Hypertension

4 December 2024

In the 21st century, arterial hypertension remains an important medical and social problem, as it is fraught with 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, you should consult a doctor immediately. Only timely and competent treatment promotes recovery.

Classification of arterial hypertension

It is accepted 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 from 20 to 30%, more than 3 aggravating factors;
4 – the risk is higher 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 detachment of the retina, hemorrhage, blindness);
blood (increased glucose levels leading to central nervous system damage);
heart (left ventricular hypertrophy, myocardial infarction);
kidneys (proteinuria, renal failure).

Depending on the severity of the cardiovascular risk, several levels of arterial pressure are distinguished, presented in table #1.

Table #1. Blood pressure levels:

Categories	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
Optimally	Below 120	Below 80
normal	120-129	80-84
High normal	130-139	85-89
Arterial hypertension 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 include:

Gender and age. Men aged 35 to 50 years 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-line relatives have suffered from the disease. If two or more relatives have had hypertension, 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 pumped blood increase. If a person is in a state of chronic stress, then the increased load leads to wear of the arteries and the risk of complications from 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 artery wall is damaged by nicotine and other components, and atherosclerotic plaques form at the sites of damage;
Atherosclerosis develops as a result of excessive consumption of foods containing cholesterol and smoking. Atherosclerotic plaques narrow the lumen of blood vessels and prevent free blood circulation. This leads to arterial hypertension, which stimulates the progression of atherosclerosis;
Increased consumption of table salt provokes spasm of the arteries, retains fluid in the body, which together leads to the development of hypertension;
Excess body weight leads to reduced physical activity. Clinical studies show that for every extra kilogram there are 2 mm. rt. Art. blood pressure;
Lack of physical activity 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". The disease in most cases does not show any symptoms, progresses and leads to fatal complications such as myocardial infarction or stroke. When it is asymptomatic, arterialhypertension can go undetected for decades.

The most common patient complaints are:

headache;
flashing of flies before the eyes;
blurred vision;
vertigo;
dyspnea;
tiredness;
chest pain;
visual impairment;
nosebleeds;
swelling of the lower limbs.

However, the most important sign of hypertension is elevated blood pressure. A headache can be manifested by a feeling of pressure on the head with a "hoop", accompanied by dizziness and nausea. They arise against the background of physical or nervous stress. If the pain lasts for a long time, irritability, irritability and sensitivity to noise appear.

Intracranial hypertension

Often, headaches can be caused by a cold, lack of sleep or overwork. It occurs due to increased intracranial pressure. If the headache becomes constant and severe, this 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 location 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 itself as:

headache;
vertigo;
attacks of nausea and vomiting;
clouding of consciousness;
convulsions

Intracranial hypertension: diagnosis

Types of pathology diagnostics include:

measurement of intracranial pressure by inserting a needle into the fluid cavities of the skull or spinal canal with a manometer attached to it.
tracking the degree of blood filling and expansion of the veins of the eyeball. If the patient has red eyes, that is, 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 computed tomography: the expansion of the brain cavities with fluid, as well as the degree of dilution of the ends of the ventricle, are examined;
conducting an encephalogram.

Intracranial hypertension: treatment, drugs

Increased intracranial pressure can lead to a decrease in the patient's intellectual abilities and disruption of the normal functioning of internal organs. Therefore, this pathology requires immediate 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 necessary. 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 ejection of blood to 140 mmHg. Art. and above this limit and/or diastolic blood pressure at the moment of relaxation of the heart muscle up to 90 mmHg. Art. and higher.

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), the pressure level above 110/70 mm Hg is considered dangerous. Art. , after 10 years – 120/80 mm Hg. The diagnosis is confirmed by repeated blood pressure measurements within four weeks at least twice on different days.

In most cases, the disease affects people aged 30 to 45 years.

Causes of the disease

Despite all the modern advances in medicine, the causes of primary hypertension have not yet been established. There are only a number of factors that increase the risk of developing this type of disease. Among them:

injuries of the spinal cord and brain, as a result of which the vascular tone in the periphery is disturbed;
nervous breakdowns, regular stress. In this case, a constant focus of excitation is observed in the cerebral cortex, a prolonged spasm causes an increase in peripheral resistance, vessels lose their elasticity;
hereditary factor;
overweight: many overweight people attribute their obesity to disturbances in the functioning of the endocrine glands, put themselves on the list of "sick" and do not want to change anything in their lifestyle. In fact, there may be no endocrine disturbances;
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 blood vessels from relaxing and dilating normally. You should 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 in the Japanese population;
Alcohol abuse and smoking lead to disruption of the normal regulation of vascular tone.

Treatment of essential hypertension

The doctor chooses treatment tactics after assessing the patient's condition and the stage of development of the pathology. In the initial stages, patients are prescribed non-drug therapy, which includes:

a special diet aimed at limiting the consumption of salt and foods with a high content of animal fat;
giving up bad habits, in particular smoking and alcohol abuse;
stress relief. In this case, yoga classes, self-training and sessions with a psychotherapist are very helpful;
patients with essential hypertension should not work in conditions of loud noise and vibration;
avoiding excessive physical activity: intense, exhausting training 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 reduce blood pressure in several ways at the same time;
angiotensin 2 receptor blockers dilate blood vessels, thereby lowering blood pressure;
beta-blockers: this type of medicine relieves pain in the heart, slows the heartbeat and dilates blood vessels;
calcium channel blockers: slow down the penetration of calcium into the tissues of blood vessels and the heart, slow down the heart rate, dilate blood vessels;
Diuretics: inhibit the absorption of sodium by 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;
drugs with central action 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 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 area is 7 mm. rt. Art. , In cases where this indicator exceeds 12-20 mm, stagnation is formed in the afferent veins and they expand. The thin walls of veins, unlike arteries, stretch under pressure and tear easily.

