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, disrupt the quality of life, and can be fatal.

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

Classification of arterial hypertension

4 risk groups of arterial hypertension are usually distinguished, depending on the probability 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 factors;
2 – the risk is within 10-20%, no more than 3 aggravating factors;
3 – risk 20-30%, more than 3 aggravating factors;
4 – the risk is higher than 30%, more than three aggravating factors and target organs are involved.

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 leads 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, several levels of blood pressure are distinguished, which are presented in Table 1.

No. 1table. Blood pressure levels:

Categories	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
Optimal	Under 120	Under 80
Normal	120-129	80-84
High normal	130-139	85-89
1st degree arterial hypertension	140-159	90-99
2 degree arterial hypertension	160-179	100-109
3 degree arterial hypertension	≥180	≥110
Isolated systolic hypertension	≥140	≤90

Causes of high blood pressure

The main risk factors for primary arterial hypertension are:

Gender and age. Men between the ages of 35 and 50 are most prone to developing the disease. In women, the risk of arterial hypertension increases significantly after menopause;
Hereditary tendency. The risk of the disease is very high in people whose first-degree relatives have suffered from the disease. If two or more relatives have had high blood pressure, the risk increases;
Increased psycho-emotional stress and stress. During psycho-emotional stress, a large amount of adrenaline is released, as a result of which the heart rate and the amount of pumped blood increase. When a person is under chronic stress, the increased strain leads to wear and tear on the arteries and the risk of heart and blood vessel complications increases;
Consumption of alcoholic beverages. In case of daily heavy alcohol consumption, the blood pressure rises by 5 mm Hg per year. Art. ;
Smoking. Tobacco smoke causes spasm of peripheral and coronary arteries. The wall of the artery is damaged by nicotine and other components, and atherosclerotic plaques form at the site of the damage;
Arteriosclerosis develops as a result of excessive consumption of foods containing cholesterol and smoking. Atherosclerotic plaques narrow the lumen of blood vessels and impede free blood circulation. This leads to arterial hypertension, which stimulates the progression of atherosclerosis;
Increased consumption of table salt provokes spasm of the arteries, retains fluid in the body, which together leads to the development of high blood pressure;
Being overweight leads to a decrease in physical activity. Clinical studies have shown that for every extra kilogram you gain 2 mm. rt. Art. blood pressure;
Physical inactivity increases the risk of developing high blood pressure by 20-50%.

Symptoms of arterial hypertension

The danger of high blood pressure is that it does not have any characteristic symptoms, but "kills" slowly, quietly. In most cases, the disease does not show any symptoms, it progresses and leads to fatal complications, such as a heart attack or stroke. If there are no symptoms, it is arterial hypertensiongoes unnoticed for decades.

The most common complaints of patients are:

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

However, the most important sign of hypertension is elevated blood pressure. Headaches can manifest as a feeling of the head being squeezed by a "hoop", accompanied by dizziness and nausea. They occur against the background of physical or nervous stress. If the pain persists for a long time, low mood, irritability and sensitivity to noise appear.

Intracranial hypertension

Headaches can often be caused by a cold, lack of sleep or overwork. It appears to be due to increased intracranial pressure. If the headache becomes persistent and severe, it indicates the need 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 causing increased intracranial pressure, as well as the stage of the disease and the speed of its development.

Moderate intracranial hypertension manifests as:

headache;
dizziness;
attacks of nausea and vomiting;
clouding of consciousness;
seizures

Intracranial hypertension: diagnosis

The types of pathological diagnosis are as follows:

measurement of intracranial pressure by inserting a needle into the fluid cavities of the skull or spinal canal with a pressure gauge connected to it.
following the degree of blood filling and expansion of the veins of the eyeball. If the patient's eyes are red, that is, the veins in the eyes are abundantly filled with blood and are clearly visible, we can speak of increased intracranial pressure;
ultrasound examination of cerebral vessels;
magnetic resonance and computer tomography: they examine the expansion of the fluid cavities of the brain and the degree of thinning of the chamber edges;
making an encephalogram.

