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 due not only to the wide spread of this disease in different age groups of the population, but also to the high rates of severe complications, disability and mortality from arterial hypertension without timely treatment.

People who are prone to high blood pressure are recommended to measure on both hands. Recent studies have shown that arterial hypertension can be confirmed with a difference in readings of 10-15 mm Hg in different hands. This sign (difference in indications) has a probability of determining hypertension up to 96%.

What is that?

In simple terms, arterial hypertension is a disease of the cardiovascular system in which the blood pressure in the arteries of the systemic circulation is constantly elevated.

Blood pressure is divided into systolic and diastolic:

1. systolic. According to the first, top number, the blood pressure is determined at the moment of compression of the heart and expulsion of blood from the artery. This indicator depends on the force with which the heart contracts, the resistance of the walls of blood vessels and the frequency of contractions.
2. diastolic. The second, lower number determines the blood pressure at the moment the heart muscle relaxes. It indicates the level of peripheral vascular resistance.

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

The average normal blood pressure of a twenty year old is 120/75 mmHg. Art. , forty years old - 130/80, over fifty - 135/84. If values of 140/90 persist, we speak of arterial hypertension. Statistics show that about 20-30 percent of the adult population is affected by this disease. With increasing age, the prevalence rate increases inexorably and by the age of 65, 50-65 percent of the elderly suffer from this disease.

classification

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

1. Essential arterial hypertension (primary). It is difficult to determine the exact cause of the development, since the visible prerequisites are missing;
2. Symptomatic (secondary). An increase in pressure is considered a consequence of the development of a specific disease and is one of its signs. The secondary type of the disease, depending on the cause of development, is divided into the following types: endocrine, renal, drug-induced, hemodynamic, neurogenic.

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

1. Border. The pressure periodically increases to 140 - 149/90, then it decreases, normalizes;
2. Systolically isolated. The upper indicator increases (it reaches 140 and more). At the same time, the lower remains within 90 and below.

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

1. In the interim. The patient occasionally has high blood pressure. This condition can last for hours or days. The pressure normalizes without the use of drugs;
2. unstable. It manifests itself at the initial stage of the development of pathology. This condition is considered borderline, since pressure surges are insignificant, unstable. The pressure will usually normalize on its own;
3. Stable arterial hypertension. The increase in pressure is persistent, supportive therapy is required to reduce it;
4. Crisis. Periodic hypertensive crises are characteristic;
5. Malignant. The pressure rises to a serious level, hypertension develops rapidly, causing serious complications. possible death.

risk factors

Currently, the severity of the described disease directly depends on the risk facts. The risk lies in the formation of cardiovascular complications against the background of hypertension. 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 of the disease and the prognosis:

• age - in men after 50 years, in women after 60 years;
• Smoking;
• high cholesterol;
• hereditary factor;
• Obesity;
• hypodynamia;
• diabetes mellitus.

The risk factors presented may 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 and physical inactivity. Uncorrected risk factors include race, family history, and age.

heaviness

There is also an international classification of the disease, developed according to 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 increases by 20-30 units during the day and usually does not exceed 180/115 mm Hg. Art. Hypertensive crises are rare and are usually provoked by a sharp change in atmospheric 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 pinnacle of negligence. Second degree arterial hypertension is usually manifested by severe headaches, weakness, dizziness and deterioration in well-being during episodes of pressure increase.

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 levels can become completely prohibitive (250/160 mm Hg and more), but in this case there is a real threat to human health and life. A patient with arterial hypertension of the 3rd degree must be under the supervision of a doctor, take all the antihypertensive drugs prescribed for him, and necessarily have a tonometer (mechanical or electronic) at home.

Symptoms of arterial hypertension

Arterial hypertension itself has no symptoms. Most adult patients with this disease do not complain at all, hypertension is detected by accident.

