A man is alive while his heart beats. The heart "pump" ensures blood circulation in the vessels. In this regard, there is such a thing as blood pressure. Abbreviated as AD. Any deviation from the normal blood pressure level is fatal.
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Risks of developing hypertension
The risk of developing hypertension or arterial hypertension - high blood pressure - consists of a number of factors. Accordingly, the more there are, the more likely a person will become hypertensive.
Risk factors for the development of hypertension:
- hereditary predisposition. The risk of the disease is higher in those who have hypertension among first-degree relatives: father, mother, grandmothers, grandfathers, brothers and sisters. The more close relatives with high blood pressure, the greater the risk;
- age over 35 years;
- stress (stress hypertension) and mental stress. The stress hormone adrenaline accelerates the heartbeat. Instantly constricts blood vessels;
- taking certain medications, for example, oral contraceptives and various dietary supplements (iatrogenic hypertension);
- bad habits: smoking or drinking alcohol. Tobacco components cause spasms of blood vessels - involuntary contractions of their walls. This constricts blood flow;
- atherosclerosis - clogging of blood vessels with plaques. Total cholesterol should not exceed 6. 5 mmol/l of blood;
- kidney failure (nephrogenic hypertension);
- endocrinopathy of the adrenal gland, thyroid gland or pituitary gland;
- excess salt in food. Table salt causes spasm of arteries and retains fluid in the body;
- inactivity. Physical inactivity is accompanied by a slow metabolism - metabolism - and gradually weakens the organism as a whole;
- excess body weight. Each additional kilogram increases blood pressure by 2 millimeters of mercury - mmHg;
- sudden change of weather;
- chronic lack of sleep and other "provocateurs".
Most risk factors for the development of hypertension are closely related. Thus, in most cases, heavy smokers develop atherosclerotic plaques, and physically inactive and malnourished people quickly gain extra pounds. Such combinations of factors significantly increase the risk of pathological abnormalities in the heart.
Depending on the combination and degree of manifestation of the above factors, as well as the probability of cardiovascular complications in the next decade, there are 4 types of risk of developing arterial hypertension:
- low (risk less than 15%);
- average (from 15 to 20%);
- high (more than 20%);
- very high (more than 30%).
Risk factors for the occurrence of arterial hypertension are also divided into 2 types based on the possibility of their elimination: correctable (corrective) and irreversible. For example, a person can stop smoking but is unable to change his background. The amount of risk is summarized from a series of indicators. A patient with hypertension of the first degree who begins to abuse alcohol will significantly increase the percentage of the chance of developing complications.
Hypertension is quite treatable. Much depends on the timely diagnosis of the disease, the patient's persistence and his willingness to radically change his lifestyle.
1st degree hypertension
Arterial hypertension can be primary, i. e. they develop independently, and secondarily - to be a complication of another disease. In the latter case, the treatment is carried out comprehensively, because it is necessary not only to normalize the pressure, but also to cure the accompanying cause of the disease.
A blood pressure reading of 120 to 80 mm Hg is considered normal. This is the "ideal" value, as they say, for astronauts. 120 is the so-called upper blood pressure or systolic pressure (at maximum contraction of the heart muscle walls). And 80 is the lower indicator or the so-called diastolic pressure (at their maximum relaxation). Accordingly, hypertension is divided into systolic, diastolic and mixed (systolic-diastolic), depending on whether the upper or lower indicators exceed the threshold value.
When the lumen of the blood stream narrows, the heart makes more effort to push blood into the vessels, it wears out faster and starts to work intermittently. An increase in heart rate - heart rate - negatively affects the functioning of the whole body. Air and nutrients contained in the blood do not have time to enter the cells.
Like any disease, hypertension progresses if left untreated. The appearance of the first hypertensive symptoms is preceded by a prehypertensive state - prehypertension.
The degree of severity depends on the stage of development of the disease:
- "soft" or light;
- moderate or borderline;
- very severe or isolated systolic.
By the way, stage 1 arterial hypertension is called a mild form of this disease. Upper blood pressure ranges from 140 to 159, and lower blood pressure ranges from 90 to 99 mm Hg. Disorders in the work of the heart appear spasmodically. Attacks usually pass without consequences. This is a preclinical form of hypertension. Periods of exacerbation alternate with the complete disappearance of symptoms of the disease. During remission, the patient's blood pressure is normal.
Diagnosis of hypertension is simple: blood pressure measurement using a tonometer. For an accurate diagnosis, the procedure is performed three times a day in a calm environment and in a relaxed state.
