hypertension

Arterial hypertension remains an important medical and social problem in the 21st century because it is fraught with complications that cause disability, disrupt quality of life, and can be fatal.The disease is successfully treated by professional doctors. If you have high blood pressure, you should consult your doctor immediately. Only timely and effective treatment can promote recovery.

Classification of arterial hypertension

Arterial hypertension is generally divided into 4 risk groups based on the likelihood of damage to the heart, blood vessels, and other target organs and the presence of exacerbating factors:

• 1 – Risk less than 15%, no aggravating factors;
• 2 – The risk is within 10-20%, with no more than 3 aggravating factors;
• 3 – Risk 20% to 30%, more than 3 aggravating factors;
• 4 - The risk is higher than 30%, there are more than 3 aggravating factors, and target organs are affected.

Arterial hypertension affects the following target organs:

• Brain (transient cerebrovascular accident, stroke);
• Organs of vision (degenerative changes and retinal detachment, hemorrhage, blindness);
• Blood (increased glucose levels leading to damage to the central nervous system);
• Heart (left ventricular hypertrophy, myocardial infarction);
• Kidneys (proteinuria, renal failure).

Depending on the severity of cardiovascular risk, different blood pressure levels can be distinguished, as shown in Table 1 .Table 1. Blood pressure level:

category	Systolic blood pressure A/D (mmHg)	Diastolic blood pressure A/D (mmHg)
best	Below 120	Below 80
Ordinary	120-129	80-84
high normal	130-139	85-89
Grade 1 arterial hypertension	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 high blood pressure

The main risk factors for essential arterial hypertension include:

• Gender and age. Men between the ages of 35 and 50 are most likely to develop the disease. In women, the risk of arterial hypertension increases significantly after menopause;
• Genetic predisposition. People who have a first-degree relative with the disease are at very high risk for developing the disease. The risk is increased if two or more relatives have high blood pressure;
• Increased psycho-emotional stress and stress. During psycho-emotional stress, large amounts of adrenaline are released, under the influence of which the heart rate and blood pump volume increase. If a person is in a state of chronic stress, the increased load can cause wear and tear on the arteries and the risk of cardiac and vascular complications increases;
• Drinking alcoholic beverages. Daily drinking of hard liquor increases blood pressure by 5 mmHg per year. Art. ;
• Smoking. Tobacco smoke causes peripheral and coronary vasospasm. The arterial wall is damaged by ingredients such as nicotine, and atherosclerotic plaques form at the damaged site;
• Atherosclerosis is caused by excessive consumption of cholesterol-containing foods and smoking. Atherosclerotic plaque narrows the lumen of blood vessels and interferes with free blood circulation. This leads to arterial hypertension, which stimulates the progression of atherosclerosis;
• Increased salt intake can cause arterial spasm, causing fluid to be retained in the body, leading to the development of high blood pressure;
• Excess weight can lead to reduced physical activity. Clinical trials show that for every kilogram gained, weight increases by 2 millimeters. RT. Art. blood pressure;
• Physical inactivity increases the risk of high blood pressure by 20-50%.

Symptoms of arterial hypertension

The danger of high blood pressure is that it is not accompanied by any characteristic symptoms, but "kills" slowly and quietly. In most cases, the disease shows no signs but progresses and leads to fatal complications, such as myocardial infarction or stroke. When asymptomatic, arterial hypertension may go undetected for decades.The most common complaints from patients are:

1. Headache;
2. Flies flicker before your eyes;
3. blurred vision;
4. Dizziness;
5. difficulty breathing;
6. fatigue;
7. chest pain;
8. visual impairment;
9. nosebleed;
10. Swelling of lower limbs.

However, the most important symptom of hypertension is elevated blood pressure. Headaches can present as a "hooked" feeling in the head, accompanied by dizziness and nausea. They occur in the context of physical or neurological stress. If the pain lasts for a long time, symptoms such as bad temper, irritability, and sensitivity to noise may occur.

intracranial hypertension

Often headaches can be caused by a cold, lack of sleep, or overexertion. It appears to be due to increased intracranial pressure. If a headache becomes persistent and severe, this is a sign to go to the hospital.

