What is Dangerous Arterial Hypertension: Symptoms, Causes, and Treatment

Arterial hypertension (AH, hypertension) is one of the most important socioeconomic and medical problems of our time.

This is not only because of the wide spread of the disease among different age groups, but also because of the high rates of severe complications, disability and mortality from arterial hypertension without prompt treatment.

It is recommended that people who are prone to hypertension measure with both hands. Recent studies have shown that arterial hypertension can be confirmed by a difference of 10-15 mm Hg readings on different hands. This marker (which varies by indication) has a 96% probability of identifying hypertension.

What's this?

In simple terms, arterial hypertension is a disease of the cardiovascular system in which the arterial blood pressure in the systemic (large) circulation increases steadily.

Blood pressure is divided into systolic and diastolic:

1. systolic period. According to the first higher number, blood pressure levels are determined at the moment when the heart is compressed and blood is drained from the arteries. This indicator depends on the strength of the heart's contractions, the resistance of the blood vessel walls, and the frequency of contractions.
2. Diastolic blood pressure. The second, lower number determines the blood pressure when the heart muscle relaxes. It indicates the level of peripheral vascular resistance.

Usually, blood pressure readings are constantly changing. They are biologically dependent on a person's age, sex and condition. During sleep, stress decreases, and physical activity or stress causes stress to increase.

The average normal blood pressure for a 20-year-old is 120/75 mm Hg. Art, forty - 130/80, over fifty - 135/84. With 140/90 going on, we're talking about arterial hypertension. Statistics show that about 20-30% of adults are affected by this disease. Prevalence inevitably increases with age, and by age 65, 50-65% of older adults have the disease.

Classification

Given the origin of the pathology, the following types are distinguished:

1. Essential arterial hypertension (primary). Difficulty in determining the exact cause of development due to the lack of visible preconditions;
2. Symptomatic (minor). Increased stress is considered to be the result of the development of a certain disease and is one of its hallmarks. The secondary types of the disease, according to the cause of development, are divided into the following types: endocrine, renal, drug-induced, hemodynamic, and neurogenic.

If taking into account the level of blood pressure, pathology is divided into the following categories:

1. boundary. The pressure periodically rises to 140 - 149/90, then falls and normalizes;
2. Systolic isolation. The cap indicator has increased (to 140 and above). Meanwhile, the lower ones remain at 90 and below.

Taking into account the nature of the pathology, experts have identified the following types:

1. Short-lived. The patient occasionally has hypertension. This state can last for hours or days. The pressure returns to normal without the use of drugs;
2. unstable. It manifests itself in the initial stages of pathological development. This state is considered critical because pressure fluctuations are insignificant and unstable. Stress usually returns to normal on its own;
3. Stable arterial hypertension. The increase in stress is persistent and supportive care is needed to reduce it;
4. crisis. Periodic hypertensive crises are characteristic;
5. vicious. Stress rises to severe levels, and high blood pressure develops rapidly, leading to serious complications. May die.

risk factor

Currently, the severity of the disease is directly dependent on the risk facts. The risk is the development of cardiovascular complications in the context of hypertension. The prognosis of the consequences of arterial hypertension is diagnosed, taking into account the complications that arise. The following risk factors can worsen the course of the disease and its prognosis:

• Age - men after 50, women after 60;
• smokes;
• high cholesterol;
• genetic factors;
• obesity;
• Lack of motivation;
• diabetes.

Risk factors presented can be eliminated (correctable) and may not be corrected. The first group of risk factors is characterized by the presence of diabetes, high cholesterol, smoking, and physical inactivity. Unadjusted risk factors included race, family history, and age.

seriousness

There is also an international classification of the disease, based on the degree of arterial hypertension:

1st degree arterial hypertension

This stage of the disease is characterized by a milder course: daytime pressure increases of 20-30 units, usually no more than 180/115 mmHg. Art. Hypertensive crises are rare and are usually caused by dramatic changes in atmospheric pressure or emotional overload. Target organ work without complications.

