Hypertension: classification and symptoms. Hypertension - a symptom or a disease? Hypertension all stages of the disease

Hypertension (HTN) is one of the most common diseases of the cardiovascular system, which only according to approximate data affects a third of the world's inhabitants. By the age of 60-65 years, more than half of the population has been diagnosed with hypertension. The disease is called a “silent killer”, because its signs may be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, greatly increasing the risk of vascular accidents.

In Western literature, the disease is called. Domestic specialists have adopted this formulation, although both “hypertension” and “hypertension” are still in common use.

Close 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 disorders in the brain, heart, and kidneys. Their prevention is the main goal of treatment aimed at maintaining normal numbers.

An important point is to identify all possible risk factors, as well as elucidating their role in the progression of the disease. The relationship between the degree of hypertension and existing risk factors is displayed in the diagnosis, which simplifies the assessment of the patient’s condition and prognosis.

For most patients, the numbers in the diagnosis after “AH” do not mean anything, although it is clear that The higher the degree and 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 hypertension

The causes of arterial hypertension are numerous. Gov shouting about us and We mean the case when there is no specific previous disease or pathology of internal organs. In other words, such hypertension occurs on its own, involving other organs in the pathological process. Primary hypertension accounts for more than 90% of cases of chronic high blood pressure.

The main cause of primary hypertension is considered to be stress and psycho-emotional overload, which contribute to disruption of the central mechanisms of pressure regulation in the brain, then humoral mechanisms suffer, and target organs are involved (kidneys, heart, retina).

The third stage of hypertension occurs with associated pathology, that is, associated with hypertension. Among the associated diseases, the most important for prognosis are strokes, heart attack and nephropathy due to diabetes, kidney failure, retinopathy (retinal damage) 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 at the same time he suffered a stroke, which means that the risk will be maximum – 4, even if stroke is the only problem besides hypertension. If the pressure corresponds to the first or second degree, and the only risk factors that can be noted are smoking and age against the background of quite good health, then the risk will be moderate - 1 tbsp. (2 tbsp.), risk 2.

To make it clearer what the risk indicator in a diagnosis means, 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 of hypertension for a particular patient. The number 1 means low risk, 2 means moderate, 3 means high, 4 means very high risk of complications.

Low risk means the probability of vascular accidents is no more than 15%, moderate - up to 20%, a high risk indicates the development of complications in a third of patients from this group; with a very high risk, more than 30% of patients are susceptible to complications.

Manifestations and complications of headache

Manifestations of hypertension are determined by the stage of the disease. In the preclinical period, the patient feels well, and only the tonometer readings indicate a developing disease.

As changes in blood vessels and the heart progress, symptoms appear in the form of headache, weakness, decreased performance, periodic dizziness, visual symptoms in the form of weakened visual acuity. All these signs are not expressed during a stable course of the pathology, but at the time of development the clinic becomes more vivid:

• Strong;
• Noise, ringing in the head or ears;
• Darkening in the eyes;
• Pain in the heart area;
• Facial hyperemia;
• Excitement and feeling of fear.

Hypertensive crises are provoked by traumatic situations, overwork, stress, consumption of coffee and alcoholic beverages, so patients with an already established diagnosis should avoid such influences. Against the background of a hypertensive crisis, the likelihood of complications increases sharply, including life-threatening ones:

1. Hemorrhage or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute renal failure;
5. Heart attack.

How to measure blood pressure correctly?

If there is reason to suspect high blood pressure, the first thing a specialist will do is measure it. Until recently, it was believed that blood pressure numbers could normally differ in different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. may occur due to pathology of peripheral vessels, so different pressures on the right and left hands should be treated with caution.

To obtain the most reliable figures, it is recommended to measure the pressure three times on each arm with short time intervals, recording each result obtained. In most patients, the smallest values ​​obtained are the most correct, but in some cases the pressure increases from measurement to measurement, which does not always speak in favor of hypertension.

A large selection and availability of devices for measuring blood pressure make it possible to monitor it in a wide range of people at home. Typically, hypertensive patients have a tonometer at home, on hand, so that if their health worsens, they can immediately measure blood pressure. It is worth noting, however, that fluctuations are also possible in absolutely healthy individuals without hypertension, so a single excess of the norm should not be regarded as a disease, and to make a diagnosis of hypertension, the pressure must be measured at different times, under different conditions and repeatedly.

When diagnosing hypertension, blood pressure figures, electrocardiography data and cardiac auscultation results are considered fundamental. When listening, it is possible to detect noise, increased tones, and arrhythmias. , starting from the second stage, will show signs of stress on the left side of the heart.

Treatment of hypertension

To correct high blood pressure, treatment regimens have been developed that include drugs of different groups and different mechanisms of action. Their the combination and dosage are chosen by the doctor individually taking into account the stage, concomitant pathology, and the response of hypertension to a specific drug. After the diagnosis of hypertension is established 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 abandon at least some of them.

First of all, it is recommended to normalize the regime, eliminate stress, and ensure physical activity. The diet is aimed at reducing salt and fluid intake, eliminating alcohol, coffee and drinks and substances that stimulate the nervous system. If you are overweight, you should limit calories and avoid fatty, floury, fried and spicy foods.

