hypertension

In the 21st century, arterial hypertension remains an important medical and social problem, as it is fraught with complications that lead to disability, impair quality of life, and can be fatal.

The disease is successfully treated by professional doctors. If you have high blood pressure, you should consult a doctor immediately. Only timely and competent treatment promotes healing.

Classification of arterial hypertension

It is customary to distinguish 4 risk groups for arterial hypertension, depending on the likelihood of damage to the heart, blood vessels and other target organs, as well as the presence of aggravating factors:

• 1 – risk less than 15%, without aggravating factors;
• 2 – the risk is within 10-20%, no more than 3 aggravating factors;
• 3 – risk from 20 to 30%, more than 3 aggravating factors;
• 4 – the risk is higher than 30%, more than three aggravating factors, target organs are affected.

In arterial hypertension, the following target organs are affected:

• brain (transient cerebrovascular accidents, stroke);
• organ of sight (degenerative changes and detachment of the retina, hemorrhage, blindness);
• blood (increased glucose level leading to central nervous system damage);
• heart (left ventricular hypertrophy, myocardial infarction);
• kidneys (proteinuria, renal failure).

Depending on the severity of the cardiovascular risk, several levels of blood pressure are distinguished, presented in table no. 1.

Table no. 1. Blood pressure levels:

Categories	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
optimum	Under 120	Under 80
Normal	120-129	80-84
Normal high	130-139	85-89
Arterial hypertension of the first degree	140-159	90-99
Arterial hypertension 2 degrees	160-179	100-109
Arterial hypertension 3 degrees	≥180	≥110
Isolated systolic hypertension	≥140	≤90

Causes of hypertension

The main risk factors for primary arterial hypertension include:

• Gender and age. Men between the ages of 35 and 50 are more prone to developing this disease. In women, the risk of arterial hypertension increases significantly after menopause;
• Hereditary predisposition. The risk of the disease is very high in people whose first-degree relatives suffered from the disease. If two or more relatives had hypertension, the risk increases;
• Increased psycho-emotional stress and stress. During psycho-emotional stress, a large amount of adrenaline is released, under the influence of which the heart rate and the volume of pumped blood increase. If a person is in a state of chronic stress, then the increased load leads to wear of the arteries and the risk of complications from the heart and blood vessels increases;
• Drinking alcoholic beverages. With daily consumption of strong alcohol, blood pressure increases by 5 mmHg per year. Art. ;
• Smoking. Tobacco smoke causes spasms of peripheral and coronary vessels. The wall of the artery is damaged by nicotine and other components, and atherosclerotic plaques form in the places of damage;
• Atherosclerosis develops as a result of excessive consumption of foods containing cholesterol and smoking. Atherosclerotic plaques narrow the lumens of blood vessels and interfere with free blood circulation. This leads to arterial hypertension, which stimulates the progression of atherosclerosis;
• Increased consumption of table salt provokes spasms of the arteries, retains fluid in the body, which together leads to the development of hypertension;
• Excess body weight leads to reduced physical activity. Clinical studies have shown that for every additional kilogram there are 2 mm. rt. Art. blood pressure;
• Physical inactivity increases the risk of developing hypertension by 20-50%.

Symptoms of arterial hypertension

The danger of high blood pressure is that it is not accompanied by characteristic symptoms, but slowly and silently "kills". The disease in most cases does not show any signs, progresses and leads to fatal complications such as myocardial infarction or stroke. When asymptomatic, arterial hypertension can remain undetected for decades.

The most frequent complaints that patients have are:

1. headache;
2. flickering of flies before the eyes;
3. blurred vision;
4. dizziness;
5. dyspnea;
6. fatigue;
7. chest pain;
8. visual impairment;
9. nosebleeds;
10. swelling of the lower extremities.

However, the most important sign of hypertension is high blood pressure. Headaches can manifest with a feeling of tightening of the head with a "circle", accompanied by dizziness and nausea. They occur against a background of physical or nervous stress. If the pain continues for a long time, short temper, irritability and sensitivity to noise appear.

Intracranial hypertension

Often a headache can be caused by a cold, lack of sleep or overwork. Appears due to increased intracranial pressure. If the headaches become permanent and severe, this is a signal to go to the hospital.

Intracranial hypertension: symptoms in adults and children

The syndrome of intracranial hypertension manifests itself in different ways, depending on the location of the pathology that causes increased intracranial pressure, as well as on the stage of the disease and the speed of its development.