Intracranial hypertension: symptoms in adults and children

Intracranial hypertension syndromes have different manifestations, depending on the location of the pathology causing the increased intracranial pressure, the stage of the disease, and its rate of progression.Moderate intracranial hypertension manifests as:

• Headache;
• Dizziness;
• attacks of nausea and vomiting;
• confusion;
• epileptic seizure

Intracranial hypertension: diagnosis

Types of pathological diagnosis include:

• Intracranial pressure is measured by inserting a needle with a pressure gauge into a fluid cavity in the skull or spinal canal.
• Track how much blood fills and dilates the veins in your eyeballs. If the patient's eyes are red, that is, the eye veins are filled with blood and are clearly visible, it can be said to have increased intracranial pressure;
• Cerebrovascular ultrasound examination;
• Magnetic resonance and computed tomography: Check for dilation of the cerebral fluid cavities and rarefaction of the ventricular edges;
• Perform an electroencephalogram.

Intracranial hypertension: treatment, medications

Increased intracranial pressure can lead to mental decline and disruption of normal function of internal organs in patients. Therefore, this pathology requires immediate initiation of treatment aimed at reducing intracranial pressure.Treatment can only be carried out if the pathological cause is correctly diagnosed. For example, if intracranial hypertension occurs due to the development of a brain tumor or hematoma, surgical intervention is required. Removal of the hematoma or tumor can normalize intracranial pressure.

essential hypertension

Essential arterial hypertension refers to an increase in systolic blood pressure to 140 mmHg during cardiac contraction and ejection. Art. and diastolic blood pressure reaches 90 mmHg above this mark and/or when the heart muscle relaxes. Art. and higher.

symptoms of essential hypertension

In medicine, the following concepts are distinguished:

• Essential arterial hypertension (essential hypertension);
• Hypertension can damage the heart and kidneys;
• Secondary hypertension: endocrine, renovascular, unspecified, etc.

True hypertension (essential hypertension) predominates in all cases of hypertension. The frequency of occurrence is 90%.For children (under 10 years old), pressure levels above 110/70 mm Hg are considered dangerous. Art, 10 years later – 120/80 mmHg. The diagnosis is confirmed if blood pressure is measured at least twice on different days within four weeks. In most cases, the disease affects people between 30 and 45 years old.

disease cause

Despite tremendous advances in modern medicine, the cause of essential hypertension has not yet been determined. There are just a lot of factors that increase the risk of developing this type of disease. Among them:

• Injuries to the spinal cord and brain leading to disturbances in peripheral vascular tone;
• Nerve shock, often stress. In this case, there will be a sustained focus of excitement in the cerebral cortex, and prolonged spasm will lead to increased peripheral resistance and loss of elasticity of blood vessels;
• genetic factors;
• Overweight: Many overweight people attribute their obesity to endocrine gland dysfunction, put themselves on the "sick" list, and do not want to change anything in their lifestyle. In fact, there may not be any endocrine disruption;
• sedentary lifestyle;
• Excessive consumption of coffee, which is loved by many. At the same time, caffeine levels in the blood increase, preventing blood vessels from relaxing and dilating normally. You should always remember: "Everything in moderation";
• Too much salt intake. It retains water in the body and causes an increase in blood pressure. It is known that Japanese people consume twice as much salt as Europeans, and essential hypertension is also common in the Japanese population;
• Alcohol abuse and smoking lead to disruption of the normal regulation of vascular tone.

Treatment of essential hypertension

Doctors choose treatment strategies after assessing the patient's condition and stage of pathological development. In the initial phase, patients receive non-pharmacological treatments, including:

1. Special diets designed to limit the consumption of salt and foods high in animal fat;
2. Quit bad habits, especially smoking and alcohol;
3. Relieve stress. In this case, yoga classes, self-training and sessions with a psychotherapist are very helpful;
4. Patients with essential hypertension should not work in an environment with strong noise and vibration;
5. Avoid excessive physical activity: Strenuous, tiring exercise on the treadmill should be replaced with a half-hour walk.

Medical treatment includes taking the following medications:

• Angiotensin-converting enzyme inhibitors. This group includes a large number of drugs that lower blood pressure in multiple ways at the same time;
• Angiotensin 2 receptor blocker This drug dilates blood vessels, thereby lowering blood pressure;
• Beta-blockers: These drugs relieve heart pain, slow the heartbeat, and dilate blood vessels;
• Calcium channel blockers: slow down the penetration of calcium into blood vessels and heart tissue, slow down the heartbeat, and dilate blood vessels;
• Diuretics: Inhibit the absorption of sodium by the kidneys and excrete it in the urine. This group of drugs also includes those that retain potassium in the body. But the diuretic effect is weak;
• Centrally acting drugs designed to reduce nervous system activity. This also includes medications that lower cholesterol levels in the body.

portal hypertension

Portal hypertension is a complication of cirrhosis. This is a phenomenon in which portal blood pressure increases due to obstruction of venous blood flow.

