Hypertension

hypertension (HD)a chronic disease whose main symptom is elevated blood pressure (BP), excluding symptomatic hypertension

If a person constantly shows an increase in blood pressure (arterial hypertension is greater than 140 and 90 mmHg), then he is usually diagnosed with hypertension.And in 90% of cases it is correct.Only in 10% of cases is it possible to identify the cause of the increase in blood pressure and often, by eliminating it, relieve the person of the symptoms of arterial hypertension - in this case, the diagnosis is symptomatic hypertension.

According to WHO recommendations, blood pressure should be considered normal if it does not exceed 140 and 90 mmHg.Art.

Normally, blood pressure is a labile value, that is, it changes depending on what a person is doing, in which position he is, level of physical activity, anxiety, etc.But after the end of the exposure in a healthy person, the blood pressure level returns to normal by itself after some time, in contrast to a patient whose blood pressure normalizes under the influence of drugs that quickly regulate the blood pressure number.  

It is assumed that the basis of the disease is a violation of blood pressure regulation mechanisms.

Epidemiology of hypertension 

Data from the Cardiology Society of the Russian Federation (2020): 30-45% of the world's population suffers from hypertension.47% of patients with hypertension were identified among men aged 25-65, and about 40% among women.After 60 years, more than 60% of patients with hypertension were registered.Due to the aging of the population, the increase in sedentary and obese people, according to forecasts, there will be 1.5 billion people with HD in the world in 2025, which means an increase in the number of people suffering from this disease by 15-20%.

WHO believes that hypertension and atherosclerosis are the most common causes of early death in the working-age population.Complications caused by these diseases, such as myocardial infarction, chronic kidney disease or acute cerebrovascular infarction, are life-threatening, but also often disable people, making them unable to work.

Pathogenesis of hypertension

"A disease of unreacted emotions," Georgy Fedorovich Lang, an outstanding Soviet therapist and scientist, called hypertension.

Blood pressure is the force with which blood presses against the walls of a vessel and depends on three hemodynamic parameters: the strength of the cardiac output, the total volume of blood circulating in the vascular bed, and how elastic the vessels are and what their tone is (total peripheral resistance).The upper number of blood pressure is determined by the force of ejection of blood from the heart - systolic pressure, and the lower number indicates the pressure at the moment of diastole - relaxation of the heart.It reflects the degree of resistance of blood vessels to blood flow.

Vascular tone, on the other hand, regulates the central and peripheral nervous system, and depends on a complex of mediators and biologically active substances that are released into the blood, and which are also secreted by the endocrine system, in different life situations: during emotions, fatigue, physical activity.The pathogenetic mechanisms of hypertension are realized by the activation of the sympathoadrenal and renin-angiotensin-aldosterone systems, the membrane transport of cations (sodium, calcium and potassium) is disturbed with increased sodium reabsorption in the kidneys.Due to excessive production of vasoconstrictor compounds and reduced production of depressor compounds, there is also a disturbance of vascular tone.These compounds affect the structure of the vascular wall, it changes due to non-infectious inflammation, due to spasm of the smooth muscles of blood vessels, which results in impaired microcirculation.

After that, the vascular stiffness increases, further increasing the total vascular resistance, and the baroreceptor connection of the central blood pressure regulatory system is disturbed.This leads to arterial hypertension, functional and organic changes in the heart, central nervous system, retina and kidneys.

Risk factors

Hypertension is a multifactorial disease.Let's look at the factors that influence the development and worsening of hypertension:

Immutable factors:

• Recorded cases of hypertension in close relatives (heredity).
• High blood pressure is more often detected in older age (age).
• Sexual - pressure is detected earlier in men than in women.Women have an increased risk of developing hypertension during menopause (60% of women suffer from high blood pressure during this period).This is due to hormonal imbalance and deterioration of emotional and nervous reactions. 
• Negroid race (these people get sick more often and have more severe complications of hypertension).
• Influence of the weather (people dependent on the weather).

Modifiable factors:

• People who are obese are susceptible to hypertension 2-6 times more often than the general population.This is due to the fact that intraperitoneal fat is hormonally active, helps suppress sex hormones, prevents glucose absorption in other tissues, supports inflammatory reactions, increases vasoconstriction and swelling of the vascular wall.
• Reduced physical activity increases the risk of disease by 29-50%, compared to more trained people.
• Excess salty food, fat imbalance and alcohol abuse also contribute to increased blood pressure.
• Smoking is an undeniable factor that has a very bad effect on the walls of the arteries and contributes to the development and worsening of arterial hypertension.Cigarette smoking can raise blood pressure by 10-30 mmHg.Art., promotes spasm and supports the inflammatory process of the vessel wall.
• Emotional overload and chronic stress affect the systems that regulate vascular tone and disturb their adaptation to stress.
• Metabolic disorders: lipid metabolism - hypercholesterolemia and resulting atherosclerosis of the arteries - always accompanies hypertension;carbohydrate metabolism and the development of diabetes mellitus - affect the severity of hypertension and mortality from it.

Symptoms of hypertension

It is important to note that sometimes hypertension does not cause symptoms.Therefore, people with risk factors for hypertension should systematically monitor their blood pressure.

Hypertension hastarget organs.These are the organs that suffer if blood pressure rises: heart, brain, kidneys, peripheral arteries, retina.Given that the increase in A/D is primarily associated with spasm of small arteries, which impairs blood circulation, and these organs are hypersensitive to worsening blood flow, the symptoms are also caused by changes in them.

The main subjective complaints of patients with high blood pressure are: headache, ringing in the ears, frequent dizziness, "spots" before the eyes.Later, when persistent changes develop in the arteries, complaints of poor sleep, deterioration of performance, memory, or signs of encephalopathy appear.On the side of the heart, rapid heart rate, difficulty breathing, pain or discomfort in the left side of the chest, rhythm disturbances are detected, and later manifestations of heart failure in the form of shortness of breath and swelling are observed.

