What is dangerous arterial 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 prevalence of the disease among different age groups of the population, but also to the high incidence of severe complications, disability and death from arterial hypertension if not treated in time.

People prone to high blood pressure are advised to take measurements with both hands. Recent studies have shown that arterial hypertension can be confirmed by a difference in readings of 10 - 15 mm Hg in different hands. This symptom (difference in indications) has a 96% chance of detecting hypertension.

What is this?

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

Blood pressure is divided into systolic and diastolic:

1. Systolic. First, according to the above figure, the level of blood pressure is determined at the moment of compression of the heart and the removal of blood from the artery. This depends on the force of contraction of the heart, the resistance of the walls of blood vessels and the frequency of contractions.
2. diastolic. The second, lower figure, determines blood pressure when the heart muscle relaxes. This indicates the level of peripheral vascular resistance.

Normally, blood pressure readings are constantly changing. They are physiologically dependent on a person's age, sex, and condition. During sleep, blood pressure decreases, and physical activity or stress causes it to increase.

The average normal blood pressure in a twenty-year-old is 120/75 mm Hg. Art. , forty years - 130/80, over fifty - 135/84. With 140/90 persistent numbers, we are talking about arterial hypertension. Statistics show that about 20-30 percent of the adult population suffers from this disease. With age, the prevalence increases exponentially, and 50-65% of people under the age of 65 suffer from this disease.

Classification

Taking into account the origin of the pathology, the following types are distinguished:

1. Primary arterial hypertension (primary). Due to the lack of apparent preconditions, it is difficult to determine the exact cause of development;
2. Symptomatic (secondary). An increase in blood pressure is considered to be the result of the development of a certain disease, one of its symptoms. The secondary type of the disease is divided into the following types, depending on the cause of development: endocrine, renal, drug-related, hemodynamic, neurogenic.

Given the level of blood pressure, the pathology is divided into the following types:

1. Border. The pressure periodically rises to 140 - 149/90, then decreases, normalizes;
2. Systolic isolation. There is an increase in the upper indicator (reaches 140 and above). At the same time, the lower ones remain at 90 and below.

Given the nature of the pathology, experts distinguish the following types:

1. Temporary. The patient has high blood pressure from time to time. This condition can last for hours or days. Blood pressure returns to normal without medication;
2. Label. This manifests itself in the early stages of pathology. This situation is considered borderline, because the pressure increases are insignificant and unstable. The pressure usually normalizes on its own;
3. Stable arterial hypertension. The increase in blood pressure is persistent, and supportive therapy is needed to reduce it;
4. Crisis. Periodic hypertensive crises are characteristic;
5. Malignant. Blood pressure rises to severe levels, hypertension develops rapidly, causing severe complications. Possible death.

Risk factors

The severity of the disease currently described depends directly on the risk factors. The risk is in the formation of cardiovascular complications against the background of high blood pressure. Taking into account the presented complications, the prognosis of the consequences of arterial hypertension is diagnosed. There are the following risk factors that worsen the course and prognosis of the disease:

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

Presented risk factors can be eliminated (corrected) and cannot be corrected. The first type of risk factors is characterized by diabetes, high cholesterol, smoking, physical inactivity. Unadjusted risk factors include race, family history, and age.

Seriousness

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

Grade 1 arterial hypertension

This stage of the disease is characterized by a mild course of the disease: the pressure increases by 20-30 units per day and usually does not exceed 180/115 mm Hg. Art. Hypertensive crises are rare and are usually triggered by sudden changes in atmospheric pressure or emotional overload. There are no complications from the work of target organs.

Grade 2 arterial hypertension

It is characterized by an increase in blood pressure to 160-179 / 100-109 mm Hg. Art. It is with such indicators that patients often consult a doctor for the first time, because to consider them the norm is the height of carelessness. Grade 2 arterial hypertension usually presents with severe headache, weakness, dizziness, and worsening of well-being during episodes of increased pressure.

Grade 3 arterial hypertension

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

Symptoms of arterial hypertension

There are no symptoms of arterial hypertension. Most adult patients with this disease generally do not complain of anything, high blood pressure is detected by chance.

