What is dangerous arterial hypertension: symptoms, causes and treatment

Arterial hypertension (AH, hypertension) is one of the most important socio-economic and health problems of our time.

This is due not only to the widespread spread of the disease among different age groups of the population, but also to the high rates of death from severe complications, disability, and arterial hypertension in the absence of timely treatment.

People who are prone to high blood pressure are advised to take a measurement with both hands. Recent studies have shown that arterial hypertension can be confirmed by a difference of 10-15 mmHg in the values measured in different hands. This sign (difference in indications) indicates high blood pressure with a probability of up to 96%.

Which?

Simply put, arterial hypertension is a disease of the cardiovascular system in which blood pressure in the arteries of the systemic (large) circulation continues to rise.

Blood pressure can be divided into systolic and diastolic pressure:

1. Systole. According to the first, upper number, the level of blood pressure is determined at the moment when the heart is compressed and the blood is expelled from the artery. This indicator depends on the strength of the heart's contraction, the resistance of the walls of the blood vessels, and the frequency of the contractions.
2. diastolic. The second, lower number determines the blood pressure at the moment the heart muscle relaxes. Indicates the level of peripheral vascular resistance.

Normally, blood pressure changes constantly. They physiologically depend on a person’s age, gender, and condition. During sleep, the pressure decreases, leading to an increase in physical activity or stress.

The average normal blood pressure of a twenty-year-old man is 120/75 mmHg. Art. , Forty years old - 130/80, over fifty years old - 135/84. In addition to sustained 140/90 data, we are talking about arterial hypertension. Statistics show that about 20 to 30 percent of the adult population is affected by this disease. As you age, the prevalence rate increases inexorably, and by the age of 65, 50 to 65 percent of the elderly suffer from the disease.

Classification

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

1. Essential arterial hypertension (primary). The exact cause of the development is difficult to determine due to the lack of visible preconditions;
2. Symptomatic (secondary). The increase in pressure is seen as a consequence of the development of a certain disease, which is one of the signs. The secondary type of the disease is divided into the following types depending on the cause of development: endocrine, kidney, drug-induced, hemodynamic, neurogenic.

Considering the level of blood pressure, the pathology is divided into the following types:

1. Border. The pressure periodically rises to 140-149/90, then goes down, normalizes;
2. Systole isolated. The top score increases (reaches 140 and above). However, it remains within and below the bottom 90.

Given the nature of the pathology, the experts identified the following types:

1. Temporary. The patient sometimes has high blood pressure. This condition can last for hours or days. The pressure returns to normal without the use of medication;
2. Unstable. It manifests itself in the initial stage of pathology development. This condition is considered a borderline case because the pressure surges are insignificant and unstable. The pressure usually returns to normal;
3. Stable arterial hypertension. Supportive therapy is needed to reduce the increase in pressure;
4. Crisis. Periodic hypertensive crises are typical;
5. Malicious. The pressure rises to severe levels, and high blood pressure develops quickly, causing severe complications. Death is possible.

Risk factors

Currently, the severity of the disease described depends directly on the risk facts. The risk lies in the development of cardiovascular complications underlying the high blood pressure. Prognosis of the consequences of arterial hypertension is diagnosed based on the complications presented. The following risk factors impair the course and prognosis of the disease:

• age - after 50 years for men and 60 years for women;
• smoking;
• high cholesterol;
• hereditary factor;
• obesity;
• hypodynamics;
• diabetes.

The risk factors presented can be eliminated (corrected) and may not be corrected. The first type of risk factors are characterized by the presence of diabetes mellitus, high cholesterol, smoking, and physical inactivity. Uncorrected risk factors include race, family history, and age.

Seriousness

The disease also has an international classification developed depending on the degree of arterial hypertension:

Grade 1 arterial hypertension

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 mmHg. Art. Hypertensive crises are rare and are usually triggered by a sharp change in atmospheric pressure or emotional overload. There are no complications from the work of the target organs.

