receptor antagonists (names ending in -sartan);
- beta blockers.
Recently, the role of the first four classes of drugs in the treatment of hypertension has been especially emphasized.Beta blockers are also used, but mainly when their use is required by concomitant diseases - in these cases, beta blockers have a dual purpose.
Currently, preference is given to combinations of medications, as treatment with any of them rarely leads to obtaining the desired blood pressure level.There are also fixed combinations of medications that make treatment more comfortable, as the patient only takes one pill instead of two or even three.The selection of the classes of medication necessary for a given patient, as well as their doses and frequency of administration, is made by the doctor, taking into account patient data such as blood pressure level, concomitant diseases, etc.
Thanks to the multifaceted positive effects of modern medicines, the treatment of hypertension involves not only lowering blood pressure as such, but also protecting internal organs from the negative effects of processes accompanying hypertension.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 the level of cholesterol in the blood, take medications that reduce the risk of blood clots (which lead to myocardial infarction or stroke), etc.Quitting smoking, no matter how trivial it may seem, can significantly reduce the risks of stroke and myocardial infarction associated with hypertension and slow the growth of atherosclerotic plaques in blood vessels.Thus, treating hypertension involves approaching the disease in several ways, and achieving normal blood pressure is just one of them.
Forecast.Prevention
The general prognosis is determined not only and not so much by the fact of hypertension, but by the number of risk factors for cardiovascular diseases, the degree of their severity and the duration of the negative impact.
These risk factors are:
- smoking;
- increased blood cholesterol levels;
- high blood pressure;
- obesity;
- sedentary lifestyle;
- age (with each decade lived after age 40, the risk increases);
- male gender and others.
In this case, not only the intensity of exposure to risk factors is important (for example, smoking 20 cigarettes a day is undoubtedly worse than 5 cigarettes, although both are associated with a worse prognosis), but also the duration of exposure.For people who do not yet have obvious cardiovascular diseases other than hypertension, the prognosis can be assessed using special electronic calculators, one of which takes into account gender, age, blood cholesterol level, blood pressure and smoking status.The SCORE electronic calculator is suitable for estimating the risk of death from cardiovascular diseases in the next 10 years from the date of the risk assessment.At the same time, the risk obtained in most cases, which is low in absolute numbers, can give a misleading impression, because The calculator allows you to calculate the risk of cardiovascular death.The risk of non-fatal complications (myocardial infarction, stroke, angina pectoris, etc.) is many times higher.The presence of diabetes mellitus increases the risk compared to that calculated using a calculator: for men by 3 times, and for women - up to 5 times.
With regard to preventing hypertension, we can say that as the risk factors for its development are known (a sedentary lifestyle, excess weight, chronic stress, regular lack of sleep, alcohol abuse, increased consumption of table salt and others), all lifestyle changes that reduce the impact of these factors also reduce the risk of developing hypertension.However, it is hardly possible to completely reduce this risk to zero - there are factors that do not depend on us or depend little on us: genetic characteristics, gender, age, social environment and some others.The problem is that people start thinking about preventing hypertension especially when they are already unhealthy and their blood pressure is already high to one degree or another.And this is not so much a question of prevention, but of treatment.