hypertension

4 December 2024

Even in the 21st century, arterial hypertension remains an important medical and social problem as it is fraught with complications that can cause disability, reduce quality of life and be fatal.

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

Classification of arterial hypertension

It is customary to distinguish 4 risk groups for arterial hypertension, depending on the likelihood of damage to the heart, blood vessels and other target organs, as well as the presence of complicating factors:

1 – risk less than 15%, no complicating factors;
2 – the risk is between 10 and 20%, no more than 3 aggravating factors;
3 – risk of 20 to 30%, more than 3 aggravating factors;
4 – the risk is higher than 30%, more than three aggravating factors, target organs are affected.

The following target organs are affected in arterial hypertension:

brain (transient cerebrovascular accidents, stroke);
organ of vision (degenerative changes and retinal detachment, hemorrhage, blindness);
blood (increased glucose levels, leading to damage to the central nervous system);
heart (left ventricular hypertrophy, myocardial infarction);
Kidneys (proteinuria, kidney failure).

Depending on the severity of the cardiovascular risk, different levels of blood pressure are distinguished, which are shown in Table No. 1.

Table No. 1. Blood pressure values:

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
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 high blood pressure

The main risk factors for primary arterial hypertension include:

Gender and age. Men aged 35 to 50 are most susceptible to 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 have this 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, under the influence of which the heart rate and the volume of blood pumped increase. If a person is in a chronic state of stress, the increased stress leads to wear and tear on the arteries and the risk of complications to the heart and blood vessels increases;
Drink alcoholic beverages. With daily consumption of strong alcohol, blood pressure increases by 5 mmHg annually. Art. ;
Smoke. Tobacco smoke causes spasms of the peripheral and coronary arteries. The artery wall is damaged by nicotine and other components and atherosclerotic plaques form at the sites of damage;
Atherosclerosis occurs due to excessive consumption of foods containing cholesterol and smoking. Atherosclerotic plaques narrow the lumens of blood vessels and impair free blood circulation. This leads to arterial hypertension, which promotes the progression of atherosclerosis;
Increased consumption of table salt leads to arterial spasms, retains fluid in the body, which together leads to the development of hypertension;
Excess body weight leads to reduced physical activity. Clinical studies have shown that for every additional kilogram there are 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 cause any characteristic symptoms, but rather slowly and quietly "kills". In most cases, the disease has no symptoms, progresses and leads to fatal complications such as heart attack or stroke. In the asymptomatic state, theArterial hypertension remains undetected for decades.

The most common complaints from 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 increased blood pressure. Headaches can manifest themselves as a feeling of squeezing the head with a "tire", accompanied by dizziness and nausea. They occur against the background of physical or nervous stress. If the pain persists for a long period of time, hot temper, irritability andSensitivity to noise.

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, this is a signal 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 itself as:

Headache;
Dizziness;
attacks of nausea and vomiting;
clouding of consciousness;
Seizures

Intracranial hypertension: diagnosis

Types of pathology diagnostics include:

Measuring intracranial pressure by inserting a needle into the fluid cavities of the skull or spinal canal to which a pressure gauge is attached.
Tracking the degree of blood filling and dilatation of the eyeball veins. If the patient has red eyes, that is, the eye veins are abundantly filled with blood and clearly visible, one can speak of increased intracranial pressure;
Ultrasound examination of cerebral vessels;
Magnetic resonance imaging and computed tomography: The extent of the brain's fluid cavities and the degree of thinning of the ventricular edges are examined;
Conducting an encephalogram.

Intracranial hypertension: treatment, medications

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

Essential hypertension

Essential arterial hypertension is an increase in systolic blood pressure to 140 mmHg at the time of heart contraction and blood ejection. Art. and above and/or 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);
high blood pressure with damage to the heart and kidneys;
secondary hypertension: endocrine, renovascular, unspecified, etc.

True high blood pressure (essential form) occupies a leading position among all cases of high blood pressure. The frequency of occurrence is 90%.

