Hypertension

4 December 2024

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 lead to death.

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

Classification of arterial hypertension

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

1 – the risk is less than 15%, there are no aggravating factors;
2 – risk within 10-20%, no more than 3 aggravating factors;
3 – 20-30% risk, more than 3 aggravating factors;
4 - risk more than 30%, more than three aggravating factors, target organs are affected.

The following target organs are affected in arterial hypertension:

brain (transient cerebrovascular accidents, stroke);
organ of vision (degenerative changes and retinal detachment, bleeding, blindness);
blood (increased glucose level, which causes damage to the central nervous system);
heart (left ventricular hypertrophy, myocardial infarction);
kidneys (proteinuria, renal failure).

Depending on the severity of cardiovascular risk, several levels of blood pressure, presented in table number 1, differ.

Table #1. Blood pressure levels:

Categories	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
Optimal	Below 120	Below 80
Normal	120-129	80-84
High normal	130-139	85-89
Arterial hypertension 1st 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 the 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 suffer from this disease. If two or more relatives have hypertension, the risk increases;
Increased psycho-emotional stress and stress. During psycho-emotional stress, a large amount of adrenaline is released, under its influence the heart rate and the volume of pumped blood increase. If a person is in a state of chronic stress, then the increased load causes wear and tear of the vessels, and the risk of complications from the heart and blood vessels increases;
Drinking alcoholic beverages. With daily heavy alcohol consumption, blood pressure increases by 5 mmHg every year. Art. ;
Smoking. Tobacco smoke causes spasm of peripheral and coronary vessels. The arterial wall is damaged by nicotine and other components, and atherosclerotic plaques form in the damaged areas;
Atherosclerosis develops as a result of excessive consumption of foods containing cholesterol and smoking. Atherosclerotic plaques narrow the lumen of blood vessels and prevent free blood circulation. This causes arterial hypertension, which stimulates the development of atherosclerosis;
Increased consumption of table salt provokes vasospasm, retains fluid in the body, which together leads to the development of hypertension;
Excess body weight leads to a decrease in physical activity. Clinical trials have shown that 2 mm falls for every additional kilogram. 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 any characteristic symptoms, but it "kills" slowly and quietly. In most cases, the disease does not show any symptoms, progresses and leads to fatal complications such as myocardial infarction or stroke. When asymptomatic, arterial hypertension can remain undetected for decades.

The most common complaints of patients are:

headache;
fluttering of flies before the eyes;
blurred vision;
dizziness;
shortness of breath;
fatigue;
chest pain;
visual impairment;
nosebleeds;
swelling of the lower extremities.

But the most important symptom of hypertension is the rise in blood pressure. It can manifest itself as a feeling of pressure in the head with a "ring" accompanied by headache, dizziness and nausea. They occur against the background of physical or nervous tension. If the pain lasts for a long time, short temper, irritability, sensitivity to noise appear.

Intracranial hypertension

Headaches can often be caused by a cold, lack of sleep, or overwork. It appears due to increased intracranial pressure. If the headaches are persistent and severe, this is a signal to go to the hospital.

Intracranial hypertension: symptoms in adults and children

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

Moderate intracranial hypertension manifests itself as follows:

headaches;
dizziness;
attacks of nausea and vomiting;
confusion of consciousness;
seizures

Intracranial hypertension: diagnosis

Types of pathological diagnosis include the following:

measuring intracranial pressure by inserting a needle with a pressure gauge attached into the fluid spaces of the skull or spinal canal.
monitoring the degree of blood filling and dilation of the vessels of the eyeball. If the patient has red eyes, that is, if the eye vessels are filled with blood and are clearly visible, we can talk about increased intracranial pressure;
ultrasound examination of cerebral vessels;
magnetic resonance and computer tomography: the expansion of the fluid cavities of the brain, as well as the degree of thinning of the edges of the ventricles are investigated;
conducting an encephalogram.

