high blood pressure

4 December 2024

In the 21st century, arterial hypertension remains an important medical and social problem because it has many complications that lead to disability, affect quality of life, and can cause death.

The disease was successfully treated by specialized doctors. If you have high blood pressure, you should consult your doctor immediately. Only timely and competent treatment promotes recovery.

Classification of arterial hypertension

People usually distinguish 4 risk groups of arterial hypertension, depending on the possibility of damage to the heart, blood vessels and other target organs, as well as the presence of aggravating factors:

1 – risk less than 15%, no aggravating circumstances;
2 – The risk is in the range of 10-20%, with no more than 3 aggravating factors;
3 – Risk from 20 to 30%, with more than 3 aggravating factors;
4 – Risk over 30%, over 3 severe circumstances, target organs affected.

In arterial hypertension, the following target organs are affected:

brain (transient cerebrovascular accident, stroke);
visual organs (retinal degeneration and detachment, hemorrhage, blindness);
blood (increased glucose concentration, leading to damage to the central nervous system);
heart (left ventricular hypertrophy, myocardial infarction);
kidney (proteinuria, renal failure).

Depending on the severity of cardiovascular risk, several blood pressure levels are distinguished, which are presented in Table No. 1.

Table number 1. Blood pressure level:

Category	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
Optimal	Below 120	Under 80
Normal	120-129	80-84
Normal high	130-139	85-89
Grade 1 arterial hypertension	140-159	90-99
Arterial hypertension 2 degrees	160-179	100-109
Arterial hypertension 3 degrees	≥180	≥110
Isolated systolic hypertension	≥140	90

Causes of high blood pressure

The main risk factors for primary arterial hypertension include:

Gender and age. Men between 35 and 50 years old are most susceptible to the disease. In women, the risk of arterial hypertension increases significantly after menopause;
Genetic predisposition. The risk of getting the disease is very high in people whose first-degree relatives have this disease. If two or more relatives have high blood pressure, the risk increases;
Stress and psycho-emotional tension increase. During psycho-emotional stress, a large amount of adrenaline is released, under its influence, the heart rate and the volume of pumped blood increase. If a person falls into a state of chronic stress, the increased load leads to wear and tear of the arteries and the risk of heart and vascular complications increases;
Drink alcoholic beverages. With daily consumption of spirits, blood pressure increases by 5 mmHg per year. Art. ;
Smoke. Cigarette smoke causes peripheral and coronary vasospasm. Arterial walls are damaged by nicotine and other components, and atherosclerotic plaques form at the damaged site;
Atherosclerosis develops due to excessive consumption of foods containing cholesterol and smoking. Atherosclerotic plaque narrows the lumen of blood vessels and impedes the free circulation of blood. This leads to increased arterial blood pressure, stimulating the progression of atherosclerosis;
Increased consumption of table salt causes constriction of the arteries, retention of fluid in the body, leading to the development of high blood pressure;
Excess body weight leads to reduced physical activity. Clinical trials have shown that each additional kilogram is 2 mm. rt. Art. blood pressure;
Physical inactivity increases the risk of developing 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. The disease in most cases has no signs, progresses and leads to dangerous complications such as myocardial infarction or stroke. When asymptomatic, arterial hypertension can go undetected for decades.

The most common complaints patients experience are:

headache;
Flies buzz before eyes;
blurred vision;
dizzy;
shortness of breath;
Tired;
chest pain;
visual impairment;
nosebleeds;
lower limb swelling.

However, the most important sign of hypertension is high blood pressure. Headaches can be manifested by a feeling of a "ring" being squeezed in the head, accompanied by dizziness and nausea. They occur in the context of physical or nervous stress. If the pain persists, irritability, irritability, and sensitivity to noise will appear.

Intracranial hypertension

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

Intracranial hypertension: symptoms in adults and children

Intracranial hypertension syndrome manifests in many different ways, depending on the location of the pathology causing increased intracranial pressure, as well as the stage of the disease and the rate of development of the disease.

