What is dangerous 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 widespread prevalence of this disease among different age groups of the population, but also to the high rate of severe complications, disability and mortality from hypertension in the absence of timely treatment.

People prone to high blood pressure are advised to take measurements on both hands. Recent studies have shown that hypertension can be confirmed by a difference in the readings of different arms of 10 - 15 mm Hg. This symptom (difference in indications) is likely to determine hypertension up to 96%.

What is?

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

Blood pressure is divided into systolic and diastolic:

1. systolic. According to the first, upper number, the level of blood pressure is determined at the time of compression of the heart and discharge 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. Shows the level of peripheral vascular resistance.

Blood pressure readings usually change constantly. They physiologically depend on the age, sex and condition of the person. During sleep, the pressure decreases, physical activity or stress leads to an 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 stable numbers 140/90 we are talking about arterial hypertension. Statistics show that about 20-30 percent of the adult population is affected by this disease. With age, the incidence increases inexorably and by the age of 65, 50-65 percent of older people suffer from this disease.

Classification

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

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

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

1. Border. The pressure periodically increases to 140 - 149/90, then decreases, normalizes;
2. Systolic isolation. There is an increase in the above indicator (reaches 140 and more). At the same time the lower remains within 90 and below.

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

1. Transient. The patient sometimes has high blood pressure. This condition can last for hours or days. The pressure returns to normal without the use of drugs;
2. Labile. Manifested in the initial stage of pathology. This condition is considered borderline because the pressure jumps are insignificant, unstable. Usually the pressure normalizes on its own;
3. Stable arterial hypertension. The increase in pressure is constant, to reduce it requires maintenance therapy;
4. Crisis. Periodic hypertensive crises are typical;
5. Malignant. The pressure rises to serious levels, hypertension develops rapidly, 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 formation of cardiovascular complications against the background of high blood pressure. Taking into account the presented complications, the prognosis for the consequences of arterial hypertension is diagnosed. There are the following risk factors that worsen the course of the disease and its prognosis:

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

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

Weight

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

Arterial hypertension 1st degree

This stage 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 usually provoked by a sudden change in atmospheric pressure or emotional overload. There are no complications from the work of the target bodies.

Arterial hypertension 2nd degree

It is characterized by an increase in blood pressure to a level of 160-179 / 100-109 mm Hg. Art. It is with such indicators that patients most often go to the doctor for the first time, as their acceptance as the norm is the pinnacle of negligence. Grade 2 hypertension usually presents with severe headache, weakness, dizziness, and deterioration in well-being during episodes of hypertension.

Arterial hypertension 3rd degree

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

Symptoms of hypertension

Hypertension itself has no symptoms. Most adult patients with this disease do not complain of anything at all, high blood pressure is detected by accident.

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

1. Headache - may be the first and main symptom. There are several types of headaches:
   • dull, not intense, characterized by a feeling of heaviness in the forehead and occiput. It occurs most often at night or in the morning, increases with a sudden change in the position of the head and even with light exercise. Such pain is caused by disruption of venous blood flow from the vessels of the skull, their overflow and stimulation of pain receptors;
   • liqueur - a burst scattered throughout the head may be pulsating. Any tension causes the pain to increase. It occurs most often in the late stages of hypertension or in the presence of pulse hypertension. As a result, the vessels are suddenly overflowing with blood and it is difficult to drain;
   • ischemic - dull or bursting in nature, accompanied by dizziness and nausea. Manifested by a sharp rise in blood pressure. There is an acute vasospasm, as a result of which the blood supply to the brain tissues is disrupted.
2. Cardiac pain - cardialgia, not ischemic, coronary vessels are in order, as long as the pain is not stopped by sublingual administration of nitrates (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 - in the beginning it appears only during sports, with the progression of hypertension it can also appear at rest. Characterizes heart dysfunction.
4. Swelling - most common in the legs due to stagnation of blood in the systemic circulation, sodium and water retention or impaired renal function. Occurrence in children with concomitant edema of hematuria and hypertension is characteristic of glomerulonephritis, which is very important to remember in the differential diagnosis.
5. Visual impairment - manifests itself in the form of blurred vision, the appearance of a veil or flickering flies. Occurs due to damage to the vessels of the retina.

Chronic arterial hypertension causes kidney damage with the development of renal failure and the corresponding complaints of renal genesis, 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 in the medical history it is necessary to record the family history and the causes of hypertension in close relatives, to clarify the time of onset of the first clinical symptoms, to note concomitant diseases.

Hypertensive crisis

This is an emergency condition, which consists in a sharp rise in blood pressure to high numbers and is characterized by a sharp deterioration in the blood supply to all internal organs, especially vital ones.

