Hypertension

Hypertension is an extremely common disease, which as a collective definition unites several types of arterial hypertension. Hypertension develops against the background of narrowing of the lumen of the walls of small vessels, arteries, as a result of which the normal movement of blood flow is disrupted, and the blood accumulating in narrowed areas begins to press on the walls of the vessels.

What is hypertension?

High blood pressure can be a symptom, but it can also be an independent disease. If a person is diagnosed with chronic pathologies of the kidneys, cardiovascular system, thyroid gland, adrenal glands, hypertension is almost inevitable as one of the manifestations of these diseases. Also, increased pressure can be an adaptive, adaptive reaction of organs and systems to changes both external - excessive physical activity, and internal - psycho-emotional factors, stress. Almost all types of hypertension, with timely diagnosis, are managed both with the help of drug therapy and with the help of other, non-drug methods.

Normal blood pressure in a relatively healthy person is fixed within the limits of 100/60 and 140/90 mm Hg; if the regulatory systems stop working properly, hypertension or hypotension may develop.

Statistics provide information that almost 30% of the world's population suffers from one or another stage of hypertension, and yet quite recently, practically nothing was known about such a disease as hypertension. Only Homo sapiens are characterized by disorders in the cardiovascular system, no representative of the animal world is susceptible to them. Until the 19th-20th centuries, little was known about hypertension in principle, one of the first cases of heart attack was reliably confirmed by doctors only in the 30s of the last century in one of the European countries, during the same period there was not a single clinically confirmed case of cardiovascular pathologies in the countries of Africa and Asia. Only with the development of urbanization and the penetration of modern technologies into these countries, the Asian and African population also became vulnerable to hypertension, the peak of which occurred in the 70s of the 20th century.

Hypertension, since the end of the last century, has been divided into primary and secondary

1. Primary (essential) hypertension is a separate nosological unit, an independent disease that is not provoked by dysfunctions of organs and systems. Blood pressure increases not due to, for example, kidney disease. Hypertension diagnosed as primary (EG - essential hypertension or GB - hypertensive disease) is characterized by a persistent clinical sign - an increase in pressure, both systolic and diastolic. Almost 90% of all patients with persistently elevated blood pressure suffer from primary hypertension.
2. Symptomatic hypertension, which is also called secondary, is hypertension provoked by an underlying disease, such as inflammatory processes in the renal system - glomerulonephritis, polycystic kidney disease, or dysfunction of the pituitary gland, pancreas. Secondary hypertension also develops against the background of pathological changes in the vascular system - atherosclerosis, can provoke symptomatic hypertension and neurotic disease. Secondary hypertension is also quite common during pregnancy and with gynecological diseases - cysts and neoplasms

Hypertension is also classified into degrees depending on the level of increase in blood pressure.

• If the blood pressure is recorded within the range of 140/90 and 159/99 mm Hg, hypertension is diagnosed as a stage I disease. In this case, the pressure may return to normal, but periodically "jump" to the specified limits.
• If the blood pressure is recorded within the range from 160/100 to 179/109 mm Hg, hypertension is considered a stage II disease. Remission is almost never seen, but the pressure can be controlled with medications.
• Blood pressure that is constantly maintained within the range of 180/110 and higher values is considered a clinical symptom of hypertension stage III. At this stage, blood pressure practically does not fall to a normal level, and if it does, it is accompanied by cardiac weakness, up to cardiac failure.

Hypertension, in addition to having stages of disease development, is also divided into separate clinical forms. Hyperadrenergic hypertension is actually the initial stage of the disease development, which, however, can last for many years. This form of hypertension is manifested by sinus tachycardia, unstable blood pressure, when the systolic indicator jumps, increased sweating, hyperemia of the skin, pulsating headache, anxiety. The face and limbs often swell, fingers go numb, urination is impaired. There is also a more serious form - malignant hypertension, which progresses rapidly. Blood pressure can increase so much that there is a risk of encephalopathy, vision loss, pulmonary edema, and there is also a risk of renal failure. Fortunately, this form is almost never encountered today, since hypertension is most often diagnosed much earlier and its development can be stopped with the help of complex therapeutic measures.

Pressure indicators

Blood pressure is one of the most important indicators of human health and an indicator of normal functioning of the cardiovascular system. Blood pressure has two parameters - systolic and diastolic. The upper figure is systole, this is the blood pressure indicator during the period of contraction of the heart muscle, when blood enters the arteries. The lower figure is the blood pressure indicator during the period of relaxation of the heart muscle. It is believed that hypertension begins when the indicators exceed the norm of 140/90 mm Hg. This, of course, is a conditional limit, since there are conditions when the risk of myocardial infarction exists even with figures of 115/75 mm Hg. However, formalization and reduction to the average level of all the diversity of blood pressure helps clinicians to notice deviations in time and begin symptomatic, and then standard treatment.

