What is dangerous arterial hypertension: symptoms, causes and treatment

Arterial hypertension (AH, hypertension) is one of the most important socio-economic and medical problems of our time.

This is due not only to the wide spread of this disease among different age groups of the population, but also to the high rates of severe complications, disability and mortality from arterial hypertension in the absence of timely treatment.

People prone to high blood pressure are advised to take measurements on both hands. Recent studies have shown that arterial hypertension can be confirmed with a difference in readings on different hands of 10 - 15 mm Hg. This sign (difference in indications) has a probability of determining hypertension up to 96%.

What it is?

In simple terms, arterial hypertension is a disease of the cardiovascular system, in which blood pressure in the arteries of the systemic (large) circulation is steadily increased.

Blood pressure is divided into systolic and diastolic:

1. Systolic. According to the first, upper number, the level of blood pressure is determined at the moment of compression of the heart and expulsion of blood from the artery. This indicator depends on the force with which the heart contracts, on the resistance of the walls of blood vessels and the frequency of contractions.
2. diastolic. The second, lower number determines the blood pressure at the moment when the heart muscle relaxes. It indicates the level of peripheral vascular resistance.

Normally, blood pressure readings are constantly changing. They physiologically depend on the age, gender and condition of the person. During sleep, pressure decreases, physical activity or stress leads to its increase.

The average normal blood pressure in a twenty-year-old person is 120/75 mm Hg. Art. , forty years old - 130/80, over fifty - 135/84. With persistent figures of 140/90, we are talking about arterial hypertension. Statistics show that about 20-30 percent of the adult population is affected by this disease. With age, the prevalence rate inexorably increases and by the age of 65, 50-65 percent of older people suffer from this disease.

Classification

Given the origin of the pathology, the following types are distinguished:

1. Essential arterial hypertension (primary). It is difficult to determine the exact cause of development due to the lack of visible prerequisites;
2. Symptomatic (secondary). An increase in pressure is considered a consequence of the development of a certain disease, it is one of its signs. The secondary type of the disease, depending on the cause of development, is divided into the following types: endocrine, renal, drug-induced, hemodynamic, neurogenic.

If we take into account the level of blood pressure, the pathology is divided into the following types:

1. Border. The pressure periodically rises to 140 - 149/90, then it goes down, normalizes;
2. Systolic isolated. There is an increase in the upper indicator (it reaches 140 and above). At the same time, the lower one remains within 90 and below.

Taking into account the nature of the pathology, experts have identified the following types:

1. Transient. The patient has occasional high blood pressure. This state can last for hours or days. The pressure returns to normal without the use of medicines;
2. Labile. It manifests itself at the initial stage of the development of pathology. This state is considered borderline, because pressure surges are insignificant, unstable. The pressure usually normalizes on its own;
3. Stable arterial hypertension. The increase in pressure is persistent, supportive therapy is needed to reduce it;
4. Crisis. Periodic hypertensive crises are characteristic;
5. Malignant. The pressure rises to serious levels, hypertension develops quickly, causing severe complications. Possible death.

Risk factors

At present, the severity of the described disease directly depends on the risk facts. The risk lies in the formation of cardiovascular complications against the background of high blood pressure. Taking into account the presented complications, the prognosis of the consequences of arterial hypertension is diagnosed. There are the following risk factors that worsen the course of the disease and its prognosis:

• age - in men after 50 years, in women after 60 years;
• smoking;
• high cholesterol;
• hereditary factor;
• obesity;
• hypodynamia;
• diabetes.

The presented risk factors can be eliminated (correctable) and may not be correctable. The first type of risk factors is characterized by the presence of diabetes mellitus, high cholesterol, smoking, physical inactivity. Uncorrected risk factors include race, family history, and age.

Severity

There is also an international classification of the disease, developed depending on the degree of arterial hypertension:

Arterial hypertension of the 1st degree

This stage of the disease is characterized by a mild course of the disease: the pressure during the day increases by 20-30 units and usually does not exceed 180/115 mm Hg. Art. Hypertensive crises occur infrequently and they are provoked, as a rule, by a sharp change in atmospheric pressure or emotional overload. There are no complications from the work of target organs.

Arterial hypertension of the 2nd degree

It is characterized by an increase in blood pressure to the level of 160-179 / 100-109 mm Hg. Art. It is with such indicators that patients most often go to the doctor for the first time, since considering them as the norm is the height of carelessness. Arterial hypertension of the 2nd degree is usually manifested by severe headache, weakness, dizziness and deterioration of well-being during episodes of increased pressure.