Grade 2 arterial hypertension

It is characterized by an increase in blood pressure to 160-179 / 100-109 mmHg. Art. With such indicators, patients most often seek medical attention for the first time, as these are considered to be the peak of inattention. Grade 2 arterial hypertension is usually manifested by severe headache, weakness, dizziness, and deterioration in well-being during episodes of increased pressure.

Grade 3 arterial hypertension

It is characterized by an increase in blood pressure to 180/110 mm Hg or higher. Art. Sometimes these numbers can reach full extent (250/160 mm Hg and higher), but in this case there is a real danger to human health and life. Patients with grade 3 arterial hypertension should be under medical supervision, take any antihypertensive medication prescribed to them, and have a tonometer (mechanical or electronic) provided at home.

Symptoms of arterial hypertension

Arterial hypertension alone has no symptoms. Most adult patients do not complain of anything at all in this disease, high blood pressure is accidentally detected.

The clinical manifestations of arterial hypertension depend on which organs are currently involved. Adults with benign hypertension may complain of the following symptoms:

1. Headache - can be the first and foremost symptom. There are several types of headaches:
   • it is characterized by a dull, non-intense, heavy sensation in the forehead and neck. It most often appears at night or in the morning, intensifying with a sharp change in the position of the head and even a slight physical exertion. Such pain is caused by a violation of the venous outflow of blood from the vessels of the skull, their overflow, and stimulation of pain receptors;
   • liquor - scattered, scattered in the head, may be throbbing. Any tension will increase the pain. It is most common in the late stages of high blood pressure or in the presence of pulsed hypertension. As a result, the vessels were sharply overflowed with blood and difficult to drain;
   • ischemic - dull or cracked, with dizziness and nausea. Occurs with a sharp rise in blood pressure. Sharp vasospasm occurs, causing the blood supply to the brain tissues to be disrupted.
2. Pain in the heart region - cardialgia, non-ischemic in nature, coronary arteries are fine, while pain is not relieved by sublingual administration of nitrates (nitroglycerin under the tongue) and can occur at rest and under emotional stress. Sport is not a provocative factor.
3. Shortness of breath - at first it may occur at rest only during exercise and when high blood pressure progresses. It is characterized by disorders of the heart.
4. Edema - most commonly found on the legs in the systemic circulation due to stagnation of blood, sodium and water retention, or impaired kidney function. In children, haematuria and hypertension are associated with concomitant edema of glomerulonephritis, which is very important to note during the differential diagnosis.
5. Impaired vision - manifests as blurred vision, the appearance of a veil, or flickering flies. Occurs due to damage to the blood vessels of the retina.

Chronic arterial hypertension causes renal damage with the development of renal failure and appropriate complaints of renal genesis, which will be discussed below. Chronic hypertension also leads to the development of dyscirculatory encephalopathy, characterized by decreased memory, attention and performance, sleep disturbances (increased daytime sleepiness, nighttime insomnia), dizziness, tinnitus and depressed mood.

During the collection of the anamnesis, the family anamnesis and the causes of arterial hypertension of close relatives should be recorded in the anamnesis, the time of the onset of the first clinical symptoms should be clarified, and the accompanying diseases should be noted.

Hypertensive crisis

It is a state of emergency characterized by a sudden rise in blood pressure to high numbers and is characterized by a sharp deterioration in the blood supply to all internal organs, especially vital organs.

Occurs when the body is exposed to various harmful factors that are unpredictable, which is why uncontrolled high blood pressure is dangerous. The urgency of the problem also lies in the fact that failure to provide timely emergency care can be fatal. For emergency care, the patient should be taken immediately to a hospital where their blood pressure will be quickly reduced with medication.

Students in health care facilities in the Department of Internal Medicine Propaedeutics are studying first aid for hypertensive crises, so it would be best if a random passer-by did not try to help but call an ambulance.