2nd degree arterial hypertension

It is characterized by an increase in blood pressure to levels of 160-179 / 100-109 mm Hg. Art. It is these metrics that patients most often visit their doctor for the first time, because treating them as the norm is the height of carelessness. 2nd degree arterial hypertension usually presents with severe headache, weakness, dizziness, and deterioration of health during periods of increased stress.

third degree hypertension

It is characterized by an increase in blood pressure to levels of 180/110 or more mmHg. Art. Sometimes these numbers can reach completely prohibitive (250/160 mmHg and above), but in this case, there is a real threat to human health and life. A patient with degree 3 arterial hypertension must take all antihypertensive medications prescribed to him under the supervision of a doctor and ensure that he has a tonometer (mechanical or electronic) at home.

Symptoms of Arterial Hypertension

Arterial hypertension itself has no symptoms. Most adult patients with this disorder don't complain about anything at all, and high blood pressure is discovered incidentally.

The clinical presentation of arterial hypertension depends on the organ currently involved. Adults with benign high blood pressure may complain of the following symptoms:

1. Headache - may be the first and main symptom. There are several types of headaches:
   • Dull, not intense, characterized by a feeling of heaviness in the forehead and occiput. It occurs most often at night or in the morning and increases with sharp changes in head position and even mild physical exertion. This pain is caused by the disruption of the venous blood outflow of the vessels of the skull, their overflow and stimulation of pain receptors;
   • Wine - The burst is all over the head and can be throbbing. Any tension can lead to increased pain. It occurs most often in the advanced stages of hypertension or in the presence of pulsed hypertension. As a result, the blood vessels fill up sharply with blood and are difficult to flow out;
   • Ischemic - sluggish or bursting in nature, accompanied by dizziness and nausea. It occurs with a sharp rise in blood pressure. There is severe vasospasm that disrupts the blood supply to the brain tissue.
2. Pain in the heart area - heartache, not ischemic, coronary vessels are ordered, and sublingual use of nitrates (nitroglycerin under the tongue) does not stop the pain and can occur with rest and emotional stress. Physical ActivityNot a stimulus.
3. Shortness of breath - occurs initially only with exercise, it may also occur at rest as hypertension progresses. It characterizes dysfunction of the heart.
4. Edema - Most commonly seen in the legs due to stagnant blood in the systemic circulation, sodium and water retention, or impaired kidney function. Concurrent hematuria and hypertension in children is characteristic of glomerulonephritis and should be kept in mind when making the differential diagnosis.
5. Visual impairment - manifested by blurred vision, the appearance of a veil, or the flickering of flies. Occurs due to damage to retinal blood vessels.

Chronic arterial hypertension can cause damage to the kidneys with the development of renal failure and corresponding complaints of the kidneys, which are discussed below. Chronic hypertension also leads to the development of circulatory encephalopathy, which is characterized by decreased memory, concentration, and performance, sleep disturbances (increased daytime sleepiness, nighttime insomnia), dizziness, tinnitus, and depressed mood.

When collecting the medical history, it is necessary to record the family history of close relatives and the cause of arterial hypertension in the medical history, to clarify the time of the first clinical symptoms, and to pay attention to concomitant diseases.

Hypertensive crisis

It is an emergency that involves a sharp rise in blood pressure to high levels, characterized by a sharp deterioration in the blood supply to all internal organs, especially vital ones.

It happens unpredictably when the body is exposed to a variety of adverse factors, which is why uncontrolled high blood pressure is dangerous. The urgency of the problem is also that without prompt emergency care, it can have fatal consequences. To provide urgent care, the patient must be taken to the hospital immediately, where he rapidly lowers his blood pressure with medication.

Medical school students learn first aid for hypertensive crises in the Department of Preventive Medicine, so passersby are better off calling an ambulance instead of trying to help.

diagnosis

The three main diagnostic methods that can determine whether a person has high blood pressure are:

1. blood pressure measurement,
2. physical examination,
3. Record the electrocardiogram.

blood pressure control

Blood pressure measurement is performed using a special device - a tonometer, which is a combination of a sphygmomanometer and a telephone endoscope. In addition, there are currently specialized electronic devices that can measure blood pressure and pulse, and can also input blood pressure indicators into the memory of the device.

medical history

The diagnosis of high blood pressure also includes a doctor's survey of the patient. The doctor finds out from the patient what disease he has or is currently suffering from. Assess risk factors (smoking, high cholesterol, diabetes), plus so-called. Genetic medical history, that is, whether the patient's parents, grandparents, and other close relatives have hypertension.

