Hypertension

Hypertension is a very common disease, which as a collective definition combines several types of arterial hypertension. Hypertension develops against the background of narrowing of the lumen of the walls of small vessels and arteries, as a result of which the normal movement of blood flow is disturbed, and the blood that accumulates in narrow places begins to exert pressure on the walls of the vessels.

What is hypertension?

High blood pressure can be a symptom, but it can also be an independent disease. If a person is diagnosed with chronic pathology of the kidneys, cardiovascular system, thyroid gland, adrenal gland, hypertension is almost inevitable as one of the manifestations of this disease. Also, increased stress can be an adaptation, an adaptive response of organs and systems to changes, both external - excessive physical activity, and internal - psycho-emotional factors, stress. Almost all types of hypertension, with timely diagnosis, are controlled both with the help of drug therapy and with the help of other, non-drug methods.

Normal blood pressure in relatively healthy people is set between 100/60 and 140/90 mmHg; if the regulatory system stops working properly, hypertension or hypotension may develop.

Statistics provide information that almost 30% of the world's population suffers from one level or another of hypertension, but until recently, practically nothing was known about such a disease as hypertension. Only Homo sapiens is characterized by disturbances in the functioning of the cardiovascular system; no representative of the animal world is exposed to them. Until the 19th-20th centuries, little was known about hypertension in principle; one of the first heart attack cases was confirmed by doctors only in the 30s of the last century in one of the European countries; during the same period there was not a single case of clinically confirmed cardiovascular pathology in African and Asian countries. Only with the development of urbanization and the penetration of modern technology into these countries, the population of Asia and Africa are also exposed to hypertension, which peaked in the 70s of the 20th century.

Hypertension, since the end of the last century, has been divided into primary and secondary.

1. Primary (essential) hypertension is a separate nosological unit, an independent disease that is not provoked by organ and system dysfunction. Blood pressure rises for reasons other than kidney disease, for example. Hypertension diagnosed as primary (EG - essential hypertension or GB - essential hypertension) is characterized by persistent clinical signs - increased pressure, both systolic and diastolic. Almost 90% of all patients with persistent high blood pressure have primary hypertension.
2. Symptomatic hypertension, also called secondary, is hypertension triggered by an underlying disease, for example, an inflammatory process in the kidney system - glomerulonephritis, polycystic kidney disease, or disorders of the pituitary gland or pancreas. Also, secondary hypertension develops against the background of pathological changes in the vascular system - atherosclerosis, and can trigger symptomatic hypertension and neurotic diseases. Also, secondary hypertension is quite common during pregnancy and with gynecological diseases - cysts and neoplasms.

Hypertension is also classified into grades depending on the degree of increase in blood pressure.

• If the blood pressure is set between 140/90 and 159/99 mmHg, hypertension is diagnosed as a stage I disease. In this case, the pressure may return to normal, but periodically "jumps" to the specified limit.
• If blood pressure is recorded in the range from 160/100 to 179/109 mmHg, hypertension is considered a stage II disease. There is practically no remission, but the pressure can be controlled with the help of drugs.
• Blood pressure that always remains in the range of 180/110 and higher is considered a clinical symptom of stage III hypertension. At this stage, blood pressure practically does not fall to normal levels, and if it falls, it is accompanied by weakness of the heart, until heart failure.

Hypertension, in addition to having stages of disease development, is also divided into separate clinical forms. Hyperadrenergic hypertension is actually the initial stage of disease development, which, however, can last for years. This form of hypertension manifests itself as sinus tachycardia, unstable blood pressure when the systolic reading fluctuates, increased sweating, skin hyperemia, throbbing headaches, and anxiety. Face and limbs often swell, fingers become numb, and urination is disturbed. There is also a more serious form - malignant hypertension, which develops rapidly. Blood pressure can increase so much that there is a risk of encephalopathy, vision loss, pulmonary edema, and there is also a risk of kidney failure. Fortunately, this form practically does not occur today, because hypertension is most often diagnosed early and its development can be stopped with the help of complex therapeutic measures.

Pressure indicator

Blood pressure is one of the most important indicators of human health and an indicator of the normal functioning of the cardiovascular system. Pressure has two parameters - systolic and diastolic. The top number is systole, which is an indicator of blood pressure during the period of contraction of the heart muscle, when blood enters the arteries. The lower number is an indicator of blood pressure during the relaxation period of the heart muscle. It is believed that hypertension begins when the reading exceeds the norm of 140/90 mmHg. This, of course, is a conditional limit, because there are situations when the risk of developing myocardial infarction exists even at a figure of 115/75 mmHg. However, formalizing and bringing to an overall average level various blood pressure conditions helps doctors to see deviations in time and initiate symptoms, and then standard treatment.

