hypertension

Hypertension (HD)a chronic disease, the main symptom of which is an increase in blood pressure (BP), subject to the exclusion of symptomatic hypertension

If a person constantly shows an increase in blood pressure (arterial hypertension is more than 140 and 90 mmHg), then he is usually diagnosed with hypertension.And in 90% of cases this is true.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 from the symptom 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 does, what position he is in, the degree of physical activity, anxiety, etc.But after the end of the exposure in a healthy person, blood pressure levels return to normal after some time on their own, in contrast to a patient whose blood pressure normalizes under the influence of drugs that quickly adjust the number of blood pressure.  

It is assumed that the basis of the disease is a violation of the 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 hypertensive patients were identified in men aged 25-65 and 40% in women.After 60 years, more than 60% of patients with hypertension are registered.Due to the aging of the population, the increase in sedentary and overweight people, according to forecasts in 2025 there will be 1.5 billion people in the world with HD, which means an increase in the number of people with this disease by 15-20%.

WHO considers hypertension and atherosclerosis to be 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 accident, are life-threatening, but also often disable people, making them unable to work.

Pathogenesis of hypertension

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

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

Vascular tone, on the other hand, is regulated by the central and peripheral nervous system and depends on the complex of mediators and biologically active substances released into the blood, also secreted by the endocrine system, in various life situations: during emotions, fatigue, physical activity.Pathogenetic mechanisms of hypertension are realized through the activation of the sympathoadrenal and renin-angiotensin-aldosterone systems, the membrane transport of cations (sodium, calcium and potassium) is disrupted with increased sodium reabsorption in the kidneys.Due to the excessive production of vasoconstrictor compounds and the reduction of the production of depressant compounds, the dysregulation of vascular tone also occurs.These compounds affect the structure of the vascular wall, it undergoes changes due to non-infectious inflammation, due to spasm of the smooth muscles of blood vessels, resulting in impaired microcirculation.

Vascular stiffness then increases, further increasing total vascular resistance, and the baroreceptor coupling of the central blood pressure regulation system is disrupted.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:

Non-modifiable factors:

• Recorded cases of hypertension in close relatives (inheritance).
• Elevated blood pressure is more often detected at older age(s).
• Sexual - pressure is detected earlier in men than in women.Women have an increased risk of developing hypertension during menopause (it is during this period that 60% of women suffer from high blood pressure).This is due to hormonal imbalance and deterioration of emotional and nervous reactions. 
• Negroid race (these people get sick more often and have more serious complications of hypertension).
• Impact of weather conditions (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 the absorption of glucose by other tissues, supports inflammatory reactions, increases vasoconstriction and swelling of the vascular wall.
• Reduced physical activity increases the risk of diseases by 29-50%, compared to more trained people.
• Excessively salty foods, fat imbalance and alcohol abuse also contribute to increased blood pressure.
• Smoking is an undeniable factor that affects the arterial walls very badly and contributes to the occurrence and worsening of arterial hypertension.One smoked cigarette can increase blood pressure by 10-30 mmHg.Art., promotes spasm and supports the inflammatory process of the blood vessel wall.
• Emotional overload and chronic stress affect the systems that regulate vascular tone and disrupt their adaptation to stress.
• Metabolic disorders: lipid metabolism - hypercholesterolemia and the resulting atherosclerosis of the arteries - always accompany 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.It is precisely these organs that suffer if blood pressure increases: heart, brain, kidneys, peripheral arteries, retina.Since the increase in A/D is associated with spasms mainly of small arteries, which damages blood circulation and these organs are super sensitive to the deterioration of blood circulation, the symptoms are also caused by changes in them.

The main subjective complaints from a patient whose blood pressure increases are: headache, tinnitus, frequent dizziness, "spots" before the eyes.Later, when persistent changes in the arteries develop, complaints of poor sleep, deterioration of performance, memory, that is, signs of encephalopathy, will appear.From the side of the heart, fast heartbeats, shortness of breath, pain or discomfort in the left side of the chest, rhythm disorders and then later manifestations of heart failure in the form of shortness of breath and swelling are observed.

Kidney damage begins very unnoticed, 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 allows confirmation of the diagnosis.

Exacerbations of hypertension sometimes occur latently, but this does not mean that it is certain.Even regardless of the pressure level, hypertension can appear with serious complications: heart attack and stroke.Sometimes an aggravation manifests as a hypertensive crisis.It is characterized by a sharp increase in blood pressure, severe headaches, facial flushing, chills and vomiting. This condition requires calling an ambulance.

Diagnosis of hypertension

Correctly collected anamnesis data play a special role in the diagnosis of hypertension.Information about the onset of the disease is 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.Particular importance is attached to the presence of a history of heart failure, kidney failure, history of strokes, detection of diabetes mellitus, retinal angiopathy and aortic aneurysm.

The examination, in addition to the measurement of blood pressure during the consultation, also includes the assessment of physical data for the target organs.This approach makes it possible to calculate the degree of risk, thanks to which a 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 has not been done before.Then, an examination is necessary.

Instrumental examination:

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

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

Treatment of hypertension 

The goal of treatment: achieving normal (target) blood pressure levels and preventing complications.Treatment is divided into medicinal and non-medicinal.

Drug treatment of headache 

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 many medications 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 select 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 absolute compliance with the course of treatment by the patient is necessary.

The rules that a patient who wants to receive effective treatment must adhere to:

1. Regular intake of medicines according to the established schedule: day, evening.
2. In case of side effects or doubts, the patient should contact the attending physician to adjust the intake of drugs.
3. You should not stop taking medications 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 deterioration of health (fill in a diary);if you feel well, for 7-10 days in the morning and in the evening to make sure it is stable, every month.
5. Visit to the doctor for a minimum examination with selected treatment and normal health 2 times a year (ambulatory visit).  

Non-pharmacological measures for the treatment of hypertension

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

What can a patient do for himself to lower or not 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 have appropriate calories 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 too much salt.It causes arterial spasms 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.It is helpful to engage in physical therapy, swimming or walking and aim to walk at least 10,000 steps each day. 
• Avoid nervous tension: Find a way to change if you often experience extreme anxiety or nervous breakdowns (fitness, yoga, long walks). 
• Avoid excessive tensionrelated to intellectual activity. 
• Do not work at nightbecause it disrupts biological rhythms. 
• Do not operate in areas with significant vibration or noise, they affect the central and peripheral nervous and vascular system. 
• Monitor blood pressure levels, especially if your close family (parents, brothers and sisters) had or have arterial hypertension, so that measures can be taken in time. 
• Contact a gynecologistin the period before menopause and after menopause to eliminate hormonal imbalance. 
• Treat co-morbidities in a timely mannerkidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid diseases, obesity, chronic infections (for example, tonsils).If you suffer from them, keep in mind that they worsen the course of the headache. 
• Do not drink too much alcohol and do not smoke. 

It is recommended to take prescribed medications systematically and for a long time under the control of blood pressure and the dynamic supervision of a cardiologist or therapist.

Remember, a happy heart is a healthy heart.Pay attention to your health every day, follow the recommendations of doctors.