High blood pressure (HTN) is one of the most common diseases of the cardiovascular system, affecting only an approximate third of the world's population. By the age of 60 to 65, more than half of the population has been diagnosed with hypertension. The disease is called a "silent killer" because its signs can be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, which significantly increases the risk of vascular accidents.
In Western literature the disease is referred to as arterial hypertension (AH). Others have adopted this wording, although both "hypertension" and "hypertension" are still in common use.
Attention to the problem of arterial hypertension is caused not so much by its clinical manifestations as by complications in the form of acute vascular diseases in the brain, heart and kidneys. Their prevention is the main goal of treatment to maintain normal blood pressure (BP).
An important point is the identification of all possible risk factors,as well as elucidating their role in disease progression. The connection between the degree of hypertension and existing risk factors is presented in the diagnosis, which simplifies the assessment of the patient's condition and prognosis.
For most patients, the numbers in the diagnosis according to "AH" mean nothing, although it is clear that the higher the degree and the risk indicator, the worse the prognosis and the more serious the pathology. In this article we will try to understand, how and why one or another degree of hypertension is diagnosed and what underlies the determination of the risk of complications.
Causes and risk factors of high blood pressure
The causes of arterial hypertension are diverse. governorSpeaking of primary or essential hypertension: we andWe mean the case when there is no specific previous illness or pathology of internal organs. In other words, such hypertension occurs on its own and involves other organs in the pathological process. Primary hypertension is responsible for more than 90% of cases of chronic hypertension.
The main cause of primary hypertension is considered to be stress and psycho-emotional overload, which contribute to the disruption of the central mechanisms of pressure regulation in the brain, then humoral mechanisms suffer and target organs (kidneys, heart, retina) are affected.
Secondary hypertension– a manifestation of another pathology, so its cause is always known. It accompanies and is secondary to diseases of the kidneys, heart, brain and endocrine disorders. After the underlying disease is cured, high blood pressure also disappears, so in this case it makes no sense to determine the risk and extent. Symptomatic hypertension accounts for no more than 10% of cases.
Everyone is also aware of the risk factors for high blood pressure. High blood pressure schools are being set up in clinics, whose specialists inform the population about unfavorable conditions that lead to high blood pressure. Any therapist or cardiologist will inform the patient about the risks as soon as high blood pressure is first detected.
Among the predisposing diseases for hypertension, the main ones are:
- Smoke;
- Too much salt in the diet, excessive fluid intake;
- Insufficient physical activity;
- alcohol abuse;
- Obesity and lipid metabolism disorders;
- Chronic psycho-emotional and physical overload.
If we can exclude the listed factors or at least try to reduce their impact on health, characteristics such as gender, age and heredity cannot be changed and therefore we must accept them, without forgetting the increasing risk.
Classification of arterial hypertension and determination of risk level
The classification of high blood pressure involves determining the stage, the degree of the disease and the level of risk of vascular accidents.
stage of diseasedepends on the clinical manifestations. To mark:
- Preclinical stage, when there are no signs of hypertension and the patient is unaware of the increase in blood pressure;
- In stage 1 hypertension, crises are possible with increased pressure, but there are no signs of target organ damage;
- Stage 2 is accompanied by damage to the target organs - the myocardium hypertrophies, changes in the retina of the eyes become noticeable and the kidneys suffer;
- In stage 3, strokes, myocardial ischemia, visual impairment, changes in large vessels (aortic aneurysm, arteriosclerosis) are possible.
Degree of hypertension
Determining the level of high blood pressure is important for risk and prognosis assessment and is based on pressure values. It must be said that normal blood pressure values also have different clinical significance. So the indicator is up to 120/80 mm Hg. Art. Art. countsoptimal,normalThe pressure is between 120 and 129 mmHg. Art. systolic and 80-84 mm Hg. Art. diastolic. Pressure values 130-139/85-89 mmHg. Art. are still within the normal range, but are approaching the borderline of pathology, which is why they are called "".extremely normal", and the patient can be told that he has high normal blood pressure. These indicators can be considered prepathology, since the pressure is only "a few millimeters" away from elevation.
