Hypertension (HD)a chronic disease, the main symptom of which is increased blood pressure (BP), excluding symptomatic hypertension
If a person continuously exhibits increased blood pressure (arterial blood pressure increase above 140 and 90 mmHg), then he or she is usually diagnosed with hypertension.And in 90% of cases this is true.Only in 10% of cases it is possible to determine the cause of hypertension, and often by eliminating it, the person gets rid of the symptoms of arterial hypertension - in this case, the diagnosis is symptomatic hypertension.
According to WHO recommendations, blood pressure is considered normal if it does not exceed 140 and 90 mmHg.Art.
Normally, blood pressure is a fluctuating value, meaning it changes depending on what a person is doing, posture, physical activity level, anxiety, etc.But after the end of exposure in a healthy person, blood pressure returns to normal on its own after some time, in contrast to a patient whose blood pressure normalizes under the influence of drugs that rapidly regulate blood pressure indicators.
It is believed that the basis of this disease is a violation of the blood pressure regulation mechanism.
Epidemiology of hypertension
Data from the Russian Federation of Cardiology Society (2020): 30-45% of the world's population suffers from hypertension.Among men aged 25-65 years, 47% of patients had identified hypertension, and among women, about 40%.After 60 years, more than 60% of hypertensive patients are registered.Due to the aging population and the increasing number of sedentary and overweight people, it is predicted that by 2025 there will be 1.5 billion people in the world with HD, meaning the number of patients with this disease will increase by 15-20%.
WHO considers hypertension and atherosclerosis the most common causes of premature death in the working-age population.Complications caused by these diseases such as myocardial infarction, chronic kidney disease or acute stroke are life-threatening but also often leave people disabled, making them unable to work.
Pathogenesis of hypertension
“A disease of unresponsive emotions,” Georgy Fedorovich Lang, an outstanding Soviet therapist and scientist, called hypertension.
Blood pressure is the force with which blood presses against the vessel walls and it depends on three hemodynamic parameters: the force of cardiac output, the total volume of blood circulating in the vascular bed and the elasticity of the blood vessels and what is their tone (total peripheral resistance).The upper blood pressure index is determined by the force of blood ejection from the heart - systolic blood pressure, the lower index represents the pressure at the time of diastole - relaxation of the heart.It reflects the degree of resistance of blood vessels to blood flow.
On the contrary, vascular tone is regulated by the central and peripheral nervous systems, and depends on the complex of mediators and biologically active substances released into the blood, also secreted by the endocrine system, in various life situations: during emotions, fatigue, physical activity.The pathogenesis of hypertension is mediated by activation of the sympathetic and renin-angiotensin-aldosterone systems, the transmembrane transport of cations (sodium, calcium and potassium) is disrupted by increased renal sodium reabsorption.Due to overproduction of vasoconstrictor compounds and decreased production of inhibitory compounds, dysregulation of vascular tone also occurs.These compounds affect the structure of the vascular wall, it undergoes changes due to non-infectious inflammation, due to spasm of vascular smooth muscle, leading to impaired microcirculation.
Vascular stiffness then increases, further increasing overall vascular resistance, and baroreceptor binding of the central blood pressure regulatory system is disrupted.This leads to arterial hypertension, functional and organic changes in the heart, central nervous system, retina and kidneys.
Risk factors
Hypertension is a multifactorial disease.Let's consider the factors that influence the development and exacerbation of hypertension:
Factors that cannot be changed:
- Cases of hypertension recorded in relatives (hereditary).
- Elevated blood pressure is detected more often at older ages (years).
- Sexual - pressure is detected earlier in men than in women.Women are at high risk of developing high blood pressure during menopause (it is during this period that 60% of women develop high blood pressure).This is due to hormonal imbalance and exacerbation of emotional and nervous reactions.
- Black race (these people get the disease more often and have more severe complications of hypertension).
- Influence of weather conditions (people depend on the weather).
Adjustable elements:
- Obese people are 2-6 times more likely to have high blood pressure than the general population.This is because peritoneal fat has hormonal activity, helping to inhibit sex hormones, prevent glucose absorption by other tissues, support inflammatory responses, increase vasoconstriction and swelling of vessel walls.
- Reduced physical activity increases the risk of disease by 29-50% compared to people who exercise more.
- Eating too much salt, fat imbalance and alcohol abuse also contribute to high blood pressure.
- Smoking is an undeniable factor that has a very negative effect on the arterial walls and contributes to the appearance and aggravation of arterial hypertension.Smoking a cigarette can increase blood pressure by 10-30 mmHg.Art., It promotes contraction and supports the inflammatory process of the vessel walls.
- Emotional overload and chronic stress affect the systems that regulate vascular tone and disrupt their adaptation to stress.
- Metabolic disorders: lipid metabolism - increased blood cholesterol and leads to atherosclerosis - always accompanied by hypertension;Carbohydrate metabolism and the development of diabetes mellitus - influence the severity of hypertension and mortality from this disease.
Symptoms of high blood pressure
It's important to note that sometimes high blood pressure doesn't cause symptoms.Therefore, people with risk factors for hypertension should systematically monitor their blood pressure.
Hypertension existstarget organ.These are exactly the organs that will be affected if blood pressure increases: heart, brain, kidneys, peripheral arteries, retina.Since an increase in A/D is associated with spasms mainly in small arteries, which impairs blood circulation, and these organs are extremely sensitive to decreases in blood flow, symptoms are also caused by changes in them.