Arterial hypertension of the 3rd degree

It is characterized by an increase in blood pressure to the level of 180/110 or more mm Hg. Art. Sometimes these figures can reach completely prohibitive (250/160 mm Hg and above), but in this case there is a real threat to human health and life. A patient with arterial hypertension of the 3rd degree must be under the supervision of a doctor, take all antihypertensive drugs prescribed to him, and be sure to have a tonometer (mechanical or electronic) at home.

Symptoms of arterial hypertension

Arterial hypertension itself has no symptoms. Most adult patients with this disease do not complain about anything at all, high blood pressure is detected by chance.

The clinical manifestations of arterial hypertension depend on which organs are affected at the present time. Adults with benign hypertension may complain of the following symptoms:

1. Headache - may be the very first and main symptom. There are several types of headaches:
   • dull, not intense, characterized by a feeling of heaviness in the forehead and occiput. It appears most often at night or in the morning, increases with a sharp change in the position of the head and even slight physical exertion. Such pain is caused by a violation of the venous outflow of blood from the vessels of the skull, their overflow and stimulation of pain receptors;
   • liquor - bursting diffuse throughout the head, can be pulsating. Any tension causes an increase in pain. It occurs most often in the late stages of hypertension or in the presence of pulse hypertension. As a result of this, the vessels are sharply overfilled with blood and its outflow is difficult;
   • ischemic - dull or breaking character, accompanied by dizziness and nausea. It occurs with a sharp increase in blood pressure. There is a sharp vasospasm, as a result of which the blood supply to the brain tissues is disturbed.
2. Pain in the region of the heart - cardialgia, not of an ischemic nature, the coronary vessels are in order, while the pain is not stopped by sublingual use of nitrates (nitroglycerin under the tongue) and can occur both at rest and during emotional stress. Sports activities are not a provoking factor.
3. Shortness of breath - at first occurs only when playing sports, with the progression of hypertension, it can also occur at rest. It characterizes the dysfunction of the heart.
4. Edema - most often found on the legs due to stagnation of blood in the systemic circulation, sodium and water retention, or impaired kidney function. The appearance in children simultaneously with edema of hematuria and hypertension is characteristic of glomerulonephritis, which is very important to remember when making a differential diagnosis.
5. Visual impairment - manifests itself in the form of blurred vision, the appearance of a veil or flickering flies. Occurs due to damage to the vessels of the retina.

Chronic arterial hypertension causes damage to the kidneys with the development of renal failure and the corresponding complaints of renal genesis, which will be discussed below. Chronic hypertension also leads to the development of dyscirculatory encephalopathy, which is characterized by a decrease in memory, attention and performance, sleep disturbance (increased daytime sleepiness, combined with insomnia at night), dizziness, tinnitus and depressed mood.

When collecting an anamnesis, in the medical history it is necessary to record a family history and the causes of arterial hypertension in close relatives, clarify the time of appearance of the first clinical symptoms, note concomitant diseases.

Hypertensive crisis

This is an emergency condition, which consists in a sharp increase in blood pressure to high numbers and is characterized by a sharp deterioration in the blood supply to all internal organs, in particular, vital ones.

It occurs when the body is exposed to various adverse factors, it cannot be predicted, which is why uncontrolled hypertension is dangerous. The urgency of the problem also lies in the fact that in the absence of timely emergency care, a fatal outcome is possible. To provide emergency care, the patient must be immediately taken to the hospital, where he is quickly reduced blood pressure with medication.

Students of medical institutes study first aid for hypertensive crisis at the Department of Propaedeutics of Internal Diseases, and therefore it would be best for a random passer-by not to try to provide assistance, but to call an ambulance.

Diagnostics

The three main diagnostic methods that allow you to determine the presence of hypertension in a person are:

1. Blood pressure measurement,
2. physical examination,
3. Recording an electrocardiogram.

Blood pressure control

Measurement of blood pressure is carried out using a special device - a tonometer, which is a combination of a sphygmomanometer with a phonendoscope. In addition, at present there are special electronic devices that measure blood pressure, pulse rate, and also allow you to enter blood pressure indicators into the memory of the device.