Even people at low risk of developing hypertension need to have their blood pressure checked regularly. One potentially dangerous factor is enough to monitor your heart more closely. For those who are significantly predisposed to heart diseases, it is advisable to buy a cardiovisor - a device for recording EKG - electrocardiogram - at home. Any disease is easier to treat at an early stage.
Symptoms of stage 1 hypertension
Symptoms of stage 1 hypertension include:
- headache that improves with exercise;
- aching or stabbing pain in left side of chest, extending to shoulder blade and arm;
- black spots before the eyes.
We must not forget that in milder forms of hypertension, all these symptoms occur occasionally. If your pulse quickens after intense physical activity or it's hard to fall asleep because of noisy neighbors, you should not panic and consider yourself hypertensive.
During the period of improvement, the patient feels great. Mild hypertension has all the signs characteristic of heart failure. More severe degrees of the disease differ only in the persistence of symptoms and the appearance of complications.
Complications of hypertension of the 1st degree
Complications include:
- kidney sclerosis - nephrosclerosis;
- hypertrophy of the heart muscle (left ventricle).
Most believe that mild arterial hypertension can be cured without consequences. But the risk of complications with grade 1 is average, i. e. about 15%. High pressure in vessels due to the narrowing of their lumen leads to insufficient blood supply to tissues. The lack of oxygen and nutrients leads to the death of individual cells and entire organs. Necrosis begins with local, focal lesions. Over time, if left untreated, an ischemic stroke is inevitable.
Circulation disorders inevitably lead to metabolic disorders. It has a detrimental effect on the respiration and nutrition of cells of any kind. Pathological changes are inevitable, for example, sclerosis - replacement by connective tissue. In nephrosclerosis, the kidney walls become pathologically denser, and the organ "shrinks". In this connection, the excretory function is disturbed, and urea enters the bloodstream.
If the blood vessels are narrowed, the heart strains to push blood through them. This leads to a pathological enlargement of the heart muscle. This hypertrophy is called true or working. The volume and mass of the left ventricle increases due to the thickening of its walls. This pathology is otherwise called cardiomyopathy. The heart adapts its structure to the needs of the body. The extra muscle tissue allows it to squeeze harder. It seems, how could this be dangerous? A "swollen" heart can compress neighboring vessels, and uneven muscle growths can block the outlet of the left ventricle. Hypertrophy of the heart sometimes leads to sudden death.
Complications from hypertension of the 1st degree occur extremely rarely. To avoid them, it is enough to minimize the risk of developing arterial hypertension, i. e. eliminate its preconditions and causes.
Treatment of stage 1 hypertension
First, the doctor will advise the patient to change his lifestyle. The patient will be advised to sleep peacefully, avoid stress, target relaxation exercises, special diet, exercise, etc. If these measures are not sufficient, drug therapy is applied.
The cardiologist prescribes the following drugs: sedatives and other antihypertensive drugs.
Medicines are chosen strictly individually, because many hypertensive patients have accompanying diseases. The choice of drugs is influenced by the age of the patient and the drugs he uses.
If it is possible to stop the disease in the initial stage and get rid of it completely, prevention cannot be neglected in the future. Its principle is simple - avoiding all risk factors for hypertension. Thanks to a healthy lifestyle, you can prevent the appearance of even hereditary pathologies.
Hypertension 2 degrees
This is hypertension in a moderate form. Upper blood pressure is 160 - 179 mm Hg, and lower 100 - 109 mm Hg. In this stage of the disease, periods of increased pressure are longer. Blood pressure rarely returns to normal.
Depending on the speed of transition of hypertension from one stage to another, benign and malignant arterial hypertension are distinguished. In the second, the disease progresses so rapidly that it is often fatal. Hypertension is dangerous because the increase in the speed of blood movement through the vessels leads to thickening of their walls and even greater narrowing of the lumen.
Symptoms of stage 2 hypertension
Typical signs of arterial hypertension occur even in mild forms of the disease.
In the second stage, the following symptoms join them:
- a throbbing sensation in the head;
- hyperemia - overflow of blood vessels, for example, redness of the skin;
- microalbuminuria – the presence of albumin protein in the urine;
- numbness and tingling of the fingers;
- fundus pathologies;
- hypertensive crises - sudden jumps in pressure (sometimes by 59 units at once);
- appearance or worsening of signs of target organ damage.
Fatigue, lethargy and swelling occur because the kidneys are involved in the pathological process. A hypertensive attack can be accompanied by vomiting, difficult urination and defecation, shortness of breath and tears. Sometimes it lasts for several hours. Complications of hypertensive crisis are myocardial infarction and pulmonary or cerebral edema.