Every year the list grows and at the same time they become more effective and safe, with fewer adverse reactions. When starting therapy, one medicine is prescribed in a minimum dose; if it is ineffective, it can be increased. If the disease progresses and the pressure does not remain at acceptable values, then another drug from a different 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.

Reducing the risk of vascular complications is important in choosing a treatment regimen. Thus, it has been noted that some combinations have a more pronounced “protective” effect on 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 there are some daily fluctuations in blood pressure.

In some cases, it is necessary to take into account concomitant pathology, which makes adjustments to headache treatment regimens. For example, men with prostate adenoma are prescribed alpha-blockers, which are not recommended for constant use to reduce blood pressure in other patients.

The most widely used ACE inhibitors, calcium channel blockers, which are prescribed to both young and elderly patients, with or without concomitant diseases, 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 (captopril, lisinopril) reduce blood pressure and at the same time have a protective effect on the kidneys and myocardium. They are preferable in young patients, women taking hormonal contraceptives, indicated for diabetes, and for older patients.

Diuretics no less popular. Hydrochlorothiazide, chlorthalidone, torasemide, and amiloride effectively reduce blood pressure. To reduce adverse reactions, they are combined with ACE inhibitors, sometimes “in one tablet” (Enap, berlipril).

Beta blockers(sotalol, propranolol, anaprilin) ​​are not a priority group for hypertension, but are effective for concomitant cardiac pathology - heart failure, tachycardia, coronary disease.

Calcium channel blockers often prescribed in combination with ACE inhibitors, they are especially good for bronchial asthma in combination with hypertension, as they do not cause bronchospasm (riodipine, nifedipine, amlodipine).

Angiotensin receptor antagonists(losartan, irbesartan) is the most prescribed group of drugs for hypertension. They effectively reduce blood pressure and do not cause coughing like many ACE inhibitors. But in America they are especially common due to a 40% reduction in the risk of Alzheimer's disease.

When treating hypertension, it is important not only to choose an effective regimen, but also to take the drugs for a long time, even for life. Many patients believe that when the pressure reaches normal levels, treatment can be stopped, but they grab the pills by the time of the crisis. It is known that unsystematic use of antihypertensive drugs is even more harmful to health than complete lack of treatment, Therefore, informing the patient about the duration of treatment is one of the important tasks of the doctor.

Hypertension (hypertension) is a serious chronic disease characterized by a persistent increase in blood pressure. A number of practicing doctors call hypertension nothing less than an “invisible killer”, since this diagnosis is often made by resuscitators, and in asymptomatic cases - only by a pathologist.

The danger of hypertension

A person does not always suspect that he has this pathology, since many clinical manifestations of hypertension have obvious similarities with the symptoms of ordinary fatigue. The disease very often leads to the development of severe complications, including life-threatening conditions. In particular, if it was previously believed that myocardial infarction and hemorrhagic strokes are caused by atherosclerotic changes in blood vessels, it has now been established that for the development of these conditions the presence of hypertension alone is quite sufficient.

Arterial hypertension, like a number of other chronic diseases, cannot be completely cured, but its development can be prevented. Even with a diagnosis already made, adequate therapeutic measures can minimize the manifestations of hypertension, greatly improving the patient’s quality of life.

note: the risk of complications almost directly depends on the patient’s age. If hypertension is diagnosed in a young person, the prognosis is less favorable than in patients of the middle age group.

To “catch” the disease at the initial stage, when the changes are reversible, you need to regularly measure your blood pressure. If periodic measurements often reveal values ​​that exceed normal values, blood pressure correction is necessary.

The following numbers are considered normal:

• for people aged 16-20 years – 100/70 – 120/80 mm. rt. Art.;
• at 20-40 years old – 120/70 – 130/80;
• 40-60 – not higher than 135/85;
• 60 years or more – no higher than 140/90.

Symptoms of hypertension

The latent course of hypertension or the initial stage of the disease can be suspected if the following are periodically observed:

• unmotivated feeling of anxiety;
• hyperhidrosis (increased sweating);
• chilliness;
• hyperemia (redness) of the skin of the facial area;
• small spots before the eyes;
• memory impairment;
• low performance;
• irritability for no reason;
• and faces in the morning;
• rapid heartbeat at rest;
• numbness of fingers.

These symptoms may occur regularly or occur quite rarely. One cannot but attach importance to them, since the disease is very insidious. These clinical manifestations require urgent lifestyle changes, since correction not carried out in a timely manner leads to fairly rapid progression of the disease. As the pathology develops, the list of constant symptoms of hypertension expands. Impaired coordination of movements and decreased visual acuity are added.

Note: even the presence of just a few characteristic symptoms from the list above is grounds for an immediate visit to the doctor. You need to listen to your body especially carefully if you have certain risk factors for hypertension. Self-medication is dangerous; uncontrolled use of drugs can only worsen the situation.