From the moment the blood pressure reached 140/90 mm Hg. Art. We can already talk about the presence of the disease. This indicator is used to determine the degree of hypertension itself:
- Hypertension of the 1st degree (HTN or AH 1st stage in diagnosis) means an increase in pressure in the range of 140-159/90-99 mmHg. Art.
- Stage 2 headaches are associated with values of 160-179/100-109 mm Hg. Art.
- In stage 3 hypertension, the pressure is 180/100 mmHg. Art. and higher.
It happens that the systolic pressure values increase and reach 140 mm Hg. Art. and higher, while the diastolic value is within normal values. In this case, they talk about itisolated systolic formHypertension. In other cases, the indicators of systolic and diastolic pressure correspond to different degrees of the disease, then the doctor makes a diagnosis in favor of a higher degree and it does not matter whether conclusions are made based on systolic or diastolic pressure.
The most accurate diagnosis of the extent of hypertension is possible at the initial diagnosis of the disease, when treatment has not yet been carried out and the patient has not taken antihypertensive drugs. The numbers decrease during therapy, but can increase sharply when therapy is discontinued, so that an adequate assessment of the extent is no longer possible.
The concept of risk in diagnosis
High blood pressure is dangerous because of its complications. It is no secret that the vast majority of patients die or become disabled not from hypertension itself, but from the acute diseases to which it leads.
Cerebral hemorrhage or ischemic necrosis, myocardial infarction and renal failure are the most dangerous diseases caused by hypertension. In this regard, for each patient after a thorough examinationThe risk is determined, which is indicated in the diagnosis by the numbers 1, 2, 3, 4. The diagnosis is therefore based on the degree of hypertension and the risk of vascular complications (e. g. hypertension/hypertension stage 2, risk 4). .
Risk stratification criteriaIn patients with high blood pressure, external diseases, the presence of other diseases and metabolic disorders, the involvement of target organs and accompanying changes in organs and systems are taken into account.
The main risk factors affecting the prognosis include:
- The patient's age is 55 years for men and 65 years for women;
- Smoke;
- Disorders of lipid metabolism (exceeding the norm of cholesterol, low-density lipoproteins, decreased high-density lipid fractions);
- Presence of cardiovascular pathology in the family in blood relatives under 65 and 55 years old in women and men, respectively;
- Overweight if the abdominal circumference exceeds 102 cm for men and 88 cm for women.
The listed factors are considered the most important, but many patients with hypertension suffer from diabetes, impaired glucose tolerance, lead a sedentary lifestyle and have abnormalities in the blood coagulation system in the form of an increase in fibrinogen concentration. Take these factors into accountadditionally, which also increases the likelihood of complications.
Damage to target organs characterizes high blood pressure from stage 2 onwards and serves as an important criterion for determining risk. Therefore, the patient's examination includes an ECG, ultrasound of the heart to determine the degree of hypertrophy of its muscles, blood, etc. Urine tests for indicators of kidney function (creatinine, protein).
First of all, the heart suffers from high blood pressure, which pushes the blood into the vessels with increased force. As the arteries and arterioles change, their walls lose elasticity and the lumens become spasmodic, the load on the heart increases progressively. A characteristic that is taken into account in risk stratificationMyocardial hypertrophy, which can be suspected by ECG, can be detected by ultrasound examination.
The involvement of the kidneys as a target organ is indicated by an increase in creatinine in the blood and urine and by the appearance of albumin protein in the urine. Against the background of hypertension, the walls of large arteries thicken, atherosclerotic plaques appear, which can be detected using ultrasound (carotid artery, brachiocephalic arteries).