Medical history

Diagnosis of hypertension also includes a survey of the patient by a doctor. The doctor finds out from the patient what diseases he previously suffered or is currently suffering from. Risk factors are assessed (smoking, high cholesterol, diabetes), plus the so-called. hereditary history, that is, whether the parents, grandparents of the patient and other close relatives suffered from hypertension.

Physical examination

Physical examination of the patient includes, first of all, the study of the heart using a phonendoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic tones (amplification or, conversely, weakening), as well as the appearance of uncharacteristic sounds. These data, first of all, speak of changes occurring in the heart tissue due to increased blood pressure, as well as the presence of defects.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a method that allows you to register changes in the electrical potentials of the heart over time on a special tape. This is an indispensable method for diagnosing, first of all, various cardiac arrhythmias. In addition, the ECG allows you to determine the so-called. hypertrophy of the wall of the left ventricle, which is typical for arterial hypertension.

echocardiography

In addition to these diagnostic methods, other methods are also used, for example, echocardiography (ultrasound examination of the heart), which allows you to determine the presence of defects in the structure of the heart, changes in the thickness of its walls and the condition of the valves.

Arteriography

Arteriography, including aortography, is an X-ray method for examining the condition of the walls of the arteries and their lumen. This method allows you to identify the presence of atheromatous plaques in the wall of the coronary arteries (coronary angiography), the presence of coarctation of the aorta (congenital narrowing of the aorta in a certain area), etc.

dopplerography

Dopplerography is an ultrasound method for diagnosing the state of blood flow in the vessels, both in the arteries and in the veins. With arterial hypertension, first of all, the doctor checks the condition of the carotid arteries and cerebral arteries. Ultrasound is widely used for this, as it is absolutely safe to use and does not provoke complications.

Blood chemistry

A biochemical blood test is also used in the diagnosis of hypertension. First of all, the level of cholesterol and high, low and very low density lipoproteins is ascertained, since they are an indicator of a tendency to atherosclerosis. In addition, the blood sugar level is determined.

In the diagnosis of hypertension, a study of the condition of the kidneys is also used, for which methods such as a general urinalysis, a biochemical blood test (for the level of creatinine and urea), as well as ultrasound of the kidneys and their vessels are used.

Thyroid ultrasound

Ultrasound of the thyroid gland and a blood test for thyroid hormones. These research methods help to identify the role of the thyroid gland in causing high blood pressure.

How to treat arterial hypertension?

Effective treatment for hypertension is selected depending on the severity of the disease and the patient's overall risk of cardiovascular disease. To assess this risk, he takes into account certain factors:

• age: 50 years for men, 60 years for women;
• family history: sudden heart attack or death of one of the parents (before age 55 in men, before age 65 in women) or stroke before age 45, regardless of the sex of the parent;
• smoking (or not smoking within the last three years);
• diabetes;
• LDL cholesterol level above 1. 60 g/l or LDL cholesterol level below 0. 40 g/l;
• abdominal obesity, kidney failure, lack of regular exercise, or excessive alcohol consumption.

General principles for the treatment of arterial hypertension at home, which should be followed by all adults with high blood pressure:

With a mild, first degree of the disease, non-drug methods are used:

• limiting salt intake to 5g / day (more on proper nutrition with high blood pressure can be found in our separate article),
• normalization of weight with its excess,
• moderate physical activity 3-5 times a week (walking, running, swimming, physiotherapy exercises),
• to give up smoking,
• reduction in alcohol consumption,
• the use of herbal sedatives for increased emotional excitability (for example, a decoction of valerian).

In the absence of the effect of the above methods in the treatment of 1 degree arterial hypertension, as well as patients with 2 and 3 degrees of hypertension, they switch to taking medications.

It should be noted that pharmacies currently offer a wide range of different drugs for the treatment of arterial hypertension, both new and known for many years. Under different trade names, preparations with the same active substance may be produced. It is quite difficult for a non-specialist to understand them.

Diuretics are the drugs of choice for the treatment of hypertension, especially in the elderly. The most common are thiazides.

Also, in the treatment of arterial hypertension, it is important to correct the risk factors:

• antiplatelet agents - acetylsalicylic acid, are used according to indications,
• statins in the presence of atherosclerosis - also in the absence of contraindications;
• drugs that lower blood glucose levels in the presence of diabetes.