Etiology and pathogenesis of hypertension

The onset of hypertension is caused by certain disorders in the central nervous system and the autonomic nervous system, which are responsible for vascular tone.

Important:In men aged 35 to 50 years and in menopausal women, the likelihood of developing hypertension increases.

One of the most important risk factors for hypertension is a family history. In patients with a hereditary predisposition, increased permeability of cell membranes is detected.

External factors that provoke the development of the disease include strong and frequent psycho-emotional (nervous shocks, difficult experiences). They cause the release of adrenaline, which increases cardiac output and increases the frequency of myocardial contractions. In combination with aggravated heredity, this often leads to the appearance of hypertension.

The immediate causes leading to hypertension include:

• dysfunctions of the nervous system;
• disturbances of ion exchange at the cellular and tissue level (increased levels of sodium and potassium ions);
• metabolic disorders;
• atherosclerotic vascular lesions.

Important:Overweight people have a 3-4 times higher risk of developing hypertension than others.

The risk of hypertension increases significantly with alcohol abuse, nicotine addiction, consumption of large amounts of table salt and physical inactivity.

A periodic increase in blood pressure forces the heart to function with increased load, which leads to myocardial hypertrophy, and subsequently to wear and tear of the heart muscle. As a consequence, chronic heart failure (CHF) develops, and insufficient nutrition of organs and tissues leads to serious consequences and the development of a number of concomitant diseases. High pressure causes thickening of the vascular walls and narrowing of the lumen of the vessel. Gradually, the walls become brittle, which greatly increases the risk of hemorrhages (including the development of hemorrhagic strokes). Permanent spasm of blood vessels maintains high blood pressure, completing this circle of disorders.

note: Normally, blood pressure fluctuations during the day do not exceed 10 units. In hypertensive patients, the numbers may differ by 50 mm. rt. Art. and more.

Hypertension can be a consequence of taking certain pharmacological agents (PS).

The following groups of drugs should be taken with extreme caution:

• glucocorticoids;
• Dietary supplements to suppress appetite;
• some anti-inflammatory drugs (in particular Indomethacin).

Hypertension or hypertension: what is the difference?

Hypertension is defined as a rise in blood pressure above 140/90. We can say that hypertension and hypertension are almost identical concepts. But hypertension is a disease, and hypertension is one of its symptoms. In approximately every tenth patient, abnormally high blood pressure is a manifestation of another pathology.

The following types of symptomatic hypertension are distinguished:

• hemodynamic;
• renal;
• endocrine;
• renovascular.

Classification of hypertension

To choose the optimal treatment tactics, you must first determine the type of this pathology.

According to etiology, it is customary to distinguish:

• primary hypertension(it is also called idiopathic or essential);
• symptomatic hypertension(against the background of other pathologies or taking certain medications).

According to the nature of its course, hypertension is divided into:

• benign(gradually progressive form, including 3 stages);
• malignant(severe, usually of endocrine etiology).

The benign form, which is diagnosed in most cases, is characterized by gradual development with damage to certain organs.

The malignant form is relatively rare and can be detected even in childhood. It is characterized by persistently high blood pressure and severe complications. Decompensated heart failure, hypertensive encephalopathy and a sharp impairment of the functional activity of the kidneys often develop.

According to the degree of increase in blood pressure, the following are distinguished:

• mild hypertension(blood pressure readings are not higher than 140/90, medications are usually not required);
• moderate form(1-2 stages, pressure up to 180/110 mm Hg);
• severe hypertension(stage 3 or malignant form).

note: The terms “mild” and “severe” speak only about blood pressure numbers, but not about the general condition.

Experts distinguish three stages of hypertension with a benign course:

• 1st (preclinical) stage of hypertension. Moderate headaches and less pronounced sleep disturbances may occur. Blood pressure does not increase above 140-160/95-100 and decreases after proper rest.
• Stage 2 hypertension. There is a narrowing of the arteries and hypertrophy of the left ventricle of the heart. Blood pressure is higher and remains stable, and at rest the numbers reach 160-180/100-110 mm. rt. Art. Laboratory tests reveal increased levels of creatinine in the blood and protein in the urine.
• Stage 3 hypertension. Angina pectoris, impaired cerebral blood flow, hemorrhages in the fundus, and dissection of the aortic walls develop. In this case, the risk of developing heart attacks, strokes and vision loss is especially high.

Note:some patients may experience the so-called. "White coat hypertension" With it, symptoms appear only in the presence of medical workers.

A special form of pathology is. This is an extreme manifestation of the disease, which is characterized by a sharp increase in blood pressure to critical levels. A serious condition with intense headache, nausea and vomiting can persist for up to a day. Due to impaired cerebral blood flow, intracranial pressure increases. Depending on the mechanism of blood pressure increase, eukinetic, as well as hypo- and hyperkinetic crises are distinguished.

Important: In case of a hypertensive crisis, it is important to provide the patient with first aid and urgently call an ambulance.

Hypertension can be isolated systolic or diastolic. With this form, there is an increase in only the “upper” or only the “lower” numbers of blood pressure.

Refractory hypertension is usually understood as a form of the disease in which therapy using three or more pharmacological agents is ineffective.

