What is dangerous arterial hypertension: symptoms, causes and treatment

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

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

People prone to high blood pressure are advised to measure on both hands. Recent studies have shown that arterial hypertension can be confirmed with a difference in reading on different arms of 10 - 15 mm Hg. This sign (difference in indications) has a probability of establishing hypertension of up to 96%.

What is it?

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

Blood pressure is divided into systolic and diastolic:

1. Systolic. According to the first, above number, the level of blood pressure is determined at the moment of compression of the heart and expulsion of blood from the artery. This indicator depends on the force with which the heart contracts, the resistance of the walls of blood vessels and the frequency of contractions.
2. diastolic. The second, lower number determines the blood pressure at the moment when the heart muscle relaxes. Indicates the level of peripheral vascular resistance.

Normally, blood pressure readings are constantly changing. They physiologically depend on the age, sex and condition of the person. During sleep, the pressure decreases, physical activity or stress leads to its increase.

The average normal blood pressure in a 20-year-old is 120/75 mm Hg. Art. , forty years - 130/80, over fifty - 135/84. With persistent figures of 140/90, we are talking about arterial hypertension. Statistics show that about 20-30 percent of the adult population suffers from this disease. With age, the prevalence rate inevitably increases and by the age of 65, 50-65 percent of the elderly suffer from this disease.

Classification

Depending on the origin of the pathology, the following types are distinguished:

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

If we take into account the level of blood pressure, the pathology is divided into the following types:

1. The border. The pressure occasionally rises to 140 - 149/90, then drops, normalizes;
2. Systolic isolated. There is an increase in the above indicator (reaches 140 and more). At the same time, the lower remains within 90 and below.

Taking into account the nature of the pathology, experts have identified the following types:

1. Transient. The patient has occasional high blood pressure. This condition can last for hours or days. The pressure returns to normal without the use of medication;
2. Labile. It is manifested in the initial phase of pathology development. This condition is considered borderline, because the pressure jumps are insignificant, unstable. The pressure usually normalizes on its own;
3. Stable arterial hypertension. The increase in pressure is persistent, supportive therapy is needed to reduce it;
4. Crisis. Periodic hypertensive crises are characteristic;
5. Malignant. The pressure rises to serious levels, hypertension develops quickly, causing severe complications. Possible death.

Risk factors

Currently, the severity of the described disease directly depends on the risk facts. The risk lies in the creation of cardiovascular complications on the background of high blood pressure. Taking into account the presented complications, the prognosis of the consequences of arterial hypertension is set. There are the following risk factors that worsen the course of the disease and its prognosis:

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

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

Seriousness

There is also an international classification of diseases, developed depending on the degree of arterial hypertension:

Grade 1 arterial hypertension

This phase of the disease is characterized by a mild course of the disease: the pressure during the day increases by 20-30 units and usually does not exceed 180/115 mm Hg. Art. Hypertensive crises are rare and are provoked, as a rule, by a sharp change in atmospheric pressure or emotional overload. There are no complications in the work of the target organs.

Grade 2 arterial hypertension

It is characterized by an increase in blood pressure to levels of 160-179 / 100-109 mm Hg. Art. With such indicators, patients usually go to the doctor for the first time, because considering them the norm is the culmination of inattention. Grade 2 arterial hypertension is usually manifested by severe headache, weakness, dizziness, and worsening of well-being during episodes of high blood pressure.

Grade 3 arterial hypertension

It is characterized by an increase in blood pressure to levels of 180/110 or more mm Hg. Art. Sometimes these figures can reach completely too high (250/160 mm Hg and more), but in this case there is a real threat to human health and life. A patient with grade 3 arterial hypertension must be under the supervision of a doctor, take all antihypertensive drugs prescribed to him and be sure to have a tonometer (mechanical or electronic) at home.

Symptoms of arterial hypertension

Arterial hypertension itself has no symptoms. Most adult patients with this disease do not complain about anything, high blood pressure is discovered by accident.