Intracranial hypertension: treatment, drugs

Increased intracranial pressure can lead to a decrease in the patient's intellectual abilities and disruption of the normal functioning of internal organs. Therefore, this pathology requires immediate 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 formation of a brain tumor or hematoma, then surgical intervention is necessary. Removal of the hematoma or neoplasm leads to normalization of intracranial pressure.

Essential hypertension

Essential arterial hypertension is an increase in systolic blood pressure to 140 mm Hg during the contraction and ejection of blood. Art. and above this mark and/or the diastolic blood pressure at the moment of relaxation of the heart muscle to 90 mmHg. 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 (essential form) takes a leading place among all cases of high blood pressure. The incidence is 90%.

For children (up to 10 years of age), a pressure level exceeding 110/70 mmHg is considered dangerous. Art. , after 10 years – 120/80 mmHg. Confirmation of the diagnosis is confirmed by blood pressure measurement performed at least twice on different days within four weeks.

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

Causes of the disease

Despite all the modern advances in medicine, the causes of primary hypertension have not yet been established. 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 vascular tone is interrupted in the periphery;
nervous shocks, regular stress. In this case, a persistent focus of excitation is observed in the cerebral cortex, the prolonged spasm causes an increase in peripheral resistance, blood vessels lose their elasticity;
hereditary factor;
overweight: many overweight people attribute their obesity to dysfunction of the endocrine glands, put themselves on the "sick" list, and do not want to change their lifestyle. In fact, there may be no endocrine disorder;
sedentary lifestyle;
excessive consumption of the favorite coffee of many. At the same time, the level of caffeine in the blood increases, which prevents the blood vessels from relaxing and dilating normally. You must always remember: "what is good in moderation";
excessive salt consumption. It retains moisture in the body and leads to increased blood pressure. Japanese people are known to consume twice as much salt as Europeans, and essential hypertension is very common in the Japanese population;
Alcohol abuse and smoking lead to disruption of the normal regulation of vascular tone.

Treatment of essential hypertension

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

a special diet aimed at limiting the consumption of salt and foods rich in animal fats;
giving up bad habits, especially smoking and alcohol consumption;
relief from stress. In this case, yoga classes, self-training and sessions with a psychotherapist are very useful;
patients diagnosed with essential hypertension cannot work in conditions of strong noise and vibration;
avoid excessive physical activity: intense, exhausting treadmill workouts 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 lower blood pressure in several ways;
angiotensin 2 receptor blockers Medicines dilate blood vessels, thereby lowering blood pressure.
beta-blockers: this type of medicine relieves heart pain, slows the heartbeat and dilates the blood vessels;
calcium channel blockers: they 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 and its excretion 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. These also include medicines that lower the body's cholesterol level.

Portal hypertension

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

What is portal hypertension

Normally, the pressure in the portal zone is 7 mm. rt. Art. , in cases where this indicator exceeds 12-20 mm, congestion develops in the afferent veins and they expand. The thin walls of veins, unlike arteries, stretch under pressure and tear easily.

Portal hypertension: symptoms

The primary 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:

the indicators of laboratory tests change - they violate the norms for the content of platelets, leukocytes and erythrocytes;
the spleen is enlarged;
blood clotting worsens;
fluid accumulation in the abdominal area (ascites) is diagnosed;
varicose veins of the digestive system develop;
in many cases, patients experience bleeding and anemia.

In cirrhosis of the liver, in the early stages of portal hypertension, they manifest themselves in the deterioration of the general state of health, bloating and heaviness under the right rib. Then the patient experiences pain 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 total, there are 4 degrees of pathology:

Grade 1 – functional (initial);
Grade 2 - Medium. Moderate dilatation of the esophageal veins, accompanied by an enlarged spleen and ascites;
Grade 3 portal hypertension is a severe form of the pathology. At this stage, pronounced hemorrhagic and ascitic syndromes can be observed;
Grade 4 (complicated). The patient develops bleeding in the esophagus and stomach, gastropathy and spontaneous bacterial peritonitis.

