Hypertension: causes, treatment, prognosis, stages and risk levels

Hypertension (HTN) is one of the most common diseases of the cardiovascular system and affects approximately one third of the world's population. Hypertension has been diagnosed in more than half of the population up to the age of 60-65. The disease is called a "silent killer" because its symptoms may not be present for a long time, changes in the walls of blood vessels begin already at an asymptomatic stage and greatly increase the risk of vascular accidents.

In Western literature, this disease is called arterial hypertension (AH). Although both "hypertension" and "hypertension" are still in common use, others have adopted this formulation.

Serious attention to the problem of arterial hypertension is not associated with its clinical manifestations, but with 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 blood pressure (BP).

An important point is to identify all possible risk factors,as well as clarifying its role in disease progression. The diagnosis shows the relationship between the degree of hypertension and existing risk factors, which facilitates the assessment of the patient's condition and prognosis.

For most patients, the numbers in the diagnosis after "AH" have no meaning, although it is clear that the higher the degree and risk index, the worse the prognosis and the more serious the pathology. In this article, we will try to understand how and why hypertension is diagnosed to one degree or another, and what is the basis for determining the risk of complications.

Causes and risk factors of hypertension

There are many causes of arterial hypertension. GovWhen talking about primary or basic hypertension, we andWe mean the case where there is no specific previous disease or pathology of the internal organs. In other words, such hypertension occurs by itself, involving other organs in the pathological process. More than 90% of cases of chronic high blood pressure are primary hypertension.

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

Secondary hypertension- a manifestation of another pathology, so its cause is always known. It accompanies kidney, heart, brain, endocrine diseases and is secondary to them. Hypertension also disappears after the recovery of the main disease, so it is meaningless to determine the risk and degree in this case. Symptomatic hypertension accounts for no more than 10% of cases.

Risk factors for hypertension are also known to everyone. Hypertension schools are established in clinics whose specialists provide information to the population about adverse conditions that cause hypertension. Any therapist or cardiologist will inform the patient about the risks at the first case of high blood pressure.

Among the conditions predisposing to hypertension, the most important are:

1. To smoke;
2. Excessive salt in food, excessive fluid intake;
3. insufficient physical activity;
4. Alcohol abuse;
5. Excess weight and fat metabolism disorders;
6. Chronic psycho-emotional and physical overload.

If we can exclude the listed factors or at least try to reduce their impact on health, characteristics such as gender, age, heredity cannot be changed, and therefore we will have to put up with them without forgetting the increased risk.

Classification of arterial hypertension and determination of risk level

Classification of hypertension involves determining the stage, degree and risk level of vascular accidents.

Disease stagedepends on clinical manifestations. Emphasize:

• Preclinical stage, when there are no signs of hypertension and the patient is unaware of the increase in blood pressure;
• The 1st stage of hypertension, when the pressure rises, crises are possible, but there are no signs of target organ damage;
• Stage 2 is accompanied by damage to target organs - myocardial hypertrophy, changes in the retina of the eyes are noticeable, the kidneys suffer;
• In the 3rd stage, strokes, myocardial ischemia, visual pathology, changes in large vessels (aortic aneurysm, atherosclerosis) are possible.

The degree of hypertension

Determining the degree of hypertension is important in assessing risk and prognosis and is based on blood pressure readings. It should be said that normal blood pressure values also have different clinical significance. Thus, the indicator is up to 120/80 mm Hg. Art. countsoptimal,normalthe pressure will be between 120-129 mmHg. Art. systolic and 80-84 mm Hg. Art. diastolic. Pressure numbers 130-139 / 85-89 mmHg. Art. they are still within normal limits, but approaching the borderline with pathology, so they are "called"very normal" and the patient can be told that the normal blood pressure is high. These indicators can be considered as pre-pathological, because the pressure is only "a few millimeters" before it rises.

From the moment the blood pressure reaches 140/90 mm Hg. Art. we can already talk about the existence of the disease. This indicator is used to determine hypertension itself:

• The 1st degree of hypertension (diagnosed as HTN or AH 1st stage) means an increase in pressure in the range of 140-159/90-99 mmHg. Art.
• Stage 2 headache is accompanied by numbers of 160-179 / 100-109 mm Hg. Art.
• In stage 3 hypertension, the pressure is 180/100 mmHg. Art. and higher.