Moderate intracranial hypertension is manifested as:

• headache;
• dizziness;
• nausea and vomiting attacks;
• clouding of consciousness;
• convulsions

Intracranial hypertension: diagnosis

Types of pathology diagnostics include:

• measuring intracranial pressure by inserting a needle into the fluid cavities of the skull or spinal canal with a pressure gauge attached to it.
• following the degree of blood filling and expansion of the veins of the eyeball. If the patient has red eyes, that is, the eye veins are abundantly filled with blood and are clearly visible, we can talk about increased intracranial pressure;
• ultrasound examination of cerebral vessels;
• magnetic resonance and computerized tomography: the expansion of the fluid cavities of the brain is examined, as well as the degree of thinning of the edges of the ventricle;
• performing an encephalogram.

Intracranial hypertension: treatment, drugs

Increased intracranial pressure can lead to a decrease in the patient's intellectual abilities and disruption in the normal functioning of internal organs. Therefore, this pathology requires the immediate start of treatment aimed at reducing intracranial pressure.

Treatment can be carried out only if the causes of the pathology are correctly diagnosed. For example, if intracranial hypertension occurs due to the development of a brain tumor or hematoma, then surgical intervention is required. Removal of a hematoma or neoplasm leads to the normalization of intracranial pressure.

Essential hypertension

Essential arterial hypertension is an increase in systolic blood pressure at the time of heart contraction and blood ejection to 140 mmHg. Art. and above this mark and/or diastolic blood pressure at the moment of relaxation of the heart muscle to 90 mmHg. Art. and above.

Symptoms of essential hypertension

In medicine, the following concepts are distinguished:

• essential arterial hypertension (primary essential hypertension);
• hypertensive diseases with heart and kidney damage;
• Secondary hypertension: endocrine, renovascular, unspecified, etc.

True hypertension (essential form) occupies a leading position in all cases of hypertension. The frequency of occurrence is 90%.

In children (up to 10 years old), a pressure level above 110/70 mm Hg is considered dangerous. Art. , after 10 years – 120/80 mm Hg. The diagnosis is confirmed in cases of repeated blood pressure measurements within four weeks at least twice on different days.

In most cases, the disease affects people aged 30 to 45 years.

Causes of the disease

Despite modern advances in medicine, the causes of primary hypertension have not yet been determined. There are only a number of factors that increase the risk of developing this type of disease. Among them:

• injuries to the spinal cord and brain, as a result of which the vascular tone in the periphery is disturbed;
• nervous breakdown, regular stress. In this case, a continuous focus of excitation is observed in the cerebral cortex, a prolonged spasm causes an increase in peripheral resistance, the vessels lose their elasticity;
• hereditary factor;
• overweight: many overweight people attribute their obesity to disorders in the functioning of the endocrine glands, put themselves on the list of "sick" and do not want to change anything in their lifestyle. In fact, there may not be any endocrine disruption;
• sedentary lifestyle;
• excessive consumption of many people's favorite coffee. At the same time, the level of caffeine in the blood increases, which prevents the blood vessels from relaxing and dilating normally. You should always remember: "what is good in moderation";
• excessive salt consumption. It retains moisture in the body and leads to an increase in blood pressure. Japanese people are known to consume twice as much salt as Europeans, and essential hypertension is very common among the Japanese population;
• Alcohol abuse and smoking lead to disruption of the normal regulation of vascular tone.

Treatment of essential hypertension

The doctor chooses treatment tactics after assessing the patient's condition and the stage of development of the pathology. In the initial stages, patients are prescribed non-drug therapy, which includes:

1. a special diet aimed at limiting the consumption of salt and foods rich in animal fats;
2. giving up bad habits, especially smoking and alcohol abuse;
3. stress relief. In this case, yoga classes, self-training and sessions with a psychotherapist are very useful;
4. patients diagnosed with essential hypertension should not work in conditions of strong noise and vibration;
5. avoiding excessive physical activity: intense, exhausting workouts on the treadmill should be replaced with half-hour walks.

Drug treatment includes taking the following medications:

• angiotensin converting enzyme inhibitors. This group includes a large number of drugs that lower blood pressure in several ways at the same time;
• Angiotensin 2 receptor blockers. Medicines dilate blood vessels, thus lowering blood pressure;
• beta blockers: this type of drug relieves heart pain, slows the heartbeat and dilates blood vessels;
• calcium channel blockers: slow down the penetration of calcium into the tissues of blood vessels and the heart, slow down the heartbeat, dilate blood vessels;
• Diuretics: inhibit the absorption of sodium in the kidneys, excreting it in the urine. This group of drugs also includes those that keep potassium in the body. However, they have a weak diuretic effect;
• drugs with central action aimed at reducing the activity of the nervous system. This includes medications that lower cholesterol levels in the body.

