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, disrupt 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 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 aggravating factors:

1 – risk less than 15%, no 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 retinal detachment, hemorrhage, blindness);
blood (increased glucose levels leading to damage to the central nervous system);
heart (left ventricular hypertrophy, myocardial infarction);
kidneys (proteinuria, renal failure).

Depending on the severity of cardiovascular risk, several levels of blood pressure are distinguished, presented in Table No. 1.

Table No. 1. Blood pressure levels:

Categories	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
Optimal	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 predisposed 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-degree relatives suffered from this disease. If two or more relatives 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 and tear of the arteries and the risk of complications from the heart and blood vessels increases;
Drinking alcoholic beverages. With daily consumption of strong alcohol, blood pressure increases by 5 mmHg annually. 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 lumens of blood vessels and interfere with 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 decreased physical activity. Clinical trials have shown that for every extra kilogram there is 2 mm. rt. Art. blood pressure;
Physical inactivity 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 any characteristic symptoms, but slowly and quietly "kills". The disease in most cases does not show any signs, progresses and leads to fatal complications such as myocardial infarction or stroke. When asymptomatic, arterial hypertension can remain undetected for decades.

The most common complaints patients have 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 elevated blood pressure. Headaches can be manifested by a feeling of squeezing the head with a "hoop", accompanied by dizziness and nausea. They occur against a background of physical or nervous stress. If the pain persists for a long time, short temper, irritability, and sensitivity to noise appear.

Intracranial hypertension

Often a headache can be caused by a cold, lack of sleep, or overwork. It appears due to increased intracranial pressure. If headaches become permanent 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 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:

headaches;
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 with a pressure gauge attached to it.
tracking the degree of blood filling and dilation 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 fluid cavities of the brain is examined, as well as the degree of rarefaction of the edges of the ventricle;
conducting an encephalogram.

Intracranial hypertension: treatment, drugs

Increased intracranial pressure can lead to a decrease in the patient’s intellectual abilities and disruptions in the normal functioning of internal organs. Therefore, this pathology requires immediate initiation of treatment aimed at reducing intracranial pressure.

Treatment can only be carried out if the causes of the pathology are correctly diagnosed. For example, if intracranial hypertension occurs due to the development of a tumor or hematoma of the brain, then 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 at the time of heart contraction and blood ejection to 140 mmHg. Art. and above this mark 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);
hypertensive disease with damage to the heart and kidneys;
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), a pressure level exceeding 110/70 mm Hg is considered dangerous. Art. , after 10 years – 120/80 mm Hg. The diagnosis is confirmed in cases of 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 vascular tone in the periphery is disrupted;
nervous shocks, regular stress. In this case, a persistent focus of excitation is observed in the cerebral cortex, a prolonged spasm causes an increase in peripheral resistance, the vessels lose their elasticity;
hereditary factor;
overweight: many people with extra pounds attribute their obesity to disturbances in the functioning 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 any endocrine disruption;
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 expanding normally. You should always remember: "what is good in moderation";
excessive salt consumption. It retains moisture in the body and leads to increased blood pressure. It is known that the Japanese consume twice as much salt as Europeans, and essential hypertension is very common among the Japanese population;
Alcohol abuse and smoking lead to disruption of 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. In the initial stages, patients are prescribed non-drug therapy, which includes:

a special diet aimed at limiting the consumption of salt and foods high in animal fats;
giving up bad habits, in particular 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 strong noise and vibration;
avoiding excessive physical activity: intense, exhausting workouts on treadmills should be replaced with half-hour walks.

Drug treatment involves taking the following medications:

angiotensin-converting enzyme inhibitors. This group includes a huge number of drugs that reduce blood pressure in several ways simultaneously;
angiotensin 2 receptor blockers. The drugs dilate blood vessels, thereby lowering blood pressure;
beta blockers: this type of drug 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 heartbeat, dilate blood vessels;
Diuretics: inhibit the absorption of sodium in 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;
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 an obstruction to the 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 forms in the afferent veins and they expand. The thin walls of the veins, as opposed to the arteries, stretch under pressure and tear easily.