It happens that the systolic pressure indicators are 140 mm Hg. Art. and higher, and the diastolic value is within normal values. In this case, they are talking about themisolated systolic formhypertension. In other cases, the indicators of systolic and diastolic pressure correspond to different degrees of the disease, then the doctor makes a diagnosis in favor of the greater degree, and it is not important to draw conclusions based on systolic or diastolic pressure.

The most accurate diagnosis of the degree of hypertension is possible when the disease is detected for the first time, when treatment has not yet been carried out and the patient does not take any antihypertensive drugs. During therapy, the numbers fall, and when stopped, on the contrary, they can increase sharply, so it is no longer possible to adequately assess the rate.

Concept of risk in diagnosis

Hypertension is dangerous due to its complications. It is no secret that the vast majority of patients die or become disabled not because of high blood pressure itself, but because of acute disorders caused by it.

Cerebral hemorrhages or ischemic necrosis, myocardial infarction, kidney failure are the most dangerous conditions provoked by high blood pressure. In this regard, after a thorough examination for each patientrisk is determined by numbers 1, 2, 3, 4 in the diagnosis. Thus, the diagnosis is based on the degree of hypertension and the risk of vascular complications (eg, hypertension/hypertension stage 2, risk 4).

Risk stratification criteriaExternal conditions, presence of other diseases and metabolic disorders, involvement of target organs, accompanying changes in organs and systems are used for hypertensive patients.

Major risk factors affecting prognosis include:

1. The patient's age is over 55 for men and over 65 for women;
2. To smoke;
3. Disorders of lipid metabolism (cholesterol, excess of low-density lipoproteins, decrease of high-density lipid fractions);
4. presence of cardiovascular pathology in the family among blood relatives between 65 and 65 and 55 years of age in men, respectively;
5. Excess body weight, when the abdominal circumference is more than 102 cm in men and 88 cm in women.

The listed factors are considered the main ones, but many patients with hypertension suffer from diabetes, impaired glucose tolerance, lead a sedentary life, and have abnormalities in the blood coagulation system in the form of increased fibrinogen concentration. These factors are taken into accountaddition, also increases the likelihood of complications.

Damage to target organs characterizes hypertension starting from the 2nd stage and serves as an important criterion for determining the risk, therefore, the examination of the patient includes ECG, ultrasound examination of the heart, the degree of muscle hypertrophy, blood and urine tests for indicators of kidney function (creatinine, protein). .

First of all, the heart suffers from high pressure, pushing blood into the veins with increased force. As the arteries and arterioles change, their walls lose elasticity and the lumens become spasmodic, the load on the heart increases. A characteristic taken into account when considering risk stratificationmyocardial hypertrophy, which can be suspected with an ECG, can be determined by an ultrasound examination.

Involvement of the kidneys as a target organ is indicated by an increase in the amount of creatinine in the blood and urine and the appearance of albumin protein in the urine. Against the background of hypertension, the walls of large vessels thicken, atherosclerotic plaques are formed that can be detected by ultrasound (carotid, brachiocephalic arteries).

The third stage of hypertension is associated with a related pathology, that is, hypertension.Among related diseases, the most important for prognosis are stroke, transient ischemic attacks, heart attack and angina pectoris, nephropathy caused by diabetes, kidney failure, and retinopathy (retinal damage) due to hypertension.

So, the reader probably understands how you can independently determine the degree of headache. It's not difficult, you just need to measure the pressure. Then, you can think about the presence of certain risk factors, such as age, gender, laboratory parameters, ECG data, ultrasound, etc. pay attention, note, notice, please note. In general, everything listed above.

For example, a patient's blood pressure is consistent with stage 1 hypertension, but at the same time he has had a stroke, which means that even if the only problem other than hypertension is stroke, the risk will be maximum - 4. If the pressure is consistent with stage 1 or stage 2 and can be recordedif the only risk factors are smoking and age against a fairly good health background, the risk will be moderate - 1 tbsp. (2 tablespoons), risk 2.

To clarify what the risk indicator means in the diagnosis, you can summarize everything in a small table. By determining your level and "calculating" 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 - medium, 3 - high, 4 - very high risk of complications.

Risk factors	BP 130-139/85-89, risk	GB (AH) 1, risk	GB 2, risk	GB 3, risk
None	1	2	3
1-2	1	2	2	4
more than three factors/target damage/diabetes	3	3	3	4
associated pathology	4	4	4	4

Low risk means that the probability of vascular accidents is no more than 15%, medium - up to 20%, high risk indicates the development of complications in one third of patients from this group, with 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 tonometer readings indicate a developing disease.

