Main criteriaarterial hypertension (or arterial hypertension)The disease group as a whole - stable, that is, an increase in blood pressure (BP) is detected by repeated measurements on different days.The question of what blood pressure is considered elevated is not as simple as it seems.In fact, there is a fairly wide range of blood pressure values in actually healthy people.Long-term observations of people with different blood pressure levels show that it has started from the 115/75 mmHg level.Art., for every 10 mmHg increase in blood pressure.Art.This is accompanied by an increased risk of cardiovascular disease, primarily coronary heart disease and stroke.However, the benefits of modern approaches to the treatment of arterial hypertension have mainly been demonstrated only in patients with blood pressures above 140/90 mmHg.Art.It is for this reason that there is consensus on this threshold as the criterion for identifying arterial hypertension.
Elevated blood pressure can accompany dozens of different chronic conditions, and hypertension is just one of them, but it's the most common: about nine out of 10.Hypertension can be diagnosed if blood pressure rises steadily but no other disease causing the rise is found.
Hypertension is a disease characterized by a steady increase in blood pressure.Risk factors that increase the likelihood of its occurrence have been identified through observations of large populations.In addition to genetic predispositions that some people have, these risk factors include:
- obesity;
- inactive;
- Excessive consumption of salt and alcohol;
- chronic stress;
- Smoking.
Generally speaking, all these characteristics are characteristic of modern urban lifestyles in industrialized countries.This is why hypertension is considered a lifestyle disease and targeted improvements should be considered as part of a hypertension treatment plan on a case-by-case basis.
What other diseases are associated with elevated blood pressure?These include many kidney diseases (pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, renal artery stenosis, etc.), some endocrine diseases (adrenal tumors, hyperthyroidism, Cushing's disease and syndromes), obstructive sleep apnea syndrome, and some other rarer conditions.Regular use of medications such as corticosteroids, nonsteroidal anti-inflammatory drugs, and oral contraceptives can also lead to persistent increases in blood pressure.The diseases and conditions listed above can lead to the development of so-called secondary or symptomatic arterial hypertension.Doctors make a diagnosis of hypertension if, during interview with the patient, history, examination, and the results of a few mostly simple laboratory and instrumental studies, any diagnosis of secondary arterial hypertension seems unlikely.
If you notice similar symptoms, talk to your doctor.Don’t self-medicate – it’s harmful to your health!
Symptoms of arterial hypertension
For many people, high blood pressure does not manifest itself in any subjective sense.If high blood pressure is accompanied by symptoms, they may include a feeling of heaviness in the head, headache, darkening of the vision, nausea, dizziness, unsteadiness when walking, and many other non-specific symptoms of high blood pressure.The above symptoms are more pronounced during a hypertensive crisis - a sudden and significant increase in blood pressure, leading to a significant worsening of the condition and health.
One could go on to list possible symptoms of high blood pressure, separated by commas, but there is no particular benefit to doing so.Why?First, all these symptoms are nonspecific for hypertension (i.e., they can appear alone or in various combinations in other diseases), and secondly, in order to establish the presence of arterial hypertension, the fact that blood pressure is steadily elevated is important.This is not revealed by assessing subjective symptoms, but can only be revealed by repeated blood pressure measurements.This means that, first, measure blood pressure two or three times "at once" (with a short break between measurements), and take the arithmetic mean of the two or three measurements as the true blood pressure.Second, the stability of elevated blood pressure (a criterion for diagnosing hypertension as a chronic disease) should be confirmed by measurements on different days, preferably at least one week apart.
If a hypertensive crisis occurs, there will definitely be symptoms, otherwise it is not a hypertensive crisis, but just an asymptomatic increase in blood pressure.These symptoms may be those listed above, or they may be other, more serious symptoms - they are discussed in the "Complications" section.
Symptomatic (secondary) arterial hypertension is part of another disease, so its presentation depends on the underlying disease in addition to the actual symptoms of hypertension (if any).For example, hyperaldosteronism may cause weakness, spasms, and even temporary paralysis (lasting hours or days) in the muscles of the legs, arms, and neck.Having obstructive sleep apnea - snoring, sleep apnea, daytime sleepiness.