The third stage of hypertension occurs with associated pathology, that is, associated with hypertension.Among the comorbidities, the most important for prognosis are stroke, transient ischemic attacks, myocardial infarction and angina, nephropathy due to diabetes, renal failure and retinopathy (damage to the retina) due to hypertension.
So the reader probably understands how you can even independently determine the degree of headache. This is not difficult, you just need to measure the pressure. Next, you can think about the presence of certain risk factors, take into account age, gender, laboratory parameters, ECG data, ultrasound, etc. In general, everything listed above.
For example, a patient's blood pressure corresponds to stage 1 hypertension, but they also suffered a stroke, meaning the risk is a maximum of 4, even if only stroke is a problem in addition to high blood pressure. If the pressure corresponds to the first or second degree and smoking and age can be identified as the only risk factors with fairly good health, the risk is moderate - 1 tbsp. (2 tbsp), risk 2.
To make it clearer what the risk indicator means in a diagnosis, you can summarize everything in a small table. By determining your degree and "counting" the factors listed above, you can determine the risk of vascular accidents and complications from hypertension for a particular patient. The number 1 means low risk, 2 - moderate, 3 - high, 4 - very high risk of complications.
| Risk factors | BP 130-139/85-89, risk | GB (AH) 1, risk | GB 2, risk | GB 3, risk |
|---|---|---|---|---|
| none | 1 | 2 | 3 | |
| 1-2 | 1 | 2 | 2 | 4 |
| more than three factors/target damage/diabetes | 3 | 3 | 3 | 4 |
| associated pathology | 4 | 4 | 4 | 4 |
Low risk means that the probability of vascular accidents is no more than 15%, moderate - up to 20%, high risk means that complications occur in a third of patients in this group, with a very high risk it is more than 30% ofPatients prone to complications.
Manifestations and complications of headaches
The manifestations of hypertension are determined by the stage of the disease. In the preclinical period, the patient is doing well and only the tonometer readings indicate a developing disease.
As changes in the blood vessels and heart progress, symptoms appear in the form of headaches, weakness, reduced performance, periodic dizziness, visual disturbances in the form of reduced visual acuity and flashing "spots" in front of the eyes. All of these signs do not manifest themselves during a stable course of thePathology, but at the time of development of a hypertensive crisis the clinic becomes brighter:
- Strong headache;
- Noise, ringing in the head or ears;
- darkening of the eyes;
- pain in the heart area;
- dyspnea;
- facial hyperemia;
- Excitement and feeling of fear.
Hypertensive crises are caused by traumatic situations, overwork, stress, coffee and alcohol consumption, so patients with an already confirmed diagnosis should avoid such influences. Against the background of a hypertensive crisis, the likelihood of complications, including life-threatening ones, increases sharply:
- bleeding or cerebral infarction;
- Acute hypertensive encephalopathy, possibly with cerebral edema;
- pulmonary edema;
- Acute kidney failure;
- Heart attack.
How do you measure blood pressure correctly?
If there is a reasonable suspicion of high blood pressure, it will first be measured by a specialist. Until recently, it was believed that blood pressure readings could normally be different on different hands, as practice has shown, however, even a difference of 10 mm Hg. Art. can occur due to pathology of peripheral vessels, therefore different pressures on the right and left hands should be treated with caution.
In order to obtain the most reliable values possible, it is recommended to measure the pressure on each arm three times at short intervals, recording each result obtained. For most patients, the smallest values determined are the most correct, although in some cases the pressure increases from measurement to measurement, which does not always indicate hypertension.
A wide range and availability of blood pressure measurement devices makes it possible to monitor a wide range of people at home. As a rule, hypertensive patients have a tonometer on hand at home so that they can immediately measure their blood pressure if their health worsens. However, it should be noted that fluctuations are possible even in absolutely healthy people without hypertension, so a one-time exceedance of the norm should not be considered a disease and to make a diagnosis of hypertension, the pressure must be measured at different times, underdifferent conditions and repeated.