Intracranial hypertension: treatment, drugs

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

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

Essential hypertension

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

Symptoms of essential hypertension

In medicine, the following concepts are distinguished:

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

True hypertension (main form) takes the leading position among all cases of hypertension. The frequency of occurrence is 90%.

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

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

Causes of the disease

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

spinal cord and brain injuries, as a result of which vascular tone in the periphery is disturbed;
nervous shocks, regular stress. In this case, a continuous focus of excitement is observed in the cerebral cortex, a long-lasting spasm leads to an increase in peripheral resistance, blood vessels lose their elasticity;
hereditary factor;
overweight: many people with extra pounds associate their obesity with disorders of the endocrine glands, put themselves on the list of "patients" and do not want to change anything in their lifestyle. In fact, there may be no 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 relaxation and normal expansion of blood vessels. You should always remember: "what is good in size";
excessive salt consumption. It retains moisture in the body and causes an increase in blood pressure. It is known that the Japanese consume twice as much salt as Europeans, and essential hypertension is very common in the Japanese population;
Alcohol abuse and smoking cause a violation of the normal regulation of vascular tone.

Treatment of essential hypertension

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

a special diet aimed at limiting the consumption of foods high in salt and animal fat;
giving up bad habits, especially smoking and alcohol abuse;
stress relief. In this case, yoga classes, self-training and sessions with a psychotherapist are very useful;
patients diagnosed with primary hypertension should not work in conditions of strong noise and vibration;
avoid excessive physical activity: intense, exhausting exercises on treadmills should be replaced by half-hour walks.

Drug treatment includes taking the following drugs:

angiotensin converting enzyme inhibitors. This group includes a large number of drugs that simultaneously reduce blood pressure in several ways;
angiotensin 2 receptor blockers drugs dilate blood vessels, thereby reducing blood pressure;
beta-blockers: drugs of this type relieve pain in the heart, slow down the heartbeat and dilate blood vessels;
calcium channel blockers: slow down the penetration of calcium into blood vessels and tissues of the heart, slow down the heartbeat, dilate blood vessels;
Diuretics: prevent the absorption of sodium in the kidneys, excrete it with urine. This group of drugs also includes those that store potassium in the body. However, they have a weak diuretic effect;
centrally acting drugs aimed at reducing the activity of the nervous system. This includes drugs that lower cholesterol levels in the body.

Portal hypertension

Portal hypertension is a complication of liver cirrhosis. This is the phenomenon of increased arterial pressure in the portal vein as a result of obstruction of blood flow from the vein.

What is portal hypertension?

Normally, the pressure in the portal zone is 7 mm. rt. Art. , when this indicator exceeds 12-20 mm, stagnation occurs in the afferent vessels and they expand. The thin walls of veins, unlike veins, 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 vein of the liver increases.

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

the indicators of laboratory tests change - the norms for the content of platelets, leukocytes and erythrocytes are violated;
the spleen enlarges;
blood clotting worsens;
fluid accumulation in the abdomen (ascites) is diagnosed;
varicose veins of the digestive system develop;
In many cases, patients have bleeding and anemia.

In the early stages, the symptoms of portal hypertension in cirrhosis of the liver are manifested in the form of deterioration of general health, swelling, heaviness under the right rib. Then the patient develops pain in the area under the right rib, the size of the liver and spleen increases, and the normal functioning of the digestive system is disturbed.

Portal hypertension: degree

In general, there are 4 degrees of pathology:

1st degree – functional (initial);
2nd grade - medium. Moderate expansion of the esophageal vessels is accompanied by an enlarged spleen and ascites;
Grade 3 portal hypertension is a severe form of pathology. At this stage, open hemorrhagic and ascites syndromes are observed;
Grade 4 (complex). The patient develops bleeding in the esophagus and stomach, gastropathy and spontaneous bacterial peritonitis.

Portal hypertension: diagnosis

Types of diagnostics in the hospital are as follows:

Ultrasound: allows 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 clearly stated. Also, an ultrasound scan can reveal enlargement of the liver and spleen;
Doppler ultrasound: allows checking the structure of blood vessels, as well as measuring the speed of blood flow through them;
FGDS (fibrogastroduodenoscopy): allows 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 liver cirrhosis is aimed at preventing bleeding.