physical examination

The patient's physical examination begins with a study of the heart using a telephone endoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic pitch (amplification or conversely attenuation), and the presence of abnormal sounds. These data first illustrate the changes that occur in heart tissue and the presence of defects due to increased blood pressure.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a method that allows you to record changes in heart potential over time on a special tape. This is an indispensable method for diagnosing various arrhythmias. Also, an EKG allows you to determine what is called. Left ventricular wall hypertrophy, typical of arterial hypertension.

echocardiography

In addition to these diagnostic methods, other methods are used, such as echocardiography (ultrasound of the heart), which can determine whether there are defects in the structure of the heart, changes in the thickness of its walls, and the condition of the valves.

arteriography

Arteriography, including aortography, is an X-ray method used to examine the condition of the arterial wall and its lumen. This method allows you to identify the presence of atherosclerotic plaque in the walls of the coronary arteries (coronary angiography), the presence of coarctation of the aorta (congenital narrowing of the aorta in a specific area), and more.

Doppler imaging

Doppler contrast is an ultrasound method used to diagnose the state of blood flow in blood vessels, including arteries and veins. For arterial hypertension, first, the doctor checks the condition of the carotid and cerebral arteries. Ultrasound is widely used for this because it is absolutely safe to use and causes no complications.

blood chemistry

Biochemical blood tests are also used to diagnose high blood pressure. First, it turns out that levels of cholesterol and high, low, and very low-density lipoproteins, as they are indicators of atherosclerotic propensity. In addition, blood sugar levels were measured.

In the diagnosis of hypertension, studies of kidney conditions are also used, such as general urinalysis, biochemical blood tests (creatinine and urea levels), and kidneys and their ultrasound using containers.

Thyroid Ultrasound

Thyroid ultrasound and thyroid hormone blood tests. These research methods help determine the role of the thyroid in causing high blood pressure.

How is arterial hypertension treated?

Effective treatment of hypertension is selected based on the severity of the disease and the patient's overall risk of developing cardiovascular disease. To assess this risk, he considered certain factors:

• Age: 50 years old for men and 60 years old for women;
• Family history: Sudden heart attack or death in one of the parents (before age 55 for men and age 65 for women) or stroke before age 45, regardless of the gender of the parent;
• smoke (or have not smoked within the past three years);
• diabetes;
• Low-density lipoprotein cholesterol level above 1. 60 g/L or low-density lipoprotein cholesterol level below 0. 40 g/L;
• Abdominal obesity, kidney failure, lack of regular exercise, or excessive alcohol intake.

General principles for the treatment of arterial hypertension at home that all adults with hypertension should follow:

For mild, first-degree disease, use a nonpharmacological approach:

• limit salt intake to 5 g/day (see our separate article for more information on proper nutrition for high blood pressure),
• overweight weight normalization,
• Moderate physical activity (walking, running, swimming, physiotherapy exercises) 3-5 times per week,
• quit smoking,
• reduce drinking,
• Use herbal sedatives to increase emotional arousal (eg, valerian decoction).

In cases where the above methods are not effective in the treatment of 1st degree arterial hypertension, as well as in patients with 2nd and 3rd degree hypertension, switch to drug therapy.

It should be noted that pharmacies currently offer several different medications for the treatment of arterial hypertension, all new and known for many years. Under different trade names, preparations with the same active substance can be produced. It is difficult for non-experts to understand them.

Diuretics are the drug of choice for the treatment of hypertension, especially in the elderly. The most common are thiazides.

In addition, when treating arterial hypertension, it is important to correct for risk factors:

• Antiplatelet agents are used according to indications - acetylsalicylic acid,
• Statins in the presence of atherosclerosis - also without contraindications;
• Medicines that lower blood sugar levels in the case of diabetes.

