Hypertension

4 December 2024

In the 21st century, high blood pressure remains a major medical and social problem, as it is plagued by complications that cause disability, alter quality of life, and can be fatal.

The disease is successfully treated by professional doctors. If you have high blood pressure, you should see a doctor immediately. Only timely and competent treatment promotes recovery.

Classification of arterial hypertension.

It is customary to distinguish 4 risk groups for high blood pressure, 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 aggravations;
2 – the risk is between 10 and 20%, no more than 3 aggravating factors;
3 – risk of 20 to 30%, more than 3 aggravating factors;
4 – the risk is greater than 30%, more than three aggravating factors, target organs are affected.

In high blood pressure, 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 causing 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)
Optimum	Below 120	below 80
Normal	120-129	80-84
high normality	130-139	85-89
1st degree arterial hypertension	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 high blood pressure include:

Gender and age. Men between 35 and 50 years old are the most predisposed to developing the disease. In women, the risk of high blood pressure increases significantly after menopause;
Hereditary predisposition. The risk of suffering from the disease is very high in people whose first-degree relatives suffered from this disease. If two or more family members had hypertension, the risk increases;
Increased psycho-emotional stress and stress. During psychoemotional 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, the increased load causes wear of the arteries and increases the risk of complications of the heart and blood vessels;
Drink alcoholic beverages. With daily consumption of strong alcohol, blood pressure increases by 5 mmHg per year. Art. ;
Smoking. Tobacco smoke causes spasms of peripheral and coronary vessels. The arterial 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 interfere with free blood circulation. This leads to high blood pressure, which stimulates the progression of atherosclerosis;
Increased consumption of table salt causes spasms of the arteries, retains fluid in the body, which together leads to the development of hypertension;
Excess body weight leads to a decrease in physical activity. Clinical trials have shown that for every extra kilogram there are 2 mm. rt. Art. blood pressure;
Physical inactivity increases the risk of developing hypertension by 20 to 50%.

Symptoms of high blood pressure.

The danger of high blood pressure is that it is not accompanied by any characteristic symptoms, but rather "kills" slowly and silently. In most cases, the disease does not show any signs, progresses and leads to fatal complications such as myocardial infarction or stroke. When asymptomatic, high blood pressure can go unnoticed for decades.

The most common complaints that patients have are:

headache;
flickering of flies before the eyes;
blurred vision;
dizziness;
dyspnoea;
fatigue;
chest pain;
visual impairment;
nosebleeds;
Swelling of the lower extremities.

However, the most important sign of hypertension is high blood pressure. Headaches can be manifested by a sensation of squeezing the head with a "hoop", accompanied by dizziness and nausea. They occur in a context of physical or nervous stress. If the pain persists for a long time, bad 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 the 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 the stage of the disease and the speed of its development.

Moderate intracranial hypertension manifests itself as:

headaches;
dizziness;
attacks of nausea and vomiting;
cloudiness of consciousness;
seizures

Intracranial hypertension: diagnosis.

Types of pathology diagnosis include:

measure intracranial pressure by inserting a needle into the fluid cavities of the skull or spinal canal with an attached manometer.
Monitoring the degree of blood filling and dilation of the veins of the eyeball. If the patient has red eyes, that is, the veins in the eyes are abundantly filled with blood and are clearly visible, we can talk about increased intracranial pressure;
ultrasound examination of cerebral vessels;
magnetic resonance imaging and computed tomography - the expansion of the liquid cavities of the brain is examined, as well as the degree of rarefaction of the edges of the ventricle;
performing an encephalogram.

Intracranial hypertension: treatment, medications.

Increased intracranial pressure can cause a decrease in the patient's intellectual abilities and alterations in the normal functioning of internal organs. Therefore, this pathology requires the immediate start 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 brain tumor or hematoma, 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 up to 90 mmHg. Art. and higher.

Symptoms of essential hypertension.

In medicine, the following concepts are distinguished:

essential arterial hypertension (primary essential 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 appearance is 90%.

In children (up to 10 years), a pressure level greater than 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 for four weeks at least twice on different days.

In most cases, the disease affects people between 30 and 45 years old.

Causes of the disease

Despite all 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:

lesions of the spinal cord and brain, as a result of which the vascular tone in the periphery is disturbed;
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 kilos attribute their obesity to alterations in the functioning of the endocrine glands, they are included in the "sick" list and do not want to change anything in their lifestyle. In fact, there may not be any endocrine disruption at all;
sedentary lifestyle;
excessive consumption of many people's favorite coffee. At the same time, the level of caffeine in the blood increases, which prevents 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 causes an increase in 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 cause 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 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;
abandon bad habits, in particular smoking and alcohol abuse;
stress relief. In this case, yoga classes, self-training and sessions with a psychotherapist are of great help;
patients diagnosed with essential hypertension should not work in conditions of strong noise and vibration;
Avoid excessive physical activity: intense and exhausting treadmill workouts should be replaced with half-hour walks.

