Hypertension

4 December 2024

In the 21st century, high blood pressure remains an important medical and social problem, as it is fraught with complications that lead to disability, disrupt quality of life and can be fatal.

The disease is successfully treated by professional doctors. If you suffer from high blood pressure, you should consult a doctor immediately. Only timely and competent treatment promotes healing.

Classification of high blood pressure

It is customary to distinguish 4 groups at risk of high blood pressure, 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 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, the target organs are affected.

In high blood pressure, the following target organs are affected:

brain (transient strokes, cerebrovascular accident);
organ of vision (degenerative changes and retinal detachment, hemorrhage, blindness);
blood (increase in glucose level leading to damage to the central nervous system);
heart (left ventricular hypertrophy, myocardial infarction);
kidneys (proteinuria, renal failure).

Depending on the severity of the cardiovascular risk, there are several levels of blood pressure, presented in table no. 1.

Table n°1. Blood pressure levels:

Categories	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
Optimal	Below 120	Below 80
Normal	120-129	80-84
Normal high	130-139	85-89
1st degree high blood pressure	140-159	90-99
High blood pressure 2 degrees	160-179	100-109
High blood pressure 3 degrees	≥180	≥110
Isolated systolic hypertension	≥140	≤90

Causes of hypertension

The main risk factors for primary hypertension include:

Sex and age. Men aged 35 to 50 are most predisposed to developing the disease. In women, the risk of high blood pressure increases considerably after menopause;
Hereditary predisposition. The risk of contracting 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 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, the increased load leads to wear and tear on the arteries and the risk of complications in the heart and blood vessels increases;
Drink alcoholic beverages. With daily consumption of strong alcohol, blood pressure increases by 5 mmHg per year. Art. ;
Smoking. Tobacco smoke causes spasms of the peripheral and coronary vessels. The arterial wall is damaged by nicotine and other components, and atherosclerotic plaques form at the damaged sites;
Atherosclerosis develops as a result of excessive consumption of cholesterol-containing foods and smoking. Atherosclerotic plaques narrow the lumens of blood vessels and interfere with free blood flow. This leads to high blood pressure, which stimulates the progression of atherosclerosis;
Increased consumption of table salt causes spasm of the arteries, retains fluid in the body, which leads to the development of hypertension;
Excess weight leads to a reduction in physical activity. Clinical trials have shown that for every extra kilo, there is 2 mm. art. 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 "kills" slowly and silently. In most cases, the disease shows no signs, progresses and leads to life-threatening complications such as myocardial infarction or stroke. When asymptomatic, high blood pressure can go unnoticed for decades.

The most common patient complaints are:

headache;
flickering of flies before the eyes;
blurred vision;
dizziness;
dyspnea;
fatigue;
chest pain;
visual impairment;
nosebleeds;
swelling of the lower limbs.

However, the most important sign of hypertension is high blood pressure. Headaches can manifest as a feeling of pinching of 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, anger, irritability and sensitivity to noise appear.

Intracranial hypertension

A headache can often be caused by a cold, lack of sleep or overwork. This appears to be 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 localization 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 is manifested by:

headaches;
dizziness;
attacks of nausea and vomiting;
disorder of consciousness;
convulsions

Intracranial hypertension: diagnosis

Types of pathological diagnoses include:

measure intracranial pressure by inserting a needle into the fluid cavities of the skull or spinal canal with a pressure gauge attached to it.
monitor 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;
perform an encephalogram.

Intracranial hypertension: treatment, medications

Increased intracranial pressure can lead to a decrease in the patient's intellectual abilities and disruptions in the normal functioning of internal organs. This pathology therefore requires the 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 brain tumor or hematoma, then surgical intervention is necessary. Removal of a hematoma or neoplasm leads to the normalization of intracranial pressure.

Essential hypertension

Essential hypertension is an increase in systolic blood pressure at the time of heart contraction and ejection of blood up to 140 mmHg. Art. and above this mark and/or the diastolic blood pressure at the time of relaxation of the heart muscle to 90 mmHg. Art. and higher.

Symptoms of essential hypertension

In medicine, we distinguish the following concepts:

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

In most cases, the disease affects people between the ages of 30 and 45.

Causes of disease

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

damage to the spinal cord and brain, leading to disruption of vascular tone in the periphery;
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 disorders 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 be no 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 blood vessels from relaxing and dilating normally. You must always remember: "what is good in moderation";
excessive salt consumption. It retains moisture in the body and leads to an increase in blood pressure. We know that the Japanese consume twice as much salt as Europeans and that 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 early stages, patients are prescribed non-drug treatment, which includes:

a special diet aimed at limiting the consumption of salt and foods rich in animal fats;
give up bad habits, especially smoking and alcohol abuse;
stress relief. In this case, yoga classes, self-training and sessions with a psychotherapist are very useful;
patients diagnosed with essential hypertension should not work in conditions of strong noise and vibration;
avoid excessive physical activity: intense and exhausting workouts on the treadmill should be replaced with half-hour walks.

