High blood pressure: causes, treatment, prognosis, stages and degrees of risk

Hypertension (HTN) is one of the most common diseases of the cardiovascular system, which only according to approximate data affects one third of the world's inhabitants. Between the ages of 60 and 65, more than half of the population has been diagnosed with hypertension. The disease is called the "silent killer" because its symptoms can be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, which significantly increases the risk of vascular accidents.

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

Much attention is paid to the problem of arterial hypertension not so much because of its clinical manifestations as because of complications in the form of acute vascular disorders in the brain, heart and kidneys. Its prevention is the main objective of treatment aimed at maintaining normal blood pressure (BP).

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

For most patients, the numbers in the diagnosis after "AH" do not mean anything, although it is clear that the higher the degree and risk indicator, the worse the prognosis and the more severe 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 high blood pressure are numerous. GovernorSpeaking of primary or essential hypertension, we andWe refer to the case in which there is no specific previous disease or pathology of the internal organs. In other words, said hypertension occurs on its own, involving other organs in the pathological process. Primary hypertension represents more than 90% of cases of chronic arterial hypertension.

It is considered that the main cause of primary hypertension is stress and psycho-emotional overload, which contribute to the alteration of the central mechanisms of pressure regulation in the brain, then the humoral mechanisms are affected and the target organs are affected ( kidneys, heart, retina).

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 cured, hypertension also disappears, so there is no point in determining the risk and degree in this case. Symptomatic hypertension represents no more than 10% of cases.

The risk factors for hypertension are also known to everyone. Hypertension schools are being created in clinics, whose specialists convey information to the population about unfavorable conditions that lead to hypertension. Any therapist or cardiologist will inform the patient about the risks already in the first case of registered high blood pressure.

Among the conditions that predispose to hypertension, the most important are:

1. Of smoking;
2. Excess salt in food, excessive fluid intake;
3. insufficient physical activity;
4. Alcohol abuse;
5. Excess weight and disorders of fat metabolism;
6. Chronic psychoemotional 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 and heredity cannot be changed and therefore we will have to tolerate them, but without forgetting the increased risk.

Classification of arterial hypertension and determination of the risk level.

The classification of hypertension involves identifying the stage, degree of the disease and the level of risk of vascular accidents.

Disease stageIt depends on the clinical manifestations. Stand out:

• Preclinical stage, when there are no signs of hypertension and the patient is unaware of the increase in blood pressure;
• Stage 1 hypertension, when pressure increases, crises are possible, but there are no signs of target organ damage;
• Stage 2 is accompanied by damage to target organs: the myocardium hypertrophies, changes are noted in the retina of the eyes, and the kidneys suffer;
• At stage 3, strokes, myocardial ischemia, vision pathology, changes in the large vessels (aortic aneurysm, atherosclerosis) are possible.

Degree of hypertension

Determining the degree of hypertension is important to assess risk and prognosis and is based on pressure figures. It must be said that normal blood pressure values also have different clinical meanings. So, the indicator is up to 120/80 mm Hg. Art. accountoptimum,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 they are approaching the limit of pathology, which is why they are called "So normal", and the patient may be told that he or she has high normal blood pressure. These indicators can be considered prepathology, because the pressure is only "a few millimeters" away from being elevated.

From the moment blood pressure reached 140/90 mm Hg. Art. We can now talk about the presence of the disease. This indicator is used to determine the degree of hypertension itself:

• The first degree of hypertension (HTN or AH, first stage of diagnosis) means an increase in pressure in the range of 140-159/90-99 mmHg. Art.
• Stage 2 headache is accompanied by figures 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 figures increase, reaching 140 mm Hg. Art. and higher, while the diastolic value is within normal values. In this case they talk aboutisolated 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 a higher degree and it does not matter whether conclusions are drawn based on systolic or diastolic pressure.

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

The 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 from hypertension itself, but from the acute disorders to which it leads.

Brain hemorrhages or ischemic necrosis, myocardial infarction and kidney failure are the most dangerous conditions caused by high blood pressure. In this sense, for each patient after a thorough examination.the 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, the presence of other diseases and metabolic disorders, the involvement of target organs and concomitant changes in organs and systems are used.

The main risk factors that affect the prognosis include:

1. The patient's age is greater than 55 years for men and 65 years for women;
2. Of smoking;
3. Disorders of lipid metabolism (cholesterol exceeding the norm, low-density lipoproteins, decrease in high-density lipid fractions);
4. Presence of cardiovascular pathology in the family among consanguineous people under 65 and 55 years of age for women and men, respectively;
5. 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, glucose intolerance, lead a sedentary life and have abnormalities in the blood coagulation system in the form of an increase in the concentration of fibrinogen. These factors consideradditional, also increasing the probability 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 their muscles, blood and urine analysis to detect indicators of kidney function (creatinine, proteins).

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 their lumens become spasmodic, the load on the heart progressively increases. A characteristic feature that is taken into account when considering risk stratification.myocardial hypertrophy, which can be suspected by ECG, can be determined by ultrasound.

