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Arterial hypertension

Arterial hypertension is a pathological condition characterized by a long increase in pressure indicators in the arteries of a large circle of blood circulation.A sign of the disease is the rise of diastolic (lower) blood pressure, but in most of the diagnosed cases, patients have a persistent growth of systolic (upper) pressure.

What pressure is considered increased

The classification of blood pressure accepted in 1999 is still valid to this day.The following are considered normal:

  • Optimal - less than 120/80 mm Hg.Art.;
  • Physiological norm - less than 130/85 mm Hg.Art.;
  • Normal increased - in the range 130–139/85–89 mm Hg.Art.

An increase in pressure indicates the formation of hypertension.The internal gradation of the pathology looks as follows:

  1. Soft (I degree) - 140–159/90–99 mm Hg.Art.
  2. Moderate (II second degree) - 160–179/100–109 mm Hg.Art.
  3. Heavy (III degree) - over 180/110.

Border guns are diagnosed in the case of indicators in 140-149/90 mm Hg.Art.And below.It is accompanied by episodes of pressure growth and its spontaneous stabilization.

Isolated systolic hypertension is diagnosed with indicators of 140 and above / 90 and below mm Hg.Art.This type of pathology is characterized by an increase in the systolic indicator at the physiological level of diastolic.

AG classification (primary, secondary)

The classification of hypertension is based on several signs.When systematizing, doctors took into account:

  • reasons provoking the development of pathology;
  • defeated by the target organs;
  • The current level of blood pressure, etc.

Depending on the etiological factors, it is customary to distinguish:

  1. Primary (essential).
  2. Secondary (symptomatic) hypertension.

By the nature of the passage, benign (slowly developing) and malignant (with a rapid deterioration of condition) arterial hypertension is distinguished.

Varieties of secondary (symptomatic) hypertension

Secondary (symptomatic) arterial hypertension is a type of disease that develops due to damage to the organs responsible for the regulation of blood pressure.It is characterized by a stubborn course, the absence of a positive reaction to the conducted hypotensive therapy, as well as changes in the target organs, in particular, the formation of cardiac, renal failure, etc.

If primary hypertension (essential format) occurs as an independent disease, then secondary forms are always a symptom of the main pathology.The syndrome of arterial hypertension accompanies a fairly significant number of diseases.It is diagnosed in 10 % of all identified cases of persistent increase in blood pressure.

The classification of symptomatic hypertension is based on factors provoking the disease.

Distinguish:

  1. Neurogenic hypertension.Development is due to the lesion of the central nervous system and related pathologies, for example, brain neoplasia.
  2. Nephrogenic (renal origin).They are divided into interstitial, renoparenchymal, renovascular, mixed and rhinopian forms.
  3. Endocrine Ag.There are adrenal, thyroid, pituitary and menopause formats.
  4. Hemodynamic - provoked by pathologies of the heart and large arterial channels.
  5. Dosage form.Its development is due to the use of oral contraceptives, glucocorticosteroid agents, etc.

The size and resistance of the increase in blood pressure, the severity of changes in the state of the left ventricle and fundus underlie another classification.Doctors distinguish the following varieties of symptomatic hypertension:

  1. Transient.For pathology, a typically short -term increase in pressure indicators.Changes in the state of the fundus are completely absent.Left ventricle hypertrophy is almost not fixed.
  2. Laby.It is characterized by a moderate, short increase in blood pressure (independent decrease does not occur).There is a weak left ventricular hypertrophy, narrowing of the vessels of the retina of the eye.
  3. Stable.It is accompanied by steadily high blood pressure.The myocardial thickening, severe violations in the vessels of the fundus is diagnosed.
  4. Malignant (uncontrolled).It is accompanied by a sharp increase in blood pressure.The outcome is unfavorable.