ICD-10 codes

I10 Essential [major] hypertension.

What causes hypertension?

Hypertension is considered a multi-etiological, multi-factorial disease, the true cause of which is not fully understood. The factors that trigger secondary hypertension are more specific, because the cause is the underlying disease. The final diagnosis of essential hypertension is made after a comprehensive examination by excluding the presence of the disease that causes it. Primary hypertension, in medical terms, is a genetic imbalance of regulatory mechanisms in the body (imbalance of suppressor and suppressor blood pressure systems).

Among the reasons that have been explained and carefully studied by doctors are as follows:

• Renal pathology - nephritis and most often glomerulonephritis. Factors that trigger secondary hypertension.
• Renal artery stenosis (narrowing).
• Congenital pathology in which the renal artery is blocked (coarctation).
• Adrenal gland neoplasm - pheochromocytosis (impaired production of norepinephrine and adrenaline).
• Increased production of aldosterone is hyperaldosteronism, which occurs during the tumor process in the adrenal gland.
• Thyroid gland function is affected.
• Alcoholism.
• Overdose or continued use of medications, especially hormonal antidepressants.
• Addiction.

Factors that are considered provocative in the sense of disruption of normal blood pressure levels can be divided into nutrition, related to age and pathology:

• Age over 55 years for men and 65 years for women.
• Increased blood cholesterol levels (over 6. 6 mmol).
• Hereditary predisposition, family history.
• Obesity, especially abdominal obesity, when waist circumference exceeds 100-15 cm in men and 88-95 in women.
• Diabetes, changes in the level of normal glucose tolerance.
• Physical inactivity, osteochondrosis.
• Chronic stress, increased anxiety.

The mechanism of development of hypertension is briefly as follows:

When arterioles—arteries of organs, often kidneys—spasm under the influence of, for example, stress factors, nutrition of kidney tissue is disturbed and ischemia develops. The kidneys try to compensate for the disorder by producing renin, which in turn triggers the activation of angiotensin, which narrows the blood vessels. As a result, blood pressure rises and hypertension develops.

Symptoms of hypertension

The main symptom of hypertension, and sometimes the main one, is considered a constant excess of 140/90 mmHg. Other signs of hypertension are directly related to blood pressure parameters. If the pressure rises slightly, the person just feels unwell, weak, and has a headache.

If the pressure exceeds the norm by 10 units, the headache becomes intense and persistent, often it is localized in the back of the head and temples. The person feels nauseous and sometimes vomits. The face becomes red, sweating increases, tremors of the fingers are noticeable, and often there is numbness.

If hypertension persists for a long time and is not treated, the pathological process develops in the activity of the heart, and the heart begins to ache. The pain can be piercing, sharp, it can radiate to the arm, but often heart pain is localized on the left side of the chest, without spreading further. Against the background of constantly rising blood pressure, anxiety and insomnia develop.

Hypertension is also characterized by dizziness and decreased vision.

Ophthalmological signs - veils or spots, "floating" in front of the eyes. Often, when the pressure rises sharply, there may be nosebleeds.

Another symptom of hypertension is dizziness. Vision deteriorates.

The terminal stage, when hypertension reaches stage III, neurosis or depression joins the usual symptoms. Often hypertension in this form occurs in a pathological "union" with coronary heart disease.

The most dangerous manifestation of hypertension is a crisis - a situation with a sudden increase or spike in blood pressure. The crisis situation is full of stroke or heart attack and is indicated by the following symptoms:

• A sharp, sudden or rapidly developing headache.
• Blood pressure reading up to 260/120 mmHg.
• Pressure in the region of the heart, aching pain.
• Severe shortness of breath.
• Vomiting, starting with nausea.
• Increased heart rate, tachycardia.
• Loss of consciousness, convulsions, paralysis.

Hypertension in the crisis stage is a threatening condition that can lead to a stroke or heart attack, therefore, at the slightest alarming sign, you should contact emergency medical help. Hypertensive crisis is controlled with the help of diuretics, cardiological and hypertensive drugs given by injection. Hypertensive patients who know the problem must always take prescribed medication to avoid a crisis situation.

Who to contact?

Cardiologist.