Pharmacological treatment involves taking the following medications:

Angiotensin-converting enzyme inhibitors. This group includes a large number of drugs that lower 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 down the heartbeat and dilates blood vessels;
calcium channel blockers - slow down the penetration of calcium into the tissues of blood vessels and heart, slow down heartbeat, dilate blood vessels;
Diuretics: inhibit the absorption of sodium in the kidneys, excreting it through the urine. This group of medications 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 of 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 veins, unlike arteries, stretch under pressure and tear easily.

Portal hypertension: symptoms

The main 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:

laboratory test indicators change: the norms for the content of platelets, leukocytes and erythrocytes are violated;
the spleen enlarges;
worsens blood clotting;
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 as a deterioration in general well-being, swelling and heaviness under the right rib. In addition, 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:

1st grade – functional (initial);
2nd degree – moderate. Accompanied by moderate dilation of the esophageal veins, enlarged spleen and ascites;
Third degree portal hypertension is a serious form of pathology. At this stage, pronounced hemorrhagic and ascites syndromes are observed;
4th grade (complicated). The patient develops bleeding in the esophagus and stomach, gastropathy and spontaneous bacterial peritonitis occur.

Portal hypertension: diagnosis

The types of diagnosis in the hospital are as follows:

Ultrasound: allows determining the size of the splenic, portal and superior mesenteric veins. If the diameter of the portal vein is greater than 15 mm and the splenic vein is greater than 7-10 mm, the presence of portal hypertension can be accurately indicated. Additionally, ultrasound examination may reveal an enlarged 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 aims to prevent bleeding.

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

maintain an adequate diet and nutritional regimen;
playing sports;
vaccines 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 comprehensive 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 under the strict supervision of doctors.

Measures to prevent the development of bleeding include:

control of blood coagulation 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 diseases are distinguished:

Renal hypertension occurs due to damage to the renal arteries. This form of the disease is called renovascular hypertension;
With Itsenko-Cushing syndrome, an increase in systolic blood pressure occurs. 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 high blood pressure. The tumor compresses the outer layer of the adrenal glands, as a result of which adrenaline and norepinephrine are released into the blood, causing a constant increase in pressure or crisis;
Hyperaldosteronism, or Cohn syndrome, is a tumor of the adrenal gland that causes increased levels of aldosterone. As a result, the level of potassium in the blood decreases and blood pressure increases;
Thyroid diseases such as hyperparathyroidism, hyperthyroidism and hypothyroidism are the cause of secondary high blood pressure;
Hemodynamic or cardiovascular arterial hypertension occurs as a result of the involvement of the great vessels in the pathological process. It occurs with coarctration 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.

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

increased blood pressure in young people;
sudden and acute onset of the disease immediately with high blood pressure levels;
lack of response 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 the diastolic is greater than 90 mm Hg. Increase in diastolic pressure to 90 mm Hg. It does not represent a threat to a person who does not have a somatic pathology.

People who have high diastolic pressure levels and do not suffer from concomitant pathologies are recommended to control their blood pressure and change their lifestyle:

regulate sleep quality;
don't drink red wine;
limit the number of cigarettes smoked per day;
avoid stress;
eliminate salt from the diet;
eat well;
maintain a normal weight;
do physical exercise or yoga.

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

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

Hypertensive crises

Hypertensive crisis is a state of individually 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 rapid control of pressure to limit or prevent damage tothe target organs.

Type 1 crisis (adrenal, neurovegetative) is manifested by an increase in systolic blood pressure, increased 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 urine output on the eve of a crisis.

In case of a complicated crisis, the respiratory tract is disinfected, the patient is provided with oxygen, and venous access is performed. The choice of antihypertensive drug is approached differently: it is administered intravenously. They quickly reduce the pressure and then, within 2 to 6 hours, switch to oral medications, which reduce it to 160/100 mmHg. The patient is hospitalized in a specialized hospital.

Diagnosis of high blood pressure.

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 correctly apply the cuff, and records the indicators. It depends on which device measures pressure: mechanical or electronic.

It is necessary to perform laboratory tests such as:

general blood and urine tests;
blood glucose levels;
creatinine, uric acid and potassium levels;
lipid profile;
C-reactive protein content in blood serum;
urine bacterial culture.
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 evaluate the presence and degree of microproteinuria. All hospital patients undergo daily blood pressure monitoring.

Treatment of high blood pressure.

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 address risk factors. In patients suffering from kidney diseases 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 high blood pressure.

To prevent the development of high blood pressure it is necessary:

organize proper nutrition;
avoid emotional stress and stress;
use rational physical activity;
normalize sleep patterns;
control your weight;
active rest;
stop smoking and drinking alcohol;
Visit your doctor periodically and get tested.

High blood pressure causes disability and death. The disease is successfully treated by doctors. Treatment of this disease involves the continued 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.