Diagnostics

The three main diagnostic methods that can be used to determine the presence of high blood pressure in a person are:

1. Measurement of blood pressure,
2. physical analysis,
3. Electrocardiogram recording.

Blood pressure control

Blood pressure is measured with a special device - a tonometer, which is a combination of a blood pressure monitor and a stethoscope. In addition, there are currently special electronic devices that measure blood pressure, heart rate, and allow blood pressure indicators to be entered into the device’s memory.

Medical history

The diagnosis of high blood pressure also includes an examination of the patient by a doctor. The doctor will find out from the patient what diseases he has had or is suffering from in the past. Risk factors (smoking, high cholesterol, diabetes) are assessed, plus the so-calledhereditary history, that is, whether the patient's parents, grandparents, and other close relatives had high blood pressure.

Physical analysis

Physical examination of the patient primarily involves examination of the heart with a stethoscope. This method makes it possible to detect the presence of heart murmur, changes in characteristic sounds (amplification or, conversely, attenuation) and the appearance of atypical sounds. These data refer primarily to changes in cardiac tissue due to increased blood pressure and the presence of defects.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a method that allows you to record changes in the electrical potential of the heart over time on a special tape. Above all, it is an indispensable method for diagnosing various arrhythmias. In addition, the ECG can be used to determine the so-calledleft ventricular wall hypertrophy, characteristic of arterial hypertension.

echocardiography

In addition to these diagnostic methods, other methods are used, such as echocardiography (ultrasound of the heart), which allows you to determine structural abnormalities of the heart, changes in wall thickness, and ultrasound of the heart. the condition of the valves.

Arteriography

Arteriography, including aortography, is an X-ray method of examining the walls and lumen of arteries. This method makes it possible to identify the presence of atheromatous plaques in the wall of the coronary arteries (coronary angiography), the presence of aortic coarctation (congenital stenosis of the aorta in a certain area), and so on.

dopplerography

Dopplerography is an ultrasound method for diagnosing the condition of blood flow in blood vessels, both arteries and veins. In case of arterial hypertension, the doctor first checks the condition of the carotid arteries and cerebral arteries. Ultrasound is widely used for this purpose as it is completely safe to use and does not cause complications.

Blood chemistry

Biochemical blood tests are also used to diagnose high blood pressure. Above all, cholesterol levels and high, low, and very low-density lipoproteins are found to be indicators of a tendency to atherosclerosis. In addition, blood sugar levels are determined.

Kidney status is also used to diagnose high blood pressure, using methods such as a general urine test, a biochemical blood test (for creatinine and urea), and an examination of the kidneys and their ultrasound. utensils are used.

Thyroid ultrasound

Thyroid ultrasound and blood tests for thyroid hormones. These research methods help identify the role of the thyroid gland in causing high blood pressure.

How to treat arterial hypertension?

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

• age: 50 years for men, 60 years for women;
• family history: sudden myocardial infarction or death of one parent (before the age of 55 in men, before the age of 65 in women) or stroke before the age of 45, regardless of the sex of the parent;
• smoking (or have not smoked in the last three years);
• diabetes;
• 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 the treatment of arterial hypertension at home that all adults with high blood pressure should follow:

In mild, first-degree disease, non-pharmacological methods are used:

• Limiting salt intake to 5 g per day (you can read more about proper nutrition for high blood pressure in our separate article),
• normalization of weight with excess
• moderate physical activity 3-5 times a week (walking, running, swimming, physiotherapy exercises),
• give up smoking,
• reducing alcohol consumption,
• use of herbal sedatives for increased emotional irritability (e. g. , valerian decoction).

In the absence of efficacy of the above methods, patients with grade 1 arterial hypertension and grade 2 and 3 hypertension are switched to medication.

It should be noted that pharmacies currently offer a wide range of drugs for the treatment of arterial hypertension that are new and known for many years. Formulations containing the same active ingredient may be prepared under different trade names. It is quite difficult for a non-professional to understand them.

Diuretics are the drug of choice for the treatment of high blood pressure, especially in the elderly. The most common are thiazides.