Treatment of hypertension

Therapeutic measures for hypertension can include both medicinal and non-medicinal methods, as well as traditional medicine.

Medicines indicated for hypertension

Drugs are prescribed if non-drug therapy for stage 1 disease does not produce a positive effect within 3-4 months or stage 2 of the disease is diagnosed. Monotherapy is indicated (i.e., the use of one PS). The “first-line” drug does not affect the metabolism of lipids and carbohydrates, does not lead to fluid retention, does not disrupt electrolyte balance, does not have a depressant effect on the central nervous system and does not provoke a sharp increase in blood pressure after discontinuation.

At stages 2-3, combinations of β-blockers with calcium antagonists, diuretics or angiotensin-converting enzyme inhibitors may be indicated. It is also possible to combine ACE inhibitors with diuretics or calcium antagonists.

For severe hypertension, combinations of 3-4 drugs belonging to the groups mentioned above, as well as α-blockers, are sometimes prescribed.

Treatment of hypertension with folk remedies

Non-drug therapy

Non-drug treatment methods are indicated for grade 1. If you have hypertension, it is important to give up bad habits and follow a diet with a limited content of sodium chloride (salt) and animal fats. An alternative to pharmacological drugs can be acupuncture therapy, acupuncture, auto-training and massage. Patients are advised to strictly adhere to the regimen, take products with antioxidant activity and general tonic herbal remedies.

Gymnastics helps with hypertension. Regular dosed physical activity contributes to the development of a pronounced antihypertensive effect. Exercises should be performed daily for 30 minutes, increasing the load gradually.

Remember that if you have been diagnosed with hypertension, then if there is a sharp deterioration in your general condition, you should immediately call a doctor at home! Before his visit, it is better to take a semi-sitting position, take a hot foot bath or put mustard plasters on your calves, take Valocordin (30-35 drops) and your “usual” medicine to lower blood pressure. For chest pain, you need to put a Nitroglycerin capsule under your tongue, and for severe headaches, take a diuretic.

Everyone has heard about heart attacks and strokes - this is what we are afraid of and strive to avoid with all our might. And yet, these are the most common causes of death in hypertension and hypertension.

Arterial hypertension or hypertension is the most common and universally recognized diagnosis. Despite the fact that, according to statistics, every third person suffers from this disease, much remains unclear, including the causes and treatment. How to prevent all these troubles? How to maintain health and quality of life? In this article we will try to answer these questions.

According to the currently accepted classification, arterial hypertension is an increase in blood pressure above 140/90 mm. rt. Art. Today, there are two forms of hypertension:

• primary (or essential, that is, the cause is unknown) - characterized by an increase in blood pressure for no apparent reason;
• secondary (symptomatic) - the cause of increased blood pressure is associated with any internal organs (liver, kidneys, lungs, brain, endocrine glands).

As the name implies, the cause of essential hypertension, despite all the achievements of modern medicine, is not clear, so the only traditional method of treatment remains eliminating high blood pressure with pills. And since pills only relieve the consequences without eliminating the cause, the relevance of hypertension is acutely felt in the modern world. However, a group of medical researchers led by physicist V.A. Fedorov developed a new concept for the development of hypertension, which explains the mechanism of the disease at the cellular level and is confirmed by numerous studies. We'll talk about this innovative approach.

First of all, any disease is a disruption in the functioning of the body. And since our large and well-coordinated body consists of cells, all the functions of the body are provided by them, small cells.

Microlife invisible to the eye is always present in the body - some cells die, others are formed. The body's task is to maintain a balance between functioning and dead cells. The immune system is involved in this task - special macrophage cells act as cleaners - their task is to find and remove such bio-debris in a timely manner. When the body's immune system cannot cope with a critical mass of dead cells, or when a cell, for various reasons, ceases to perform its tasks normally, the balance is disrupted and a disease occurs.

When does uncontrolled cell death occur and when the cell does not perform its functions? The answer is simple: when the cell itself lacks resources. By resources we mean anything that needs to be obtained from the outside for the cell to perform its function. Any cell, in order to maintain its functioning and “clean up” waste products, constantly interacts with the intercellular fluid, which, in turn, restores and renews its composition through contact with blood. The blood receives resources, including from the external environment: the lungs produce oxygen, the digestive system - nutrients in the form of water, fats, carbohydrates and proteins.

The effectiveness of treating hypertension using these devices has been confirmed by many studies, including:

• at the Military Medical Academy named after. CM. Kirov (“ ", 1998 And " ", 2003);
• at the State Medical Academy named after. I.I. Mechnikov (“ ", 2003);
• at the Vladimir Regional Clinical Hospital (“ » . And "", 2000).
• at the Federal State Educational Institution “Institute for Advanced Studies of the Federal Medical and Biological Agency” (dissertation of candidate of medical sciences Svizhenko A.A. “”, 2009).

Impaired blood supply to the brain

Another cause may be a disruption in the blood supply to the brain or spinal cord due to narrowing or pinching of the arteries. This can happen as a result of problems in the spine (intervertebral hernia), congenital features of the vascular bed, which may worsen over time, or atherosclerosis.