What is portal hypertension

Typically, the pressure in the header area is 7 mm. RT. Art. , if this indicator exceeds 12-20 mm, the afferent veins develop stasis and dilate. Unlike arteries, veins have thin walls that stretch under pressure and tear easily.

Portal hypertension: symptoms

The main cause of portal hypertension is cirrhosis of the liver. In this pathological condition, the pressure in the portal vessels of the liver increases.As the disease progresses, the following symptoms of portal hypertension may appear:

• Changes in laboratory test indicators - platelet, white blood cell and red blood cell levels exceed standards;
• enlargement of the spleen;
• worsening of blood clotting;
• Diagnosis of fluid accumulation in the abdomen (ascites);
• Development of varices in the digestive tract;
• In many cases, patients develop bleeding and anemia.

In the early stages, symptoms of cirrhosis and portal hypertension include worsening of general health, abdominal distension, and heaviness under the right rib cage. Next, the patient developed pain in the area below the right ribs, the liver and spleen enlarged, and the normal function of the digestive tract was disrupted.

Portal hypertension: degrees

There are 4 pathology levels in total:

• Level 1 - Functional (initial);
• Level 2 – Moderate. With moderate esophageal venous dilatation, splenomegaly, and ascites;
• Third-degree portal hypertension is a severe form of pathology. At this stage, significant hemorrhage and ascites syndrome can be observed;
• Level 4 (Complex). The patient developed esophageal and gastric bleeding, gastropathy, and spontaneous bacterial peritonitis.

Portal Hypertension: Diagnosis

The hospital's diagnosis types are as follows:

• Ultrasonography: can determine the size of the splenic, portal, and superior mesenteric veins. If the diameter of the portal vein exceeds 15 mm and the diameter of the splenic vein exceeds 7-10 mm, the presence of portal hypertension can be accurately determined. In addition, ultrasound examination may reveal enlargement of the liver and spleen;
• Doppler ultrasound: can examine the structure of blood vessels and measure the speed of blood flow through them;
• FGDS (fibrogastroduodenoscopy): Allows you to identify varices in the cardiac part of the stomach and esophagus, which can cause bleeding in the gastrointestinal tract.

Portal Hypertension: Treatment

The goal of treatment of portal hypertension in cirrhosis is to prevent bleeding.Sclerotherapy is approximately 80% effective. The procedure involves using an endoscope to inject medication into the damaged vein. As a result, the vein lumen becomes blocked and the vein walls "stick together. "This treatment method is considered classic.

Portal Hypertension: Prevention

Measures to prevent the development of the disease include:

• maintain a proper diet and nutritional regimen;
• participate in sports;
• Get vaccinated against viral hepatitis;
• Say no to the misuse of alcoholic beverages;
• Avoid exposure to harmful production factors in the form of poisonous substances.

Preventive measures for liver disease include:

• Undertake a comprehensive examination to diagnose liver disease in its early stages and start treatment;
• Strictly follow all doctor's recommendations;
• Perform complex treatments in a hospital setting under the strict supervision of a physician.

Measures to prevent bleeding include:

• Control blood coagulation function;
• Sigmoidoscopy - an annual examination of the sigmoid colon and rectum;
• Fiberoptic gastroduodenoscopy twice a year.

secondary hypertension

The most common type is essential hypertension, sometimes called hypertension. In addition to primary or idiopathic hypertension, commonly known as hypertension, secondary hypertension is also known.Depending on the cause, the following types of diseases can be distinguished:

• Renal hypertension occurs due to damage to the renal arteries. This disease is called renovascular hypertension.
• Itsenko-Cushing syndrome causes an increase in systolic blood pressure. In this condition, the adrenal medulla is affected;
• Pheochromocytoma is a disease affecting the adrenal medulla. It is the cause of malignant arterial hypertension. The tumor compresses the outer lining of the adrenal gland, causing epinephrine and norepinephrine to be released into the bloodstream, causing a persistent or critical increase in stress;
• Hyperaldosteronism, or Cohen syndrome, is an adrenal gland tumor that causes elevated aldosterone levels. As a result, potassium levels in the blood decrease and blood pressure increases;
• Thyroid disorders such as hyperparathyroidism, hyperthyroidism, and hypothyroidism are causes of secondary arterial hypertension;
• Hemodynamic or cardiovascular arterial hypertension occurs due to the involvement of large blood vessels in pathological processes. It occurs with aortic stenosis or aortic valve insufficiency.
• Central arterial hypertension in adults is caused by brain disorders secondary to central dysregulation (stroke, encephalitis, head injury);
• Medication-induced hypertension may occur with oral contraceptives, NSAIDs, and corticosteroids.

