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 age 60-65, more than half of the population has been diagnosed with hypertension. The disease is called the "silent killer", because its signs can be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic phase, significantly increasing the risk of vascular accidents.
In Western literature, the disease is called arterial hypertension (AH). Others have adopted this wording, although both "hypertension" and "hypertension" are still in common use.
Special 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 blood pressure (BP).
An important point is to identify all possible risk factors,as well as clarifying their role in disease progression. 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" mean nothing, 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. GovernorSpeaking of primary, or essential, hypertension, we andWe mean the case in which there is no previous disease or pathology of the 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 chronic hypertension cases.
The main cause of primary hypertension is considered to be stress and psycho-emotional overload, which contribute to the disruption of the central mechanisms of pressure regulation in the brain, so 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 diseases of the kidneys, heart, brain, endocrine disorders and is secondary to them. After the underlying disease is treated, hypertension also disappears, so in this case it makes no sense to determine the risk and degree. Symptomatic hypertension represents no more than 10% of cases.
The risk factors for hypertension are also known to everyone. Hypertension schools are created in clinics, whose specialists inform the population about unfavorable conditions that lead to hypertension. Any therapist or cardiologist will inform the patient of the risks at the first recorded case of arterial hypertension.
Among the conditions that predispose to hypertension, the most important are:
- To smoke;
- Excess salt in foods, excessive fluid intake;
- Insufficient physical activity;
- Alcohol abuse;
- Overweight and fat metabolism disorders;
- Chronic psycho-emotional and physical overload.
If we can exclude the listed factors or at least try to reduce their impact on health, then characteristics such as gender, age, heredity cannot be changed, and therefore we will have to put up with them, without forgetting the growing risk.
Classification of arterial hypertension and determination of the risk level
Classification of hypertension involves identification of the stage, degree of the disease and level of risk of vascular accidents.
Stage of the diseasedepends on the clinical manifestations. Make evident:
- Preclinical stage, when there are no signs of hypertension and the patient is not aware of the increase in blood pressure;
- Stage 1 of hypertension, when blood pressure is elevated, crises are possible, but there are no signs of target organ damage;
- Stage 2 is accompanied by damage to target organs: hypertrophy of the myocardium, changes in the retina of the eyes are noticeable, and the kidneys suffer;
- At stage 3, stroke, myocardial ischemia, vision pathologies, changes in large vessels (aortic aneurysm, atherosclerosis) are possible.
Degree of hypertension
Determining the degree of hypertension is important for assessing risk and prognosis and is based on blood pressure values. It must be said that even normal blood pressure values have a different clinical meaning. So, the indicator is up to 120/80 mm Hg. Art. mattersoptimal,normalthe pressure will be between 120 and 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 are approaching the border with pathology, which is why they are called "highly normal", and the patient may be told that he has normal-to-high blood pressure. These indicators can be considered pre-disease, because the pressure is only "a few millimeters" away from increasing.
From the moment the blood pressure reached 140/90 mm Hg. Art. we can already talk about the presence of the disease. This indicator is used to determine the degree of hypertension itself:
- The 1st degree of hypertension (1st stage HTN or AH in the diagnosis) indicates an increase in blood pressure in the range 140-159/90-99 mmHg. Art.
- Stage 2 headache is accompanied by the numbers 160-179/100-109 mm Hg. Art.
- With stage 3 hypertension, the pressure is 180/100 mmHg. Art. and higher.
It happens that the systolic pressure values increase, equal to 140 mm Hg. Art. and higher, while the diastolic value is within normal values. In this case they talk about itisolated systolic formhypertension. In other cases, the indicators of systolic and diastolic pressure correspond to different degrees of the disease, so the doctor makes a diagnosis in favor of a higher degree and it does not matter whether conclusions are drawn on the basis of systolic or diastolic pressure.
The most accurate diagnosis of the degree of hypertension is possible when the disease is diagnosed for the first time, when treatment has not yet been carried out and the patient has not taken antihypertensive drugs. During therapy the numbers decrease, and when it is stopped, on the contrary, they can increase significantly, so it is no longer possible to adequately evaluate the degree.
The concept of risk in diagnosis
Hypertension is dangerous because of its complications. It is no secret that the vast majority of patients die or become disabled not because of hypertension itself, but because of the acute disorders to which it leads.
Cerebral hemorrhages or ischemic necrosis, myocardial infarction, renal failure are the most dangerous conditions caused by hypertension. In this regard, for each patient after a thorough examinationthe risk is determined, indicated in the diagnosis with the numbers 1, 2, 3, 4. Therefore, the diagnosis is based on the degree of hypertension and the risk of vascular complications (for example, hypertension/hypertension stage 2, risk 4) .
Risk stratification criteriaFor patients with hypertension, external conditions, presence of other diseases and metabolic disorders, involvement of target organs and concomitant changes in organs and systems are used.
Major risk factors that influence prognosis include:
- The patient's age is over 55 for men and 65 for women;
- To smoke;
- Disorders of lipid metabolism (exceeding the norm of cholesterol, low-density lipoproteins, decrease in high-density lipid fractions);
- Presence of cardiovascular pathology in the family among relatives aged under 65 and 55 for females and males respectively;
- Excess body weight, when the abdominal circumference exceeds 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 lifestyle and have abnormalities in the blood coagulation system in the form of increased fibrinogen concentration. These factors consideradditional, also increasing the likelihood of complications.