Portal hypertension

Portal hypertension is a complication of liver cirrhosis. This is the phenomenon of increased blood pressure in the portal vein caused by an obstruction of blood flow from the vein.

What is portal hypertension

Normally, the pressure in the port area is 7 mm. rt. Art. , in cases where this indicator exceeds 12-20 mm, stagnation is formed in the afferent veins and they expand. The thin walls of veins, compared to arteries, stretch under pressure and tear easily.

Portal hypertension: symptoms

The main cause of portal hypertension is cirrhosis. With this pathology, the pressure in the portal vessel of the liver increases.

As the disease progresses, the following signs of portal hypertension appear:

• laboratory test indicators change - the norms for the content of platelets, leukocytes and erythrocytes are violated;
• the spleen is enlarged;
• blood coagulation worsens;
• fluid accumulation in the abdominal area (ascites) is diagnosed;
• varicose veins of the digestive tract develop;
• in many cases, patients experience bleeding and anemia.

In the early stages, the signs of portal hypertension in cirrhosis of the liver appear in the form of deterioration of general health, swelling and heaviness under the right rib. Then, the patient develops pain in the area under the right rib, the liver and spleen increase in size, and the normal functioning of the digestive tract is disrupted.

Portal hypertension: degrees

In total, there are 4 degrees of pathology:

• First degree – functional (initial);
• Second degree - moderate. It is accompanied by moderate expansion of the veins of the esophagus, enlarged spleen and ascites;
• Portal hypertension of the 3rd degree is a severe form of pathology. At this stage, pronounced hemorrhagic and ascitic syndromes are observed;
• 4th degree (complicated). The patient develops bleeding in the esophagus and stomach, gastropathy and spontaneous bacterial peritonitis occur.

Portal hypertension: diagnosis

The types of diagnostics in the hospital are as follows:

• Ultrasound: allows you to determine the size of the splenic, portal and superior mesenteric veins. If the diameter of the portal vein is more than 15 mm and the splenic vein is more than 7-10 mm, the presence of portal hypertension can be accurately determined. Also, ultrasound examination can reveal an enlargement of the liver and spleen;
• Doppler ultrasound: allows you to examine the structure of blood vessels, as well as measure the speed of blood flow through them;
• FGDS (fibrogastroduodenoscopy): allows you to identify varicose veins of the cardiac part of the stomach and esophagus, which cause bleeding in the gastrointestinal tract.

Portal hypertension: treatment

Treatment of portal hypertension in cirrhosis of the liver is aimed at preventing bleeding.

The effectiveness of sclerotherapy is about 80%. The procedure involves injecting drugs into the damaged veins using an endoscope. Thus, the lumen of the veins is blocked and their walls "stick together". This treatment method is considered classic.

Portal hypertension: prevention

Measures to prevent the development of the disease include:

• maintaining a proper diet and feeding regime;
• playing sports;
• vaccines against viral hepatitis;
• refusal to abuse alcoholic beverages;
• avoiding exposure to harmful production factors in the form of poisoning with toxic substances.

Preventive measures for liver diseases are:

• a complete examination to make a diagnosis in the early stages of liver disease and start treatment;
• strict compliance with all doctor's recommendations;
• complex therapy in a hospital environment under the strict supervision of doctors.

Measures to prevent bleeding include:

• control of blood coagulation function;
• sigmoidoscopy - that is, examination of the sigmoid and rectum, every year;
• fibrogastroduodenoscopy twice a year.

Secondary hypertension

The most common type is primary hypertension, sometimes called hypertensive hypertension. In addition to the primary or idiopathic form of the disease, which is often called hypertension, secondary hypertension is also known.

Depending on the cause, the following types of the disease are distinguished:

• renal hypertension occurs due to damage to the renal arteries. This form of the disease is called renovascular hypertension;
• An increase in systolic blood pressure occurs with Itsenko-Cushing syndrome. In this case, the adrenal medulla is affected;
• Pheochromocytoma is a disease that affects the adrenal medulla. It is the cause of a malignant form of arterial hypertension. The tumor compresses the outer layer of the adrenal glands, as a result of which adrenaline and norepinephrine are released into the blood, which causes a constant increase or crisis of pressure;
• Hyperaldosteronism, or Cohn's syndrome, is a tumor of the adrenal gland that causes an increase in aldosterone levels. As a result, the level of potassium in the blood decreases and blood pressure increases;
• thyroid diseases such as hyperparathyroidism, hyper- and hypothyroidism are causes of secondary arterial hypertension;
• Hemodynamic or cardiovascular arterial hypertension occurs as a result of the involvement of large vessels in the pathological process. Occurs with coarctation, or narrowing, of the aorta and aortic valve insufficiency;
• arterial hypertension in adults of central origin develops in brain diseases with a secondary disturbance of central regulation (stroke, encephalitis, head injuries);
• Drug-induced hypertension can occur when taking oral contraceptives, nonsteroidal anti-inflammatory drugs, and glucocorticosteroids.

