Hypertension

4 December 2024

In the 21st century, arterial hypertension remains an important medical and social problem, because it is full of complications that lead to disability, impair the quality of life and can be fatal.

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

Classification of arterial hypertension

It is common to distinguish 4 risk groups for 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:

1 – risk less than 15%, without aggravating factors;
2 – the risk is within 10-20%, no more than 3 aggravating factors;
3 – risk of 20 to 30%, more than 3 aggravating factors;
4 – risk 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 vision (degenerative changes and retinal detachment, bleeding, blindness);
blood (increased glucose level leading to central nervous system damage);
heart (left ventricular hypertrophy, myocardial infarction);
kidneys (proteinuria, kidney failure).

Depending on the severity of the cardiovascular risk, there are several levels of blood pressure, shown in table no. 1.

Table no. 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 of the 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 are:

Gender and age. Men aged 35 to 50 are most prone to developing 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 suffered from this disease. If two or more relatives have hypertension, the risk increases;
Increased psycho-emotional stress and stress. During psychoemotional stress, a large amount of adrenaline is released, under the influence of which the heart rate and the volume of pumped blood increase. If a person is in a state of chronic stress, then the increased load leads to wear and tear of the arteries and the risk of complications on the heart and blood vessels increases;
Drinking alcoholic beverages. Daily consumption of strong alcohol increases blood pressure by 5 mmHg per year. Art. ;
Smoking. Tobacco smoke causes spasm of peripheral and coronary vessels. The wall of the artery is damaged by nicotine and other components, and at the places of damage, atherosclerotic plaques form;
Atherosclerosis 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 causes spasm of arteries, retains fluid in the body, which together leads to the development of hypertension;
Excess body weight leads to reduced physical activity. Clinical tests have shown that for every extra kilogram, there is 2 mm. capeArt. 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 characteristic symptoms, but slowly and quietly "kills". In most cases, the disease does not show any signs, progresses and leads to fatal complications such as myocardial infarction or stroke. When it is asymptomatic, arterial hypertension can remain undetected for decades.

The most common complaints of patients are:

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

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

Intracranial hypertension

Often a headache can be caused by a cold, lack of sleep or overwork. It occurs due to increased intracranial pressure. If the headaches become permanent and severe, it is a signal to go to the hospital.

Intracranial hypertension: symptoms in adults and children

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

Moderate intracranial hypertension manifests as:

headaches;
dizziness;
attacks of nausea and vomiting;
clouding of consciousness;
attacks

Intracranial hypertension: diagnosis

Types of pathology diagnostics include:

measuring intracranial pressure by inserting a needle into the liquid cavities of the skull or spinal canal with a manometer attached to it.
monitoring the degree of blood filling and expansion of the veins of the eyeball. If the patient has red eyes, i. e. the eye veins are abundantly 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 rarefaction of the edges of the ventricles, are examined;
performing an encephalogram.

Intracranial hypertension: treatment, drugs

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

Treatment can be carried out only if the causes of the pathology are correctly diagnosed. For example, if intracranial hypertension occurs due to the development of a brain tumor or hematoma, then 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 during cardiac contraction and blood ejection to 140 mmHg. Art. and above this mark and/or diastolic blood pressure at the moment of relaxation of the heart muscle up to 90 mmHg. Art. and more.

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

In children (up to 10 years), a pressure level exceeding 110/70 mm Hg is considered dangerous. Art. , after 10 years – 120/80 mm Hg. The diagnosis is confirmed in cases of 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 disease

Despite all modern advances in medicine, the causes of primary hypertension have not yet been determined. 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, due to which the vascular tone in the periphery is disturbed;
nervous shocks, regular stress. In this case, a permanent focus of excitation is observed in the cerebral cortex, a prolonged spasm causes an increase in peripheral resistance, blood vessels lose elasticity;
hereditary factor;
overweight: many overweight people attribute their obesity to disorders of the endocrine glands, put themselves on the "sick" list and do not want to change anything in their lifestyle. In fact, there may not be any endocrine disruption;
sedentary lifestyle;
excessive consumption of coffee, the favorite of many. At the same time, the level of caffeine in the blood increases, which prevents the normal relaxation and expansion of blood vessels. Always remember: "what is good in moderation";
excessive salt consumption. It retains moisture in the body and leads to an increase in blood pressure. Japanese people are known to consume twice as much salt as Europeans, and essential hypertension is very common among the Japanese population;
Alcohol abuse and smoking lead to disturbances in 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. In the initial stages, patients are prescribed drug-free therapy, which includes:

a special diet aimed at limiting the consumption of salt and foods rich in animal fat;
giving up bad habits, especially smoking and alcohol abuse;
stress relief. In this case, yoga classes, auto-training and sessions with a psychotherapist are very helpful;
patients diagnosed with essential hypertension should not work in conditions of strong noise and vibration;
avoiding 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 huge number of drugs that lower blood pressure in several ways at the same time;
Angiotensin 2 receptor blockers Medicines dilate blood vessels, which lowers blood pressure;
beta blockers: this type of drug relieves heart pain, slows the heartbeat and dilates blood vessels;
calcium channel blockers: they slow down the penetration of calcium into the tissues of blood vessels and the heart, slow down the work of the heart, 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. This is a phenomenon of elevated blood pressure in the portal vein caused by obstruction of blood flow from the vein.