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 very first and foremost symptom. There are different types of headaches:
   • dull, not intense, characterized by a feeling of heaviness in the forehead and occiput. It occurs most often at night or in the morning, increases with a sharp change in head position and even light physical exertion. Such pain is caused by a violation of the venous outflow of blood from the cranial vessels, their overflow and stimulation of pain receptors;
   • CSF - Bursting diffusely throughout head, may be pulsating. Any tension causes an increase in pain. It occurs most commonly in the late stages of hypertension or in the presence of pulsatile hypertension. As a result, the vessels are severely crowded with blood and their outflow is difficult;
   • ischemic - dull or bursting in nature, accompanied by dizziness and nausea. It occurs with a sharp increase in blood pressure. There is a sharp vasospasm, as a result of which the blood supply to the tissues of the brain is disrupted.
2. Pain in the heart region - cardialgia, non-ischemic in nature, the coronary vessels are fine, while the pain is not stopped by sublingual use of nitrates (nitroglycerin under the tongue) and can occur both at rest and with emotional stress . Sports activities are not a provocative factor.
3. Shortness of breath - initially only occurs during sport, with progressive high blood pressure it can also occur at rest. It characterizes the dysfunction of the heart.
4. Edema - most commonly in the legs due to congestion in the systemic circulation, sodium and water retention, or impaired kidney function. The occurrence in children simultaneously with edema of hematuria and hypertension is characteristic of glomerulonephritis, which is very important in the differential diagnosis.
5. Visual impairment - manifests itself in the form of blurred vision, the appearance of a veil or flickering flies. Occurs due to damage to the vessels of the retina.

Chronic arterial hypertension causes kidney damage with the development of renal insufficiency and the corresponding symptoms of renal genesis, which will be discussed below. Chronic hypertension also leads to the development of dyscirculatory encephalopathy, which is characterized by a decrease in memory, attention and performance, sleep disorders (increased daytime sleepiness combined with nocturnal insomnia), dizziness, tinnitus and depressed mood.

When collecting an anamnesis, in the anamnesis it is necessary to record a family history and the causes of arterial hypertension in close relatives, to clarify the time of the appearance of the first clinical symptoms, to pay attention to concomitant diseases.

Hypertensive Crisis

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

It occurs when the body is exposed to various adverse factors, it cannot be predicted, which is why uncontrolled high blood pressure is dangerous. The urgency of the problem also lies in the fact that without timely emergency care, a fatal outcome is possible. For emergency care, the patient must be taken to the hospital immediately, where he is treated with medication to quickly lower blood pressure.

Students of medical institutes study first aid for hypertensive crises at the Department of Propaedeutics of Internal Diseases, and therefore the best thing for a casual passerby would be not to try to provide help, but to call an ambulance.

diagnosis

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. Recording an electrocardiogram.

blood pressure control

Blood pressure measurement is carried out using a special device - a tonometer, a combination of a sphygmomanometer and a phonendoscope. In addition, currently there are special electronic devices that measure blood pressure and pulse rate, and also allow you to enter blood pressure indicators into the memory of the device.

medical history

Diagnosing high blood pressure also includes interviewing the patient by a doctor. The doctor learns from the patient which diseases he has previously suffered from or is currently suffering from. Risk factors are evaluated (smoking, high cholesterol, diabetes), as well as the so-called. hereditary history, that is, whether the patient's parents, grandparents and other close relatives suffered from hypertension.

Physical examination

The physical examination of the patient first involves examining the heart with a phonendoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic tones (intensification or, conversely, attenuation), as well as the appearance of uncharacteristic murmurs. First of all, these data speak of changes in the heart tissue due to increased blood pressure, as well as defects.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a method that allows you to register changes in the heart's electrical potentials 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 hypertrophy of the wall of the left ventricle, which is typical for arterial hypertension.

echocardiography

In addition to these diagnostic methods, other methods are also used, for example, echocardiography (an 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 procedure used to study the condition of the walls of the arteries and their lumen. This method allows you to determine the presence of atheromatous plaques in the wall of the coronary arteries (coronary angiography), the presence of aortic stenosis (congenital narrowing of the aorta in a certain area), etc.

Dopplerography

Dopplerography is an ultrasound technique used to diagnose blood flow in vessels, both arteries and veins. With arterial hypertension, the doctor first checks the condition of the carotid arteries and cerebral arteries. Ultrasound is often used for this, since it is absolutely safe to use and does not cause any complications.

blood chemistry

A biochemical blood test is also used in diagnosing high blood pressure. First of all, it turns out that the level of cholesterol and high, low and very low density lipoproteins is an indicator of a tendency to atherosclerosis. The blood sugar level is also determined.

When diagnosing hypertension, a study of the state of the kidneys is also used, for which methods such as a general urine analysis, a biochemical blood test (for the level of creatinine and urea), as well as ultrasound of the kidneys and their vessels are used.

Thyroid ultrasound

Ultrasound of the thyroid and a blood test for thyroid hormones. These research methods help to identify the role of the thyroid gland in the development of hypertension.

How is arterial hypertension treated?