If high blood pressure causes damage to various organs (in which case they are called "target organs") over time (usually many years), then this can manifest as memory and mental decline, stroke or transient cerebrovascular accident, increased heart wall thickness, accelerated development of atherosclerotic plaques in the blood vessels of the heart and other organs, myocardial infarction or angina, reduced hemofiltration rate in the kidneys, etc.Accordingly, clinical manifestations will be caused by these complications rather than by elevated blood pressure.
The pathogenesis of arterial hypertension
The main content of hypertension is imbalance of blood vessel tone and elevated blood pressure, which can be said to be its "essence".Factors mainly related to lifestyle characteristics such as genetic predisposition, obesity, lack of activity, excessive consumption of salt, alcohol, chronic stress, smoking, etc., can, over time, lead to the destruction of the function of the endothelium, the inner layer of arterial blood vessels, one layer thick, which actively participates in the regulation of tension, thereby destroying the vascular lumen.Microvascular tone and local blood flow in organs and tissues are autonomously regulated by the endothelium rather than directly by the central nervous system.This is a local blood pressure regulation system.However, there are other levels of blood pressure regulation - the central nervous system, the endocrine system and the kidneys (which also achieve their regulatory role largely due to their ability to participate in hormonal regulation at the level of the whole organism).In general, violation of these complex regulatory mechanisms results in a reduced ability of the entire system to finely adapt to the changing blood supply demands of organs and tissues.
Over time, arterioles develop persistent spasms, and their walls subsequently change so much that they no longer return to their original state.In larger blood vessels, atherosclerosis develops at an accelerated rate as blood pressure continues to rise.The heart wall thickens, the myocardium becomes hypertrophic, and the left atrium and left ventricle enlarge.Increased pressure can damage the glomeruli and reduce their number, resulting in a decrease in the kidneys' ability to filter blood.In the brain, negative changes also occur due to changes in the blood vessels supplying the brain - small foci of bleeding appear, as well as small areas of necrosis (death) of brain cells.When atherosclerotic plaque ruptures in a large enough blood vessel, thrombosis occurs and the vessel lumen becomes blocked, leading to a stroke.
Classification and stages of development of arterial hypertension
Hypertension is divided into three grades according to the degree of increase in blood pressure.Furthermore, consider that the risk of cardiovascular disease increases over the "decade" range, already starting with blood pressure levels above 115/75 mm Hg.In art, there are several levels of blood pressure levels.
If the values for systolic and diastolic blood pressure belong to different categories, the degree of arterial hypertension is assessed by the highest of the two values, and it does not matter whether systolic or diastolic blood pressure.The degree of elevation in blood pressure used to diagnose hypertension is determined by repeated measurements on different days.
In some countries, the stages of hypertension still differ, and the European Guidelines for the Diagnosis and Treatment of Arterial Hypertension do not mention any stages.The determination of stages is intended to reflect the stages of hypertension from onset to complications.
Divided into three stages:
- first stageThis means that there is still no visible damage to the organs most commonly affected by this disease: there is no enlargement (hypertrophy) of the left ventricle of the heart, there is no significant decrease in the filtration rate of the kidneys, as determined by the level of creatinine in the blood, no albumin is detected in the urine, no thickening of the walls of the carotid arteries or atherosclerotic plaques in them is detected, etc.This damage to internal organs is usually asymptomatic.
- Diagnosis is made if at least one of the listed symptoms is presentsecond stagehypertension.
- Finally, aboutThe third stageHypertension is called hypertension when there is at least one cardiovascular disease with clinical manifestations related to atherosclerosis (myocardial infarction, stroke, angina pectoris, atherosclerotic lesions of the lower limbs) or, for example, severe renal damage manifested by a marked reduction in filtration and/or a significant loss of protein in the urine.
These stages do not always naturally replace each other: for example, a person suffers from a myocardial infarction and several years later develops an increase in blood pressure - it turns out that such a patient immediately has stage III hypertension.The purpose of staging is primarily to rank patients according to their risk of developing cardiovascular complications.The treatment measures also depend on this: the higher the risk, the more intensive the treatment.In formulating a diagnosis, risk is assessed in four levels.At the same time, Level 4 corresponds to the greatest risk.
Complications of arterial hypertension
The goal of treating hypertension is not to "lower" hypertension but to minimize the risk of cardiovascular and other complications in the long term because, again, this risk increases with every 10 mmHg increase when assessed on a "ten-year" scale.Art.Blood pressure levels had reached 115/75 mmHg.Art.This refers to complications such as stroke, coronary heart disease, vascular dementia (dementia), chronic renal failure and chronic heart failure, and atherosclerotic vasculopathy of the lower extremities.