The body cannot allow interruptions in the blood supply to the brain, so it increases the pressure in order to push the required volume of blood through the narrowed vessels.

Then fixing the problem with the blood supply to the brain or spinal cord may reduce the pressure. For this purpose it can also be used using . With the help of special transducers (vibraphones), the mechanical microvibration of the device is transmitted by contact into the human body to a depth of 10 cm and leads to increased microcapillary blood and lymph flow. And this, in turn, leads to improved cell nutrition and...

Hypertension in older people also has its own characteristics, because... choosing the dosage of medications due to concomitant diseases can be very difficult, and often the doctor finds himself in a kind of “fork” - when the prescription of drugs to lower blood pressure leads to the deterioration of the functioning of other organs. And in this case, phonation can come to the rescue, which is safe and effective when used in elderly patients (“”, magazine “Doctor” No. 7/2014.

You can ask questions (below) on the topic of the article and we will try to answer them competently!

Arterial hypertension, as defined by the WHO Expert Committee, is persistently elevated systolic and/or diastolic blood pressure (140/90 mmHg and above).

Hypertension is a condition in which the systolic blood pressure level is above 140 mmHg. Art. and/or diastolic blood pressure above 90 mm Hg. Art. in persons not taking antihypertensive drugs, or any level in patients taking antihypertensive drugs. Moreover, blood pressure should be determined as the average of two or more measurements during at least two examinations by a doctor on different days.

What are the risk factors for hypertension?

The occurrence, progression and complication of hypertension are closely related to the presence of risk factors for the development of this pathology in a person. Arterial hypertension is the result of a complex interaction of external (environment) and internal (organism) factors. The occurrence of this pathology is facilitated by congenital and acquired characteristics of the body, which weaken its resistance to unfavorable external factors. All risk factors can be divided into endogenous and exogenous.

Endogenous (individual) risk factors:

• Genetic predisposition is one of the most influential factors in the development of the disease. There is a close relationship between blood pressure levels in first-degree relatives (parents, brothers, sisters). If both parents have hypertension, the disease usually develops in 50%-75% of cases. The probability of developing arterial hypertension in individuals whose parents had normal blood pressure is 4-20%;
• Age. The prevalence of arterial hypertension increases with age and is approximately: 15% among people aged 50 to 60 years, 30% among people aged 60 to 70 years, 40% among people over 70 years of age.
• Floor. The prevalence of arterial hypertension under the age of 40 is significantly higher in men than in women. At older ages, these differences are smoothed out.
• Body weight (obesity). The relationship between body weight and blood pressure is direct, significant and stable. An increase in body weight of 10 kg is accompanied by an increase in systolic blood pressure by 2-3 mmHg. Art., and diastolic - by 1-3 mm Hg. Art. Excess body weight is associated with a 2- to 6-fold increase in the risk of hypertension. According to the Framingham study, 78% of men and 64% of women have hypertension due to excess body weight. Losing body weight in people with hypertension leads to a decrease in hypertension. It should be taken into account that obesity is one of the main atherogenic risk factors, including low lipoprotein lipase activity, hyperinsulinemia, and insulin resistance.
• Diabetes mellitus (impaired carbohydrate tolerance). Arterial hypertension occurs twice as often in people with diabetes than without it.
• Features of personality and behavior. Persons with an easily excitable nervous system, prone to ambition, suspicion, dissatisfaction with what has been achieved and an uncontrollable desire to compete have a higher likelihood of developing arterial hypertension.
• Pregnancy, menopause and menopause.
• Dyslipidemia and increased uric acid levels contribute to the development of not only coronary heart disease, but also arterial hypertension.
• Neurocirculatory dystonia or vegetative-vascular dystonia of the hypertensive type.

Risk factors associated with lifestyle and environmental influences

• Nutritional factors. Consumption of table salt more than 5 g per day, magnesium deficiency, coffee and alcohol consumption contribute to the development of arterial hypertension.
• Smoking. Smoking has been proven to increase blood pressure. It should be remembered that cerebral stroke and coronary heart disease occur 2-3 times more often in smokers than in non-smokers.
• Psycho-emotional factors. Stress, repeated negative emotions, mental stress, mental fatigue contribute to the development of arterial hypertension.
• Physical activity. People leading a sedentary lifestyle have a 25% higher risk of developing arterial hypertension than those who are physically active or trained. At the same time, physical activity during professional duties contributes to an increase in blood pressure, and during leisure hours it decreases.

Theories of the occurrence of essential arterial hypertension

1. Neurogenic theory G.F. Langa, essential arterial hypertension is a classic “disease of regulation”, the development of which is associated with prolonged sneezing trauma and overexertion, negative emotions.
2. Volume-salt theory of A. Guyton, the development of the disease is based on a weakening of the excretory function of the kidneys, leading to the retention of sodium and water ions and, as a result, an increase in the volume of circulating blood, cardiac output and blood pressure.