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

1. Headache - can be the first and main symptom. There are several types of headaches:
   • blunt, not intense, characterized by a feeling of heaviness in the forehead and nape. It appears most often at night or in the morning, increases with a sharp change in the position of the head, and even mild physical exertion. Such pain is caused by violation of the venous outflow of blood from the blood vessels of the skull, their overflow and stimulation of pain receptors;
   • liqueur - shooting diffusely over the head, may pulsate. Each tension causes an increase in pain. It most often occurs in the late stages of hypertension or in the presence of pulse hypertension. As a result, the veins are sharply filled with blood and its outflow is difficult;
   • ischemic - dull or shooting nature, accompanied by dizziness and nausea. It occurs with a sudden rise in blood pressure. There is a sharp vasospasm, which disrupts the blood supply to the brain tissues.
2. Cardiac pain - cardialgia, is not ischemic in nature, coronary vessels are normal, while pain is not stopped by sublingual administration of nitrate (nitroglycerin under the tongue) and can occur both at rest and under emotional stress. . Sports activities are not a provoking factor.
3. Shortness of breath - initially occurs only when playing sports, with the progression of hypertension can occur at rest. It characterizes heart dysfunction.
4. Edema - most often occurs on the legs due to stagnation of blood in the systemic circulation, sodium and water retention or impaired kidney function. Occurrence in children simultaneously with edema of hematuria and hypertension is characteristic of glomerulonephritis, which is very important to remember when making a differential diagnosis.
5. Visual impairment - manifests itself in the form of blurred vision, the appearance of a veil or flickering flies. It occurs due to damage to the blood vessels of the retina.

Chronic arterial hypertension causes kidney damage with the development of renal failure and corresponding renal genesis disorders, which will be discussed below. Chronic hypertension also leads to the development of dyscirculatory encephalopathy, which is characterized by decreased memory, attention and performance, sleep disturbance (increased daytime sleepiness, combined with insomnia at night), dizziness, tinnitus, and depressed mood.

When collecting the anamnesis, it is necessary to record the family anamnesis and the causes of arterial hypertension in close relatives, to clarify the time of appearance of the first clinical symptoms, to observe the accompanying diseases.

Hypertensive crisis

This is an emergency consisting of a sudden rise in blood pressure to high numbers and is characterized by a sudden deterioration in the blood supply to all internal organs, especially vital ones.

It occurs when the organism is exposed to various unfavorable factors, which cannot be predicted, which is why uncontrolled hypertension is dangerous. The urgency of the problem is also in the fact that in the absence of timely emergency care, a fatal outcome is possible. In order to provide emergency care, the patient must be taken immediately to a hospital, where his blood pressure is quickly reduced with medication.

Students of medical institutes are studying first aid for a hypertensive crisis at the Department of Propaedeutics of Internal Medicine, so it would be best if a passer-by did not try to provide help, but called an ambulance.

Diagnosis

The three main diagnostic methods that allow you to determine the presence of hypertension in a person are:

1. Blood pressure measurement,
2. review,
3. Electrocardiogram recording.

Blood pressure control

Blood pressure is measured using a special device - a tonometer, which is a combination of a pressure gauge and a phonendoscope. In addition, there are currently special electronic devices that measure blood pressure, pulse rate, and also allow you to enter blood pressure indicators in the device's memory.

Medical history

The diagnosis of hypertension includes an examination of the patient by a physician. The doctor finds out from the patient which diseases he has suffered from before or which ones he is currently suffering from. Risk factors (smoking, high cholesterol, diabetes) are assessed, plus the so-calledhereditary history, ie whether the patient's parents, grandparents and other close relatives suffered from hypertension.

Overview

The physical examination of the patient includes, above all, the study of the heart with a phonendoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic tones (amplification or, conversely, attenuation), as well as the appearance of non-characteristic sounds. These data, first of all, speak about the changes that occur in the heart tissue due to high blood pressure, as well as the presence of defects.

electrocardiogram (ECG)

An electrocardiogram (ECG) is a method that allows you to record changes in the electrical potentials of the heart over time on a special tape. This is an indispensable method for diagnosing, above all, various cardiac arrhythmias. In addition, the ECG allows you to determine the so-called. left ventricular wall hypertrophy, which is typical of arterial hypertension.

echocardiography

In addition to these diagnostic methods, other methods are used, for example, echocardiography (ultrasound examination of the heart), which allows you to determine the presence of defects in the structure of the heart, changes in the thickness of its walls and valve condition.

Arteriography

Arteriography, including aortography, is an X-ray method for examining the condition of artery walls and their lumens. This method allows you to identify the presence of atheromatous plaques in the wall of the coronary arteries (coronary angiography), the presence of aortic coarctation (congenital narrowing of the aorta in a certain area), etc.

dopplerography

Doppler is an ultrasound method for diagnosing the state of blood flow in the veins, both in the arteries and in the veins. In arterial hypertension, first of all, the doctor checks the condition of the carotid arteries and cerebral arteries. Ultrasound is widely used for that, because it is absolutely safe to use and does not cause complications.

Blood chemistry

A biochemical blood test is also used in the diagnosis of hypertension. First of all, it turns out that the levels of cholesterol and lipoproteins are high, low and very low density, because they are an indicator of the tendency towards atherosclerosis. In addition, blood sugar levels are determined.

