Hypertension or arterial hypertension - a condition characterized by stable, which is, detected by repeated measurements, increased blood pressure. Accompanying many diseases, it is considered a risk factor for the development of dangerous complications from the cardiovascular system, including myocardial stroke and heart attack. Hypertonic disease, as the main cause of the pathology in question, requires the intake of drugs, normalization of the patient's lifestyle and nutrition.
Blood pressure is a force with which circulating blood acts on the walls of the blood vessels. This pressure at the time of cardiac contraction is called systolic and during its relaxation - diastolic. The interval of normal values for these indicators is quite large.
During numerous observations, scientists came to the conclusion that the risk of cardiovascular complications increases with any further increase in blood pressure by 10 mm hg. Art. Already starting from a level of 115/75 mm RT. Art. However, a decrease in the pressure drug only greater than 140/90 mm proved to be appropriate. RT. Art. , Therefore, is precisely such a value that is taken as a criterion for determining arterial hypertension.
Reasons
In about 90% of cases, hypertension becomes the cause of a stable increase in blood pressure. This diagnosis is made to the patient when other diseases accompanied by hypertension were found during the exam. Among the latter:
- Renal pathologies - Pyelonefrite, Glomerulonefrite, Polycying Nephropathy, Diabetic, Renal arteries stenosis;
- Endocrine-Neoplasms disorders of the adrenal gland, pancreas or pituitary gland, thyroid hyperfunction, izenko-cushing syndrome, pheochromocytoma;
- Obstructive apnea syndrome in a dream;
- Vicus of valves or atherosclerotic damage to the aorta.
Regular use of a series of drugs can also cause an increase in blood pressure. These include oral contraceptives, anti -anti -inflammatory drugs non -pounds, amphetamines, corticosteroids, drugs containing erythropoetine, cyclosporine, cocaine.
The probability of cardiovascular diseases, including hypertension, has a close relationship with the following risk factors:
- improper nutrition, including an excess of sodium salt, saturated fats and trans fats, a lack of leafy vegetables, vegetables and fruit in the diet;
- obesity;
- pathologies of the heart and blood vessels in narrow relatives;
- age of over 65 years of age;
- sedentary lifestyle;
- chronic stress;
- Collection habits - smoke, excessive alcohol consumption.
Classification
If it was possible to identify the disease that leads to an increase in blood pressure, arterial hypertension is called secondary or symptomatic. In the case of an unidentified cause of hypertension, it is considered primary, caused by hypertension.
The latter has a staging current:
- Phase I. There are no evident signs of violations of the work of the target organs affected by a stable increase in the heart of blood pressure, kidneys, arterial vessels and venous.
- Phase II. There is one of the signs listed or their totality, as an increase in the left ventricle of the heart, a pronounced reduction in the filtration rate in the kidneys, albumin in the urine, an increase in the thickness of the walls of the carotid arteries or the appearance of the atherosclerotic plaques in their lights. In this case, the clinical manifestations of the disease can be absent.
- Hypertension III Stadium. There are one or more pathologies associated with atherosclerotic processes in the heart and vessels: myocardial infarction, acute cerebrovascular accident, angina pectoris, atherosclerosis of the arteries of the lower limbs or serious renal damage, expressed by a strong decrease in filtration and/or significant loss of urine protein.
Arterial hypertension is divided into different degrees, depending on the maximum indicators of the measured blood pressure:
- The first degree. Sistolic blood pressure from 140 to 159 mm. Rt. Art. And/or diastolic - from 90 to 99 mm. Rt. Art.
- The second degree. Sistolic blood pressure from 160 to 179 mm. Rt. Art. And/or diastolic - from 100 to 109 mm. Rt. Art.
- The third degree. The systolic blood pressure is over 180 mm. Rt. Art. and/or diastolic over 110 mm. Rt. Art.
There is also an isolated form of arterial hypertension, in which only the figures of systolic pressure in the normal diastolic.
Symptoms
Often an increase in blood pressure is not accompanied by a deterioration of well -being and can go unnoticed for the patient, so it is so important to regularly measure blood pressure, in particular medium -age and older people.
The following symptoms can be the manifestations of hypertension:
- headache, mainly in the morning after the awakening;
- Bleeding from the nose;
- hemorrhage under the mucous membrane of the eye;
- violation of the heart rhythm;
- blurred vision, tremoli of flies;
- tinnitus.
A strong leap of blood pressure to high numbers, accompanied by a pronounced deterioration of well -being, is called hypertensive crisis. Very often, it occurs with an increase in systolic pressure of over 180 mm hg. Art. and/or diastolic over 120 mm hg. Art. At the same time, the patient has weakness, nausea, vomiting, who does not bring relief, compromised consciousness, anxiety and fear, muscle tremor, thoracic pain.