Hypertension: classification

Depending on the cause and mechanism of development, arterial hypertension is divided into two types:

1. Essential hypertension (primary hypertension or essential hypertension) is an increase in blood pressure in the absence of an obvious reason for its increase. This type occurs in 90-96% of cases of all arterial hypertension.
2. Secondary hypertension (symptomatic) is hypertension for which the cause can be identified.

Classification of hypertension depending on blood pressure level

There is also a more simplified American (JNC 7 of 2003) classification of arterial hypertension. It includes three levels of blood pressure:

• normal<120/80 мм рт. ст.
• prehypertension 120-139/80-89 mmHg. Art.
• arterial hypertension >160/100 mm Hg. Art.

The American classification is quite simple and understandable. It does not contain terms that cause additional questions and confusion.

As can be seen from the table, blood pressure is considered normal according to the European classification - 120-129/80-84 mmHg, and according to the American classification - 120/80 mmHg.

Why is this blood pressure level taken as the norm?

It is with the risk of possible complications that the blood pressure is in the range of 120-139/80-89 mm Hg. and is called prehypertension in the American classification in order to increase public concern about the consequences of this situation.

What is "working pressure"?

Based on the current position of cardiologists around the world, this concept should be treated as a misunderstanding. This term is not included in any modern classification of blood pressure. How did it come about? Who invented it? And, most importantly, it is impossible to say what the meaning is. Currently, there are only three terms that characterize blood pressure: normal, prehypertension (meaning a level that requires prevention) and arterial hypertension - a level that requires ongoing treatment.

Classification of hypertension according to the degree of target organ damage

The term " stage“implies a gradual, steady progression of the process over time, which does not necessarily occur with proper treatment of arterial hypertension.

Hypertension 1st degree— there are no objective manifestations of target organ damage (heart, brain, fundus vessels, kidneys).

Hypertension 2nd degree- the presence of at least one of the following signs of target organ damage: left ventricular hypertrophy, narrowing of retinal vessels, impaired renal function, atherosclerotic plaques in the carotid arteries, iliac, femoral arteries.

Hypertension 3rd degree— there are objective signs of target organ damage and their clinical manifestations.

• heart - angina pectoris, myocardial infarction, heart failure;
• brain - stroke, transient cerebrovascular accident, hypertensive encephalopathy;
• fundus - hemorrhage and exudates with swelling of the optic nerve;
• kidneys - renal failure;
• vessels - dissecting aortic aneurysm, occlusive lesions of the arteries.

Main symptoms of hypertension

• The typical onset of the disease is between the ages of 30 and 45 in people with a hereditary predisposition.
• Before complications develop, the disease is often asymptomatic, and its only manifestation is high blood pressure.
• Periodic headache, often in the back of the head, dizziness and tinnitus.
• Impaired vision, memory, pain in the heart and irritability.
• Shortness of breath during physical activity.
• The volume of the left ventricle increases.
• Arterial vessels are affected.
• As a result, heart failure develops.

What can be the complications of hypertension?

The course of hypertension is often accompanied by exacerbations and complications, especially in people who do not take treatment or when antihypertensive treatment is not started in a timely manner.

• hypertensive (hypertensive) crisis is one of the most common complications of hypertension;
• bleeding in the brain (hemorrhagic stroke);
• ischemic stroke (cerebral infarction);
• hypertrophy and enlargement of the heart;
• cardiac ischemia;
• acute left ventricular failure (cardiac asthma and pulmonary edema);
• chronic heart failure;
• disturbance of heart rhythm and conduction;
• dissecting aortic aneurysm;
• retinal angiopathy;

Treatment of hypertension

Basic principles:

• treatment (non-drug and drug) should be started as early as possible and carried out continuously, usually throughout life;
• for people with high blood pressure, lifestyle modifications are necessary;
• it is better to use antihypertensive drugs with 24-hour action;

Non-drug treatment is aimed at correcting risk factors and is indicated for all patients with arterial hypertension and people with high normal blood pressure (130-139/85-89 mm Hg) to reduce the risk of developing this pathology:

• to give up smoking;
• in case of obesity - decrease in body weight;
• reducing alcohol consumption;
• regular performance of dynamic physical exercises;
• limiting the consumption of table salt to 5 g per day;
• increasing the consumption of fruits and vegetables, sea fish, reducing the consumption of fats and cholesterol.

Drug treatment of arterial hypertension

First line drugs:

For all groups of first-line drugs, numerous studies have proven their ability to reduce the risk of stroke, myocardial infarction, cardiovascular death and, in most cases, overall mortality, as well as safety (no significant side effects) during long-term use.

Second line drugs:

1. alpha-1 adrenergic blockers (Doxazosin);
2. central alpha-2 agonists (Methyldopa, Clonidine). Methyldopa is the drug of choice for pregnant women;
3. direct vasodilators (Hydralazine, Sodium Nitropruside);
4. imidazoline receptor agonists (Moxonidine);
5. renin inhibitors (Aliskirin).

Second-line drugs are used only in combination therapy as the third or fourth component.