Forms of hypertensive crisis:
- neurovegetative (increased heart rate, excessive excitement, shaking hands, unmotivated panic, dry mouth);
- edematous (lethargy, swelling of the eyelids, inhibited consciousness);
The symptoms of stage 2 hypertension are more difficult for patients to tolerate. He constantly suffers from pathological manifestations of high blood pressure. The disease is reluctant to go away at this stage and often returns.
Complications of hypertension of the 2nd degree
Complications of hypertension of the 2nd degree include the following diseases: aneurysm of the aorta - pathological protrusion of its wall.
On the target organs, i. e. Internal organs affected by hypertension include:
- Bleeding in various organs occurs because the walls of blood vessels thicken, lose elasticity and become brittle. Increased blood flow easily destroys such vessels. The reverse process occurs with the development of an aneurysm. Here the walls are stretched and thinned due to increased blood circulation. They are so weakened that they tear easily.
- A pathologically narrow lumen increases the likelihood of developing atherosclerosis - fatty deposits on the walls - and thrombosis - clogging them with a blood clot. Bleeding of brain cells leads to oxygen starvation and their death. This phenomenon is called encephalopathy. Ischemia is starving the heart of oxygen. Angina pectoris is constant chest pain.
In connection with it, pathological processes associated with the underlying disease develop. Accordingly, if you do not start treatment on time or violate medical prohibitions, there will be more and more target organs, and it will become almost impossible to restore health.
Disability hypertension of the 2nd degree
Hypertensive patients are under constant supervision in the dispensary and undergo periodic examinations. In addition to daily blood pressure measurements, they are regularly prescribed an ECG. In some cases, an ultrasound - an ultrasound examination of the heart, urine tests, blood tests and other diagnostic procedures may be required. Hypertensive patients with a moderate form of the disease are less productive than healthy people.
If there is a permanent impairment of bodily functions caused by hypertension, the patient is sent for examination to the bureau in order to obtain the results of the medical and social examination. In rare cases, hypertensive patients are examined at home, in the hospital or even in absentia. Sometimes an additional exam program is drawn up. For people with disabilities, the specialists of the Institute for Medical and Social Expertise prepare a mandatory individual rehabilitation program.
To determine the disability group, the expert committee, along with the degree of hypertension, takes into account the following factors:
- data from the anamnesis about hypertensive crises;
- working conditions of the patient.
The procedure for establishing a disability group is necessary for proper employment. Whether it will be easy to find an employer who is willing to tolerate the work of an "inferior" employee is another question. If an applicant for employment submits documents confirming his disability, then, in accordance with federal legislation, he must be provided with the necessary working conditions.
Employers are reluctant to hire people with disabilities because. . . working hours for them are shortened while retaining full salary (for group 1 and 2). In addition, they are forced to go on sick leave more often than other employees, and their annual leave has also been increased. In this regard, most group 3 disabled people hide their illnesses in order to get a well-paid position. Violation of medical instructions on working conditions leads to worsening of the disease over time.
Persons with disabilities of the 3rd group receive financial benefits and are allowed to engage in professional activities with certain restrictions:
- strong vibrations and noise are contraindicated;
- You cannot work overtime, weekends or night shifts without the employee's consent;
- Constant physical or psycho-emotional stress is not allowed;
- prohibition of work at great heights, in hot shops, near dangerous mechanisms;
- reducing the duration of work that involves high concentration of attention;
- seven-hour working day.
A special case is malignant arterial hypertension of the second stage. His development is so fast, and the patient's condition is serious, that the commission assigns him the 2nd disability group. This is no longer a working group. For 2 and 3 degrees of disability, a medical and social examination is performed every year. Persons with disabilities of the following categories are exempted from re-examination:
- men older than 60 years;
- women older than 55;
- people with irreversible anatomical defects.
The assignment of a disability group is conditioned by the need for social protection of hypertensive patients. His ability to engage in work activity is limited.
Treatment of 2 stages of hypertension
At this stage of the disease, one cannot do without medication. Tablets are taken regularly, preferably at the same time of day. The patient should not think that only taking medicine will be enough to solve the disease. If he does this while simultaneously indulging in, for example, fatty food and alcohol, then the positive effect of the therapy will quickly disappear. The disease will move to the next stage, in which any treatment is no longer effective.
Hypertension 3 degrees
Why are doctors alarmed by deviations in blood pressure readings from the norm, even by one? The fact is that when the pressure increases by several units, the risk of developing cardiovascular complications increases by the same percentage. For example, if a person has mild hypertension and blood pressure deviates from the normal 120 to 80 mm Hg. for 39 units, then there is a very high probability of pathological abnormalities in various organs (39%). What then can be said about the 3rd degree of the disease, in which the deviation is at least 60 units?