Portal hypertension: diagnosis

The types of hospital diagnostics are as follows:

Ultrasound: makes it possible 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 accurately determined. In addition, ultrasound may show enlargement of the liver and spleen;
Doppler ultrasound: makes it possible to examine the structure of blood vessels and measure the speed of blood flow through them;
FGDS (fibrogastroduodenoscopy): allows identification of 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.

Sclerotherapy is about 80% effective. During the procedure, the drug is injected into the damaged veins using an endoscope. Thus, the lumen of the veins becomes clogged and their walls "stick together". This method of treatment is considered a classic.

Portal hypertension: prevention

Measures to prevent the development of the disease are as follows:

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

Measures to prevent liver disease include:

a full examination to diagnose liver disease at an early stage and start treatment;
strict adherence to all the doctor's recommendations;
complex therapy in a hospital environment under the strict supervision of doctors.

Measures to prevent bleeding are as follows:

regulation of blood clotting function;
sigmoidoscopy - i. e. examination of the sigmoid and rectum annually;
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 of the disease, we distinguish the following types of diseases:

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 in Itsenko-Cushing syndrome. In this case, the adrenal gland is involved;
Pheochromocytoma is a disease that affects the adrenal medulla. The cause of the 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 aldosterone levels to rise. As a result, blood potassium levels decrease and blood pressure increases;
thyroid diseases such as hyperparathyroidism, hyper- 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. It occurs with coarctation or stenosis of the aorta and aortic valve insufficiency;
in adults, arterial hypertension of central origin develops in brain diseases with a secondary disturbance of central regulation (stroke, encephalitis, head injury);
drug-induced high blood pressure may occur when taking oral contraceptives, non-steroidal anti-inflammatory drugs and glucocorticosteroids.

Diagnosing secondary hypertension is difficult, but several signs indicate it:

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

Diastolic hypertension

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

For people who have elevated diastolic pressure and do not have concomitant pathology, it is recommended to control their blood pressure and change their lifestyle:

regulates the quality of sleep;
do not drink red wine;
limit the number of cigarettes smoked per day;
avoid stress;
remove salt from the diet;
eat right;
maintain a normal weight;
do exercise or yoga.

Diastolic hypertension requires hospitalization if persistently high diastolic pressure is present. The underlying disease is treated, for example, by surgical correction of aortic valve disease. Doctors prescribe high blood pressure medications individually. The following tablets are used to treat high blood pressure:

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

Hypertensive crises

A hypertensive crisis is a condition when, in patients with primary or secondary arterial hypertension, an individually significant increase in blood pressure occurs, accompanied by the appearance or worsening of clinical symptoms, and requires rapidly regulated 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, extrasystole and agitation. Type 2 crisis (water-salt, norepinephrine) is associated with 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 the crisis.

In case of a complicated crisis, the airways are disinfected, the patient is supplied with oxygen, and venous access is provided. The blood pressure-lowering drug is selected on a differential basis and is administered intravenously. They lower the pressure quickly, then switch to oral medications within 2-6 hours to bring it down to 160/100 mmHg. The patient is treated in a special hospital.

Diagnosis of arterial hypertension

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

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

general blood and urine analysis;
blood sugar;
creatinine, uric acid, and potassium levels;
lipid profile;
C-reactive protein content in blood serum;
bacterial urine culture.
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 examines the fundus and assesses the presence and degree of microproteinuria. All hospitalized patients undergo a daily blood pressure measurement.

Treatment of arterial hypertension

The goal of treating patients with high blood pressure 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 management of risk factors. In patients with kidney disease and diabetes, the pressure should be reduced to 130/80 mm Hg. This improves the quality of life and eliminates the symptoms of the disease.

Prevention of arterial hypertension

In order to prevent the development of arterial hypertension, it is necessary to:

organizing proper nutrition;
avoid emotional stress and stress;
use of rational physical activity;
normalizes sleep habits;
watch your weight;
active rest;
stop smoking and drinking alcohol;
Visit your doctor regularly and have an examination.

High blood pressure leads to 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 pressure changes should be avoided.

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