Hypertension is a chronic disease that is characterized by a persistent increase in blood pressure to high levels due to a violation of the regulation of blood circulation in the human body. Terms such as arterial hypertension and hypertension are also used to refer to this condition.

Medical statistics are such that today hypertension is one of the most common diseases. It usually begins to progress in people after 40 years of age, but there is a risk of progression at any age. Thus, the disease is increasingly being detected in patients of working age. It is worth noting that representatives of the fair sex get sick several times more often than men. But it is in men that hypertension is more severe, since they are more prone to the development of blood vessels.

Blood pressure may increase with strong mental or physical stress for a short period of time - this is an absolutely normal phenomenon. A longer increase in blood pressure is observed in a number of diseases of the kidneys, endocrine glands, and also during pregnancy. But in this case, hypertension is only one of the symptoms that indicates changes in the organs. In hypertension, an increase in blood pressure is an independent, primary, painful process.

The pathogenesis of hypertension is such that, under the influence of exogenous and endogenous factors, the tone of the walls of arterioles in the body increases. As a consequence of this, they gradually narrow and the blood flow in the affected vessels is disrupted. During this pathological process, blood pressure on the walls of the arteries increases, which entails further symptoms.

Etiology

The main reason for the progression of hypertension is an increase in the activity of the sympathetic-adrenal system. The vasomotor center is located in the medulla oblongata in humans. From it, certain impulses travel along nerve fibers to the walls of blood vessels, causing the vessels to expand or contract. If this center is in a state of irritation, then only impulses will flow to the vessels, increasing the tone of their walls. As a result, the lumen of the artery narrows.

Arterial hypertension is characterized by a simultaneous increase in systolic and diastolic pressure. This is observed under the influence of various unfavorable factors.

Exogenous risk factors:

• severe nervous tension is the most common cause of progression;
• physical inactivity;
• poor nutrition. Non-compliance with the diet and consumption of large quantities of fatty and fried foods;
• excessive consumption of alcoholic beverages;
• smoking;
• drug use.

Endogenous risk factors:

• burdened heredity;
• atherosclerosis of the coronary vessels of the heart;
• increased blood viscosity (the heart cannot fully transport it through the vessels);
• kidney ailments such as,;
• metabolic disorder;
• the presence of endocrine pathologies;
• increased calcium concentration in the blood;
• the effect of adrenaline on the heart during stressful situations;
• increased sodium concentration in the blood.

Classification

Over the entire period of studying the disease, scientists have developed more than one classification of hypertension - according to the appearance of the patient, according to etiology, according to the level of increase in pressure, the nature of the course, etc. Some have long been irrelevant, while others, on the contrary, are being used more and more often.

Degrees of hypertension (by pressure level):

• optimal – indicators 120/80;
• normal – upper from 120 to 129, lower – from 80 to 84;
• increased normal - upper indicators - from 130 to 139, lower - from 85 to 89;
• stage 1 hypertension – DM from 140 to 159, DD – from 90 to 99;
• stage 2 hypertension - systolic pressure increases to 160–179, and diastolic pressure increases to 100–109;
• stage 3 hypertension - systolic pressure rises above 140, and diastolic pressure rises above 110.

WHO stages of hypertension:

• Stage 1 hypertension – blood pressure rises, but no changes in internal organs are observed. It is also called transient. The pressure will stabilize after a short period of rest;
• Stage 2 or stable. At this stage of hypertension, blood pressure increases constantly. The main target organs are affected. During the examination, damage to the heart, fundus vessels, and kidneys can be noted;
• Stage 3 or sclerotic. This stage of hypertension is characterized not only by a critical increase in DM and DD, but also by pronounced sclerotic changes in the blood vessels of the kidneys, heart, brain, and fundus. Dangerous complications develop - angioretinopathy, etc.

Forms of the disease (depending on which organ vessels are affected):

• renal form;
• heart shape;
• brain shape;
• mixed.

Types of hypertension:

• benign and slow-flowing. In this case, symptoms of progression of the pathology may gradually appear over 20 years. Phases of both exacerbation and remission are observed. The risk of complications is minimal (with timely therapy);
• malignant. The pressure increases sharply. This form of hypertension is practically untreatable. As a rule, the pathology is accompanied by various kidney diseases.

It is worth noting that often with hypertension of 2nd degree and 3rd degree the patient experiences. This is an extremely dangerous condition not only for human health, but also for his life. Clinicians identify the following types of crises:

• neurovegetative. The patient is hyperactive and very agitated. The following symptoms of hypertension appear: tremor of the upper extremities, and excessive urination;
• hydropic. In this case, the patient is drowsy and his reactions are inhibited. There is muscle weakness, swelling of the face and hands, decreased diuresis, and a persistent increase in blood pressure;
• convulsive. This option is the most dangerous, as there is a high risk of developing dangerous complications. It is worth noting that it is the least common. It is characterized by the following symptoms: convulsions and impaired consciousness. A complication is cerebral hemorrhage.

Symptoms

The symptoms of the disease directly depend on what stage of hypertension the patient has.