The following forms of symptomatic hypertension are found:

  • Pulmonary hypertension (hypertension of a small circle of blood circulation).It is established as a diagnosis when determining the blood pressure in the pulmonary artery over 25 mm.RT.Art.
  • Vasorsenal AH is a secondary form of pathology due to insufficient blood circulation in the kidneys as a result of impaired arterial throughput.
  • Portal hypertension is one of the varieties of the symptomatic form of the disease, accompanied by an increase in pressure inside the gate vein.
  • Hypertension of the Virsungov duct.It develops against the background of chronic inflammation of the pancreas.

Consequences and complications

With a long-flowing hypertension, the vessels of the target organs are damaged: heart, brain, kidneys and eyes.Violation of the circulatory process can lead to consequences such as:

  • angina pectoral attacks,
  • myocardial infarction,
  • Neurological complications, etc.

Important!The formation of acute states against the background of a sharp rise in blood pressure requires its reduction in the first minutes/hours.

Reasons

The reasons for the development of the essential form of pathology are not known to doctors for certain.Several theories are nominated:

  1. Neurogenic (inheritance).The cause of development is chronic stress, significant emotional shocks, and psychological injuries.All this provokes a failure in the process of neural regulation, accompanied by an increase in the activity of the sympathetic system.The result is the divergence of signals to all organs and an increase in the tone of the walls of the vessels.
  2. Voluminous salt.Due to impaired processes of the output of excess fluid and certain trace elements.As a result of the excessive content of sodium salts, an increase in the total volume of blood occurs.The body's attempts to maintain the hemostasis process at the physiological level lead to spasming of small vessels.The indicators of the minute volume of the heart are stabilized, but the total blood pressure is raised.

Important!Doctors argue that the reason for the development of AH is an increase in the activity of the sympathetic system.

Modified (variable) risk factors capable of provoking the occurrence of arterial hypertension are:

  • age - diagnosis of the disease occurs in people of the older age category;
  • bad habits - smoking, alcohol intake;
  • a state of chronic stress;
  • insufficient physical activity;
  • overweight;
  • The presence of concomitant pathologies - diabetes are especially unfavorable;
  • Excess salt with a lack of potassium.

The reasons for increasing blood pressure can be different.The active work of the adrenal glands, as well as a tendency at the genetic level, can act as a provoking factor.

Symptoms

In the initial stage of formation, arterial hypertension is asymptomatic.The patient will learn about the presence of a problem only after the development of serious complications.

The only sign of pathology can be called an increase in pressure indicators.There are no complaints at all, or they are not specific:

  • headaches localized in the area of the forehead and the back of the head;
  • dizziness;
  • noise.

The first complaints are formed against the background of the defeat of target organs.At this stage, the appearance of the following symptoms is noted:

  • dizziness, accompanied by headaches, noise - arise as a logical result of circulatory disorders;
  • beginning problems with the memorization of information;
  • Hands/legs numbness;
  • weakness;
  • doubling of the visible image;
  • flickering black dots in the field of view;
  • speech violation (rarely);
  • nephropathy.

Symptoms are typical for final stages.At the beginning of the formation of pathology, they are coming.

With damage to the heart, the left ventricle (LV) begins to hypertrophic.The cause of the change is the compensatory reaction of the body, which allows to stabilize increased loads on its wall.An increase in the ventricle is due to an increase in the number of cardiomyocytes.As the condition worsens, the heart chambers are dilated.

Such damage to the organ can manifest itself in the form:

  • the formation of heart failure,
  • a sudden cardiac arrest,
  • ischemic disease,
  • gastric rhythm disorders,
  • heart asthma,
  • Strong shortness of breath during loads.

Important!Cardi pain against the background of AG develops during the period of absolute rest or as a result of emotional overvoltage.A characteristic feature is the inability to stop the attack with a pill of glycerol.

If the kidneys are damaged, the presence of protein in the urine can be observed.The appearance of blood impurities is not excluded.The probability of renal failure is minimal.

urine analysis for arterial hypertension

The main clinical sign of arterial hypertension is headache.Appears at any time of the day, but most often in the morning.It is felt by patient as bursting or pain.The place of localization is the back of the head, but the spread to other areas of the head is not excluded.Soreness is enhanced by tilting and during cough.It may occur as a response to stressful situations, physical strain.