Most people with high blood pressure won't worry about anything for a while, so they don't have much incentive to get treatment, take a certain minimum amount of medication regularly and change their lifestyle to a healthier one.However, in the treatment of high blood pressure, there is no one-time measure that can make you forget about this disease forever without taking any other measures to treat it.
Diagnosis of arterial hypertension
For the diagnosis of arterial hypertension, everything is usually very simple: just repeat the recording of blood pressure at the level of 140/90 mm Hg.Art.and higher.But hypertension and arterial hypertension are not the same thing: as already mentioned, elevated blood pressure can manifest itself in many diseases, of which hypertension is only one, albeit the most common.When making a diagnosis, the physician must, on the one hand, ensure that the increase in blood pressure is stable and, on the other hand, assess whether the increase in blood pressure is a manifestation of symptomatic (secondary) arterial hypertension.
To do this, in the first stage of the diagnostic search, the doctor will find out the age at which blood pressure first begins to rise, the presence of symptoms such as snoring during sleep, apnea, muscle weakness, unusual impurities in the urine, sudden heartbeat accompanied by sweating and headaches.It makes sense to know which medications and dietary supplements a patient is taking because, in some cases, they may cause an increase in blood pressure or worsen already elevated blood pressure.Some routine (almost all patients with high blood pressure) diagnostic tests, along with information obtained during a conversation with your doctor, can help evaluate the possibility of some forms of secondary hypertension: a complete urinalysis, which measures blood concentrations of creatinine and glucose, and sometimes potassium and other electrolytes.In general, given the low prevalence of secondary arterial hypertension (approximately 10% of all cases), further search for these conditions as possible causes of hypertension must be well justified.Therefore, if at the first stage of the diagnostic search no important data are found in favor of secondary arterial hypertension, then in the future it is assumed that the increase in blood pressure is caused by hypertension.This judgment may sometimes be subsequently revised as new data about the patient become available.
In addition to looking for data on possible secondary causes of elevated blood pressure, doctors also determine the presence of risk factors for cardiovascular disease (which is necessary to assess the prognosis and more specifically search for damage to internal organs), as well as the possible presence of disease of the cardiovascular system or its asymptomatic damage - this affects the assessment of the prognosis and stage of hypertension and the choice of therapeutic measures.For this purpose, in addition to interview and examination of the patient, a number of diagnostic studies are performed (for example, electrocardiogram, echocardiogram, ultrasonography of the neck vessels and, if necessary, some other studies, the nature of which is determined by the medical data obtained about the patient).
Daily blood pressure monitoring using a special compact device allows you to evaluate blood pressure changes during the patient's daily lifestyle.This study is not necessary in all cases - mainly, whether it is necessary to assess nighttime blood pressure if blood pressure measured at a doctor's appointment is significantly different from blood pressure measured at home, and sometimes to assess the effectiveness of treatment if a hypotensive episode is suspected.
Therefore, when examining patients with hypertension, certain diagnostic methods are appropriate in all cases; other methods are used more selectively, depending on the data that have been obtained about the patient to check the assumptions made by the doctor during the initial examination.
Treatment of arterial hypertension
Regarding non-pharmacological measures to treat high blood pressure, the most convincing evidence points to the positive effects of reducing salt intake, losing and maintaining body weight at this level, regular physical activity (exercise), not exceeding moderate amounts of alcohol, and increasing the content of vegetables and fruits in the diet.All these measures are effective only as part of a long-term change in the unhealthy lifestyle that leads to the development of high blood pressure.For example, if you lose 5 kilograms of weight, your blood pressure will drop by an average of 4.4/3.6 mm Hg.Art.- It may seem small, but combined with the other lifestyle improvements listed above, the effects can be quite significant.