Drug treatment involves taking the following medications:

angiotensin converting enzyme inhibitors. This group includes a large 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 medicine relieves heart pain, slows the heart rate 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 in the kidneys and excrete 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 obstruction of blood flow from the vein.

What is portal hypertension

Normally, the pressure in the door area is 7 mm. art. 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

Cirrhosis is the main cause of portal hypertension. 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 suffer from bleeding and anemia.

In the early stages, signs of portal hypertension in liver cirrhosis are manifested by deterioration in general condition, bloating and heaviness under the right rib. Then the patient develops pain in the area below 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 dilatation of the esophageal veins, enlargement of the 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

The types of diagnoses in the hospital are as follows:

Ultrasound: helps determine the size of the splenic, portal and superior mesenteric veins. If the diameter of the portal vein is greater than 15 mm and that of the splenic vein is greater than 7 to 10 mm, the presence of portal hypertension can be accurately seen. Additionally, ultrasound examination may 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): helps identify varicose veins in 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 approximately 80%. The procedure involves injecting the medicine 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:

maintain proper diet and nutrition;
playing sports;
vaccinations against viral hepatitis;
refusal to abuse alcoholic beverages;
avoid exposure to harmful production factors in the form of poisoning with toxic substances.

Preventive measures against liver diseases include:

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 setting under the strict supervision of doctors.

Measures to prevent the development of bleeding include:

control of blood clotting function;
sigmoidoscopy – i. e. annual examination of the sigmoid and rectum;
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, often called hypertension, secondary hypertension is also known.

Depending on the cause, the following types of diseases are distinguished:

Renal hypertension is 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 high blood pressure. The tumor compresses the outer layer of the adrenal glands, which leads to the release of adrenaline and norepinephrine into the blood, which causes a constant increase or crisis in pressure;
Hyperaldosteronism, or Cohn syndrome, is a tumor of the adrenal gland that causes increased 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 cause secondary hypertension;
Hemodynamic or cardiovascular hypertension results from the involvement of large vessels in the pathological process. This 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 disruption of central regulation (stroke, encephalitis, head trauma);
Drug-induced hypertension may occur when taking oral contraceptives, nonsteroidal anti-inflammatory drugs, and glucocorticosteroids.

The diagnosis of secondary hypertension is difficult, but several signs allow it to be suspected:

increased blood pressure in young people;
sudden and acute onset of the disease immediately accompanied by high blood pressure;
unresponsiveness to current antihypertensive treatment;
sympatho-adrenal crises.

Diastolic hypertension

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

It is recommended that people who have high diastolic pressure and who do not have concomitant pathologies control their blood pressure and change their lifestyle:

regulate 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 well;
maintain normal weight;
do physical exercise or yoga.

In case of diastolic hypertension, hospital treatment is necessary if high diastolic pressure is persistently present. The underlying disease is treated, for example, by surgical correction of aortic valve disease. Doctors prescribe medications for hypertension individually. 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 significant individual increase in blood pressure in patients with primary or secondary arterial hypertension, accompanied by the appearance or worsening of clinical symptoms and requiring rapid pressure control to limitor prevent target organ damage.

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 notable decrease in diuresis on the eve of an attack.

In the event of a complicated crisis, the respiratory tract is disinfected, the patient receives oxygen and venous access is provided. The choice of antihypertensive medication is approached in a differentiated manner; it is administered intravenously. They quickly reduce the pressure, then within 2-6 hours switch to oral medications, which reduce it to 160/100 mm Hg. 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 demonstrates how to correctly apply the cuff 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.

The ophthalmologist will examine the back of the eye and assess the presence and degree of microproteinuria. All hospitalized patients have their blood pressure monitored daily.

Treatment of high blood pressure

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, i. e. 140/80 mmHg. and fight against risk factors. In patients with renal failure 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, you must:

organize proper nutrition;
avoid emotional stress and stress;
engage in rational physical activity;
normalize sleep patterns;
watch your weight;
active rest;
stop smoking and drinking alcohol;
See your doctor regularly and get tested.

High blood pressure leads to disability and death. The disease is successfully treated by doctors. Treatment for this condition involves the continued use of medications to control blood pressure. Hypertensive crises and sudden changes in pressure should be avoided.

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