Diagnosis

Diagnosis of the disease is designed to solve the following problems:

  • Establishment of pathology, determination of the current degree;
  • identification of the origin of hypertension (primary/secondary form);
  • performing differential diagnosis;
  • Determination of the presence/absence of damage to target organs.

During a personal conversation with the patient, the doctor finds out the necessary points:

  1. Have there are cases of disease in the immediate environment.
  2. How often the pressure is fixed.
  3. Are there a history of chronic diseases in the patient, etc.

The body mass index (BMI) is calculated.Obesity is one of the potential provocateurs of the formation of hypertension.

After the inspection is completed, blood pressure is measured.To determine the degree of arterial hypertension, the patient is prescribed by the performance of the profile of blood pressure, i.e.Making measurements to patients on their own at home.It is necessary to make 4 measurements: two in the morning and two in the evening, for several days in a row.

The results must be included in the table.If the indicators exceed 140/90 mm Hg.Art., we can talk about the presence of arterial hypertension.

Sometimes a brush is prescribed (daily monitoring of blood pressure).The technique is shown if the patient’s measurements remain normal, but another symptoms of the disease occur.

Important!SMAD is multiple measurements of blood pressure indicators for a full day.Measurements are performed by a special device.

To establish the true cause of the development of arterial hypertension and determine the force of damage to the target organs, are prescribed:

  • Examination of the renal system.Includes the study of urine - a general test.A re -trial, ultrasound of the renal system, renography with the introduction of a radioactive isotope are prescribed.
  • Heart test.ECG is used (the electrocardiogram shows the growth of the Road R), echocardiography (allows you to see signs of a pathological increase in the left ventricle and other transformations).
  • Ophthalmological examination of the eye.A sign of the disease is the visual impregnation of blood vessels, sealing.Hemorrhages are not excluded.
  • Ultrasound of the thyroid gland and adrenal glands.
  • Blood examination is a general test and expanded biochemistry.

When diagnosing the secondary form of hypertension, it is necessary to perform differential diagnostics (DIF).She passes in two stages:

  • Analysis of the clinical picture, raising complaints, a physics examination of the patient in particular, auscultation, instrumental/laboratory studies;
  • Diagnostic measures that allow you to evaluate the functional state of the organs and existing changes, in particular, it is necessary to remove the cardiogram.

The methods considered help to confirm the diagnosis, determine the origin of the disease and choose therapy adequate to the state.

Treatment

Treatment of hypertension begins with a revision of lifestyle and non -drug therapy.The exception is secondary hypertension.

Drug therapy of arterial hypertension provides for the intake of the following groups of drugs:

  1. Diuretics.The drugs have a positive effect on the state of the cardiovascular system.Reception is not accompanied by the development of side effects.Therapy of the disease begins with diuretics (contraindication - diabetes and gout).Against the background of treatment, the volume of urine removed by the kidneys and, accordingly, excess water and sodium salts, increases.Diuretics are prescribed in combination with other hypertension.
  2. Alpha-blockers.Medications are distinguished by good tolerance.They do not affect the level of blood sugars.Provide a decrease in blood pressure with a slight increase in the pulse (frequency of contraction of the heart muscle).The occurrence of orthostatic hypotension at the beginning of treatment with the drugs of this group becomes a side effect.To exclude its development, it is advisable to take medicine before bedtime.
  3. Beta-blockers.Reduce heart rate, which is accompanied by a decrease in blood pressure.
  4. ACE inhibitor.Modern drugs are distinguished by a high therapeutic effect and good tolerance.Against the background of taking funds in the patient’s body, the form of angiotensin II - a hormone provoking a narrowing of the lumen of blood vessels does not occur.Thanks to this, the peripheral vessels expand, the heart works in a calmer rhythm.There is a decrease in blood pressure indicators.
  5. Antagonists angiotensin-II.Medicines are also blocking angiotensin II.They are appointed if it is impossible to receive ACE inhibitors.
  6. Calcium antagonists.Medications expand the gaps of blood vessels, thereby preventing the development of stroke.The drugs have an excellent therapeutic effect and are well tolerated.Have a small list of contraindications.Most often prescribed as part of complex therapy.