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

• Age: 50 years for men, 60 years for women;
• Family history: sudden myocardial infarction or death of a parent (before age 55 for men, before age 65 for women) or stroke before age 45, regardless of parent's sex;
• smoking (or not smoking in the last three years);
• diabetes mellitus;
• LDL cholesterol levels above 1. 60 g/L or LDL cholesterol levels below 0. 40 g/L;
• abdominal obesity, kidney failure, lack of regular exercise, or excessive alcohol consumption.

General principles for home treatment of arterial hypertension that should be followed by all adults with hypertension:

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

• limiting salt intake to 5 g / day (read our separate article for more on proper nutrition for hypertension),
• normalization of weight with its excess,
• moderate physical activity 3-5 times a week (walking, running, swimming, physiotherapy exercises),
• stop smoking,
• reducing alcohol consumption,
• the use of herbal sedatives to increase emotional excitability (for example, a decoction of valerian).

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

It should be noted that pharmacies currently offer a wide range of various drugs for the treatment of arterial hypertension, both new and well-known for many years. Preparations with the same active ingredient can be manufactured under different trade names. It is quite difficult for a layman to understand them.

Diuretics are the drugs of choice to treat high blood pressure, especially in the elderly. The most common are thiazides.

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

• Antiplatelet agents - acetylsalicylic acid, are used according to indications,
• Statins for atherosclerosis - even without contraindications;
• Drugs that lower blood sugar levels in 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 Sartan)
• diuretic + calcium antagonist
• Dihydropyridine calcium antagonist + beta-blocker
• Calcium antagonist + ACE inhibitor (or sartan)

Invalid combinations:

• Non-dihydropyridine calcium antagonist + beta-blockers (possible development of heart blocks and death)
• ACE inhibitors + sartan

For the treatment and examination of high blood pressure, you need to see a doctor. Only a specialist, after a full examination and analysis of the results of the examination, can correctly diagnose and prescribe competent treatment.

Why is high blood pressure dangerous?

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

Despite the fact that currently there is a large number of antihypertensive drugs that allow you to maintain blood pressure at an appropriate level, hypertensive crises and complications such as heart failure (HF) and renal failure (RF), aortic and mitral valve insufficiency, cardiac aneurysm and aorta occur, MI (heart attack), stroke, etc. in patients with hypertension remains extremely high.

This is mainly due to the fact that many patients do not want to carry out antihypertensive therapy systematically, believing that the hypertensive crisis that developed in them was a one-off and will not repeat itself.

According to statistics, of patients who know they have arterial 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 due to the systematic use of antihypertensive therapy, monitoring blood pressure values and regular visits to the doctor, as well as following his recommendations.

Despite the fact that arterial hypertension is one of the controllable risk factors for the development of cardiovascular pathologies, such unfortunate indicators are due to the patient's banal misunderstanding 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 without adequate and systematic treatment of hypertension due to cardiac and renal failure, 30-40% of patients die within three years after a severe (complicated) hypertensive crisis.

Comprehensive treatment, responsible approach to one's own health, systematic use of drugs for arterial hypertension and control of one's own pressure make it possible to reduce these frightening numbers to a minimum.

Prevention of arterial hypertension

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

1. First of all, this is regular examination by a cardiologist and compliance with the rules of a decent lifestyle, which will help to delay and often eliminate the disease of arterial hypertension. If you have had relatives with a history of hypertension, you should reconsider your lifestyle and radically change many of the habits and lifestyles that are risk factors.
2. You should rethink your dietary principles, avoiding salty and greasy foods and switching to a low-calorie diet rich in fish, seafood, fruit and vegetables. Do not get carried away 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, move more depending on age, this is ideal for running, swimming, hiking, cycling and skiing. Physical activity should be introduced gradually, without overloading the body. Outdoor exercise is especially beneficial. Physical exercise strengthens the heart muscle and nervous system and helps prevent stress.
4. Try to have a favorable psycho-emotional environment around you. Avoid conflicts if possible, remember that a dysfunctional nervous system very often triggers the mechanism for the development of arterial hypertension.
5. Quit smoking, the substances contained in nicotine provoke changes in the walls of the arteries, increase their stiffness, and therefore can be the culprits of hypertension. In addition, nicotine is very dangerous for the heart and lungs.

So we can briefly say that the prevention of arterial hypertension includes regular examinations by a cardiologist, the right way of life and a favorable emotional environment for your environment.

prognosis for life

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

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

In young people, an extremely unfavorable course of arterial hypertension is observed. They are at high risk of stroke, myocardial infarction, heart failure, sudden death.

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