It occurs when the body is exposed to various adverse factors, it can not be predicted, so uncontrolled hypertension is dangerous. The urgency of the problem lies in the fact that in the absence of timely emergency care, a fatal outcome is possible. To provide emergency care, the patient must be taken immediately to a hospital, where blood pressure is rapidly reduced with medication.

Students from medical institutes study first aid in case of hypertensive crisis in the Department of Propaedeutics of Internal Medicine, so it is best for a passer-by not to try to help, but to call 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. physical examination,
3. Electrocardiogram recording.

Blood pressure control

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

Medical history

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

Physical examination

The patient's physical examination primarily includes examination 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 uncharacteristic sounds. These data primarily indicate changes 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 various cardiac arrhythmias. In addition, the ECG allows you to determine the so-called hypertrophy of the left ventricular wall, which is typical of hypertension.

echocardiography

In addition to these diagnostic methods, other methods are used, such as 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 the condition of the valves.

Arteriography

Arteriography, including aortography, is an X-ray method that examines the condition of the walls of the arteries 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 coarctation of the aorta (congenital narrowing of the aorta in a particular area) and others.

dopplerography

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

Blood chemistry

A biochemical blood test is also used to diagnose hypertension. First of all, it turns out the level of cholesterol and lipoproteins with high, low and very low density, as they are an indicator of a tendency to atherosclerosis. In addition, blood sugar levels are determined.

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

Ultrasound of the thyroid gland

Thyroid ultrasound and blood test for thyroid hormones. These methods help to determine the role of the thyroid gland in causing high blood pressure.

How to treat high blood pressure?

Effective treatment of hypertension is selected depending on the severity of the disease and the overall risk of the patient with 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 parent;
• smoking (or non-smoking in the last three years);
• diabetes;
• LDL cholesterol level above 1. 60 g / l or LDL cholesterol level below 0. 440 g / l;
• abdominal obesity, renal failure, lack of regular exercise or excessive alcohol consumption.

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

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

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

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

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

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

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

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

If the effect is insufficient, a second or third medicine may need to be added. 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 block to death)
• ACE inhibitor + sartan

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

Why is hypertension dangerous?

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 blood pressure at an adequate level, the incidence of hypertensive crises and complications such as heart failure (HF) and renal failure (RF), aortic and mitral valve regurgitation, heartaneurysm and aorta, MI (heart attacks), strokes, etc. in patients with hypertension remains extremely high.

This is primarily due to the fact that many patients do not want to take antihypertensive therapy systematically, believing that they have a single hypertensive crisis and this will not happen again.

According to statistics, only about 40% of women and 35% of men who know they have high blood pressure receive medical treatment. At the same time, only 15% of women and about five percent of men reach the required blood pressure levels due to the systematic use of antihypertensive therapy, monitoring of blood pressure and regular visits to the doctor and following his recommendations.

Despite the fact that hypertension is one of the controllable risk factors for the development of cardiovascular pathology, such poor indicators are due to the banal misunderstanding of the patient about the seriousness of his diagnosis and therefore the lack of serious and responsible approach to treatment.

The most common severe complications that develop due to 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, from heart and kidney failure within three years after a severe (complicated) hypertensive crisis, 30 to 40% of patients die.

Comprehensive treatment, a responsible approach to health, the systematic use of drugs against hypertension and blood pressure control allow these frightening figures to be minimized.

Prevention of arterial hypertension

For people with a hereditary predisposition to hypertension and weighed down by risk factors, disease prevention is of great importance.

1. First of all, it is a regular examination by a cardiologist and compliance with the rules of proper lifestyle, which will help to slow down and often eliminate the disease of hypertension. If you have a history of relatives with hypertension, you need to reconsider your lifestyle and radically change many of the habits and lifestyle that are risk factors.
2. You need to reconsider your eating principles, stop eating salty and fatty foods, switch to a low-calorie diet that includes plenty of fish, seafood, fruits and vegetables. Don't get carried away with alcoholic beverages and especially beer. They contribute to obesity, uncontrolled consumption of salt, adversely affect the heart, blood vessels, liver and kidneys.
3. It is necessary to lead an active lifestyle, 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 exercises are especially useful. Exercise 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 hypertension.
5. Stop smoking, the substances contained in nicotine, provoke changes in the walls of arteries, increase their hardness, therefore, may be the culprits of high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.

So we can briefly say that the prevention of hypertension includes regular check-ups with a cardiologist, proper lifestyle and a favorable emotional background for your 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 damage to target organs;
• 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.

With early treatment of hypertension and careful adherence of the patient to all the recommendations of the attending physician, it is possible to slow the progression of the disease, improve the quality of life of patients and sometimes achieve long-term remission. .