Hypertension, or arterial hypertension - a condition characterized by stable, that is, detected by repeated measurements, increased blood pressure. Accompanying many diseases, it is considered a risk factor for the development of hazardous complications from the cardiovascular system, including myocardial stroke and infarction. Hypertonic disease, as the main cause of the pathology under consideration, requires taking drugs, normalizing the lifestyle of the patient and nutrition.
Blood pressure is a force with which circulating blood acts on the walls of blood vessels. Such pressure at the time of heart contraction is called systolic, and during its relaxation - diastolic. The range of normal values for these indicators is quite wide.
In the course of numerous observations, scientists came to the conclusion that the risk of cardiovascular complications increases with each additional increase in blood pressure by 10 mm Hg. Art. Already starting with a level of 115/75 mm RT. Art. However, a drug decrease in pressure only above 140/90 mm turned out to be appropriate. RT. Art. , Therefore, it is precisely such a value that is taken as a criterion for determining arterial hypertension.
Reasons
In approximately 90% of cases, hypertension becomes the cause of a stable increase in blood pressure. Such a diagnosis is made to the patient when other diseases accompanied by hypertension were not found during the examination. Among the latter:
- kidney pathologies - pyelonephritis, glomerulonephritis, polycystic, diabetic nephropathy, stenosis of the renal arteries;
- Endocrine disorders-neoplasms of the adrenal gland, pancreas or pituitary gland, thyroid hyperfunction, Izenko-Cushing syndrome, pheochromocytoma;
- obstructive apnea syndrome in a dream;
- Valve vices or atherosclerotic damage to the aorta.
Regular use of a number of drugs can also cause an increase in blood pressure. These include oral contraceptives, non -steroidal anti -inflammatory drugs, amphetamines, corticosteroids, drugs containing erythropoetin, cyclosporine, cocaine.
The likelihood of cardiovascular diseases, including hypertension, is in a close relationship with the following risk factors:
- improper nutrition, including an excess of sodium salt, saturated fats and trans fats, a lack of leafy greens, vegetables and fruits in the diet;
- obesity;
- pathologies of the heart and blood vessels in close relatives;
- age older than 65 years;
- sedentary lifestyle;
- chronic stress;
- Harvesting habits - smoking, excessive alcohol consumption.
Classification
If it was possible to identify the disease leading to an increase in blood pressure, arterial hypertension is called secondary or symptomatic. In the case of an unidentified cause of hypertension, it is considered primary, caused by hypertension.
The latter has a staging current:
- Stage I. There are no obvious signs of violations of the work of target organs affected by a stable increase in blood pressure-heart, kidneys, arterial and venous vessels.
- Stage II. There is one of the listed signs or their totality, such as an increase in the left ventricle of the heart, a pronounced decrease in the rate of filtration in the kidneys, albumin in the urine, an increase in the thickness of the walls of the carotid arteries or the appearance of atherosclerotic plaques in their lumen. In this case, the clinical manifestations of the disease may be absent.
- Stage III Hypertension. There are one or more pathologies associated with atherosclerotic processes in the heart and vessels - myocardial infarction, acute cerebrovascular accident, angina pectoris, atherosclerosis of the arteries of the lower extremities, or a serious kidney damage, manifested by a pronounced decrease in filtration and/or significant loss of urine protein.
Arterial hypertension is divided into several degrees, depending on the maximum indicators of the measured blood pressure:
- The first degree. Systolic blood pressure from 140 to 159 mm. RT. Art. And/or diastolic - from 90 to 99 mm. RT. Art.
- The second degree. Systolic blood pressure from 160 to 179 mm. RT. Art. And/or diastolic - from 100 to 109 mm. RT. Art.
- The third degree. Systolic blood pressure is more than 180 mm. RT. Art. and/or diastolic over 110 mm. RT. Art.
There is also an isolated form of arterial hypertension, in which only the figures of systolic pressure in normal diastolic.
Symptoms
Often an increase in blood pressure is not accompanied by a deterioration in well -being and may go unnoticed for the patient, so it is so important to regularly measure blood pressure, especially middle -aged and elderly persons.
The following symptoms can be the manifestations of hypertension:
- headache, mainly in the morning after awakening;
- Bleeding from the nose;
- hemorrhage under the mucous membrane of the eye;
- violation of heart rhythm;
- blurred vision, flickering of flies;
- tinnitus.
A sharp leap of blood pressure to high numbers, accompanied by a pronounced deterioration in well -being, is called a hypertensive crisis. Most often, it occurs with an increase in systolic pressure of more than 180 mm Hg. Art. and/or diastolic over 120 mm Hg. Art. At the same time, the patient has weakness, nausea, vomiting, which does not bring relief, impaired consciousness, anxiety and fear, muscle trembling, chest pain.