If the effect is insufficient, it may be necessary to add a second or third drug. Rational combinations:

• diuretic + beta-blocker
• diuretic + ACE inhibitor (or sartan)
• diuretic + calcium antagonist
• dihydropyridine calcium antagonist + beta-blocker
• calcium antagonist + ACE inhibitor (or sartan)

Invalid combinations:

• non-dihydropyridine calcium antagonist + beta-blocker (possible development of heart blocks up to death)
• ACE inhibitor + sartan

For treatment and examination of hypertension, you need to see a doctor. Only a specialist after a full examination and analysis of the results of examinations will be able to correctly diagnose and prescribe competent treatment.

Why is hypertension dangerous?

Arterial hypertension is one of the leading causes of severe CVS pathologies.

Despite the fact that at the moment there is a huge number of antihypertensive drugs that allow you to maintain blood pressure at an adequate level, the incidence of hypertensive crises and complications such as heart failure (HF) and renal failure (RF), aortic and mitral valve regurgitation, heart aneurysmand aorta, MI (heart attacks), strokes, etc. in patients with hypertension remains extremely high.

This is primarily due to the fact that many patients do not want to systematically take antihypertensive therapy, believing that the hypertensive crisis that developed in them was a single one and this will not happen again.

According to statistics, of patients who are aware that they have arterial hypertension, only about 40% of women and 35% of men receive drug treatment. At the same time, only 15% of women and about five percent of men reach the required levels of pressure due to the systematic use of antihypertensive therapy, monitoring blood pressure indicators and regular visits to the doctor and following his recommendations.

Despite the fact that arterial hypertension is one of the controllable risk factors for the formation of cardiovascular pathologies, such unfortunate indicators are due to the patient's banal misunderstanding of the seriousness of his diagnosis, and, consequently, the lack of a serious and responsible approach to treatment.

The most common severe complications that develop due to crises of hypertensive origin are:

• stroke (about thirty percent of patients);
• pulmonary edema (twenty-three percent);
• hypertensive encephalopathy (16%);
• acute heart failure (fourteen percent);
• cerebral hemorrhage (five percent of cases);
• dissecting aortic aneurysm (2. 5%), etc.

It should be noted that in the absence of adequate and systematic treatment of hypertension, from heart and kidney failure within three years after suffering a severe (complicated) hypertensive crisis, 30 to 40% of patients die.

Comprehensive treatment, a responsible approach to one's health, the systematic use of drugs against arterial hypertension and control of one's pressure, allow these frightening figures to be reduced to a minimum.

Prevention of arterial hypertension

For people with a hereditary predisposition to arterial hypertension and weighed down by risk factors, disease prevention is of great importance.

1. First of all, this is a regular examination by a cardiologist and adherence to the rules of a proper lifestyle, which will help to delay, and often eliminate the disease of arterial hypertension. If you have a history of relatives with hypertension, you should reconsider your lifestyle and radically change many of the habits and lifestyle that are risk factors.
2. You should reconsider your dietary principles, stop eating salty and fatty foods, switch to a low-calorie diet that includes a large amount of fish, seafood, fruits and vegetables. Do not get carried away with alcoholic beverages and, especially, beer. They contribute to obesity, uncontrolled consumption of table salt, adversely affect the heart, blood vessels, liver and kidneys.
3. It is necessary to lead an active lifestyle, move more, depending on age, this is ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually, without overloading the body. Outdoor exercise is especially beneficial. Physical exercise strengthens the heart muscle and nervous system and helps prevent stress.
4. Try to have a favorable psycho-emotional environment around you. If possible, avoid conflicts, remember that a shattered nervous system very often triggers the mechanism for the development of arterial hypertension.
5. Quit smoking, the substances contained in nicotine provoke changes in the walls of the arteries, increase their rigidity, therefore, they can be the culprits of high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.

Thus, we can briefly say that the prevention of arterial hypertension includes regular examinations by a cardiologist, the right lifestyle and a favorable emotional background for your environment.

Forecast for life

The prognosis for arterial hypertension is determined by the nature of the course (malignant or benign) and the stage of the disease. Factors that worsen the prognosis are:

• rapid progression of signs of damage to target organs;
• III and IV stage of arterial hypertension;
• severe damage to the blood vessels.

An extremely unfavorable course of arterial hypertension is observed in young people. They have a high risk of stroke, myocardial infarction, heart failure, sudden death.

With early treatment of arterial hypertension and subject to careful compliance by the patient with all the recommendations of the attending physician, it is possible to slow down the progression of the disease, improve the quality of life of patients, and sometimes achieve long-term remission.