Hypertension

In the 21st century, arterial hypertension remains an important medical and social problem, as it is full of complications that lead to disability, disrupt the quality of life and can be fatal.

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

Classification of arterial hypertension

It is customary to distinguish 4 risk groups for arterial hypertension, depending on the possibility 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 – risk higher than 30%, more than three aggravating factors, target organ affected.

In arterial hypertension, the following target organs are affected:

• brain (transient cerebrovascular accident, stroke);
• organs of vision (degenerative changes and detachment of the retina, bleeding, blindness);
• blood (increased glucose levels leading to damage to the central nervous system);
• heart (left ventricular hypertrophy, myocardial infarction);
• kidney (proteinuria, kidney failure).

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

Table No. 1. Blood pressure level:

Category	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
Optimum	Below 120	Below 80
It's normal	120-129	80-84
Normal high	130-139	85-89
Arterial hypertension degree 1	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 are most susceptible to this disease. In women, the risk of arterial hypertension increases significantly after menopause;
• Hereditary tendency. The risk of this disease is very high in people whose first degree relatives suffer from this disease. If two or more relatives have hypertension, the risk increases;
• Increased stress and psycho-emotional stress. During psycho-emotional stress, a large amount of adrenaline is released, under the influence of which the heart rate and the amount of blood pumped 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;
• Drink alcoholic beverages. With strong alcohol intake every day, blood pressure increases by 5 mmHg every year. Art. ;
• Smoking. Tobacco smoke causes spasm of peripheral and coronary vessels. Arterial walls are damaged by nicotine and other components, and atherosclerotic plaques form at the site of damage;
• Atherosclerosis develops as a result of excessive consumption of foods containing cholesterol and smoking. Atherosclerotic plaque narrows the lumen of blood vessels and interferes with free blood circulation. This leads to arterial hypertension, which stimulates the development of atherosclerosis;
• Increased consumption of table salt causes arterial spasms, retaining fluid in the body, which together leads to the development of hypertension;
• Excess body weight leads to a decrease in physical activity. Clinical tests have shown that for every additional kilogram there are 2 mm. right. Art. blood pressure;
• Lack of physical activity increases the risk of 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 silently "kills". This disease in most cases does not show any signs, develops and leads to fatal complications such as myocardial infarction or stroke. When asymptomatic, arterial hypertension can remain undetected for decades.

The most common complaints experienced by patients are:

1. headache;
2. the flickering of flies before the eyes;
3. blurred vision;
4. dizziness;
5. breathing difficulties;
6. tiredness;
7. chest pain;
8. visual impairment;
9. nosebleeds;
10. swelling on the bottom of the leg.

However, the most important sign of hypertension is high blood pressure. Headache can be manifested by a feeling of squeezing the head with a "loop", accompanied by dizziness and nausea. It occurs on the background of physical or nervous stress. If the pain persists for a long time, short temper, quick temper, and sensitivity to sound appear.

Intracranial hypertension

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

• headache;
• dizziness;
• attacks of nausea and vomiting;
• cloudiness of consciousness;
• convulsions

Intracranial hypertension: diagnosis

Pathological diagnostic types include:

• measure intracranial pressure by inserting a needle into the cranial fluid cavity or spinal canal with a pressure gauge attached to it.
• detect the level of blood filling and dilation of eyeball veins. If the patient has red eyes, that is, the eye veins are filled with a lot of 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 fluid cavity is checked, as well as the degree of rarefaction of the ventricular edge;
• conduct an encephalogram.

Intracranial hypertension: treatment, medication

Increased intracranial pressure can cause a decrease in the patient's intellectual abilities and disturbances in the normal functioning of internal organs. Therefore, this pathology requires immediate treatment aimed at reducing intracranial pressure.

Treatment can only be carried out if the cause of the pathology is 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 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 when the heart muscle relaxes to 90 mmHg. Art. and higher.

Symptoms of hypertension are important

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), pressure levels above 110/70 mm Hg are considered dangerous. Art. , after 10 years - 120/80 mm Hg. The diagnosis is confirmed in the case 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.

Cause of disease

Despite all the modern advances in medicine, the cause of primary hypertension has not yet been established. There are only a few factors that increase the risk of getting 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 shock, normal stress. In this case, a constant focus of excitation is observed in the cerebral cortex, prolonged spasms cause an increase in peripheral resistance, vessels lose their elasticity;
• hereditary factors;
• overweight: many people who are overweight 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 the 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 keeps moisture in the body and leads to increased blood pressure. It is known that Japanese people 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 hypertension is important

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

1. a special diet aimed at limiting the consumption of salt and foods high in animal fat;
2. giving up bad habits, especially smoking and alcohol abuse;
3. relieve stress. In this case, yoga classes, auto training, and sessions with a psychotherapist are very helpful;
4. patients diagnosed with essential hypertension should not work in conditions of strong noise and vibration;
5. avoid excessive physical activity: intense and exhausting exercise on the treadmill should be replaced by walking for half an hour.

