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 the age of 60-65 years, more than half of the population has been diagnosed with hypertension. The disease is called a "silent killer", because its signs may be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, greatly increasing 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.
Close 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 elucidating their role in the progression of the disease. 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" do not mean anything, 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. GovSpeaking about primary, or essential, hypertension, we andWe mean the case when there is no specific previous disease or pathology of 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 cases of chronic high blood pressure.
The main cause of primary hypertension is considered to be stress and psycho-emotional overload, which contribute to disruption of the central mechanisms of pressure regulation in the brain, then humoral mechanisms suffer, and target organs are involved (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 goes away, so it makes no sense to determine the risk and degree in this case. Symptomatic hypertension accounts for no more than 10% of cases.
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 leading to hypertension. Any therapist or cardiologist will tell the patient about the risks already at the first case of recorded high blood pressure.
Among the conditions predisposing to hypertension, the most important are:
- Smoking;
- Excess salt in food, excessive fluid intake;
- Insufficient physical activity;
- Alcohol abuse;
- Excess weight 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 such characteristics as gender, age, heredity cannot be changed, and therefore we will have to put up with them, but not forgetting the increasing risk.
Classification of arterial hypertension and determination of risk level
Classification of hypertension involves identifying the stage, degree of the disease and the level of risk of vascular accidents.
Disease stagedepends on clinical manifestations. Highlight:
- Preclinical stage, when there are no signs of hypertension and the patient is unaware of the increase in blood pressure;
- Stage 1 of hypertension, when the pressure is elevated, 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 in the retina of the eyes are noticeable, and the kidneys suffer;
- At stage 3, strokes, myocardial ischemia, vision pathology, changes in large vessels (aortic aneurysm, atherosclerosis) are possible.
Degree of hypertension
Determining the degree of hypertension is important in assessing risk and prognosis and is based on pressure figures. It must be said that normal blood pressure values also have different clinical significance. So, the indicator is up to 120/80 mm Hg. Art. countsoptimal,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. still lie 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 high normal blood pressure. These indicators can be regarded as pre-pathology, because the pressure is only "a few millimeters" from being elevated.
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:
- 1st degree of hypertension (HTN or AH 1st stage in the diagnosis) means an increase in pressure in the range of 140-159/90-99 mmHg. Art.
- Stage 2 headache is accompanied by 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 figures increase, amounting to 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 greater 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 it is 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 the fact of high blood pressure itself, but from the acute disorders to which it leads.
Cerebral hemorrhages or ischemic necrosis, myocardial infarction, renal failure are the most dangerous conditions provoked by high blood pressure. In this regard, for each patient after a thorough examinationthe risk is determined, indicated in the diagnosis by the numbers 1, 2, 3, 4. Thus, 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, involvement of target organs, and concomitant changes in organs and systems are used.
The main risk factors affecting the prognosis include:
- The patient’s age is after 55 years for men and 65 for women;
- Smoking;
- Lipid metabolism disorders (exceeding the norm of cholesterol, low-density lipoproteins, decreased high-density lipid fractions);
- Presence of cardiovascular pathology in the family among blood relatives under 65 and 55 years of age 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 life, and have abnormalities in the blood coagulation system in the form of an increase in 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 risk is determined, therefore, examination of the patient includes an ECG, ultrasound of the heart to determine the degree of hypertrophy of his 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 increased force. As the arteries and arterioles change, when their walls lose elasticity and the lumens become spasmodic, the load on the heart progressively increases. A characteristic feature taken into account when stratifying risk is consideredmyocardial 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 albumin protein 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 strokes, transient ischemic attacks, cardiac infarction and angina, nephropathy due to diabetes, kidney failure, retinopathy (retinal damage) due to hypertension.
So, the reader probably understands how you can 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 suffered 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 against the background of quite good health, then the risk will be moderate - 1 tbsp. (2 tbsp. ), risk 2.
To make it clearer what the risk indicator in a diagnosis means, 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 |
|---|---|---|---|---|
| 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 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 from 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 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 are not expressed during a stable course of the pathology, but at the time of development of a hypertensive crisis, the clinic becomes brighter:
- Strong 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 sharply, including life-threatening ones:
- Hemorrhage or cerebral 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 numbers could normally differ in different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. may occur due to pathology of peripheral vessels, so different pressures on the right and left hands should be treated with caution.
To obtain the most reliable figures, it is recommended to measure the pressure three times on 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 measurement to measurement, which does not always speak in favor of hypertension.
A large selection 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 at home, on hand, so that if their health worsens, they can immediately measure blood pressure. It is worth noting, however, that fluctuations are also possible in absolutely healthy individuals without hypertension, so a single excess of the norm should not be regarded as a disease, and to make a diagnosis of hypertension, the pressure must be measured at different times, under different conditions and repeatedly.
When diagnosing hypertension, blood pressure figures, electrocardiography data and cardiac auscultation results are considered fundamental. When listening, it is possible to detect noise, increased tones, and arrhythmias. The ECG, starting from the second stage, will show signs of stress on the left side of the heart.
Treatment of hypertension
To correct high blood pressure, treatment regimens have been developed that include drugs of different groups and different mechanisms of action. Theirthe combination and dosage are chosen by the doctor individuallytaking into account the stage, concomitant pathology, and the response of hypertension to a specific drug. After the diagnosis of hypertension has been established and before drug treatment begins, the doctor will suggest non-drug 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 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-drug measures in the initial stage of hypertension can have such a good effect that the need to prescribe medications will no longer be necessary. If these measures do not work, the doctor prescribes appropriate medications.
The goal of treating hypertension is not only to reduce blood pressure, but also to eliminate, if possible, its cause.
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, one medicine is prescribed in a minimum dose; if it is ineffective, it can be increased. If the disease progresses and the pressure does not remain at acceptable values, then 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 amount.
Reducing the risk of vascular complications is important in choosing a treatment regimen.Thus, it has been noted that some combinations have a more pronounced "protective" effect on organs, while others allow better control of pressure. In such 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 adjustments 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 widely used ACE inhibitors, calcium channel blockers,which are prescribed to both young and elderly patients, with or without concomitant diseases, diuretics, sartans. Drugs in 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 for older patients.
Diureticsno less popular. To reduce adverse reactions, they are combined with ACE inhibitors, sometimes "in one tablet. "
Beta blockersare not a priority group for hypertension, but are effective for concomitant cardiac pathology - heart failure, tachycardia, coronary disease.
Calcium channel blockersoften prescribed in combination with ACE inhibitors, they are especially good for bronchial asthma in combination with hypertension, as they do not cause bronchospasm.
Angiotensin receptor antagonists– the most prescribed group of drugs for hypertension. They effectively reduce blood pressure and do not cause coughing like many ACE inhibitors. But in America they are especially common due to a 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 the drugs for a long time, even for life. Many patients believe that when the pressure reaches normal levels, treatment can be stopped, but they grab the pills by 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.