Moderate intracranial hypertension manifests as follows:

headache;
dizzy;
attacks of nausea and vomiting;
the covering up of consciousness;
epileptic seizures

Intracranial hypertension: diagnosis

Types of pathological diagnoses include:

Measure intracranial pressure by inserting a needle into the fluid cavity of the skull or spinal canal with a pressure gauge attached.
Monitor the degree of blood filling and dilation of the ocular veins. If the patient has red eyes, that is, the eye veins contain a lot of blood and are clearly visible, we can talk about increased intracranial pressure;
Ultrasound examination of cerebral vessels;
magnetic resonance and computed tomography: check the expansion of the fluid cavities in the brain, as well as the degree of rarefaction of the edges of the ventricles;
perform a brain scan.

Intracranial hypertension: treatment, drugs

Increased intracranial pressure can lead to a decrease in the patient's intellectual abilities and disruption of the normal functioning of internal organs. Therefore, this pathology requires the immediate initiation of treatment aimed at reducing intracranial pressure.

Treatment can only be carried out if the cause of the disease is accurately diagnosed. For example, if intracranial hypertension occurs due to the growth of a tumor or hematoma in the brain, surgical intervention is required. Removal of the hematoma or tumor leads to normalization of intracranial pressure.

Essential hypertension

Essential arterial hypertension is a condition in which the systolic blood pressure at the time of heart contraction and ejection of blood reaches 140 mmHg. Art. and above this level and/or diastolic blood pressure at the time the myocardium relaxes to 90 mmHg. Art. and higher.

Symptoms of essential hypertension

In medicine, the following concepts are distinguished:

essential arterial hypertension (essential primary hypertension);
Hypertension causes heart and kidney damage;
Secondary hypertension: endocrine, vascular remodeling, unspecified, etc. v.

True hypertension (essential form) occupies the leading position among all cases of hypertension. The frequency of occurrence is 90%.

In children (up to 10 years old), pressure levels exceeding 110/70 mm Hg are considered dangerous. Art. , after 10 years – 120/80 mm Hg. Diagnosis is confirmed in case of repeated blood pressure measurements within four weeks at least twice on different days.

In most cases, the disease affects people between 30 and 45 years old.

Cause of the disease

Despite all the modern advances in medicine, the cause of primary hypertension remains unknown. There are only a few factors that increase the risk of developing this disease. Among them:

injury to the spinal cord and brain, as a result of which vascular tone in the periphery is disrupted;
Nervous shock, frequent stress. In this case, the cerebral cortex focuses on continuous stimulation, prolonged contractions cause an increase in peripheral resistance, blood vessels lose elasticity;
genetic factors;
overweight: many overweight people believe that their obesity is due to dysfunction of the endocrine glands, put themselves on the list of "diseases" and do not want to change anything in their lifestyle. me. In fact, there may not be any endocrine disruption at all;
sedentary lifestyle;
overconsumption of many people's favorite coffee. At the same time, high levels of caffeine in the blood cause blood vessels to not relax and dilate normally. You should always remember: "what is good in moderation";
Consuming too much salt. It retains moisture in the body and leads to increased blood pressure. It is known that Japanese people consume twice as much salt as Europeans and essential hypertension is very common in Japanese people;
Alcohol abuse and smoking lead to violations of the normal regulation of vascular tone.

Treatment of essential hypertension

The doctor chooses treatment tactics after assessing the patient's condition and the stage of pathology development. In the early stages, patients are prescribed non-drug treatments, including:

special diet aimed at limiting the consumption of salt and foods rich in animal fats;
give up bad habits, especially smoking and alcohol abuse;
reduce stress. In this case, yoga classes, autonomic training and sessions with a psychotherapist are very useful;
Patients diagnosed with essential hypertension should not work in conditions of strong noise and vibration;
avoid excessive physical activity: intense, tiring exercises on the treadmill should be replaced with half an hour of walking.

Drug treatment includes taking the following medications:

angiotensin-converting enzyme inhibitors. This group includes a large number of drugs that reduce blood pressure in several ways at once;
angiotensin 2 receptor blockers. Drugs that dilate blood vessels, thereby reducing blood pressure;
beta blockers: this medication relieves pain in the heart, slows the heart rate and dilates blood vessels;
Calcium channel blockers: slow down the entry of calcium into vascular tissues and the heart, slow down the heart rate, dilate blood vessels;
Diuretics: inhibit sodium absorption in the kidneys, excrete sodium through urine. This group of drugs also includes drugs that retain potassium in the body. However, they have a weak diuretic effect;
Centrally acting drugs aim to reduce the activity of the nervous system. This also includes medications that lower cholesterol levels in the body.