The diagnosis of secondary hypertension is difficult, but there are some signs to suspect:

• increased blood pressure in young people;
• sudden acute onset of the disease immediately with high blood pressure numbers;
• unresponsiveness to continuous antihypertensive therapy;
• sympathoadrenal seizures.

Diastolic hypertension

The diagnosis of "isolated diastolic hypertension" is valid when the systolic value is less than 140 mm. Hg, and diastolic is more than 90 mm Hg. Increased diastolic pressure to 90 mm Hg. it does not pose a threat to a person who does not have a somatic pathology.

People who have high diastolic pressure and have no accompanying pathology are recommended to control their blood pressure and change their lifestyle:

• adjust the quality of sleep;
• do not drink red wine;
• limit the number of cigarettes smoked per day;
• avoid stress;
• eliminate salt from the diet;
• eat properly;
• maintain normal weight;
• do physical exercise or yoga.

When diastolic hypertension occurs, hospital treatment is necessary if persistently high diastolic pressure is present. The underlying disease is treated, for example, surgical correction of aortic valve disease. Doctors prescribe individually medicines for hypertension. The following tablets are used for hypertension:

• diuretics;
• beta blockers;
• calcium channel blockers;
• ACE inhibitors;
• angiotensin II receptor blockers.

Hypertensive crises

Hypertensive crisis is a state of individual significant increase in blood pressure in patients suffering from primary or secondary arterial hypertension, accompanied by the appearance or worsening of clinical symptoms and requiring rapidly controlled pressure to limit or prevent organ damagetargeted.

Type 1 crisis (adrenal, neurovegetative) is manifested by an increase in systolic blood pressure, an increase in pulse pressure, tachycardia, extrasystole and agitation. Type 2 crisis (water-salt, norepinephrine) has the following symptoms:

• a predominant increase in diastolic pressure with a decrease in pulse pressure;
• swelling of the face, legs, arms;
• a noticeable decrease in diuresis on the verge of a crisis.

In case of a complicated crisis, the airways are disinfected, the patient is provided with oxygen and venous access. The choice of antihypertensive drug is administered in a differentiated manner; They quickly lower the pressure and then within 2-6 hours switch to oral medications, which reduce it to 160/100 mmHg. The patient is admitted to a specialized hospital.

Diagnosis of arterial hypertension

It is very important to know how to measure blood pressure, only then can hypertension be diagnosed. The exercise begins with an explanation of the person's behavior during the procedure, then they show how to correctly apply the cuff and record the indicators. It depends on which device measures the pressure: mechanical or electronic.

It is necessary to perform laboratory tests such as:

• general analysis of blood and urine;
• blood glucose levels;
• creatinine, uric acid and potassium levels;
• lipid profile;
• the content of C-reactive protein in the blood serum;
• bacterial culture of urine.
• Patients are prescribed the following instrumental research methods:
• electrocardiogram;
• echocardiogram;
• X-ray of the chest;
• ultrasound examination of the kidneys and adrenal glands;
• Ultrasound of the renal and brachycephalic arteries.

The ophthalmologist will examine the fundus of the eye and assess the presence and degree of microproteinuria. All patients in the hospital undergo daily blood pressure monitoring.

Treatment of arterial hypertension

The goal of treatment for any patient with hypertension is to reduce the risk of cardiovascular complications and death. The selection of drugs for the treatment of hypertension is determined by the following strategy: reaching the target blood pressure, i. e. 140/80 mmHg. and addressing risk factors. In patients suffering from kidney disease and diabetes, the pressure should be reduced to 130/80 mmHg. This will improve the quality of life and eliminate the symptoms of the disease.

Prevention of arterial hypertension

To prevent the development of arterial hypertension it is necessary:

• organize the right food;
• avoid emotional stress and stress;
• use rational physical activity;
• normalization of sleep patterns;
• monitor your weight;
• active rest;
• stop smoking and drinking alcohol;
• Visit your doctor regularly and have a test.

Arterial hypertension leads to disability and death. The disease is successfully treated by doctors. Treatment for this disease involves the continued use of medications to control blood pressure. Hypertensive crises and sudden pressure changes should be avoided.

If you have faced this problem, call and the coordinating doctor will schedule an appointment with a cardiologist and answer all your questions.