In the diagnosis of hypertension, the study of the condition of the kidneys is also used, for which methods such as general urine analysis, biochemical blood test (for creatinine and urea), as well as ultrasound of the kidneys and their vessels are used.

Thyroid ultrasound

Thyroid ultrasound and blood test for thyroid hormones. These research methods help to discover 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 overall risk of the patient from cardiovascular disease. To assess this risk, it takes into account certain factors:

• age: 50 years for men, 60 years for women;
• family history: sudden heart attack or death of one of the parents (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 parents;
• smoking (or non-smoking in the last three years);
• diabetes;
• LDL cholesterol levels above 1. 60 g / l or LDL cholesterol levels below 0. 440 g / l;
• abdominal obesity, kidney failure, lack of regular exercise or excessive alcohol consumption.

General principles for the treatment of arterial hypertension at home, which should be followed by all adults with high blood pressure:

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

• limiting salt intake to 5g per day (you can find more about proper nutrition in high blood pressure in our special article),
• normalization of weight with its excess,
• moderate physical activity 3-5 times a week (walking, running, swimming, physiotherapy exercises),
• to quit smoking
• reduction of alcohol consumption,
• the use of herbal sedatives for increased emotional irritability (for example, valerian decoction).

In the absence of the effect of these methods in the treatment of grade 1 arterial hypertension, as well as patients with grade 2 and 3 hypertension, they switch to medication.

It should be noted that pharmacies currently offer a wide range of different drugs for the treatment of arterial hypertension, both new and known for many years. Preparations with the same active substance can be produced under different trade names. They are quite difficult for a non-specialist to understand.

Diuretics are the drugs of choice for the treatment of hypertension, especially in the elderly. Thiazides are the most common.

Also, in the treatment of arterial hypertension, it is important to correct risk factors:

• antiplatelet agents - acetylsalicylic acid, used according to indications,
• statins in the presence of atherosclerosis - also in the absence of contraindications;
• drugs that lower blood glucose levels in the presence of diabetes.

If the effect is insufficient, 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 (possible development of heart blocks to death)
• ACE inhibitor + sartan

It is necessary to visit a doctor for the treatment and examination of hypertension. Only a specialist, after a complete examination and analysis of the examination results, will be able to correctly diagnose and prescribe competent treatment.

Why is hypertension dangerous?

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

Despite the fact that there are currently a huge number of antihypertensive drugs that allow you to maintain adequate blood pressure, the incidence of hypertensive crises and complications such as heart failure (HF) and renal failure (RF), aortic and mitral valve regurgitation, aneurysms, heart and aortic aneurysmsIM (heart attacks), strokes, etc. in patients with hypertension it remains extremely high.

This is primarily due to the fact that many patients do not want to take antihypertensive therapy systematically, believing that the hypertensive crisis that has developed in them was unique and that it will not happen again.

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

Despite the fact that arterial hypertension is one of the controlled risk factors for cardiovascular pathologies, such unfortunate indicators are the result of a banal misunderstanding of the seriousness of the patient's diagnosis, and thus the lack of a serious and responsible approach to diagnosis. treatment.

The most common severe complications caused by crises of hypertensive origin are:

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

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

Comprehensive treatment, responsible approach to one's health, systematic use of drugs against arterial hypertension and control of blood pressure, enable these frightening numbers to be reduced to a minimum.

Prevention of arterial hypertension

For people with a hereditary predisposition to arterial hypertension and burdened with risk factors, disease prevention is of great importance.

1. First of all, this is a regular check-up with a cardiologist and adherence to the rules of proper lifestyle, which will help to delay and often eliminate the disease of arterial hypertension. If you have a history of relatives with hypertension, you should reconsider your lifestyle and radically change many of the habits and lifestyle that are risk factors.
2. You should reconsider the principles of your diet, 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 with 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, move more, depending on the age, this is ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually, without overloading the body. Exercising outdoors is especially helpful. Physical activity strengthens the heart muscle and nervous system and helps prevent stress.
4. Try to have a favorable psycho-emotional environment around you. If possible, avoid conflicts, remember that a broken nervous system very often triggers the mechanism for the development of arterial hypertension.
5. Stop smoking, the substances contained in nicotine cause changes in the walls of arteries, increase their stiffness, so they can be the culprits of high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.

So, in short, we can say that the prevention of arterial hypertension includes regular examinations by a cardiologist, a proper lifestyle and a favorable emotional background for the environment.

Life forecast

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

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

Extremely unfavorable course of arterial hypertension is observed in young people. They have a high risk of stroke, myocardial infarction, heart failure, sudden death.

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