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

1. Headache - may be the first and main symptom. There are several types of headaches:
   • dull, not dense, characterized by a feeling of heaviness in the forehead and occiput. Most often seen at night or in the morning, there is a sharp change in the position of the head and even a slight increase in physical strength. Such pain is caused by disruption of venous blood flow from the cranial vessels, their overflow and stimulation of pain receptors;
   • drink - an explosion, pulsation, which spreads to all sides of the head. Any tension causes an increase in pain. Most often it occurs in the late stages of hypertension or in the presence of pulse hypertension. As a result, the arteries fill with blood and become difficult to drain;
   • ischemic - dull or explosive in nature, accompanied by dizziness and nausea. Occurs with a sharp rise in blood pressure. There is an acute vasospasm, as a result of which the blood supply to the brain tissue is disrupted.
2. Pain in the heart is not cardiac, ischemic, coronary artery disease, pain is not stopped by sublingual use of nitrates (nitroglycerin under the tongue) and can occur both at rest and during emotional stress. . Sports activity is not a motivating factor.
3. Shortness of breath - initially occurs only when playing sports, with the development of hypertension, can also occur at rest. Characterizes heart dysfunction.
4. Edema is most commonly found in the legs due to blood stasis, sodium and water retention, or impaired renal function in the systemic circulation. The simultaneous appearance of hematuria and hypertension in children with edema is characteristic of glomerulonephritis, which is very important to remember when making a differential diagnosis.
5. Visual impairment - blurred vision, manifested in the form of tremors or tremors of flies. Occurs due to damage to the vessels of the retina.

Chronic arterial hypertension damages the kidneys with the development of renal failure and relevant complaints of renal genesis, which will be discussed below. Chronic hypertension also leads to the development of dyscirculatory encephalopathy, characterized by decreased memory, attention and performance, sleep disturbances (increased daytime sleepiness, accompanied by insomnia at night), dizziness, tinnitus, and depressed mood.

When collecting anamnesis, it is necessary to record the family history of the disease and the causes of arterial hypertension in close relatives, to clarify the time of onset of the first clinical symptoms, to record the accompanying diseases.

Hypertensive crisis

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

Occurs when the body is exposed to various adverse factors, it is impossible to predict, so uncontrolled hypertension is dangerous. The urgency of the problem is also the possibility of fatal consequences in the absence of an ambulance in time. To provide emergency care, the patient should be taken to a hospital immediately, where the drug rapidly lowers blood pressure.

Medical students study first aid during a hypertensive crisis at the Department of Propaedeutics of Internal Medicine, so it would be better if someone passing by did not try to help, call an ambulance.

Diagnostics

Here are three main diagnostic methods that can help determine the presence of hypertension in a person:

1. Blood pressure measurement,
2. physical examination,
3. Recording of electrocardiogram.

Blood pressure control

Blood pressure is measured using a special device - a tonometer, which combines a sphygmomanometer with a phonendoscope. In addition, there are now special electronic devices that measure blood pressure, heart rate, as well as allow you to enter blood pressure readings in the device's memory.

Medical History

The diagnosis of hypertension also includes a patient's request from a doctor. The doctor learns from the patient what diseases he used to suffer from or what diseases he is currently suffering from. Risk factors (smoking, high cholesterol, diabetes) are also assessed so-called. hereditary history, ie whether the patient's parents, grandparents and other close relatives suffer from hypertension.

Physical examination

Physical examination of the patient primarily involves the study of the heart using a phonendoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic tones (strengthening or weakening), as well as the appearance of uncharacteristic sounds. These data speak primarily of changes in heart tissue due to increased blood pressure, as well as the presence of defects.

Electrocardiogram (ECG)

Electrocardiogram (ECG) is a method that allows you to record changes in the electrical potential of the heart over time on a special tape. First of all, it is an invaluable method for the diagnosis of various cardiac arrhythmias. In addition, the ECG allows for so-called identification. hypertrophy of the left ventricular wall, which is characteristic of arterial hypertension.

echocardiography

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

Arteriography

Arteriography, including aortography, is an X-ray method to examine the condition of the walls of blood vessels and their lumen. This method detects the presence of atheromatous plaques on the wall of the coronary arteries (coronary angiography), coarctation of the aorta (congenital narrowing of the aorta in a certain area), etc.

dopplerography

Dopplerography is an ultrasound method to diagnose the condition of both blood vessels and blood flow. With arterial hypertension, first of all, the doctor checks the condition of the carotid arteries and cerebral vessels. Ultrasound is widely used for this purpose, because its use is completely safe and does not cause complications.

Blood chemistry

A biochemical blood test is also used to diagnose hypertension. First of all, the levels of cholesterol and high, low and very low density lipoproteins appear because they are an indicator of the tendency to atherosclerosis. In addition, blood sugar levels are determined.

The study of the condition of the kidneys is also used in the diagnosis of hypertension, using a general urine test, biochemical blood test (for creatinine and urea levels), as well as ultrasound of the kidneys and their vessels.