Hypertension of the third stage is a severe, chronic form of the disease. Blood pressure rises above 180/110 mm Hg, never falling to the normal 120/80. Pathological changes are already irreversible.
Symptoms of hypertension of the third degree
Symptoms of stage three hypertension include:
- impaired movement coordination;
- permanent visual impairment;
- paresis and paralysis due to cerebral circulation disorders;
- prolonged hypertensive crises with speech disorders, blurred consciousness and sharp pain in the heart;
- significant limitation of the ability to move independently, communicate and take care of oneself.
In severe cases, hypertensive patients can no longer cope without external help, they require constant attention and care. The aforementioned signs of hypertension show that the patient's condition is gradually worsening, that the disease is spreading to new organ systems, and that there are more and more complications.
Complications of hypertension of the 3rd degree
Complications of stage 3 hypertension include the following diseases:
- myocardial infarction – the middle muscle layer of the heart;
- cardiac asthma - suffocation attacks;
- peripheral artery damage;
- hypertensive retinopathy affects the retina of the eyes;
- scotoma ("darkness") is a defect, a blind spot in the field of vision.
Complications of arterial hypertension of the 3rd degree are otherwise called associated clinical conditions. When the cerebral circulation is disturbed, a stroke develops, followed by loss of sensation in the limbs and fainting. Heart failure is a whole complex of cardiac pathologies. The kidneys gradually fail. If hypertension is a secondary disease and occurs on the background of diabetes mellitus, then nephropathy is inevitable.
The more advanced the disease, the more terrible and severe its consequences. The circulatory system is so important for the life of the organism that even the slightest deviation in its functioning has a powerful destructive effect.
Disability hypertension of the 3rd degree
In severe cases of the disease, disability group 1 is determined. At this stage, patients are practically unable to work. Sometimes they are recognized as partially able to work and continue to work, but only at home or under special conditions.
But even with the most severe degree of disability, the patient must undergo rehabilitation procedures. In this state of affairs, it is necessary to prevent death.
Treatment of 3 stages of hypertension
As the course of the disease worsens, more and more powerful drugs are prescribed or their list remains the same, but the dose increases. At this stage of hypertension, the effect of drug therapy is minimal. Chronic hypertensive patients are condemned to take pills for life.
When the disease becomes serious, surgery may be required. The operation is indicated for certain pathologies of blood vessels and heart. The method of stem cell therapy for arterial hypertension of the third stage is considered innovative.
Hypertension 4 degrees
Some experts also identify stage 4 of the disease, which is very severe. In most cases, death is near. They try to relieve the patient's suffering as much as possible, and provide first aid in every hypertensive crisis. The patient is laid down, raising his head. He is urgently given medication that sharply lowers his blood pressure.
Without treatment, new complications appear. Some of them cause others, and the diseases overcome the person more and more. In order to stop this destructive process in time, you just need to monitor the dynamics of blood pressure changes, at least with an ordinary tonometer.
Example of risk calculation depending on the stage of hypertension
Stages of hypertension Other risk factors, POM or disease BP (mmHg)
| High normal | Level 1 | Level 2 | Level 3 | ||
| GARDEN 130-139 DBP 85-89 |
GARDEN 140-159 DBP 90-99 |
GARDEN 160-179 DBP 100-109 |
SBP ≥180 DBP ≥110 |
||
| Phase I | No other FRs | Low risk (risk 1) |
Low risk (risk 1) | Moderate risk (risk 2) |
High risk (risk 3) |
| 1-2 FR | Low risk (risk 1) |
Moderate risk (risk 1) |
moderate / high risk |
High risk (risk 3) |
|
| ≥3 FR | Short / moderate risk (risk 1) |
moderate / high risk |
High risk (risk 3) |
High risk (risk 3) |
|
| Phase II | POM, CKD stage 3 or DM without organ damage |
moderate / high risk |
High risk (risk 3) |
High risk (risk 3) |
high / very high risk |
| Phase III | Established CVD, CKD stage ≥4 or diabetes with organ damage |
Very high risk (risk 4) |
Very high risk (risk 4) |
Very high risk (risk 4) |
Very high risk (risk 4) |
GB - hypertension
SBP - systolic blood pressure
DBP - diastolic blood pressure
RF is a risk factor
CVD - cardiovascular disease
CKD - chronic kidney disease
DM - diabetes mellitus
POM - target organ damage
Once the risk category is determined, the doctor can identify factors that can be influenced to reduce it. Among these variable characteristics:
- Obesity (with BMI over 30), as well as central or visceral obesity, which is determined by waist circumference.
- Social isolation.
- Chronic stress.
Left ventricular hypertrophy, chronic kidney disease, severe heart rhythm disorders such as atrial fibrillation, and others can also increase the risk.