Drug treatment involves taking the following drugs:

• angiotensin-converting enzyme inhibitors. This group includes a large number of drugs that reduce blood pressure in several ways simultaneously;
• angiotensin 2 receptor blockers Medicines dilate blood vessels, thereby lowering blood pressure;
• beta blockers: this type of medicine relieves pain in the heart, slows the heartbeat and expands blood vessels;
• calcium channel blockers: slow down the penetration of calcium into the tissue of blood vessels and the heart, slow down the heartbeat, dilate blood vessels;
• Diuretic: prevents 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 a phenomenon of increased blood pressure in the portal vein caused by obstruction to blood flow from the vein.

What is portal hypertension

Normally, the pressure in the portal zone is 7 mm. right. Art. , In cases where this indicator exceeds 12-20 mm, stagnation is formed in the afferent veins and they develop. The thin walls of veins, compared to 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 tract of the liver increases.

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

• laboratory test indicators change - norms for the content of platelets, leukocytes and erythrocytes are violated;
• enlarged spleen;
• 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 liver cirrhosis manifest themselves in the form of general health deterioration, abdominal bloating, and weight under the right rib. Next, the patient experiences pain in the area under the right rib, the liver and spleen increase in size, and the normal function of the digestive tract is disturbed.

Portal hypertension: degree

In total, there are 4 degrees of pathology:

• First degree - functional (initial);
• grade 2 – moderate. Accompanied by moderate dilation of esophageal veins, enlarged spleen and ascites;
• Portal hypertension of the 3rd degree is a severe form of pathology. At this stage, significant hemorrhagic and ascitic syndromes are observed;
• degree 4 (complicated). The patient had bleeding in the esophagus and stomach, gastropathy and spontaneous bacterial peritonitis occurred.

Portal hypertension: diagnosis

The 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, an ultrasound examination can reveal 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 cardiac 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 about 80%. This procedure involves injecting drugs into the damaged vein using an endoscope. Therefore, the lumen of the vein becomes clogged and the wall "sticks". This method of treatment is considered classic.

Portal hypertension: prevention

Measures to prevent the development of the disease include:

• maintain a proper diet and nutritional regimen;
• playing sports;
• vaccination against viral hepatitis;
• refusal to abuse alcoholic beverages;
• avoid exposure to dangerous production factors in the form of poisoning with toxic substances.

Preventive measures for liver disease are:

• complete examination to make a diagnosis in the early stages of liver disease and start treatment;
• strict compliance with all doctor's recommendations;
• complex therapy in a hospital environment under the strict supervision of a doctor.

Steps to prevent the development of bleeding include:

• regulates blood clotting function;
• sigmoidoscopy - that is, examination of the sigmoid and rectum, every year;
• 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 as a result of damage to the renal arteries. This form of the disease is called renovascular hypertension;
• Increased 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 the malignant form of arterial hypertension. The tumor compresses the outer layer of the adrenal gland, as a result of which adrenaline and norepinephrine are released into the blood, which causes a constant increase in pressure or a crisis;
• Hyperaldosteronism, or Cohn's syndrome, is a tumor of the adrenal gland that causes an increase in aldosterone levels. As a result, potassium levels in the blood decrease and blood pressure increases;
• thyroid diseases such as hyperparathyroidism, hyper- and hypothyroidism are causes of secondary arterial hypertension;
• Hemodynamic or cardiovascular arterial hypertension occurs due to the involvement of large 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 brain diseases with secondary disturbances of central regulation (stroke, encephalitis, head injury);
• Drug-induced hypertension can occur when taking birth control pills, non-steroidal anti-inflammatory drugs and glucocorticosteroids.

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

• increased blood pressure in young people;
• sudden onset of acute illness with high blood pressure numbers;
• unresponsive to ongoing antihypertensive therapy;
• sympathoadrenal crisis.

Diastolic hypertension

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

People with high diastolic pressure numbers and no concomitant pathology are recommended to control their blood pressure and change their lifestyle:

• control the quality of sleep;
• do not drink red wine;
• limit the number of cigarettes smoked per day;
• avoid stress;
• eliminate salt from the diet;
• eat right;
• maintain a normal weight;
• do physical exercise or yoga.

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

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

Hypertensive crisis

A hypertensive crisis is a condition of a significant increase in individual blood pressure in patients with primary or secondary arterial hypertension, accompanied by the appearance or worsening of clinical symptoms and requiring rapid controlled pressure to limit or prevent damage to target organs.

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

• a major increase in diastolic pressure with a decrease in pulse pressure;
• swelling of the face, legs, arms;
• significant decrease in diuresis the night before the crisis.

In the case of a complicated crisis, the airway is cleared, the patient is supplied with oxygen, and venous access is made. The choice of antihypertensive drugs is approached in different ways; it is given intravenously. They quickly reduce the pressure, and then within 2-6 hours switch to oral medication, which reduces it to 160/100 mmHg. Patients are hospitalized in specialized hospitals.

Diagnosis of arterial hypertension

It is very important to know how to measure blood pressure, then hypertension can be diagnosed. The training begins with an explanation of one's behavior during the procedure, then they show how to use the cuff correctly and record the indicators. It depends on the device that measures the 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;
• 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.

An 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: reaching the target blood pressure, that is, 140/80 mmHg. and address risk factors. For patients with kidney disease and diabetes, the 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 pressure;
• using 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 was successfully treated by doctors. Treatment for this disease involves the continuous use of medications to control blood pressure. Hypertensive crises and sudden changes in pressure should be avoided.

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