Complications
A stable increase in blood pressure with hypertension significantly increases the risk of cardiovascular diseases, including the patient's life. These include:
- acute brain circulation (race);
- Angina Pectoris, myocardial infarction;
- vascular dementia (dementia);
- Chronic renal and cardiac insufficiency;
- Atherosclerotic lesions of the vessels of the lower ends.
Diagnostics
The main symptom of hypertension is a stable increase in blood pressure, has revealed at least three dimensions in different days during a calm environment. In the first measurement of blood pressure in the hospital or clinic for the correctness of the results, it is important to respect the following rules:
- Before examining, the patient must sit for several minutes in a quiet room to calm down;
- The size of the tometer bracelet should correspond to the thickness of the arm and the device itself - to be attached to the level of the heart;
- Two measurements are performed with a 1-2 minutes interval on each hand, with a big difference in the numbers obtained, an additional measurement is made;
- In elderly patients, as well as people suffering from diabetes mellitus, or in case of suspicion of reducing blood pressure in the event of change in the body's position, the measurement is performed in the first and fifth minute in the upright position;
- In addition, heart rate is measured within 30 seconds.
The doctor in an interview with the patient clarifies at what age the pressure has started to increase, if there are symptoms such as snoring with respiratory stops in a dream, attacks of muscle weakness or sudden palpitations with sweating and headache and unusual impurities in the urine. It is also important to find out which medicines and biodes takes.
As part of the first phase of the exam, the following tests for hypertension are performed:
- Clinical blood test;
- General urine analysis, the detection of microalbumin in its parts in a time and daily;
- Biochemical blood test (cholesterol, lipoproteins to evaluate the risk of atherosclerosis, electrolytes in the blood - potassium, sodium, chlorine, calcium, as well as glucose and creatinine);
- Determination of the level of glycated hemoglobin;
- Determination of the concentration of hormones: thyroxine, triiodotironine and thyroid hormone -mmer, thyroid antibodies -peroxidase and thyroidoglobulin, aldosterone.
In the case of suspicion of a hereditary predisposition to the disease, it is possible to determine the polymorphisms of the genes associated with the development of arterial hypertension.
In order to clarify the risk factors for the development and identification of cardiovascular pathologies existing for hypertension, instrumental diagnostic methods are used:
- Daily monitoring of blood pressure;
- Electrocardiographic study;
- echocardiography;
- Daily monitoring of Holter;
- Duplex scan of brachyocephalic, kidney or iliac arteries;
- Ultrasound study of the kidneys and adrenal glands;
- Inspection of the bottom of the eyes.
With hypertension, blood pressure control at home is important to maintain a diary in which it is necessary to correct all the results of the measurements of the time, taking drugs and stress episodes that can cause an increase in blood pressure. At the same time, the measurements must be performed in a sitting position, after several minutes of rest, holding the hand on the same level with the heart.
Treatment
With a moderate and low risk of cardiovascular complications, the patient is recommended only to change in lifestyle, correction of the diet, weight loss, increase in physical activity and special gymnastics for hypertension, refusal of bad habits against the background of regular blood pressure. Often these measures are sufficient to normalize blood pressure.
The hypertension diet involves the limitation of table salt, caffeine, sharp, salty, smoked and spicy and spicy, produced with a high content of fat, offal, pastry with oil cream and alcoholic beverages. It is allowed to use no more than 5 g of salt per day outside the exacerbation of the disease. The recommended daily fluid speed is 1-1, 2 liters.
In the case of a non -successful drug treatment for several months, as well as with a high risk of complications, they resort to hypotensive therapy using hypertension drugs, whose purpose is a decrease in blood pressure of less than 140/90 mm. Rt. Art. For patients with diabetes or people who already suffer from pathologies of the cardiovascular system, the target pressure level is even less than 13/80 mm. Rt. Art.
The modern pharmacological treatment of hypertension includes a combination of two or more drugs of the following groups:
- Calcium antagonists;
- Angiotenzinoproding enzyme inhibitors;
- blockers for angiotensin II;
- diuretics (diuretics);
- B-blockers;
- Alpha-blockers.
The vast majority of them is produced in the form of tablets by hypertension.
Prevention
The prevention of the exacerbations of hypertension includes timely diagnosis and therapy for diseases of cardiovascular, nervous, urinary and endocrine systems, incessantly followed by the doctor's recommendations, including non -union treatment and drugs, as well as the regular measurement of blood pressure.