With changes in blood vessels and the progression of the heart, symptoms appear in the form of headache, weakness, decreased performance, periodic dizziness, weakening of visual acuity, flashing "spots" in front of the eyes. All these symptoms are not expressed during a stable course of pathology, but during the development of a hypertensive crisis, the clinic becomes brighter:

• Severe headache;
• Noise, ringing in the head or ears;
• Darkness in the eyes;
• Pain in the heart region;
• Shortness of breath;
• facial hyperemia;
• A feeling of excitement and fear.

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

1. bleeding or brain infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute kidney 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 can normally be different in different hands, but as experience shows, there is even a difference of 10 mm Hg. Art. can occur due to the pathology of peripheral vessels, therefore, 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 in each arm three times with short time intervals, recording each result obtained. The smallest values obtained in most patients 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 wide selection and availability of devices for measuring blood pressure allows monitoring it at home in a wide range of people. Typically, hypertensive patients have a tonometer at home so that they can measure their blood pressure immediately if their health worsens. However, it should be noted that fluctuations are also possible in completely healthy people without hypertension, so a single excess of the norm should not be considered a disease, and the pressure should be measured at different times to diagnose hypertension. , under different conditions and repeatedly.

When diagnosing hypertension, blood pressure indicators, electrocardiography data and heart auscultation results are considered the main ones. When listening, it is possible to detect noise, increased tones, arrhythmias. The EKG will show signs of stress on the left side of the heart, beginning with the second stage.

Treatment of hypertension

Treatment regimens containing different groups of drugs and different mechanisms of action have been developed to correct high blood pressure. Theircombination and dosage are selected individually by the doctortaking into account the stage, the accompanying pathology and the reaction of hypertension to a certain drug. After the diagnosis of hypertension and before starting drug treatment, the doctor will suggest non-drug measures that significantly increase the effectiveness of pharmacological drugs and sometimes allow to reduce the dose of drugs or at least to abandon some of them.

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

In the initial stage of hypertension, non-drug measures can have such a good effect that there is no need to prescribe drugs. If these measures do not work, the doctor prescribes appropriate drugs.

The goal of treating hypertension is not only to reduce the pressure, but also, if possible, to eliminate its cause.

Antihypertensive drugs from the following groups are traditionally used to treat hypertension:

• diuretics;
• angiotensin II receptor antagonists;
• ACE inhibitors;
• adrenergic blockers;
• Calcium channel blockers.

Every year, the list of drugs that reduce blood pressure increases, and at the same time, they are more effective and safer, with fewer adverse reactions. When starting therapy, a drug 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 with combination therapy is better than prescribing the maximum amount of one drug.

It is important to reduce the risk of vascular complications in choosing a treatment regimen.Thus, it has been noted that some compounds 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 reduce the likelihood of complications, even if there are some daily fluctuations in blood pressure.

In some cases, it is necessary to take into account the accompanying pathology, which makes adjustments to the treatment regimens of headache. For example, alpha-blockers are prescribed to men with prostate adenoma, but they are not recommended for regular use to lower blood pressure in other patients.

The most commonly used ACE inhibitors, calcium channel blockers,those prescribed for both young and old patients, with or without concomitant diseases, diuretics, sartans. Medicines in these groups are suitable for initial treatment, and then a third medicine with a different composition can be added.

ACE inhibitors reduce blood pressure and at the same time have a protective effect on the kidneys and myocardium. It is preferred in young patients, women taking hormonal contraceptives indicated for diabetes, and elderly patients.

Diureticsnot less popular. To reduce adverse reactions, they are combined with ACE inhibitors, sometimes "in one tablet".

Beta blockersit is not a priority group for hypertension, but it is effective for accompanying heart pathology - heart failure, tachycardia, coronary diseases.

Calcium channel blockersoften prescribed together with ACE inhibitors, they are especially good for bronchial asthma with hypertension as they do not cause bronchospasm.

Angiotensin receptor antagonists- the most prescribed drug group for hypertension. They effectively reduce blood pressure and do not cause coughing like many ACE inhibitors. However, it is especially common in America 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 drugs for a long time, even for life. Many patients believe that the treatment can be stopped when the pressure reaches a normal level, but they take pills during a crisis. It is known that the unsystematic use of antihypertensive drugs is more harmful to health than the complete lack of treatment, so informing the patient about the duration of treatment is one of the important duties of the doctor.