Complications
A stable increase in blood pressure with hypertension significantly increases the risk of cardiovascular pathologies, including the patient's life. These include:
- acute cerebral circulation (stroke);
- angina pectoris, myocardial infarction;
- vascular dementia (dementia);
- chronic renal and heart failure;
- Atherosclerotic lesions of the vessels of the lower extremities.
Diagnostics
The main symptom of hypertension is a stable increase in blood pressure, revealed at least three dimensions on different days during a calm environment. In the first measurement of blood pressure in a hospital or clinic for the correctness of the results, it is important to comply with the following rules:
- Before examining, the patient needs to sit for several minutes in a quiet room to calm down;
- The size of the tonometer cuff should correspond to the thickness of the arm, and the device itself - to be attached to the level of the heart;
- Two measurements are performed with an interval of 1-2 minutes on each hand, with a large difference in the obtained numbers, additional measurement is made;
- In elderly patients, as well as persons suffering from diabetes mellitus, or in case of suspicion of reducing blood pressure in case of change in body position, the measurement is carried out in the first and fifth minutes in the standing position;
- Additionally, heart rate is measured within 30 seconds.
The doctor in an interview with the patient clarifies at what age the pressure first began to increase, if there are symptoms such as snoring with breathing stops in a dream, bouts of muscle weakness or sudden palpitations with sweating and headache, and unusual impurities in the urine. It is also important to find out what medicines and biodes he takes.
Within the framework of the first stage of the examination, the following tests are carried out for hypertension:
- Clinical blood test;
- general urine analysis, the detection of microalbumin in its one -time and daily portions;
- biochemical blood test (cholesterol, lipoproteins for assessing the risk of atherosclerosis, blood electrolytes - potassium, sodium, chlorine, calcium, as well as glucose and creatinine);
- determination of the level of glycated hemoglobin;
- Determination of the concentration of hormones - thyroxine, triiodothyronine and thyroid -mmer hormone, antibodies to thyroid -peroxidase and thyroidoglobulin, aldosterone.
In case of suspicion of a hereditary predisposition to the disease, it is possible to determine the polymorphisms of genes associated with the development of arterial hypertension.
In order to clarify the risk factors for the development and identification of existing cardiovascular pathologies for hypertension, instrumental diagnostic methods are used:
- daily monitoring of blood pressure;
- electrocardiographic study;
- echocardiography;
- Holter Daily monitoring;
- duplex scanning of brachiocephalous, renal or iliac arteries;
- ultrasound study of the kidneys and adrenal glands;
- Inspection of the eye bottom.
With hypertension, blood pressure control at home is important with maintaining a diary in which it is necessary to fix all the results of the time measurements, taking drugs and stress episodes that can provoke a rise in blood pressure. At the same time, the measurements must be performed in a sitting position, after several minutes of rest, holding the hand at the same level with the heart.
Treatment
With a moderate and low risk of cardiovascular complications, the patient is recommended only to change in lifestyle, correction of the diet, weight loss, increase in physical activity and special gymnastics for hypertension, rejection of bad habits against the background of regular blood pressure. Often these measures are enough to normalize blood pressure.
The diet for hypertension involves the limitation of table salt, caffeine, sharp, salty, smoked and spicy dishes, products with a high fat content, offal, confectionery with oil cream and alcoholic beverages. It is permissible to use no more than 5 g of salt per day outside the exacerbation of the disease. The recommended daily fluid rate is 1-1. 2 liters.
In the case of unsuccessful non -drug treatment for several months, as well as with a high risk of complications, resort to hypotensive therapy using drugs for hypertension, the purpose of which is a decrease in blood pressure less than 140/90 mm. RT. Art. For patients with diabetes or persons already suffering from pathologies of the cardiovascular system, the level of target pressure is even lower-130/80 mm. RT. Art.
Modern drug treatment of hypertension includes a combination of two or more drugs from the following groups:
- calcium antagonists;
- angiotenzinzinoproding enzyme inhibitors;
- blockers for angiotensin II;
- diuretics (diuretics);
- b-blockers;
- Alpha-blockers.
The vast majority of them are produced in the form of tablets from hypertension.
Prevention
Prevention of exacerbations of hypertension includes timely diagnosis and therapy for diseases of the cardiovascular, nervous, urinary and endocrine systems, relentless followed by the doctor’s recommendations, including non-union treatment and medication, as well as regular measurement of blood pressure.