What causes hypertension?

Hypertension is considered a multi-etiological, multifactorial disease, the real causes of which have not been fully studied. More specific are the factors that provoke secondary hypertension, since the cause is the underlying disease. The final diagnosis of essential hypertension is made after a comprehensive examination by excluding the presence of provoking diseases. Primary hypertension, in medical terms, is a genetic imbalance of regulatory mechanisms in the body (imbalance of the pressor and depressor systems of blood pressure).

Among the causes that clinicians have described and carefully studied, the following can be named:

• Kidney pathologies - nephritis and most often glomerulonephritis. A factor that provokes secondary hypertension.
• Stenosis (narrowing) of the renal arteries.
• A congenital condition in which the renal artery is blocked (coarctation).
• Adrenal neoplasms – pheochromocytosis (impaired production of norepinephrine and adrenaline).
• Increased production of aldosterone is hyperaldosteronism, which occurs with a tumor process in the adrenal glands.
• Dysfunction of the thyroid gland.
• Alcoholism.
• Overdose or chronic use of medications, especially hormonal drugs and antidepressants.
• Addiction.

Factors that are considered provocative in terms of disruption of normal blood pressure levels can be divided into dietary, age-related and pathological:

• Age over 55 years for men and 65 years for women.
• Increased blood cholesterol levels (above 6.6 mmol).
• Hereditary predisposition, family history.
• Obesity, especially abdominal, when the waist circumference is above 100-15 cm for men and 88-95 for women.
• Diabetes, change in normal glucose tolerance.
• Hypodynamia, osteochondrosis.
• Chronic stress, increased anxiety.

The mechanism of hypertension development is briefly as follows:

When arterioles – organ arteries, most often kidneys, spasm under the influence of, for example, a stress factor, the nutrition of renal tissue is disrupted, ischemia develops. The kidneys try to compensate for the disruption by producing renin, which in turn provokes the activation of angiotensin, which constricts blood vessels. As a result, the pressure increases, hypertension develops.

Symptoms of hypertension

The primary symptom of hypertension, and sometimes the main one, is a persistent excess of 140/90 mm Hg. Other signs of hypertension are directly related to blood pressure parameters. If the pressure increases slightly, a person simply feels unwell, weak, and has a headache.

If the pressure exceeds the norm by 10 units, the headache becomes intense, constant, most often it is localized in the back of the head and temples. The person feels sick, sometimes there is vomiting. The face turns red, sweating increases, tremors of the fingers are noticeable, often their numbness.

If hypertension lasts a long time and is not treated, pathological processes in cardiac activity develop, the heart begins to hurt. The pain can be stabbing, sharp, it can radiate to the arm, but most often heart pain is localized on the left in the chest, without spreading further. Against the background of constantly elevated pressure, anxiety and insomnia develop.

Hypertension is also characterized by dizziness and decreased vision.

Ophthalmological signs - veil or spots, "flies" before the eyes. Often, when the pressure increases sharply, there may be nosebleeds.

Another symptom of hypertension is dizziness. Vision deteriorates.

The terminal stage, when hypertension passes into stage III, neurosis or depression will join the typical symptoms. Often hypertension in this form occurs in a pathological "union" with ischemic heart disease.

The most dangerous manifestation of hypertension is a crisis - a condition with a sharp increase, jump in blood pressure. A crisis condition is fraught with a stroke or heart attack and is manifested by the following symptoms:

• A sharp, sudden or rapidly worsening headache.
• Blood pressure readings up to 260/120 mmHg.
• Pressure in the heart area, aching pain.
• Severe shortness of breath.
• Vomiting that begins with nausea.
• Increased heart rate, tachycardia.
• Loss of consciousness, convulsions, paralysis.

Hypertension in the crisis stage is a threatening condition that can end in a stroke, heart attack, therefore, at the slightest alarming signs, you should call emergency medical care. Hypertensive crisis is stopped with the help of diuretics, cardiological and hypertensive drugs administered by injection. A hypertensive patient who knows about his problem should constantly take the prescribed drugs to prevent a crisis condition.

Treatment of hypertension

Hypertension in the initial stage, when blood pressure indicators do not often exceed the norm, can be treated with non-drug means. The first method is to control body weight and follow a low-carbohydrate and fat-free diet. A diet for hypertension also involves limiting the intake of salty foods, controlling fluid intake - no more than 1.5 liters per day. Psychotherapy, autogenic training, which relieve the level of general anxiety and tension, are also effective. These methods are effective for stage I hypertension, although they can be used as auxiliary and additional elements to the main therapy of stage II and III hypertension.