Kidney damage begins very imperceptibly, but leads to nephrosclerosis and disruption of their functions.Hypertensive angiopathy develops in the retina, which is detected by an ophthalmologist in the early stages of the disease, and in some cases, it allows the diagnosis to be confirmed.

Exacerbations of hypertension sometimes occur latently, but this does not mean that it is safe.Even regardless of the pressure level, hypertension can manifest itself in serious complications: heart attack and stroke.Sometimes the exacerbation manifests itself as a hypertensive crisis.It is characterized by a sudden increase in blood pressure, severe headaches, facial flushing, chills and vomiting. This condition requires an emergency call.

Diagnosis of hypertension

Correctly collected data from the anamnesis play a special role in the diagnosis of hypertension.Data on the onset of the disease are carefully clarified, all possible risk factors and patient complaints are studied, with the main emphasis on complaints that characterize the involvement of target organs in the process.Special importance is attached to the presence of heart failure in the anamnesis, renal failure, stroke, detection of diabetes mellitus, retinal angiopathy and aortic aneurysm.

The examination, in addition to measuring blood pressure during the consultation, also includes an assessment of physical data on the target organs.This approach makes it possible to calculate the degree of risk, thanks to which the prognosis of the disease is created.It is necessary to calculate the body mass index if there is an increase in weight.

After the first consultation, the doctor makes a preliminary diagnosis, if it was not made earlier.Then an examination is necessary.

instrumental review:

1. 24-hour monitoring of blood pressure and ECG in 12 leads.
2. Ultrasound examination of the heart (ECHO).It gives an idea about the condition of the heart cavities and the movement of blood in it.
3. Ultrasound dopplerography of the kidney and neck arteries.
4. Urine analysis for albuminuria and blood biochemical parameters.
5. Thyrostimulating hormone and free T4.To assess thyroid function.
6. Examination by an ophthalmologist to assess the condition of the blood vessels of the fundus.

When the diagnosis is clarified, the cardiologist or therapist (if the patient is being treated by a therapist) prescribes drug therapy after analyzing the examination data and all possible risk factors.

Treatment of hypertension 

Treatment goal: achieving normal (target) blood pressure and preventing complications.Treatment is divided into medical and non-medical.

Treatment of headache with drugs 

When choosing therapy, doctors are guided by international recommendations developed by medical communities for the treatment of hypertension.

Now in the medical arsenal there are a lot of drugs that lower blood pressure.They affect the known pathogenetic mechanisms of the disease and eliminate or reduce their impact.These are several groups of drugs, for example, diuretics (diuretics), renin channel blockers, beta blockers, calcium channel blockers, ACE inhibitors.It is the doctor's responsibility to choose them for this particular patient, and it may take some time, since each group of drugs has its own characteristics and side effects, in addition, the effect of the drug is not always fast;sometimes it is necessary to choose them in combination with each other.

In order for the treatment to be effective and to achieve its long-term goals, interaction between the patient and the doctor and the absolute agreement of the patient with the course of treatment are necessary.

The rules that a patient who wants effective treatment must follow:

1. Regular taking of medicines according to the prescribed schedule: day, evening.
2. In case of side effects or doubts, the patient should consult a doctor to adjust the intake of the drug.
3. You should not stop taking medication on your own without consulting your doctor, even if your blood pressure and health are normal.
4. Blood pressure measurement when choosing therapy in the morning and evening (keep a diary), in case of any worsening of the health condition (fill in the diary);if you feel well, 7-10 days in the morning and evening to make sure it is stable, monthly.
5. A visit to the doctor for a minimum check-up with the selected treatment and a normal state of health 2 times a year (dispensary check-up).  

Non-pharmacological measures for the treatment of hypertension

At any stage of hypertension, it is necessary to work with modifiable risk factors.This is the prevention of hypertension.

What can the patient do for himself to reduce or not get high blood pressure given the existing risk factors for hypertension?

• Avoid accumulation of fatty deposits.Weight correction is the most important way to adjust A/D.An increase in weight of 10 kg leads to an increase in blood pressure by 10 mm Hg.Art. 
• Eat wisely.Your diet should contain calories appropriate for your weight, be rich in foods containing potassium and magnesium, and unsaturated fats, while saturated fats and simple carbohydrates should be limited.   
• Do not eat a lot of salt.It causes spasm of the arteries and fluid retention in the body.It has been proven that when a person consumes >5 g of salt per day, the risk of developing hypertension increases significantly. 
• Try to move a lot, but don't overdo it.Doing physical therapy, swimming or walking is helpful, and aim to walk at least 10,000 steps every day. 
• Avoid nervous tension: Find a way to switch if you often experience extreme anxiety or nervous shock (fitness, yoga, long walks). 
• Avoid excessive tensionassociated with intellectual activity. 
• It doesn't work at nightbecause it disrupts biological rhythms. 
• Do not work in areas with significant vibration or noise, affect the central and peripheral nervous and vascular systems. 
• Monitor blood pressure levels, especially if your immediate family (parents, brothers and sisters) had or has arterial hypertension, so that you can take action in time. 
• Consult a gynecologistin the pre-menopause and post-menopause period to eliminate hormonal imbalance. 
• Treat concomitant diseases in a timely mannerkidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (for example, tonsillitis).If you suffer from them, keep in mind that they worsen the course of the headache. 
• Do not drink too much alcohol or smoke. 

Systematic and long-term taking of prescribed medications is recommended, with blood pressure control and dynamic monitoring by a cardiologist or therapist.

Remember, a happy heart is a healthy heart.Pay attention to your health every day, follow the doctor's recommendations.