Hypertension

4 December 2024

In the 21st century, high blood pressure remains a major 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 suffer from high blood pressure, you should consult a doctor immediately. Only timely and competent treatment promotes recovery.

Classification of arterial hypertension

It is customary to distinguish 4 groups at risk of 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%, no aggravating circumstances;
2 – the risk is between 10-20%, no more than 3 aggravating factors;
3 – risk from 20 to 30%, more than 3 aggravating factors;
4 – the risk is greater 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 levels leading to damage to the central nervous system);
heart (left ventricular hypertrophy, myocardial infarction);
kidneys (proteinuria, renal failure).

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

Table no. 1. Blood pressure levels:

Categories	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
Optimal	Below 120	Under 80
Normal	120-129	80-84
High normal	130-139	85-89
1st degree arterial hypertension	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 most likely to develop the disease. In women the risk of arterial hypertension increases significantly after menopause;
Hereditary predisposition. The risk of contracting the disease is very high in people whose first-degree relatives have suffered from this disease. If two or more relatives suffer from hypertension the risk increases;
Increased stress and psycho-emotional stress. During psycho-emotional stress, a large amount of adrenaline is released, under the influence of which the heart rate and volume of pumped blood increase. If a person is in a state of chronic stress, the increased load leads to wear of the arteries and increases the risk of complications affecting the heart and blood vessels;
Drink alcoholic beverages. With daily consumption of strong alcohol, blood pressure increases by 5 mmHg per year. Art. ;
Smoking. Tobacco smoking causes spasm of the peripheral and coronary vessels. The wall of the artery is damaged by nicotine and other components, and atherosclerotic plaques form at the sites of damage;
Atherosclerosis develops due to 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 causes spasm of the arteries, retains fluid in the body, which together leads to the development of hypertension;
Excess body weight leads to a decrease in physical activity. Clinical studies have shown that for every extra 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 hypertension is that it is not accompanied by any characteristic symptoms, but "kills" slowly and silently. In most cases the disease shows no signs, progresses and leads to fatal complications such as myocardial infarction or stroke. When asymptomatic, high blood pressure can remain undetected for decades.

The most common complaints that patients have are:

heachache;
flickering of flies before the eyes;
blurred vision;
dizziness;
dyspnea;
fatigue;
chest pain;
visual impairment;
nosebleeds;
swelling of the lower limbs.

However, the most important sign of hypertension is high blood pressure. Headaches can manifest themselves as a sensation of squeezing the head in a "hoop", accompanied by dizziness and nausea. They occur in a context of physical or nervous stress. If the pain persists for a long time, irritability, irritability and sensitivity to noise appear.

Intracranial hypertension

Often headaches can be caused by a cold, lack of sleep or overwork. It appears to be due to increased intracranial pressure. If the headache becomes permanent 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 localization of the pathology causing increased intracranial pressure, as well as the stage of the disease and the speed of its development.

Moderate intracranial hypertension manifests as:

heachache;
dizziness;
attacks of nausea and vomiting;
clouding of consciousness;
convulsions

Intracranial hypertension: diagnosis

Types of pathological diagnostics include:

measurement of intracranial pressure by inserting a needle into the fluid cavities of the skull or spinal canal with a manometer attached to it.
monitor the degree of blood filling and dilation of the veins of the eyeball. If the patient has red eyes, i. e. the ocular veins are abundantly filled with blood and are clearly visible, we can talk about increased intracranial pressure;
ultrasound examination of cerebral vessels;
magnetic resonance imaging and computed tomography: the expansion of the fluid cavities of the brain is examined, as well as the degree of rarefaction 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 disruptions in the normal functioning of internal organs. Therefore, this pathology requires immediate initiation of treatment aimed at reducing intracranial pressure.

Treatment can only be carried out if the causes of the pathology are correctly diagnosed. For example, if intracranial hypertension occurs due to the development of a tumor or brain hematoma, surgery is required. Removal of a 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 when the heart contracts and blood is ejected. Art. and above this value and/or diastolic pressure at the moment of relaxation of the cardiac muscle to 90 mmHg. Art. and higher.

Symptoms of essential hypertension

In medicine the following concepts are distinguished:

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

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

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

In most cases, the disease affects people between the ages of 30 and 45.

Causes of the disease

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

lesions of the spinal cord and brain, as a result of which the vascular tone in the periphery is disrupted;
nervous shocks, regular stress. In this case, a persistent focus of excitation in the cerebral cortex is observed, a prolonged spasm causes an increase in peripheral resistance, the vessels lose their elasticity;
hereditary factor;
overweight: many people with extra pounds 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 be no endocrine disruption at all;
sedentary lifestyle;
excessive consumption of the coffee preferred by many people. At the same time, the level of caffeine in the blood increases, which prevents blood vessels from relaxing and expanding normally. You should always remember: "what is good in moderation";
excessive consumption of salt. It maintains moisture in the body and leads to increased blood pressure. It is known that the Japanese consume twice as much salt as Europeans, and essential hypertension is widespread among the Japanese population;
Alcohol abuse and smoking lead to disruption of the normal regulation of vascular tone.