Portal hypertension: symptoms

The primary cause of portal hypertension is 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 for the content of platelets, leukocytes and erythrocytes are violated;
the spleen enlarges;
blood clotting worsens;
accumulation of fluid 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 deterioration in general health, bloating, and heaviness under the right rib. Next, 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 disrupted.

Portal hypertension: degrees

In total, there are 4 degrees of pathology:

1st degree – functional (initial);
2nd degree – moderate. Accompanied by moderate dilation 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 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

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 accurately state the presence of portal hypertension. Also, ultrasound examination can reveal an enlargement of 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 cardial 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 about 80%. The procedure involves injecting the drug into damaged veins using an endoscope. Thus, the lumen of the veins becomes blocked and their walls "glue together. "This treatment method is considered classic.

Portal hypertension: prevention

Measures to prevent the development of the disease include:

maintaining a proper diet and nutrition 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:

a complete examination to make a diagnosis in the early stages of liver disease and initiate treatment;
strict compliance with all doctor’s recommendations;
complex therapy in a hospital setting under the strict supervision of doctors.

Measures to prevent the development of bleeding include:

control of blood clotting function;
sigmoidoscopy - that is, examination of the sigmoid and rectum, 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;
An increase in systolic blood pressure occurs with Itsenko-Cushing syndrome. 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, resulting in the release of adrenaline and norepinephrine into the blood, which causes a constant or crisis increase in pressure;
Hyperaldosteronism, or Cohn's syndrome, is a tumor of the adrenal gland that causes an increase in aldosterone levels. As a result, the level of potassium in the blood decreases and blood pressure increases;
thyroid diseases such as hyperparathyroidism, hyper- and hypothyroidism are the cause of secondary arterial hypertension;
hemodynamic or cardiovascular arterial hypertension occurs as a result of involvement of the great vessels in the pathological process. It occurs with coarthration, 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, nonsteroidal anti-inflammatory drugs, and glucocorticosteroids.

Diagnosis of secondary hypertension is difficult, but there are several signs to suspect it:

increased blood pressure in young people;
acute sudden onset of the disease immediately with high blood pressure numbers;
unresponsiveness to ongoing antihypertensive therapy;
sympathoadrenal crises.

Diastolic hypertension

The diagnosis of "isolated diastolic hypertension" is valid when the systolic value is less than 140 mm. Hg, and diastolic is more than 90 mm Hg. Increase in diastolic pressure 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 numbers and do not have concomitant pathologies are recommended to control their blood pressure and change their lifestyle:

regulate sleep quality;
do not 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.

When diastolic hypertension occurs, hospital treatment is necessary if persistently high diastolic pressure is present. The underlying disease is treated, for example, surgical correction of aortic valve disease. Doctors individually prescribe medications for hypertension. The following tablets for hypertension are used:

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

Hypertensive crises

Hypertensive crisis is a state of individual significant increase in blood pressure in patients suffering from 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.

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

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

In case of a complicated crisis, the respiratory tract is sanitized, the patient is provided with oxygen, and venous access is made. The choice of antihypertensive drug is approached in a differentiated manner; it is administered intravenously. They quickly reduce the pressure, and then within 2-6 hours switch to oral medications, which reduce it to 160/100 mmHg. The patient is 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 they show how to correctly apply the cuff and record the indicators. It depends on which device measures pressure: mechanical or electronic.

It is necessary to carry out laboratory tests such as:

general blood and urine analysis;
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 instrumental research methods:
electrocardiogram;
echocardiogram;
chest x-ray;
ultrasound examination of the kidneys and adrenal glands;
Ultrasound of the renal and brachycephalic arteries.

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

Treatment of arterial hypertension

The goal of treatment for any patient with hypertension is to reduce the risk of cardiovascular complications and death. The selection 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, blood pressure must 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;
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 for this disease involves 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.