Lifestyle improvements are reasonable for almost all people with high blood pressure, but in most cases, medication is necessary, although not always.Pharmacological treatment (the long-term therapeutic benefit of which has been demonstrated in many clinical studies) is mandatory in patients with grade 2 and 3 elevated blood pressure and in any grade of hypertension with a calculated high cardiovascular risk, whereas for grade 1 hypertension with a calculated low and moderate cardiovascular risk, the benefit of this treatment has not yet been convincingly demonstrated in large clinical trials.In this case, the possible benefits of drug therapy are assessed individually based on patient preference.If such patients have persistently elevated blood pressure for several months over multiple visits despite lifestyle improvements, it may be necessary to reevaluate the need for medication.Furthermore, the calculated risk magnitude often depends on the completeness of the patient's examination and may be significantly higher than initially thought.In almost all cases of hypertension treatment, they strive to stabilize blood pressure below 140/90 mmHg.Art.This does not mean that in 100% of measurements, blood pressure will fall below these values, but the fewer instances when blood pressure exceeds this threshold when measured under standard conditions (described in the Diagnosis section), the better.With this treatment, the risk of cardiovascular complications is significantly reduced, and hypertensive crises, if they occur, are much less common than without treatment.Thanks to modern drugs, those negative processes in hypertension that inevitably and potentially damage the internal organs (mainly the heart, brain, and kidneys) over time are slowed down or suspended, and in some cases can even be reversed.
There are five main categories of drugs for treating high blood pressure:
- diuretics (diuretics);
- Calcium antagonists;
- angiotensin-converting enzyme inhibitors (names ending in -adj);
- angiotensin II receptor antagonists (names ending in -sartan);
- Beta blockers.
Recently, special emphasis has been placed on the role of the first four classes of drugs in the treatment of hypertension.Beta-blockers are also used, but mainly when concomitant diseases require their use - in these cases, beta-blockers have a dual purpose.
Today, drug combinations are preferred because treatment with any one drug rarely achieves ideal blood pressure levels.There are also fixed combinations of medications, making treatment more convenient since patients only have to take one pill instead of two or even three.Doctors will consider the patient's blood pressure level, concomitant diseases and other data to select the necessary drug class and its dose and frequency of administration for a specific patient.
Due to the multifaceted positive effects of modern drugs, treatment of hypertension includes not only lowering blood pressure itself, but also protecting internal organs from the negative effects of the processes accompanying hypertension.In addition, since the main goal of treatment is to minimize the risk of complications and increase life expectancy, it may be necessary to correct blood cholesterol levels, take medications that reduce the risk of blood clots (leading to myocardial infarction or stroke), etc.Quitting smoking, no matter how trivial it sounds, can significantly reduce the risk of stroke and myocardial infarction related to high blood pressure and slow the growth of atherosclerotic plaque in blood vessels.Therefore, treating hypertension involves a variety of approaches, of which achieving normal blood pressure is only one.
forecast.prevention
The overall prognosis depends not only on the fact of hypertension, but also on the number of cardiovascular disease risk factors, their severity, and the duration of their negative effects.
These risk factors are:
- smoking;
- increased blood cholesterol levels;
- hypertension;
- obesity;
- sedentary lifestyle;
- age (risk increases with every decade of life after age 40);
- Male and other genders.
In this case, not only the intensity of exposure to the risk factor matters (for example, smoking 20 cigarettes a day is undoubtedly worse than smoking 5 cigarettes, although both are associated with worse prognosis), but also the duration of exposure.For people who do not yet have significant cardiovascular disease other than high blood pressure, prognosis can be assessed using special electronic calculators, one of which takes into account gender, age, blood cholesterol levels, blood pressure and smoking status.The SCORE electronic calculator is suitable for estimating the risk of death from cardiovascular disease over the next 10 years from the date of risk assessment.At the same time, the risks obtained in most cases, whose absolute numbers are low, may give a misleading impression, since calculators allow you to calculate the risk of cardiovascular death.The risk of non-fatal complications (myocardial infarction, stroke, angina, etc.) is many times higher.Compared with the results calculated using the calculator, the risk of developing diabetes increases: 3 times for men and 5 times for women.
Regarding the prevention of high blood pressure, we can say that since the risk factors for the development of high blood pressure are known (lack of activity, excess weight, chronic stress, frequent lack of sleep, alcohol abuse, increased salt intake, etc.), all lifestyle changes that reduce the impact of these factors will also reduce the risk of developing high blood pressure.However, it is almost impossible to completely reduce this risk to zero - there are factors that do not depend on us at all or very little: genetic characteristics, gender, age, social environment, etc.The problem is that people mainly start to think about preventing high blood pressure when their bodies are already unhealthy and their blood pressure has risen to a certain level.This is not so much a matter of prevention as it is a matter of treatment.