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

Portal hypertension: prevention

Measures to prevent the development of the disease include:

maintaining a proper diet and nutrition regime;
play sports;
vaccines against viral hepatitis;
refusal to abuse alcoholic beverages;
not to be exposed to harmful production factors in the form of poisoning with toxic substances.

Preventive measures for liver diseases are:

full examination to diagnose liver disease in the early stages and start treatment;
strictly follow all the doctor's recommendations;
complex therapy in a hospital setting under the strict supervision of doctors.

Measures to prevent the development of bleeding include:

control of blood clotting function;
sigmoidoscopy - i. e. annual examination of the sigmoid and rectum;
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 affecting the adrenal medulla. It is the cause of 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 or crisis increase in pressure;
Hyperaldosteronism, or Cohn's syndrome, is a tumor of the adrenal gland that causes increased aldosterone levels. As a result, the level of potassium in the blood decreases and blood pressure rises;
thyroid diseases such as hyperparathyroidism, hyperthyroidism and hypothyroidism cause secondary arterial hypertension;
hemodynamic or cardiovascular arterial hypertension occurs as a result of the involvement of large vessels in the pathological process. This occurs with coarctation or narrowing of the aorta and aortic valve insufficiency;
arterial hypertension in adults of central origin develops in brain diseases with secondary disturbances of central regulation (stroke, encephalitis, head injuries);
drug-induced hypertension may occur when taking oral contraceptives, nonsteroidal anti-inflammatory drugs, and glucocorticosteroids.

Diagnosis of secondary hypertension is difficult, but there are several signs to suspect it:

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

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. An increase in diastolic pressure up to 90 mm Hg. does not pose a threat to a person without somatic pathology.

People with elevated diastolic pressure and no accompanying pathologies are advised to control their blood pressure and change their lifestyle:

regulate the quality of sleep;
do not drink red wine;
limit the number of cigarettes smoked per day;
avoid stress;
exclude salt from the diet;
eating right;
maintain a 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 drugs for hypertension individually. The following tablets are used for hypertension:

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

Hypertensive crises

A hypertensive crisis is a state of individually 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 rapid pressure control to limit or prevent damage to target organs.

Type 1 crisis (adrenal, neurovegetative) is manifested by increased systolic blood pressure, increased pulse pressure, tachycardia, extrasystole and excitement. 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 eve of a crisis.

During a complex crisis, the airway is sanitized, the patient is supplied with oxygen, and venous access is ensured. The choice of antihypertensive drug is treated differentially, it is given intravenously; They lower blood pressure quickly and then switch to oral medications that lower blood pressure to 160/100 mmHg within 2-6 hours. The patient is admitted to a special hospital.

Diagnosis of arterial hypertension

It is very important to know how to measure blood pressure, only then can a diagnosis of hypertension be made. The training begins with an explanation of the person's behavior during the procedure, then shows how to properly apply the cuff and record the readings. It depends on the pressure measuring device: mechanical or electronic.

It is necessary to carry out laboratory tests, for example:

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

The ophthalmologist will examine the fundus of the eye and assess the presence and degree of microproteinuria. All hospital patients 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: achieving the target blood pressure, that is, 140/80 mmHg. and elimination of risk factors. Blood pressure should be reduced to 130/80 mmHg in patients suffering from kidney disease and diabetes. 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, the following is necessary:

organize proper nutrition;
avoid emotional stress and stress;
use rational physical activity;
normalize sleep patterns;
monitor your weight;
active recreation;
stop smoking and drinking alcohol;
Visit your doctor regularly and undergo tests.

Arterial hypertension causes disability and death. The disease is successfully treated by doctors. Treatment of this disease involves the continuous use of drugs to control blood pressure. Hypertensive crises and sudden changes in pressure should be avoided.

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