Ultrasound of the thyroid gland

Ultrasound of the thyroid gland and blood test for thyroid hormones. These research methods help determine the role of the thyroid gland in causing high blood pressure.

How to treat high blood pressure?

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

• age: 50 years for men, 60 years for women;
• family history: sudden heart attack or death of one of the parents (up to 55 years in men, up to 65 years in women) or stroke before the age of 45, regardless of the sex of the parent;
• smoking (or not smoking for 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 of treatment of arterial hypertension at home, which should be followed by all adults with high blood pressure:

With mild, first-degree disease, non-pharmacological methods are used:

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

In the absence of the above methods in the treatment of grade 1 hypertension, patients with grade 2 and 3 hypertension also switch to medication.

It should be noted that pharmacies currently offer a wide range of drugs for the treatment of arterial hypertension, both new and known for many years. Drugs with the same active ingredient may be produced under different trade names. It is very difficult for a non-specialist to understand.

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

It is also important to correct risk factors in the treatment of arterial hypertension:

• Antiplatelet agents - acetylsalicylic acid, used according to instructions,
• 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 drug. Rational combinations:

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

Incorrect combinations:

• non-dihydropyridine calcium antagonist + beta-blocker (possible development of cardiac block until death)
• ACE inhibitor + sartan

It is necessary to consult a doctor for the treatment and examination of hypertension. Only a specialist can make a correct diagnosis and prescribe competent treatment after a thorough examination and analysis of the results of examinations.

Why is hypertension dangerous?

Arterial hypertension is one of the main causes of severe CVS pathologies.

Although there are currently many antihypertensive drugs that allow blood pressure to be adequately maintained, the frequency of hypertensive crises and complications such as heart failure (HF) and kidney failure (RF), aorta, and heart failure. mitral valve insufficiency, cardiac aneurysm and aorta, MI (infarction), strokes, etc. remains extremely high in patients with hypertension.

This is primarily due to the reluctance of many patients to receive systematic antihypertensive therapy, believing that their hypertensive crisis is unique and that it will never happen again.

According to statistics, only about 40% of patients with arterial hypertension receive medical treatment in women and 35% in men. At the same time, only 15% of women and about five percent of men reach the required blood pressure level through the systematic use of antihypertensive therapy, monitoring of blood pressure and regular visits to the doctor and following his recommendations.

Although arterial hypertension is one of the managed risk factors for the development of cardiovascular pathologies, such unfortunate indications are due to the patient's misunderstanding of the seriousness of the diagnosis and, consequently, the lack of a serious and responsible approach to the disease. treatment.

The most common complications that develop as a result of 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);
• rupture of the aortic aneurysm (2. 5%), etc.

It should be noted that within three years after a severe (complex) hypertensive crisis, 30-40% of patients die from heart and kidney failure without adequate and systematic treatment of hypertension.

Comprehensive treatment, a responsible approach to one's health, systematic use of antihypertensive drugs and blood pressure control can minimize these alarming figures.

Prevention of arterial hypertension

For people with a hereditary predisposition to arterial hypertension and aggravated by risk factors, prevention of the disease is of great importance.

1. First of all, it is a regular examination by a cardiologist and adherence to the rules of proper lifestyle, which will help to delay and often eliminate arterial hypertension. If your relatives have hypertension, you need to reconsider your lifestyle and radically change many habits and lifestyles that are risk factors.
2. You need to reconsider your diet principles, stop eating salty and fatty foods, and switch to a low-calorie diet that includes plenty of fish, seafood, fruits and vegetables. Avoid alcoholic beverages, especially beer. They contribute to obesity, uncontrolled consumption of table salt, have a negative effect on the heart, blood vessels, liver and kidneys.
3. To lead an active lifestyle, you need to move more, depending on age, it is ideal for running, swimming, walking, cycling and skiing. Physical activity should be applied gradually without overloading the body. It is especially useful to exercise outdoors. Exercise strengthens the heart muscle and nervous system and prevents stress.
4. Try to create a favorable psycho-emotional environment around you. If possible, avoid conflicts, keep in mind that a fragmented nervous system very often triggers the mechanism of development of arterial hypertension.
5. Quit smoking, the substances in nicotine cause changes in the walls of blood vessels, increase their hardness, so they can be the culprit of high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.

Thus, in short, the prevention of arterial hypertension includes regular examinations by a cardiologist, a healthy lifestyle and a favorable emotional background for your surroundings.

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:

• rapid development of signs of damage to target organs;
• stage III and IV of arterial hypertension;
• serious damage to blood vessels.

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

With early treatment of arterial hypertension and careful adherence 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. .