Diagnosis of secondary hypertension is difficult, but there are several signs to suspect it:

• Elevated blood pressure in young people;
• Acute sudden illness is immediately accompanied by high blood pressure figures;
• unresponsive to ongoing antihypertensive treatment;
• Sympathoadrenal crisis.

diastolic hypertension

The diagnosis of "isolated diastolic hypertension" is valid when the systolic blood pressure value is less than 140 mm. Mercury, diastolic blood pressure greater than 90 mmHg. Diastolic blood pressure increased to 90 mm Hg. There is no threat to people without physical pathology.People with elevated diastolic blood pressure and no concomitant medical conditions are advised to control their blood pressure and make lifestyle changes:

• Regulate sleep quality;
• Don’t drink red wine;
• Limit the number of cigarettes smoked per day;
• avoid stress;
• Eliminate salt from your diet;
• Eat right;
• Maintain a normal weight;
• Do physical exercise or yoga.

When diastolic hypertension occurs, hospitalization is required if diastolic blood pressure remains high. Treatment of underlying conditions, such as surgical correction of aortic valve disease. Doctors prescribe medications to treat high blood pressure alone. Use the following tablets to treat high blood pressure:

• diuretics;
• beta blockers;
• Calcium channel blockers;
• angiotensin-converting enzyme inhibitors;
• Angiotensin II receptor blockers.

hypertensive crisis

Hypertensive crisis is a state in which individual blood pressure in patients with primary or secondary arterial hypertension is significantly elevated, accompanied by the emergence or worsening of clinical symptoms, and requires rapid pressure control to limit or prevent target organ damage.Type 1 crisis (adrenal, autonomic) manifests as increased systolic blood pressure, increased pulse pressure, tachycardia, extrasystoles, and restlessness. Type 2 crisis (water salt, norepinephrine) has the following symptoms:

• Diastolic blood pressure increased significantly and pulse pressure decreased;
• Swelling of the face, legs, and arms;
• Diuresis is significantly reduced on the eve of the crisis.

In the event of a complicated crisis, the respiratory tract will be disinfected, the patient will be given oxygen, and intravenous access will be established. The selection of antihypertensive drugs should be carried out in a different way: intravenously. They rapidly lowered the pressure and then switched to oral medication within 2-6 hours, lowering the pressure to 160/100 mmHg. The patient is being hospitalized in a specialist hospital.

Diagnosis of arterial hypertension

It is important to know how to measure blood pressure so that high blood pressure can be diagnosed. The exercise begins by explaining the patient's behavior during the procedure and then demonstrates how to properly use the cuff and record the metrics. It depends on the device that measures the pressure: mechanical or electronic.Laboratory tests are necessary, such as:

• General blood and urinalysis;
• blood sugar levels;
• creatinine, uric acid, and potassium levels;
• blood lipid profile;
• Serum C-reactive protein content;
• Urine bacterial culture.
• Patients underwent the following instrumental study methods:
• electrocardiogram;
• echocardiography;
• Chest X-ray;
• Ultrasound examination of the kidneys and adrenal glands;
• Ultrasound examination of the renal and brachycephalic arteries.

The ophthalmologist will examine the fundus of the eye and assess the presence and extent of microalbuminuria. All hospitalized patients receive daily blood pressure monitoring.

Treatment of arterial hypertension

The goal of treatment for any patient with hypertension is to reduce the risk of cardiovascular complications and death. The choice of medication to treat hypertension is determined by the following strategy: Achieve target blood pressure, which is 140/80 mmHg. and address risk factors. In patients with kidney disease and diabetes, the pressure must be reduced to 130/80 mmHg. This will improve quality of life and eliminate disease symptoms.

Prevent arterial hypertension

To prevent the occurrence of arterial hypertension, it is necessary:

• Arrange for proper nutrition;
• Avoid emotional stress and stress;
• Use reasonable physical activity;
• normalize sleep patterns;
• Monitor your weight;
• active rest;
• Stop smoking and drinking;
• See your doctor regularly and get tested.

Arterial hypertension causes disability and death. This disease has been successfully treated by doctors. Treatment for this disease involves continued use of medications to control blood pressure. Hypertensive crises and sudden changes in pressure should be avoided.If you are experiencing this problem, please call and the coordinating physician will schedule an appointment with a cardiologist and answer all of your questions.