In children (up to 10 years of age), a pressure value above 110/70 mm Hg is considered dangerous. Art. , after 10 years – 120/80 mm Hg. The diagnosis is confirmed if blood pressure is repeatedly measured 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 modern advances in medicine, the causes of primary hypertension have not yet been clarified. There are just a number of factors that increase the risk of developing this type of disease. Including:

Injuries to the spinal cord and brain, disrupting vascular tone in the periphery;
nervous shocks, regular stress. In this case, a persistent focus of excitement is observed in the cerebral cortex, a prolonged spasm leads to an increase in peripheral resistance, the vessels lose their elasticity;
hereditary factor;
Overweight: Many people with extra pounds attribute their excess weight to dysfunction 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 an endocrine disorder.
sedentary lifestyle;
excessive consumption of many people's favorite coffee. At the same time, the level of caffeine in the blood increases, which prevents the normal relaxation and expansion of blood vessels. You should always remember: "What is good in moderation";
excessive salt consumption. It retains moisture in the body and leads to increased blood pressure. The Japanese are known to consume twice as much salt as Europeans, and essential hypertension is common in the Japanese population;
Alcohol abuse and smoking lead to a disruption in the normal regulation of vascular tone.

Treatment of essential hypertension

The doctor selects 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 high in animal fat;
giving up bad habits, especially smoking and alcohol abuse;
Relief from stress. 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 high noise and vibration.
Avoid excessive physical activity: Intense, strenuous exercise sessions on treadmills should be replaced with half-hour walks.

Drug treatment includes taking the following medications:

Angiotensin converting enzyme inhibitors. This group includes a variety of drugs that lower blood pressure in different ways at the same time;
Angiotensin-2 receptor blockers The drugs expand the blood vessels and thereby lower blood pressure.
Beta blockers: This type of medication relieves heart pain, slows the heartbeat, and dilates blood vessels.
Calcium channel blockers: slow down the penetration of calcium into the tissues of the blood vessels and heart, slow down the heartbeat, dilate blood vessels;
Diuretics: Inhibit the absorption of sodium in the kidneys and excrete 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 medications that lower cholesterol levels in the body.

Portal hypertension

Portal hypertension is a complication of liver cirrhosis. This is the phenomenon of increased 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. rt. Art. : In cases where this indicator exceeds 12-20 mm, stagnation occurs in the afferent veins and they expand. Unlike arteries, the thin walls of veins stretch under pressure and tear easily.

Portal hypertension: symptoms

The main cause of portal hypertension is liver 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 of the content of platelets, leukocytes and erythrocytes are violated;
the spleen enlarges;
blood clotting worsens;
Fluid accumulation in the abdominal area (ascites) is diagnosed.
varicose veins of the digestive tract develop;
In many cases, patients experience bleeding and anemia.

In the early stages, signs of portal hypertension in liver cirrhosis manifest themselves in the form of a deterioration in general well-being, bloating and a feeling of heaviness under the right rib. Next, the patient develops pain in the area under the right rib, the liver and spleen increase, and the normal functioning of the digestive tract is disrupted.

Portal Hypertension: Grade

In total there are 4 degrees of pathology:

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

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 more than 15 mm and the splenic vein is more than 7-10 mm, one can safely conclude that portal hypertension is present. An ultrasound scan can also reveal enlargement of the liver and spleen;
Doppler ultrasound: allows you to study the structure of blood vessels, as well as measure the speed of blood flow through them;
FGDS (Fibrogastroduodenoscopy): allows to identify varicose veins in 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 effectiveness of sclerotherapy is around 80%. The procedure involves injecting the medication into damaged veins using an endoscope. As a result, the lumen of the veins is blocked and their walls "stick together". This method of treatment is considered classic.

Portal hypertension: prevention

Measures to prevent the development of the disease include:

maintaining a proper diet and meal plan;
To do sports;
vaccinations against viral hepatitis;
Refusal to abuse alcoholic beverages;
Avoidance of exposure to harmful production factors in the form of poisoning with toxic substances.

Preventive measures for liver disease include:

a complete examination to diagnose and initiate treatment in the early stages of liver disease;
strict adherence to all medical recommendations;
complex therapy in the hospital under strict medical supervision.

Measures to prevent bleeding include:

control of blood clotting function;
Sigmoidoscopy – that is, annual examination of the sigmoid colon and rectum;
fibrogastroduodenoscopy twice a year.

Secondary hypertension

The most common form is primary hypertension, sometimes called hypertensive hypertension. In addition to the primary or idiopathic form of the disease, which is often referred to as hypertension, secondary hypertension is also known.