Treatment of hypertension

Hypertension in the early stages, when blood pressure readings are not often above normal levels, can be treated with non-drug medications. The first way is to control your weight and follow a low-carb and low-fat diet. A diet for hypertension also involves limiting the intake of salty foods and controlling fluid intake - no more than 1. 5 liters per day. Psychotherapy and autogenic exercises, which relieve general anxiety and tension, are also effective. This method is effective for stage I hypertension, although it can be used as an additional element and supplement to the main therapy of stage II and III hypertension.

Pharmacological agents involved in the treatment of hypertension are prescribed according to the "stepwise" principle. It is used sequentially, targeting various organs and systems, until blood pressure is completely stable.

Hypertension in stage I involves the use of diuretics (diuretics), beta blockers, adrenergic receptor blockers to stop tachycardia. The dose of beta-blocker is calculated based on the patient's medical history, weight and condition. If the blood pressure returns to normal after two to three days, the dose is reduced, usually taking it every day. As a diuretic, drugs from the thiazide group are effective, prescribed 25 mg once, alternating doses every one or two days, so as not to weaken the heart muscle. If hypertension begins to decrease, diuretics can be prescribed once a week. There are often cases when diuretics and beta blockers cannot be used because of possible side effects (diabetes, gout or asthma); in such situations, taking antispasmodics is indicated. During the entire treatment, you need to monitor your blood pressure level three times a day.

Stage II hypertension is monitored by complex therapy, including beta-blockers, diuretics, antispasmodics, ACE inhibitors (angiotensin-converting enzyme inhibitors) and potassium preparations. Among the b-blockers, effective drugs are those that can control rapid heartbeat and reduce peripheral vascular resistance. These drugs are also effective for diagnosed bradycardia, when the heart rate is reduced. Angiotensin-converting enzyme inhibitors can neutralize increased renin production, which increases blood pressure. These drugs activate the work of the left ventricle of the heart, reduce hypertrophy, widen the coronary vessels, thereby helping to normalize peripheral blood flow. Calcium antagonists are designed to block calcium channels in the vascular wall, increasing their lumen. Calcium antagonists can only be prescribed by a doctor or cardiologist, as all these drugs can cause swelling, dizziness and headaches. A set of drugs is selected taking into account all possible side risks and contraindications. It should also be noted that long-term use of diuretics can cause a decrease in potassium levels in the body (hypokalemia), so diuretics should be taken together with potassium supplements.

Stage III hypertension is a severe form of the disease, which is characterized by the body's resistance to traditional medicine. Therefore, treatment must be carefully selected taking into account all the individual characteristics of the patient. Therapeutic complexes including diuretics, often sparing potassium, and the use of peripheral vasodilators are also indicated. The pharmaceutical industry today produces many effective drug combinations. These drugs act on patients whose bodies are either accustomed to monotherapy and have stopped responding to it, or have significant contraindications to the use of standard treatments used for stage I and II hypertension.

Hypertension of severity III is also monitored by vasodilators. Increasingly, vasodilators have begun to be replaced by alpha blockers. Combination drugs that combine alpha and beta blocking properties may also be effective. This drug, in combination with diuretics, can replace three or even four other less effective drugs. ACEI is used to prescribe drugs that improve peripheral circulation and control renin levels. This medicine is taken three to four times a day, combined with a diuretic, which allows you to reduce blood pressure to normal after a week.

Hypertension degrees I and II can be treated at home and does not require hospitalization. In rare cases, inpatient treatment is possible to conduct analytical examinations and monitor health status. Hypertension, which occurs in a severe form, is treated only in the hospital, in the cardiology department; the length of stay depends on the state of blood pressure and the performance of organs and body systems.

How is hypertension prevented?

Hypertension, if it has developed, unfortunately, stays with a person forever. Prevention in this sense only involves the prevention of crisis situations through the regular use of prescribed medications, daily blood pressure monitoring, feasible physical activity and weight loss.

However, if a person has a family history of relatives with hypertension, but the disease has not yet appeared, preventive measures can be taken. The rules are quite simple - maintain a healthy lifestyle and physical activity, because one of the causes of hypertension is physical inactivity. Hypertension is also prevented by a regular diet, where cholesterol and salty foods are kept to a minimum.

Hypertension is also a bad habit, therefore, if a person does not want to join the ranks of hypertensive patients, he should stop smoking and limit the consumption of alcoholic beverages. In addition, a positive mood and attitude helps to overcome any disease, and hypertension "likes" pessimism. The recipe is simple - enjoy life, stay calm and take care of your nerves, then your heart and blood vessels will work "like a clock", and stress will, according to a famous saying, "like an astronaut" .