The main subjective complaints of patients with increased blood pressure are: headaches, tinnitus, frequent dizziness, "spots" in front of the eyes.Later, when persistent changes in the arteries develop, complaints of poor sleep, impaired performance, memory, that is, signs of encephalopathy, will appear.On the part of the heart, tachycardia, shortness of breath, pain or discomfort in the left chest, arrhythmia are detected, and then manifestations of heart failure are noticed in the form of shortness of breath and swelling.
Kidney damage begins very unnoticed, but leads to hardening of the kidneys and disruption of their function.Hypertensive angiopathy develops in the retina, is detected by an ophthalmologist at an early stage of the disease and in some cases allows confirmation of the diagnosis.
Severe episodes of high blood pressure sometimes occur silently, but this does not mean it is safe.Even regardless of the pressure level, hypertension can still manifest itself with serious complications: heart attack and stroke.Sometimes an exacerbation manifests itself in the form of a hypertensive crisis.It is characterized by a sharp increase in blood pressure, severe headaches, facial flushing, chills and vomiting may occur. This condition requires calling an ambulance.
Diagnosis of hypertension
Accurately collected historical data play a special role in the diagnosis of hypertension.Information about the onset of the disease is carefully clarified, all possible risk factors and patient complaints are studied, focusing mainly on complaints that characterize the involvement of target organs in the process.Particular importance is attached to the presence of a history of heart failure, renal failure, a history of stroke, the presence of diabetes mellitus, retinal angiopathy and aortic aneurysm.
The examination, in addition to measuring blood pressure during the consultation, also includes assessment of physical data on target organs.This approach helps calculate the level of risk, thereby creating a prognosis of the disease.Body mass index should be calculated if there is weight gain.
After the first consultation, the doctor will make a preliminary diagnosis, if it has not been done before.Next, an examination is necessary.
Check tools:
- Monitor blood pressure and ECG 24 hours in 12 leads.
- Echocardiographic examination (ECHO).It gives an idea of the state of the heart chambers and the movement of blood in them.
- Dopplerography of the renal and cervical arteries.
- Urine analysis to determine albuminuria and blood biochemical parameters.
- Thyroid-stimulating hormone and free T4.To evaluate thyroid function.
- Examination by an ophthalmologist to evaluate the condition of the fundus vessels.
When the diagnosis is clarified, the cardiologist or therapist (if the patient is being treated by a therapist) will prescribe drug treatment after analyzing the examination data and all possible risk factors.
Treatment of hypertension
Treatment goals: achieve normal (target) blood pressure levels and prevent complications.Treatment is divided into pharmacological and non-pharmacological.
Medicines to treat headaches
When choosing therapy, doctors are guided by international recommendations developed by the medical community for the treatment of hypertension.
Currently, there are many types of antihypertensive drugs in medical warehouses.They affect the known pathogenic mechanisms of the disease and eliminate or reduce their effects.These are several groups of drugs, for example diuretics (diuretics), renin channel blockers, beta blockers, calcium channel blockers, ACE inhibitors.It is the responsibility of the treating doctor to select them for this particular patient and it may take some time, since each group of drugs has its own characteristics and side effects, moreover, the effects of the drugs are not always quick;Sometimes it is necessary to choose them in combination with each other.
For treatment to be effective and achieve long-term goals, there needs to be interaction between patient and doctor and absolute patient compliance during treatment.
Rules that patients who want effective treatment must adhere to:
- Take medicine regularly according to the prescribed schedule: day, evening.
- In case of side effects or doubts, the patient should contact the doctor to adjust the dosage.
- You should not stop taking medication without consulting your doctor, even if your blood pressure and health are normal.
- Measure blood pressure when choosing therapy in the morning and evening (keep a diary), in case of deterioration of health (fill in the diary);If you feel well, apply it for 7-10 days in the morning and evening to ensure stability, monthly.
- Go to the doctor for a minimum examination with selective treatment and normal health 2 times a year (go to the clinic).
Non-pharmacological measures in the treatment of hypertension
At any stage of hypertension, it is necessary to work with modifiable risk factors.This is how to prevent high blood pressure.
What can patients do to reduce or avoid high blood pressure due to existing hypertension risk factors?
- Avoid fat accumulation.Weighting correction is the most important way to adjust A/D.A 10 kg weight gain will increase blood pressure by 10 mm Hg.Art.
- Eat wisely.Your diet should contain calories appropriate for your weight, be rich in foods containing potassium, magnesium and unsaturated fats, and should limit saturated fats and simple carbohydrates.
- Don't eat a lot of salt.It causes constriction of arteries and water retention in the body.It has been shown that when a person consumes > 5 g of salt per day, the risk of hypertension increases significantly.
- Try to move a lot but don't overdo it.It is helpful to participate in physical therapy, swimming or walking and aim to walk at least 10,000 steps a day.
- Avoid nervous tension: Find a switch if you frequently feel extreme anxiety or nervous shock (exercise, yoga, long walks).
- Avoid excessive stressassociated with intellectual activity.
- Don't work at nightbecause it disrupts circadian rhythms.
- Do not operate in areas with loud vibration or noise, they affect the central and peripheral nervous and vascular systems.
- Monitor your blood pressure levels, especially if your immediate family (parents, siblings) has or is suffering from arterial hypertension, to take timely measures.
- Contact your gynecologistduring premenopause and postmenopause to eliminate hormonal imbalance.
- Timely treatment of accompanying diseaseskidney and adrenal glands, atherosclerosis, diabetes, thyroid disease, obesity, chronic infections (eg, tonsillitis).If you get them, remember that they will aggravate headaches.
- Don't drink too much alcohol and don't smoke.
The prescribed medication should be taken systematically and over a long period of time under blood pressure control and active supervision by a cardiologist or therapist.
Remember, a happy heart is a healthy heart.Pay attention to your health every day, follow your doctor's advice.