Increased portal venous pressure

Portal hypertension is a complication of cirrhosis. This is a phenomenon of increased blood pressure in the portal vein due to blockage of blood flow from the vein.

What is portal hypertension

Normally, the pressure in the door area is 7 mm. rt. Thing. , in cases where this indicator exceeds 12-20 mm, stagnation forms in the radial veins and they dilate. The thin walls of veins, in contrast to arteries, stretch under pressure and tear easily.

Portal hypertension: symptoms

The main cause of portal hypertension is cirrhosis. With this pathology, pressure in the portal vessels of the liver increases.

As the disease progresses, signs of posterior portal hypertension appear:

laboratory test indicators change - the norms of the content of platelets, white blood cells and red blood cells are violated;
spleen enlarged;
worsened blood clotting;
Diagnosis of fluid accumulation in the abdominal area (ascites);
Gastrointestinal varicose veins develop;
In many cases, patients experience bleeding and anemia.

In the early stages, signs of portal hypertension in cirrhosis appear in the form of impaired overall health, abdominal bloating, and heaviness in the right subcostal area. Next, the patient experiences pain in the area below the right ribs, the liver and spleen increase in size, and the normal functioning of the digestive tract is interrupted.

Portal hypertension: degrees

In total, there are 4 degrees of pathology:

Level 1 – functional (initial);
Level 2 - moderate. Accompanied by moderate dilatation of the esophageal veins, splenomegaly and ascites;
Grade 3 portal hypertension is a serious form of the disease. At this stage, pronounced hemorrhagic syndromes and ascites are observed;
Level 4 (complex). The patient suffered from bleeding in the esophagus and stomach, with gastroenteritis and spontaneous bacterial peritonitis.

Portal hypertension: diagnosis

The types of diagnoses in hospitals are as follows:

Ultrasound: allows you to determine the size of the splenic vein, portal vein and superior mesenteric vein. If the diameter of the portal vein is greater than 15 mm and the splenic vein is greater than 7-10 mm, one can accurately determine the presence of portal hypertension. Additionally, ultrasound examination may show enlarged liver and spleen;
Doppler ultrasound: allows you to examine the structure of blood vessels, as well as measure the speed of blood flowing through them;
FGDS (fibergastroduodenoscopy): allows you to identify varicose veins in the cardiac part of the stomach and esophagus, the cause of bleeding in the gastrointestinal tract.

Portal hypertension: treatment

Treatment of portal hypertension in cirrhosis is aimed at preventing bleeding.

The effectiveness of sclerotherapy is about 80%. This procedure involves injecting medication into damaged veins using an endoscope. As a result, the veins become clogged and their walls "glue together". This method of treatment is considered classic.

Portal hypertension: prevention

Measures to prevent the development of the disease include:

maintain proper diet and nutrition;
sports;
vaccination against viral hepatitis;
refuse to abuse alcoholic beverages;
Avoid exposure to harmful production factors in the form of toxic substance poisoning.

Measures to prevent liver disease are:

comprehensive examination to diagnose liver disease in its early stages and initiate treatment;
strictly follow all the doctor's recommendations;
Complex therapy in a hospital environment under the close supervision of a doctor.

Measures to prevent the development of bleeding include:

control blood clotting function;
sigmoidoscopy - that is, annual examination of the sigmoid and rectum;
gastroduodenal endoscopy twice a year.

Secondary hypertension

The most common type is primary hypertension, sometimes called hypertension. In addition to the primary or idiopathic form of the disease, commonly known as hypertension, secondary hypertension is also known.

Depending on the cause, people distinguish the following types of diseases:

Renal hypertension occurs due to damage to the renal arteries. This form of the disease is called regenerative hypertension;
An increase in systolic blood pressure occurs with Itsenko-Cushing syndrome. In this case, the adrenal medulla is affected;
Pheochromocytoma is a disease that affects the adrenal medulla. It causes a form of malignant arterial hypertension. The tumor compresses the outer layer of the adrenal gland, as a result of which adrenaline and norepinephrine are released into the blood, causing a constant increase in pressure or crisis;
Hyperaldosteronism, or Cohn syndrome, is a tumor of the adrenal gland that causes increased aldosterone levels. As a result, blood potassium levels decrease and blood pressure increases;
Thyroid diseases 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 the pathological process. It occurs with aortic stenosis or stenosis and aortic valve insufficiency;
Arterial hypertension in adults of central origin develops in diseases of the brain with secondary central dysregulation (stroke, encephalitis, head trauma);
Drug-induced hypertension may occur with oral contraceptives, nonsteroidal anti-inflammatory drugs, and glucocorticosteroids.