Treatment of essential hypertension

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

a special diet aimed at limiting the consumption of salt and foods rich in animal fats;
abandon bad habits, especially smoking and alcohol abuse;
stress relief. In this case, yoga lessons, self-training and sessions with a psychotherapist are very useful;
patients diagnosed with essential hypertension should not work in conditions of loud noise and vibration;
avoid excessive physical activity: intense and exhausting workouts on treadmills should be replaced with half-hour walks.

Pharmacological treatment involves taking the following drugs:

angiotensin converting enzyme inhibitors. This group includes a huge number of drugs that reduce blood pressure in several ways at once;
angiotensin 2 receptor blockers. The drugs 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 the penetration of calcium into the tissues of blood vessels and the heart, slow 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 retain potassium in the body. However, they have a weak diuretic effect;
centrally acting drugs aimed at reducing the activity of the nervous system. This also includes drugs that lower cholesterol levels in the body.

Portal hypertension

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

What is portal hypertension

Normally, the pressure in the portal 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, unlike 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 enlarges;
blood clotting worsens;
accumulation of fluid in the abdominal area (ascites) is diagnosed;
varicose veins of the digestive tract develop;
in many cases, patients experience bleeding and anemia.

In the initial stages, signs of portal hypertension in liver cirrhosis are manifested in the form of deterioration of general health, swelling and heaviness under the right rib. Subsequently, 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:

1st degree – functional (initial);
2nd degree – moderate. Accompanied by moderate dilation of the esophageal veins, enlargement of the spleen and ascites;
3rd degree portal hypertension is a serious form of pathology. In this phase, 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 greater than 15 mm and the splenic vein is greater than 7-10 mm, the presence of portal hypertension can be precisely stated. Additionally, ultrasound examination may reveal an enlarged 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 liver cirrhosis is aimed at preventing bleeding.

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

Portal hypertension: prevention

Measures to prevent the development of the disease include:

maintain an adequate diet and nutritional regime;
play sports;
vaccinations against viral hepatitis;
refusal to abuse alcoholic beverages;
avoid exposure to harmful production factors in the form of poisoning with toxic substances.

Preventive measures for liver diseases are:

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

Measures to prevent the development of bleeding include:

control of blood coagulation function;
sigmoidoscopy - that is, examination of the sigmoid colon 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 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, causing a constant or critical increase in pressure;
Hyperaldosteronism, or Cohn syndrome, is a tumor of the adrenal gland that causes increased aldosterone levels. As a result, the potassium level in the blood decreases and blood pressure increases;
thyroid diseases such as hyperparathyroidism, hyper- and hypothyroidism cause secondary arterial hypertension;
hemodynamic or cardiovascular arterial hypertension occurs due to the involvement of large vessels in the pathological process. It manifests itself with coartration, or narrowing, of the aorta and insufficiency of the aortic valve;
arterial hypertension in adults of central origin develops into diseases of the brain with a secondary disorder of central regulation (stroke, encephalitis, head injuries);
Drug-induced hypertension can occur while taking oral contraceptives, nonsteroidal anti-inflammatory drugs, and glucocorticosteroids.

The diagnosis of secondary hypertension is difficult, but there are several signs that make it suspect:

increased blood pressure in young people;
sudden and acute onset of the disease immediately with high blood pressure values;
failure to respond to ongoing antihypertensive therapy;
sympathetic-adrenal crises.

Diastolic hypertension

The diagnosis of "isolated diastolic hypertension" is valid when the systolic value is less than 140 mm. Hg and the diastolic is greater than 90 mm Hg. Increase in diastolic blood 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 blood pressure values and do not have concomitant 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;
eliminate salt from your diet;
eat well;
maintain normal weight;
do exercise or yoga.

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

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

Hypertensive crisis

Hypertensive crisis is a state of significant individual 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 damage to target organs.

Type 1 crisis (adrenal, neurovegetative) is manifested by an increase in systolic blood pressure, an increase in pulse pressure, tachycardia, extrasystoles and agitation. Type 2 seizure (sea 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 notable decrease in diuresis on the eve of a crisis.

In case of a complicated crisis, the airways are disinfected, the patient is provided with oxygen and venous access is carried out. The choice of antihypertensive drug is approached in a differentiated way; it is administered intravenously; They quickly reduce the pressure, and then switch within 2-6 hours to oral drugs, 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 it will be possible to diagnose hypertension. The exercise begins with the explanation of the person's behavior during the procedure, then it is shown how to correctly apply the bracelet and the indicators are recorded. It depends on which device measures pressure: mechanical or electronic.

It is necessary to carry out laboratory tests such as:

general blood and urine tests;
blood glucose levels;
creatinine, uric acid and potassium levels;
lipid profile;
content of C-reactive protein in blood serum;
bacterial culture of urine.
Patients are prescribed the following instrumental research methods:
electrocardiogram;
echocardiogram;
chest x-ray;
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 evaluate 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: achievement of the target blood pressure, i. e. 140/80 mmHg. and address risk factors. In patients suffering from kidney disease and diabetes, blood 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 proper nutrition;
avoid emotional distress and stress;
use rational physical activity;
normalize sleep patterns;
monitor your weight;
active rest;
stop smoking and drinking alcohol;
Visit your doctor regularly and get tested.

High blood pressure leads to disability and death. The disease is successfully treated by doctors. Treatment of this disease involves continuous use of medications to control blood pressure. Hypertensive crises and blood pressure changes should be avoided.

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