Correction of risk factors is also important in the treatment of arterial hypertension:

• antiplatelet agents - acetylsalicylic acid, indicated for indications
• statins in the presence of atherosclerosis - even in the absence of contraindications;
• medicines that lower blood sugar in diabetes.

If the effect is unsatisfactory, 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-blocker (formation of heart block up to death)
• ACE inhibitor + sartan

You should see a doctor to treat and test your high blood pressure. Only after a complete examination by the specialist and analysis of the results of the examinations will he be able to correctly diagnose and prescribe the appropriate treatment.

Why is high blood pressure dangerous?

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

Although there are currently a large number of antihypertensive drugs that allow blood pressure to be maintained at an appropriate level, high blood pressure crises and complications such as heart failure (HF) and renal failure (RF), aortic and mitral regurgitation, cardiac aneurysm and aorta, MI(heart attack), stroke, etc. remains extremely high in patients with high blood pressure.

This is mainly due to the fact that many patients do not want to take systemic antihypertensive therapy because their hypertensive crisis was one-off and will not recur.

According to statistics, only about 40% of women and 35% of men receive medication for patients who are aware that they have arterial hypertension. However, due to the systematic use of antihypertensive therapy, monitoring of blood pressure indicators and regular doctor visits, and adherence to recommendations, only 15% of women and about five percent of men reach the required pressure level.

Although arterial hypertension is a controllable risk factor for the development of cardiovascular pathologies, such unfortunate indicators stem from the patient’s banal misunderstanding of the severity of the diagnosis and, consequently, the lack of a serious and responsible approach. treatment.

The most common serious complications from crises of hypertension are:

• stroke (about thirty percent of patients);
• pulmonary edema (twenty-three percent);
• hypertensive encephalopathy (16%);
• acute heart failure (fourteen percent);
• stroke (five percent of cases);
• dissection of the aortic aneurysm (2. 5%), etc.

It should be noted that in the absence of appropriate and systematic treatment of hypertension, 30-40% of patients die within three years of suffering from a severe (complicated) hypertensive crisis due to heart and kidney failure.

Comprehensive treatment, a responsible attitude to health, the systematic use of anti-arterial antihypertensive drugs, and the regulation of pressure make it possible to minimize these frightening numbers.

Prevention of arterial hypertension

Prevention of diseases is very important for people with a hereditary predisposition to high blood pressure and risk factors.

1. Above all, it is a regular cardiologist examination and adherence to the rules of proper lifestyle that will help to delay and often eliminate the disease of arterial hypertension. If your relatives have already had high blood pressure, you will need to rethink your lifestyle and radically change a number of habits and lifestyles that are considered risk factors.
2. You need to rethink your nutritional principles, stop eating salty and fatty foods, switch to a low-calorie diet that includes large amounts of fish, seafood, fruits and vegetables. Don’t get carried away by alcoholic beverages and especially beer. They contribute to obesity, uncontrolled consumption of table salt, and have a detrimental effect on the heart, blood vessels, liver and kidneys.
3. It is necessary to lead an active lifestyle, to move more, depending on age, it is ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually without overloading the body. Outdoor exercise is especially beneficial. Exercise strengthens the heart muscle and nervous system and helps prevent stress.
4. Try to surround a favorable psycho-emotional environment. Avoid conflicts if possible, keep in mind that a broken nervous system very often triggers the mechanism of arterial hypertension.
5. Quit smoking, the substances in nicotine cause changes in the walls of the arteries, increase their stiffness, so they can cause high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.

Thus, in short, the prevention of arterial hypertension involves regular cardiological examinations, a proper lifestyle, and an emotional background conducive to their environment.

Forecast for a lifetime

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

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

Extremely unfavorable course of arterial hypertension is observed in young people. There is a high risk of stroke, heart attack, heart failure, and sudden death.

Early treatment of arterial hypertension and careful adherence to all recommendations by the treating physician can slow the disease, improve patients' quality of life, and sometimes achieve long-term remission. .