Pharmacological agents that involve the treatment of hypertension are prescribed according to the "step" principle. They are used sequentially, targeting various organs and systems, until the arterial pressure is completely stabilized.

Stage I hypertension involves the use of diuretics (water pills), beta-blockers, and adrenergic receptor blockers to stop tachycardia. The dose of anaprilin is calculated based on the patient's medical history, weight, and condition, and is usually 80 milligrams per day. If blood pressure returns to normal in two or three days, the dose of anaprilin is reduced, and it is often prescribed to be taken every other day. Hypothiazide is effective as a diuretic, and is prescribed at 25 mg once, alternating the dose every other day or two, so as not to weaken the heart muscle. If hypertension begins to subside, the diuretic can be prescribed once a week. There are frequent cases when diuretics and beta-blockers cannot be used due to possible side effects (diabetes, gout, or asthma), and in such situations, antispasmodics are indicated. During the entire course of treatment, it is necessary to monitor blood pressure levels three times a day.

Stage II hypertension is treated with complex therapy, including beta-blockers, diuretics, antispasmodics, ACE inhibitors (angiotensin-converting enzyme inhibitors) and potassium preparations. Of the b-blockers, atenolol, lokren, and visken are effective; they can control rapid heartbeat and reduce vascular resistance in the periphery. These drugs are also effective in diagnosed bradycardia, when the heart rate is reduced. Angiotensin-converting enzyme inhibitors can neutralize increased production of renin, which increases blood pressure. These are spirapril, etanolol, metiopril, capoten and other drugs in this group. These drugs activate the left ventricle, reducing hypertrophy, dilate the coronary vessels, thereby promoting normalization of peripheral blood flow. Calcium antagonists are designed to block calcium ducts in the vascular walls, increasing their lumen. These are corinfar, amlodipine, felodipine and other drugs in this category of drugs. Calcium antagonists should only be prescribed by a therapist or cardiologist, since all these drugs can cause swelling, dizziness and verbal pain. A set of drugs is selected taking into account all possible side risks and contraindications. It should also be taken into account that long-term use of diuretics can cause a decrease in the level of potassium in the body (hypokalemia), so diuretics should be taken together with panangin or asparkam. Hypothiazide is not prescribed to diabetics; it is replaced with veroshpiron.

Stage III hypertension is a severe form of the disease, which is characterized by the body's resistance to traditional drugs. Therefore, treatment should be carefully selected taking into account all the individual characteristics of the patient. The therapeutic complex includes diuretics, most often potassium-sparing, such as amiloride or spironolactone, in addition, the use of peripheral vasodilators is indicated. The pharmaceutical industry today produces many combined effective drugs such as adelfan, brinerdin, triresit. These drugs act on those patients whose body has either become accustomed to monotherapy and has stopped responding to it, or has significant contraindications to the use of standard treatment used for hypertension stages I and II.

Stage III hypertension is also treated with vasodilators, such as phenigidine or corinfar, which is prescribed three times a day, 10 milligrams. Increasingly, vasodilators are being replaced by alpha-blockers - pratsiol, fentalomine. A combination drug that combines the properties of alpha and beta blockers - trandate (labetalol hydrochloride) can also be effective. This drug, in combination with a diuretic, can replace three or even four other less effective drugs. Of the ACE inhibitors, captopril is indicated, which improves peripheral circulation and controls renin levels. Captopril is taken three to four times a day, combined with a diuretic, which allows you to achieve a decrease in blood pressure to normal after just a week.

Stage I and II hypertension is treated at home and does not require hospitalization. In rare cases, inpatient treatment is possible in order to conduct analytical examinations and monitor the health condition. Hypertension, occurring in severe forms, is treated only in a hospital, in the cardiology department, the length of stay depends on the state of blood pressure and the performance of organs and systems of the body.

How is hypertension prevented?

Hypertension, if it has already developed, unfortunately, stays with a person forever. Prevention in this sense concerns only the prevention of crisis situations by regularly taking prescribed medications, daily monitoring of blood pressure, feasible physical activity and weight loss.

However, if a person has relatives with hypertension in their family history, but the disease has not yet manifested itself, preventive measures can be taken. The rules are quite simple - maintaining a healthy lifestyle and physical activity, because one of the causes that provoke hypertension is physical inactivity. Hypertension is also prevented by a normal diet, where cholesterol and salty foods are reduced to a minimum.

Hypertension is also bad habits, so if a person does not want to join the ranks of hypertensive patients, he needs to give up smoking and limit alcohol consumption. In addition, a positive mood and attitude help to cope with any disease, and hypertension "loves" pessimists. The recipe is simple - enjoy life, stay calm and take care of your nerves, then your heart and blood vessels will work "like a clock", and your blood pressure will be, according to the well-known saying, "like an astronaut's."