Damage to target organs characterizes hypertension, starting from stage 2, and serves as an important criterion by which the risk is determined, therefore the patient's examination includes an ECG, an ultrasound of the heart to determine the degree of hypertrophy of your muscles, blood and urine tests for indicators of kidney function (creatinine, protein).
First of all, the heart suffers from high blood pressure, which pushes blood into the vessels with greater force. As the arteries and arterioles change, as their walls lose elasticity and the lumens become spasmodic, the load on the heart progressively increases. A characteristic feature taken into account when considering risk stratificationmyocardial hypertrophy, which can be suspected by ECG, can be determined by ultrasound examination.
The involvement of the kidneys as a target organ is indicated by an increase in creatinine in the blood and urine and the appearance of the protein albumin in the urine. Against the background of hypertension, the walls of large arteries thicken, atherosclerotic plaques appear, which can be detected by ultrasound (carotid, brachiocephalic arteries).
The third stage of hypertension occurs with associated pathology, that is, associated with hypertension.Among the associated diseases, the most important for prognosis are stroke, transient ischemic attacks, heart attack and angina, nephropathy due to diabetes, renal failure, retinopathy (retinal damage) due to hypertension.
Thus, the reader probably understands how it is possible to 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 had 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 in a context of good health, the risk will be moderate: 1 tbsp. (2 tablespoons), risk 2.
To make it clearer what the risk indicator means in a diagnosis, 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 – moderate, 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 |
|---|---|---|---|---|
| Nobody | 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%, moderate - up to 20%, high risk indicates the development of complications in a third of patients of this group, with a very high risk more than 30% of patients I am 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.
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, flashing "spots" before the eyes. All these signs do not manifest themselves during the stable course of the pathology, but at the time of the development of the hypertensive crisis the clinic becomes brighter:
- Bad headache;
- Noise, ringing in the head or ears;
- Darkening in the eyes;
- Pain in the heart area;
- Dyspnea;
- 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 significantly, including life-threatening ones:
- Cerebral hemorrhage or infarction;
- Acute hypertensive encephalopathy, possibly with cerebral edema;
- Pulmonary edema;
- Acute renal failure;
- 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 values can normally differ from one hand to another, but, as practice has shown, even a difference of 10 mm Hg. Art. may occur due to pathologies of the peripheral vessels, therefore different pressures on the right and left hand should be treated with caution.
To obtain more reliable data, it is recommended to measure the blood pressure three times on each arm with short time intervals, recording every result obtained. In most patients, the smallest values obtained are the most correct, but in some cases the pressure increases from one measurement to another, which does not always speak in favor of hypertension.
A wide choice 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 on hand at home, so that if their health worsens, they can immediately measure their blood pressure. It is worth noting, however, that fluctuations are possible even in absolutely healthy individuals without hypertension, so a single excess of the norm should not be considered a disease, and to make a diagnosis of hypertension it is necessary to measure pressure at different times, in different conditions and repeatedly.
When diagnosing hypertension, blood pressure values, electrocardiography data and cardiac auscultation results are considered crucial. While listening it is possible to detect noises, increased tones and arrhythmias. The ECG, starting from the second phase, will show signs of stress in the left side of the heart.
Treatment of hypertension
To correct high blood pressure, therapeutic regimens have been developed that include drugs from different groups and different mechanisms of action. Theythe combination and dosage are chosen individually by the doctortaking into account the stage, concomitant pathology and the response of hypertension to a specific drug. After the diagnosis of hypertension is established and before the start of drug treatment, the doctor will suggest non-pharmacological 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 the intake of salt and liquids, 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.
Non-pharmacological measures in the early stage of hypertension can have such a positive effect that prescription drugs will no longer be necessary. If these measures do not work, the doctor prescribes the appropriate medications.
The goal of treating hypertension is not only to reduce blood pressure, but also to eliminate the cause, if possible.
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 grows and at the same time becomes more effective and safe, with fewer adverse reactions. When starting therapy, a medicine is prescribed in a minimal dose; if it is ineffective, it can be increased. If the disease progresses and the pressure does not remain at acceptable values, 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 quantity.
Reducing the risk of vascular complications is important when choosing a treatment regimen.It has therefore been noted that some combinations have a more pronounced "protective" effect on the organs, while others allow better pressure control. In these 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 changes 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 used ACE inhibitors, calcium channel blockers,which are prescribed to both young and elderly patients, with or without concomitant diseases, diuretics, sartans. Drugs from these groups are suitable for initial treatment, which can then be supplemented with a third drug of different composition.
ACE inhibitors reduce blood pressure and at the same time have a protective effect on the kidneys and myocardium. They are preferable in young patients, in women taking hormonal contraceptives, indicated for diabetes, and in older patients.
Diureticsno less popular. To reduce adverse reactions, they are combined with ACE inhibitors, sometimes "in a single tablet".
Beta blockersthey are not a priority group for hypertension, but are effective for concomitant cardiac pathology: heart failure, tachycardia, coronary heart disease.
Calcium channel blockersoften prescribed in combination with ACE inhibitors, they are particularly suitable for bronchial asthma in combination with hypertension, since they do not cause bronchospasm.
Angiotensin receptor antagonists– the group of drugs most prescribed for hypertension. They effectively reduce blood pressure and do not cause coughing like many ACE inhibitors. But in America they are particularly widespread due to the 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 when the pressure reaches normal levels, the treatment can be stopped, but they take the pills at the time of the crisis. It is known that non-systematic use of antihypertensive drugs is even more harmful to health than the complete absence of treatment, therefore informing the patient about the duration of treatment is one of the important tasks of the doctor.