In the diagnosis of hypertension, blood pressure values, electrocardiography data and cardiac auscultation results are of fundamental importance. When listening, it is possible to detect murmurs, increased tones and cardiac arrhythmias. From the second stage onwards, the ECG shows signs of strain on the left side of the heart.
Treatment of high blood pressure
To correct hypertension, treatment regimens have been developed that include drugs of different groups and different mechanisms of action. HerThe combination and dosage are selected individually by the doctortaking into account the stage, accompanying pathology and response of hypertension to a particular drug. After the diagnosis of hypertension has been made and before starting drug treatment, the doctor will suggest non-drug measures that significantly increase the effectiveness of pharmacological drugs and sometimes allow you to reduce the dose of drugs or at least cancel some of them.
First of all, it is recommended to normalize the regime, reduce stress and ensure physical activity. The diet aims to reduce salt and fluid intake and avoid alcohol, coffee and drinks, as well as substances that stimulate the nervous system. If you are overweight, you should limit your calorie intake and avoid fatty, floury, fried and spicy foods.
Non-drug measures in the early stages of high blood pressure can have such a good effect that the prescription of medication is no longer necessary. If these measures do not work, the doctor will prescribe appropriate medication.
The aim of treating high blood pressure is not only to lower blood pressure, but also, if possible, to eliminate its cause.
To treat high blood pressure, antihypertensive drugs from the following groups are traditionally used:
- diuretics;
- angiotensin II receptor antagonists;
- ACE inhibitors;
- adrenergic blockers;
- Calcium channel blockers.
Every year the list of drugs that lower blood pressure while becoming more effective and safe, with fewer side effects, grows. At the beginning of therapy, a drug is prescribed in a minimum dose; if it is ineffective, the dose can be increased. If the disease progresses and the pressure does not remain at acceptable levels, another drug from another group is added to the first drug. Clinical observations show that the effect is better with combination therapy than with prescribing one drug in the maximum amount.
When choosing a treatment regimen, it is important to reduce the risk of vascular complications.So, it was found that some combinations have a more pronounced "protective" effect on the organs, while others allow better control of pressure. In such cases, experts prefer a combination of drugs that reduces the likelihood of complications, even if the blood pressure is partially dailyfluctuates.
In some cases, it is necessary to take into account concomitant pathologies that require adjustment of headache treatment regimens. For example, men with prostate adenoma are prescribed alpha-blockers, the constant use of which to lower blood pressure in other patients is not recommended.
The most commonly used ACE inhibitors, calcium channel blockers,which are prescribed to both young and elderly patients with or without comorbidities, diuretics, sartans. Drugs in these groups are suitable for initial treatment, which can then be supplemented with a third drug of a different composition.
ACE inhibitors lower blood pressure and at the same time have a protective effect on the kidneys and heart muscle. They are preferable in young patients, women taking hormonal contraceptives indicated for diabetes and in elderly patients.
Diureticsno less popular. To reduce side effects, they are combined with ACE inhibitors, sometimes "in one tablet".
Beta blockersare not a priority group for hypertension, but are effective in concomitant heart disease – heart failure, tachycardia, coronary artery disease.
Calcium channel blockersThey are often prescribed in combination with ACE inhibitors and are particularly good for bronchial asthma in combination with high blood pressure because they do not cause bronchospasm.
Angiotensin receptor antagonists– the most commonly prescribed group of medications for high blood pressure. They effectively lower blood pressure and do not cause a cough like many ACE inhibitors. However, they are particularly common in America, as the risk of developing Alzheimer's is reduced by 40%.
When treating high blood pressure, it is important not only to choose effective therapy, but also to take the medication for a long period of time, even for life. Many patients believe that treatment can be stopped when the pressure reaches normal levels, but at the time of crisis they resort to pills. It is known that the unsystematic use of antihypertensive medications is even more harmful to health than completely foregoing treatment. Therefore, informing the patient about the duration of treatment is one of the doctor's important tasks.