Depending on the cause, the following types of disease are distinguished:

Renal hypertension occurs due to damage to the renal arteries. This form of the disease is called renovascular hypertension;
In Itsenko-Cushing syndrome, there is an increase in systolic blood pressure. In this case, the adrenal medulla is affected;
Pheochromocytoma is a disease that affects the adrenal medulla. It is the cause of a malignant form of arterial hypertension. The tumor compresses the outer layer of the adrenal glands, causing adrenaline and norepinephrine to be released into the blood, resulting in a constant or crisis increase in pressure;
Hyperaldosteronism or Cohn syndrome is a tumor of the adrenal gland that causes an increase in aldosterone levels. This causes potassium levels in the blood to fall and blood pressure to rise;
Thyroid diseases such as hyperparathyroidism, hyperthyroidism and hypothyroidism are the cause of secondary arterial hypertension;
Hemodynamic or cardiovascular arterial hypertension arises as a result of the involvement of the large vessels in the pathological process. It occurs when there is coarthrization or narrowing of the aorta and aortic valve insufficiency;
arterial hypertension in adults of central origin develops in diseases of the brain 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.

Diagnosing secondary hypertension is difficult, but there are several signs of it:

increased blood pressure in young people;
acute sudden onset of illness immediately with increased blood pressure values;
lack of response to ongoing antihypertensive therapy;
sympathoadrenal crises.

Diastolic hypertension

The diagnosis of "isolated diastolic hypertension" is considered when the systolic value is less than 140 mm. Hg and the diastolic value is more than 90 mm Hg. Increase in diastolic pressure to 90 mm Hg. Art. does not pose a danger to a person whohas no somatic pathology.

People with elevated diastolic blood pressure and no concomitant diseases are recommended to control their blood pressure and make lifestyle changes:

regulate sleep quality;
don't drink red wine;
Limit the number of cigarettes smoked per day.
avoid stress;
eliminate salt from the diet;
eat right;
maintain normal weight;
Do physical exercise or yoga.

If diastolic hypertension occurs and persistently high diastolic pressure, inpatient treatment is necessary. The underlying disease is treated, for example, by surgically correcting aortic valve disease. Doctors prescribe medication for high blood pressure individually. The following tablets for high blood pressure are used:

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

Hypertensive crises

Hypertensive crisis is an individually significant increase in blood pressure in patients with primary or secondary arterial hypertension, accompanied by the appearance or worsening of clinical symptoms and requiring rapid pressure control 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 restlessness. Type 2 crisis (water-salt, norepinephrine) has the following symptoms:

a predominant increase in diastolic pressure with a simultaneous decrease in pulse pressure;
swelling of the face, legs, arms;
a noticeable decrease in diuresis on the eve of a crisis.

In the event of a complicated crisis, the airways are disinfected, the patient is provided with oxygen and a venous access is established. The choice of antihypertensive drug is approached in a differentiated manner; the administration takes place intravenously. They reduce the pressure quickly and then switch to oral medications within 2-6 hours that lower it to 160/100 mmHg. The patient is admitted to a specialist hospital.

Diagnosis of arterial hypertension

It is very important to know how to measure blood pressure because only then can high blood pressure be diagnosed. The exercise begins with an explanation of the person's behavior during the procedure. Then it is shown how to put the cuff correctly and the indicators are recorded. It depends on which device measures the pressure: mechanical or electronic.

It is necessary to carry out laboratory tests such as:

general blood and urine analysis;
blood sugar levels;
creatinine, uric acid and potassium levels;
lipid profile;
C-reactive protein content in blood serum;
Bacterial culture in urine.
The following instrumental research methods are prescribed to patients:
Electrocardiogram;
echocardiogram;
chest x-ray;
Ultrasound examination of the kidneys and adrenal glands;
Ultrasound of the renal and brachycephalic arteries.

The ophthalmologist examines the back of the eye and assesses the presence and degree of microproteinuria. All hospital patients undergo daily blood pressure checks.

Treatment of arterial hypertension

The goal of treating any patient with hypertension is to reduce the risk of cardiovascular complications and death. The choice of medication to treat high blood pressure is determined by the following strategy: achieving the target blood pressure, i. e. 140/80 mmHg. and managing risk factors. In patients with kidney disease and diabetes, the pressure must be reduced to 130/80 mmHg. This improves the quality of life and eliminates the symptoms of the disease.

Prevention of arterial hypertension

To prevent the development of arterial hypertension it is necessary:

organize proper nutrition;
avoid emotional stress and stress;
use rational physical activity;
normalize sleep patterns;
monitor your weight;
active rest;
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. Treatment of this disease requires continuous use of medications to control blood pressure. Hypertensive crises and sudden changes in pressure should be avoided.

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