Diagnosing secondary hypertension is difficult, but there are some signs to suspect:

high blood pressure in young people;
The disease has an immediate acute sudden onset with high blood pressure counts;
unresponsive to ongoing antihypertensive treatment;
sympathetic crisis.

Increased diastolic blood pressure

The diagnosis of "isolated diastolic hypertension" is valid when the systolic value is less than 140 mm. Hg and diastolic greater than 90 mm Hg. Increased diastolic blood pressure to 90 mm Hg. does not pose a threat to people without somatic diseases.

People with elevated diastolic blood pressure and no comorbidities are encouraged to control their blood pressure and make lifestyle changes:

regulate sleep quality;
do not drink red wine;
Limit the number of cigarettes smoked per day;
avoid stress;
eliminate salt from the diet;
eat properly;
maintain normal weight;
exercise or yoga.

When diastolic hypertension occurs, hospital treatment is required if high diastolic blood pressure persists. The underlying disease is treated, for example, surgically correcting aortic valve disease. Doctors prescribe individual antihypertensive medications. The following tablets for the treatment of hypertension are used:

diuretics;
beta blockers;
calcium channel blockers;
ACE inhibitors;
angiotensin II receptor blockers.

Hypertensive crisis

Hypertensive crisis is a significant increase in blood pressure in an individual patient with primary or secondary arterial hypertension, accompanied by the appearance or worsening of clinical symptoms and the need for rapid pressure control. to limit or prevent damage to target organs.

Type 1 crisis (adrenal, autonomic) is manifested by an increase in systolic blood pressure, hypertension, tachycardia, extrasystole and agitation. Level 2 attack (salt, norepinephrine) has the following symptoms:

an increase in diastolic pressure prevails with a decrease in pulse pressure;
swelling of the face, legs, hands;
Diuresis is markedly reduced on the eve of the crisis.

In case of a complicated crisis, the airway is cleaned, the patient is given oxygen and an intravenous line is placed. The choice of antihypertensive medication is approached differently; which is intravenous injection. They quickly reduce the pressure, then within 2-6 hours switch to oral medication, reducing it to 160/100 mmHg. The patient was admitted to a specialized hospital.

Diagnosis of arterial hypertension

It is very important to know how to measure blood pressure, only then can hypertension be diagnosed. The exercise begins with an explanation of the person's behavior during the procedure, then they demonstrate how to wear the cuff correctly and record the readings. It depends on the pressure measuring device: mechanical or electronic.

It is necessary to perform laboratory tests such as:

general blood and urine analysis;
blood sugar levels;
creatinine, uric acid, and potassium levels;
lipid profile;
serum C-reactive protein content;
Urine bacterial culture.
Patients are prescribed the following instrumental research methods:
electrocardiogram;
echocardiography;
chest X-ray;
Ultrasound examination of the kidneys and adrenal glands;
Ultrasound of the renal artery and short cephalic artery.

The ophthalmologist will examine the fundus and evaluate the presence and extent of microproteinuria. All hospitalized patients have their blood pressure monitored daily.

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 antihypertensive medication is determined by the following strategy: achieving target blood pressure, i. e. 140/80 mmHg. and address risk factors. In patients with kidney disease and diabetes, blood pressure should be reduced to 130/80 mmHg. This will improve the quality of life and eliminate the symptoms of the disease.

Prevention of arterial hypertension

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

organize proper nutrition;
Avoid stress and emotional tension;
use reasonable physical activity;
normalizes sleep;
track your weight;
active rest;
stop smoking and drinking alcohol;
See your doctor regularly and get tested.

Arterial hypertension leads to disability and death. The disease was successfully treated by doctors. Treatment of this disease involves the continuous use of medications to control blood pressure. Hypertensive attacks and sudden changes in pressure should be avoided.

If you have this problem, call and the dispatcher will make an appointment with a cardiologist and answer all your questions.