The involvement of the kidneys as a target organ is indicated by an increase in creatinine in blood and urine and the appearance of albumin protein in the urine. Against the background of hypertension, the walls of large arteries thicken and atherosclerotic plaques appear, which can be detected using 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 the prognosis are strokes, transient ischemic attacks, heart attack and angina pectoris, nephropathy due to diabetes, kidney failure, retinopathy (retinal damage) due to hypertension.

Then the reader will probably understand how it is even possible to 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, sex, laboratory parameters, ECG data, ultrasound, etc. In general, all of the above.

For example, a patient's blood pressure corresponds to stage 1 of hypertension, but at the same time he suffered a stroke, which means that the risk will be maximum - 4, even if the 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 observed are smoking and age against the background of good health, then 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 its 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 factor's	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 suffering from vascular accidents does not exceed 15%, moderate - up to 20%, high risk indicates the development of complications in a third of patients in this group, with a 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 the tonometer readings indicate a developing disease.

As the changes in the blood vessels and heart progress, symptoms appear in the form of headache, weakness, decreased performance, periodic dizziness, visual symptoms in the form of weakened visual acuity and flickering "spots" before the eyes. All these signs are not expressed during a stable course of pathology, but at the time of the development of a hypertensive crisis the clinic becomes brighter:

• Strong headache;
• Noise, ringing in the head or ears;
• Darkening of the eyes;
• Pain in the heart area;
• dyspnoea;
• Facial hyperemia;
• Emotion 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 sharply, including life-threatening ones:

1. Hemorrhage or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute kidney failure;
5. Myocardial infarction.

How to measure blood pressure correctly?

If there are reasons to suspect high blood pressure, the first thing a specialist will do is measure it. Until recently, it was believed that blood pressure figures could normally differ in different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. It can occur due to pathology of peripheral vessels, so different pressures in the right and left hand should be treated with caution.

To obtain the most reliable figures, it is recommended to measure the pressure three times in each arm with short time intervals., recording each 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 large selection and availability of blood pressure measuring devices makes it possible to monitor blood pressure in a wide range of people at home. Hypertensive patients usually have a tonometer on hand at home, so that if their health worsens, they can immediately measure blood pressure. However, it is worth noting that fluctuations are also possible 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, the pressure must be measured at different times. . , in different conditions and repeatedly.

When diagnosing hypertension, blood pressure figures, electrocardiogram data and the results of cardiac auscultation are considered essential. When listening, it is possible to detect noises, increased tones and arrhythmias. The ECG, starting in the second stage, will show signs of tension in the left side of the heart.

Hypertension treatment

To correct high blood pressure, treatment regimens have been developed that include drugs from different groups and different mechanisms of action. Histhe combination and dosage are chosen by the doctor individuallytaking into account the stage, concomitant pathology and the response of hypertension to a specific drug. Once the diagnosis of hypertension is established and before starting pharmacological treatment, the doctor will suggest non-pharmacological measures that significantly increase the effectiveness of the drugs and, sometimes, allow the dose of the drugs to be reduced 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 aims to reduce salt and fluid intake, 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 at the initial stage of hypertension can have such a good effect that it will no longer be necessary to prescribe medications. If these measures do not work, the doctor will prescribe the appropriate medications.

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

To treat hypertension, antihypertensive drugs from the following groups are traditionally used:

• Diuretics;
• Angiotensin II receptor antagonists;
• ACE inhibitors;
• Adrenergic blockers;
• Calcium channel blockers.

Every year the list of medications that reduce blood pressure grows and at the same time becomes more effective and safer, with fewer adverse reactions. When starting therapy, a drug is prescribed in a minimum dose, if it is not effective, it can be increased. If the disease progresses and the pressure does not remain at acceptable values, another drug from another group is added to the first drug. Clinical observations show that the effect is better with combined therapy than with prescribing one drug in the maximum amount.

Reducing the risk of vascular complications is important when choosing a treatment regimen.Thus, it has been observed that some combinations have a more pronounced "protective" effect on the organs, while others allow better pressure control. In such cases, experts prefer a combination of medications 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 requires adjustments to headache treatment regimens. For example, men with prostate adenoma are prescribed alpha-blockers, the constant use of which is not recommended to lower blood pressure in other patients.

The most commonly used ACE inhibitors, calcium channel blockers,which are prescribed to 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 a 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, women taking hormonal contraceptives, indicated for diabetes and 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 blockersThey are often prescribed in combination with ACE inhibitors, and are especially good for bronchial asthma in combination with hypertension, since they do not cause bronchospasm.

Angiotensin receptor antagonists– the most prescribed group of drugs for hypertension. They effectively lower blood pressure and do not cause cough like many ACE inhibitors. But in the United States they are especially common due to a 40% reduction in the risk of Alzheimer's disease.

In the treatment of hypertension, it is important not only to choose an effective regimen, but also to take the medications 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 the unsystematic 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.