To stop treatment even after stabilization of blood pressure is strictly prohibited.In this case, the disease will again begin to progress, which will negatively affect the state of target organs.In addition, the risk of developing heart attack and stroke increases significantly.

The treatment of the disease is carried out on an outpatient basis: the patient independently takes selected medications.Hospitalization in the hospital is recommended only in severe cases.

The treatment of pathology in addition to taking medications provides for massage.Procedures contribute not only to reducing pressure, but also to the overall strengthening of the body, improve the activity of the cardiovascular system, etc.Read more about various types of massage in our article: massage with high pressure - classic, point and other effective methods.

Nutrition

Compliance with the principles of dietary nutrition is one of the important stages to stabilize blood pressure indicators.With hypertension, the diet No. 10 is recommended.

At the initial stage of the formation of pathology (AH 1 degree), it is necessary to adhere to diet No. 5.It provides for a restriction in the use of table salt.With a deterioration in the state and the development of violations in the work of the heart and the vascular system, the transition to diet No. 5 A. is recommended

If the disease is complicated by atherosclerosis, the diet No. 10 C. The hypocholesterol diet is prescribed to reduce the consumed fats of animal origin, easily digestible carbohydrates.The diet should include foods with a high content of dietary fibers, vegetable fats and proteins.

The list of permitted products is presented by the following positions:

  • Bread - wheat, rye, whole grain, with bran.Non -love baking, baking.
  • Vegetable soups seasoned with cereals.
  • Dietary varieties of meat: poultry, rabbit.It is allowed to boil and bake.
  • Sea/river fish.Seafood.
  • Seasonal vegetables.From them you can prepare the stew.
  • Sour -milk products and cottage cheese of low fat.Low -fat sour cream (placed in a dish).
  • Soft eggs (no more than 3 pieces per week).
  • Dairy and tomato sauces.
  • Croats, pasta.
  • Oil (for adding to a finished dish).
  • Fruits/berries (in any form).It can be used for the preparation of compotes, jelly, jelly.
  • Juices, tea with milk, rosehip decoction.

It must be completely excluded from the diet:

  • Freshly baked bread, sdoba, complicated pastries.
  • Favarous broths.
  • Fatty meat.
  • Smoked meats, sausages.
  • Fish (salty/smoked), caviar.
  • Fat sauces, cheeses, cream.
  • Spring, radishes, spinach, horseradish, mushrooms.
  • Ice cream, chocolate, confectionery, strong tea, coffee.

Salt consumption must be significantly reduced.

Salt with arterial hypertension

Prevention

Prevention of the disease is non -specific.Standard recommendations:

  1. Adhere to the principles of dietary nutrition, excluding or significantly reducing the volume of certain products.Reduce the consumption of animal salt and fats.In the process of cooking, it is advisable not to suck food at all.It is necessary to abandon fat/sharp/fried dishes.
  2. Daily physical activity in accordance with the age group.Performing gymnastics improves human well -being.It is recommended to engage in running, walking, swimming, visiting the gym, perform breathing exercises.At the beginning of classes, the body should receive a minimum load.It must be increased gradually.
  3. Normalization of weight is one of the prerequisites for successful prevention.
  4. It is necessary to learn how to control stressful situations, since it is precisely a violation of the work of the central nervous system that doctors call almost the main reason for the development of the disease.Autotoring, meditation, self -hypnosis helps well in this.
  5. A complete rejection of bad habits.Smoking and alcohol are also capable of provoking a pathology.

Pathophysiology considers arterial hypertension as one of the most serious pathologies, not only a worsening quality of life of the patient, but capable of causing death.That is why when the episodes of increased blood pressure appear, it is necessary to get a specialist consultation and, if necessary, start treatment.