Portal hypertension: symptoms

The main cause of portal hypertension is cirrhosis. In this pathology, the pressure in the portal vessel of the liver increases.

As the disease progresses, the following signs of portal hypertension appear:

the parameters of the laboratory tests change - the norms for the content of platelets, leukocytes and erythrocytes are violated;
the spleen is enlarged;
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, the signs of portal hypertension in cirrhosis of the liver are manifested in the form of deterioration of general health, abdominal swelling and heaviness under the right rib. After that, the patient develops pain in the area under the right rib, the liver and spleen increase in size, and the normal functioning of the digestive tract is disturbed.

Portal hypertension: degrees

In total, there are 4 degrees of pathology:

1 degree – functional (initial);
2nd degree - moderate. Accompanied by moderate expansion of the esophageal veins, enlarged spleen and ascites;
Portal hypertension of the 3rd degree is a severe form of pathology. At this stage, pronounced hemorrhagic and ascites syndromes are observed;
4th degree (complicated). The patient developed 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 spleen, portal and superior mesenteric veins. If the diameter of the portal vein is more than 15 mm, and the spleen is more than 7-10 mm, the presence of portal hypertension can be accurately said. Also, an ultrasound examination can reveal an increase in 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 cirrhosis of the liver is aimed at preventing bleeding.

The effectiveness of sclerotherapy is about 80%. The procedure involves injecting the drug into damaged veins using an endoscope. Thus, 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:

following a proper diet and eating regimen;
playing sports;
vaccinations against viral hepatitis;
refusal to abuse alcoholic beverages;
avoiding exposure to harmful production factors in the form of poisoning with toxic substances.

Preventive measures for liver diseases are:

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

Measures to prevent the development of bleeding include:

control of blood clotting function;
sigmoidoscopy - t. is. sigmoid and rectal examination, 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 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, an increase in systolic blood pressure is observed. 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, as a result of which adrenaline and norepinephrine are released into the blood, which causes a constant or crisis increase in pressure;
Hyperaldosteronism, or Kohn's syndrome, is an adrenal tumor that causes aldosterone levels to rise. As a result, the level of potassium in the blood decreases and blood pressure increases;
diseases of the thyroid gland 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 vessels in the pathological process. This occurs with coarctation 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 disturbance of central regulation (stroke, encephalitis, head injuries);
Drug-induced hypertension can occur when taking oral contraceptives, non-steroidal anti-inflammatory drugs and glucocorticosteroids.

The 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 numbers;
lack of response to current antihypertensive therapy;
sympathoadrenal crises.

Diastolic hypertension

The diagnosis "isolated diastolic hypertension" is valid when the systolic value is below 140 mm. Hg, and diastolic is more than 90 mm Hg. Increase in diastolic pressure up to 90 mm Hg. does not pose a threat to a person who does not have a somatic pathology.

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

regulates sleep quality;
do not drink red wine;
limiting the number of cigarettes smoked per day;
avoid stress;
removing salt from the diet;
eat right;
maintain a normal weight;
do exercise or yoga.

If 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 individually prescribe drugs for hypertension. 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 an individual significant increase in blood pressure in patients with 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.

Crisis type 1 (adrenal, neurovegetative) is manifested by an increase in systolic blood pressure, an increase in pulse pressure, tachycardia, extrasystole and agitation. Crisis type 2 (water-salt, norepinephrine) has the following symptoms:

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

In case of a complicated crisis, sanitation of the respiratory tract, provision of oxygen and implementation of venous access is carried out. The choice of an antihypertensive drug is approached differently, it is administered intravenously. They quickly reduce the pressure and then within 2-6 hours switch to oral drugs that 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 records 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 levels;
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 research tools:
electrocardiogram;
echocardiogram;
chest x-ray;
ultrasound examination of the kidneys and adrenal glands;
Ultrasound of renal and brachycephalic arteries.

The ophthalmologist will examine the fundus of the eye and assess the presence and degree of microproteinuria. All patients in the hospital undergo daily blood pressure monitoring.

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 drugs for the treatment of hypertension is determined by the following strategy: achieving the target blood pressure, that is, 140/80 mmHg. and addressing risk factors. In patients suffering from kidney disease and diabetes, the pressure should be reduced to 130/80 mmHg. This will improve the quality of life and eliminate 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;
normalization of sleep;
monitor your weight;
active rest;
stop smoking and drinking alcohol;
Visit your doctor regularly and get yourself checked.

Arterial hypertension leads to disability and death. The disease is successfully treated by doctors. The treatment of this disease involves the long-term use of drugs to control blood pressure. Hypertensive crises and sudden changes in pressure should be avoided.

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