Neurogenic

An increase in blood pressure is usually observed against the background of severe psycho-emotional stress or due to increased physical activity. At this stage, there may be no signs of pathology at all. Sometimes patients begin to complain of pain in the heart, irritability, headache, tachycardia, and a feeling of heaviness in the back of the head. The indicators of diabetes and diarrhea are increasing, but they can easily be normalized.

Sclerotic

This clinical picture is supplemented by the following symptoms:

• increased headache;
• dizziness;
• feeling of a rush of blood to the head;
• poor sleep;
• periodic numbness of the fingers on the extremities;
• fast fatiguability;
• “flies” before the eyes;
• persistent increase in blood pressure.

It is worth noting that this stage can progress over several years and at the same time patients will be active and mobile. But disruption of the blood supply to certain organs entails disruption of their functioning.

Ultimate

Usually at this stage, doctors detect and, as well as a violation of blood circulation in the brain. The outcome of the disease, as well as the development of complications, is determined by the form of hypertension. Crises often occur.

In the cardiac form, the patient gradually progresses to heart failure. Shortness of breath, pain in the projection of the heart, and swelling appear. With the brain form, a person is bothered by severe headaches and visual impairment.

Hypertension and pregnancy

Hypertension during pregnancy is the most common cause of premature birth of a child or perinatal fetal death. Typically, a woman already has hypertension before pregnancy and then simply becomes more active, because carrying a child is a kind of stress for the body.

Considering the high risk for the mother and the unborn child, if the disease is diagnosed, it is important to determine exactly the degree of this risk in order to decide on further bearing the fetus or terminating the pregnancy. Doctors distinguish three degrees of risk (based on the stage of arterial hypertension):

• Risk level 1 – pregnancy complications are minimal, crises rarely develop. Possible angina. Pregnancy in this case is acceptable;
• Level 2 risk – pronounced. Complications develop in 20–50% of cases. A pregnant woman experiences hypertensive crises, insufficiency of the coronary vessels of the heart, and high blood pressure. Termination of pregnancy is indicated;
• 3 degree of risk. Pregnancy complications occur in 50% of cases. Perinatal mortality is observed in 20% of cases. Possible placental abruption and impaired blood circulation in the brain. Pregnancy poses a danger to the mother's life, so it is terminated.

Patients who continue to be pregnant must visit a doctor once a week so that he can monitor their condition. Treatment of hypertension is mandatory. The following antihypertensive drugs are allowed:

• antispasmodics;
• saluretics;
• sympatholytics;
• clonidine derivatives;
• rauwolfia preparations;
• ganglion blockers;
• beta blockers.

Also, in order to treat illness during pregnancy, doctors resort to physiotherapy.

Diagnostics

When the first signs of illness appear, it is important to immediately contact a medical facility to confirm or refute the diagnosis. The sooner this is done, the lower the risk of progression of dangerous complications (damage to the heart, kidneys, brain). During the initial examination, the doctor must measure the pressure in both arms. If the patient is elderly, then measurements are also taken in a standing position. During diagnosis, it is important to clarify the true cause of the progression of the pathology.

A comprehensive plan for diagnosing hypertension includes:

• taking anamnesis;
• ABPM;
• determining the level of bad cholesterol in the blood;
• X-ray;
• fundus examination;

Treatment

Treatment of hypertension is carried out in an inpatient setting so that doctors can constantly monitor the patient’s condition and, if necessary, adjust the treatment plan. It is important to normalize the patient’s daily routine, correct his weight, limit the use of table salt, and completely abandon bad habits.

The following medications are prescribed to correct blood pressure:

• alpha-blockers;
• beta blockers;
• calcium channel blockers;
• diuretics. This group of drugs is especially important as it helps reduce sodium levels in the blood, thereby reducing swelling of the walls of blood vessels.

All of these medications should be taken only as prescribed by your doctor. Uncontrolled use of such drugs can only worsen the patient's condition. These drugs are taken according to a specific schedule.

Diet

During the treatment of hypertension, in addition to taking medications, it is important to adhere to a special diet. For hypertension, the patient is prescribed table No. 10. The principles of this diet:

• add seafood to your diet;
• limit salt intake;
• fractional meals;
• limit carbohydrates and animal fats in your diet.

The diet for this pathology implies restriction:

• Sahara;
• of bread;
• potatoes;
• pasta;
• cereal dishes;
• animal fats;
• ghee;
• sour cream and so on.

Diet No. 10 is complete and can be followed for a long time. To improve the taste of dishes you can add:

• prunes;
• vinegar;
• jam;
• cranberries;
• lemon.

The diet is indicated not only during treatment, but also after it, so as not to provoke a worsening of the condition. It is worth noting that the diet is developed strictly individually for each patient, taking into account the characteristics of his body. An important point is that while following a diet you should consume no more than 1.5 liters of liquid per day.

Prevention

Prevention of hypertension is quite simple. The first thing you need to do is normalize your diet and lead an active lifestyle. In order for the blood vessels to be elastic, you need to eat more vegetables and fruits, drink up to 2 liters of water per day. You can take vitamin supplements. Also, prevention of hypertension involves avoiding smoking and drinking alcoholic beverages.