If the effect is not sufficient, a second or third drug may need to be added. Reasonable combination:

• Diuretics + beta blockers
• Diuretic + ACE inhibitor (or sartan)
• Diuretics + calcium antagonists
• Dihydropyridine calcium antagonist + beta blocker
• Calcium antagonist + ACE inhibitor (or sartan)

Invalid combination:

• Non-dihydropyridine calcium antagonist + beta-blocker (may develop heart block until death)
• ACE inhibitor + sartan

For the treatment and examination of high blood pressure, you will need to see a doctor. Only a specialist who has thoroughly examined and analyzed the results of the examination can correctly diagnose and prescribe qualified treatment.

Why is high blood pressure dangerous?

Arterial hypertension is one of the main causes of severe CVS lesions.

Although a large number of antihypertensive drugs are currently available to keep your blood pressure at adequate levels, the incidence of hypertensive crisis and complications such as heart failure (HF) and renal failure (RF), aortic and mitral valvesRegurgitation, heart aneurysm and aorta, MI (heart attack), stroke, etc. remains extremely high in hypertensive patients.

This is mainly due to the fact that many patients do not want to receive antihypertensive therapy systematically, believing that the hypertensive crisis that occurs in them is single and will not recur.

According to statistics, only about 40% of women and 35% of men who knew they had arterial hypertension received medication. At the same time, only 15% of women and about 5% of men achieve the desired stress level due to systematic use of antihypertensive therapy, monitoring of blood pressure markers and regular doctor visits and following his recommendations.

Although arterial hypertension is one of the controllable risk factors for the development of cardiovascular disease, these unfortunate indicators are due to patients' banal misunderstanding of the severity of their diagnosis, and thus the lack of a serious and responsible approach to treatment.

The most common serious complications that develop as a result of a crisis at the origin of hypertension are:

• stroke (about 30 percent of patients);
• Pulmonary edema (23%);
• Hypertensive encephalopathy (16%);
• Acute heart failure (14%);
• Intracerebral hemorrhage (5% of cases);
• Anatomy of aortic aneurysm (2. 5%), etc.

It should be noted that in the absence of adequate and systemic treatment of hypertension, 30% to 40% of patients die within three years after suffering a severe (complex) hypertensive crisis, with cardiac and renal failure.

A combination of treatment, a responsible approach to health, the systematic use of anti-arterial hypertension medications, and managing your own stress can keep these dire numbers to a minimum.

Prevent arterial hypertension

Disease prevention is important for people with a hereditary predisposition to arterial hypertension and who are affected by risk factors.

1. First of all, it is regular check-ups by a cardiologist and adherence to the rules of a proper lifestyle, which will help delay and often eliminate the disease of arterial hypertension. If your relative has a history of high blood pressure, you should reconsider your lifestyle and make fundamental changes to many of the habits and lifestyles that are risk factors.
2. You should reconsider your dietary principles, stop eating salty and greasy foods, and switch to a low-calorie diet that includes plenty of fish, seafood, fruits, and vegetables. Don't indulge in alcoholic beverages, especially beer. They lead to obesity, uncontrolled consumption of table salt, adverse effects on the heart, blood vessels, liver and kidneys.
3. It is necessary to live an active lifestyle and be active according to age, ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually without overloading the body. Outdoor exercise is especially beneficial. Physical activity strengthens the heart muscle and nervous system and helps prevent stress.
4. Try to have a favorable psycho-emotional environment around you. If possible, avoid conflict, remembering that the breakdown of the nervous system often triggers the mechanism for the development of arterial hypertension.
5. Quit smoking, the substances contained in nicotine can cause changes in the walls of arteries, increasing their stiffness, therefore, they may be the culprit in high blood pressure. Also, nicotine is very dangerous to the heart and lungs.

Therefore, we can simply say that the prevention of arterial hypertension involves regular check-ups by a cardiologist, a correct lifestyle, and an environmentally favorable emotional background.

life prediction

The prognosis of arterial hypertension depends on the nature of the course (malignant or benign) and the stage of the disease. Factors that worsen prognosis include:

• Rapid development of signs of target organ damage;
• Stage III and IV arterial hypertension;
• Serious damage to blood vessels.

A very unfavorable course of arterial hypertension is observed in young adults. They are at high risk for stroke, myocardial infarction, heart failure, and sudden death.

With early treatment of arterial hypertension and when the patient carefully follows all the recommendations of the attending physician, it is possible to slow the progression of the disease, improve the patient's quality of life, and sometimes achieve long-term remission.