What is portal hypertension

Normally, the pressure in the portal zone is 7 mm. capeArt. , in cases where this indicator exceeds 12-20 mm, stagnation is created 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:

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 abdominal area (ascites) is diagnosed;
dilated veins of the digestive tract develop;
in many cases patients have bleeding and anemia.

In the early stages, the signs of portal hypertension in cirrhosis of the liver are manifested in the form of deterioration of general health, bloating and heaviness under the right rib. Then the patient experiences pain in the area under the right rib, the liver and spleen enlarge, and the normal functioning of the digestive tract is disturbed.

Portal hypertension: degrees

In total, there are 4 degrees of pathology:

1st degree – functional (initial);
2nd degree – moderate. Follows moderate dilatation of esophageal veins, enlarged spleen and ascites;
Portal hypertension of the 3rd degree is a severe form of pathology. In this phase pronounced hemorrhagic and ascitic syndromes are observed;
4th degree (complicated). The patient has bleeding in the esophagus and stomach, gastropathy and spontaneous bacterial peritonitis.

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 accurately determined. Also, an ultrasound scan can reveal enlargement of the 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 efficiency of sclerotherapy is about 80%. The procedure involves injecting medicine into the damaged veins using an endoscope. Thus, the lumen of the veins is blocked and their walls are "glued". This method of treatment is considered classic.

Portal hypertension: prevention

Measures to prevent the development of the disease include:

maintenance of proper nutrition and diet regime;
Playing sports;
vaccinations against viral hepatitis;
refusal to abuse alcoholic beverages;
avoiding exposure to harmful production factors in the form of poisoning by toxic substances.

Preventive measures for liver diseases are:

a complete examination to establish a diagnosis in the early stages of liver disease and start treatment;
strict compliance with all doctor's recommendations;
complex therapy in hospital conditions under the strict supervision of a doctor.

Measures to prevent bleeding include:

control 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, the following types of diseases are distinguished:

renal hypertension is caused by 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 medulla is affected;
Pheochromocytoma is a disease that affects the medulla of the adrenal gland. It is the cause of a malignant form of arterial hypertension. The tumor compresses the outer layer of the adrenal gland, 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 an increase in aldosterone levels. As a result, blood potassium levels decrease and blood pressure increases;
thyroid diseases such as hyperparathyroidism, hyper- and hypothyroidism are the cause of secondary arterial hypertension;
hemodynamic or cardiovascular arterial hypertension occurs as a result of the involvement of large blood vessels in the pathological process. It occurs with coarctation or narrowing of the aorta and aortic valve insufficiency;
arterial hypertension in adults of central origin develops in brain diseases with a secondary disorder 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:

high blood pressure in young people;
acute sudden onset of the disease immediately with high blood pressure;
failure to respond 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 the diastolic value is greater than 90 mm Hg. An increase in diastolic pressure to 90 mm Hg does not pose a danger to a person who does not have a somatic pathology.

People who have elevated diastolic pressure and do not have accompanying pathologies are recommended to control their blood pressure and change their lifestyle:

they regulate the quality of sleep;
do not drink red wine;
limit the number of cigarettes smoked per day;
avoid stress;
eliminate salt from the diet;
eat right;
maintain a normal weight;
do physical exercises or yoga.

When diastolic hypertension occurs, hospital treatment is required 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 condition of a single 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 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, extrasystole and agitation. A type 2 crisis (aqueous salt, norepinephrine) has the following symptoms:

dominant increase in diastolic pressure with decrease in pulse pressure;
swelling of the face, legs, hands;
noticeable decrease in diuresis before the crisis.

In case of a complicated crisis, the respiratory tract is repaired, the patient is given oxygen and venous access is performed. The choice of an antihypertensive drug is approached in a differentiated way, and it is administered intravenously. They quickly reduce the pressure, and then within 2-6 hours switch to oral medications, which reduce it to 160/100 mmHg. The patient was hospitalized in a specialized hospital.

Diagnosis of arterial hypertension

It is very important to know how to measure blood pressure, only then can hypertension be diagnosed. The exercise begins with an explanation of the person's behavior during the procedure, then shows how to properly place the cuff and record the indicators. It depends on which device measures the pressure: mechanical or electronic.

It is necessary to perform laboratory tests such as:

general analysis of blood and urine;
blood glucose level;
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 kidneys and adrenal glands;
Ultrasound of renal and brachycephalic arteries.

The ophthalmologist will examine the fundus and assess the presence and degree of microproteinuria. All hospital patients have their blood pressure monitored daily.

Treatment of arterial hypertension

The goal of treating every 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, i. e. 140/80 mmHg. and addressing risk factors. In patients suffering from kidney disease and diabetes, the pressure must be reduced to 130/80 mmHg. This will improve the quality of life and remove the symptoms of the disease.

Prevention of arterial hypertension

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

organize a proper diet;
avoid emotional stress and stress;
use rational physical activity;
normalize sleep patterns;
track your weight;
active vacation;
stop smoking and drinking alcohol;
Visit your doctor regularly and get tested.

Arterial hypertension leads to disability and death. The disease is successfully treated by doctors. The 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 schedule an appointment with a cardiologist and answer all your questions.