hypertension

High blood pressure (HD)a chronic disease whose main symptom is increased blood pressure (BP), subject to the exclusion of symptomatic hypertension

If a person has a constant increase in blood pressure (arterial hypertension is more than 140 and 90 mmHg), he is usually diagnosed with hypertension.And that's true 90% of the time.Only in 10% of cases is it possible to identify the cause of the increase in blood pressure and often, by eliminating it, eliminate the symptom of arterial hypertension - in this case the diagnosis is symptomatic hypertension.

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

Normally, blood pressure is an unstable value, i.e.  

It is believed that the disease is based on a violation of the mechanisms of blood pressure regulation.

Epidemiology of hypertension 

Data from the Cardiological Society of the Russian Federation (2020): 30-45% of the world population suffers from hypertension.In men aged 25 to 65 years, 47% of patients with hypertension were identified, and in women about 40%.After 60 years, more than 60% of patients are registered with hypertension.Due to the aging population, the increase in sedentary people and overweight people, it is predicted that there will be 1.5 billion people with Huntington's disease worldwide by 2025, representing a 15-20% increase in patients with the disease.

The WHO considers high blood pressure and arteriosclerosis to be the most common causes of early death in the working-age population.Complications caused by these diseases such as heart attack, chronic kidney disease or acute stroke are life-threatening, but often also lead to disability and inability to work.

Pathogenesis of hypertension

“A disease of unreacted emotions,” Georgy Fedorovich Lang, an outstanding Soviet therapist and scientist, called high blood pressure.

Blood pressure is the force with which blood presses on the vascular walls and depends on three hemodynamic parameters: the force of cardiac output, the total volume of blood circulating in the vascular bed, and the elasticity and tone of the vessels (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 at the time of diastole - relaxation of the heart.It reflects the degree of resistance of blood vessels to blood flow.

Vascular tone, in turn, is regulated by the central and peripheral nervous system and depends on the complex of mediators and biologically active substances that are released into the blood in various life situations and also excreted by the endocrine system: during emotions, fatigue, physical activity.The 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 and there is an increased reabsorption of sodium in the kidneys.Dysregulation of vascular tone also occurs due to excessive production of vasoconstrictor compounds and decreased production of depressant compounds.These compounds affect the structure of the vascular wall, it undergoes changes due to non-infectious inflammation, due to spasms of vascular smooth muscles, which leads to impaired microcirculation.

Subsequently, vascular stiffness increases, further increasing overall vascular resistance and disrupting the baroreceptor connection of the central blood pressure regulation system.This leads to arterial hypertension, functional and organic changes in the heart, central nervous system, retina and kidneys.

Risk factors

High blood pressure is a multifactorial disease.Let's look at the factors that influence the development and exacerbation of hypertension:

Factors that cannot be changed:

• Recorded cases of high blood pressure in close relatives (heredity).
• Elevated blood pressure is more common in older people.
• Sexual pressure is recognized earlier in men than in women.Women have an increased risk of developing high blood pressure during menopause (60% of women suffer from high blood pressure during this time).This is due to hormonal imbalance and exacerbation of emotional and nervous reactions. 
• Negro race (these people get sick more often and have more serious complications from high blood pressure).
• Influence of weather conditions (weather-dependent people).

Modifiable factors:

• Overweight people are two to six times more likely to develop high blood pressure than the general population.This is due to the fact that intraperitoneal fat is hormonally active, contributes to the suppression of 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 disease by 29-50% compared to better trained people.
• Excessively salty foods, fat imbalance, and alcohol abuse also contribute to increased blood pressure.
• Smoking is an undeniable factor that has a very negative effect on the arterial walls and contributes to the development and aggravation of arterial hypertension.A smoked cigarette can increase blood pressure by 10-30 mmHg.It promotes antispasmodic properties and supports the inflammatory process of the vascular wall.
• Emotional overload and chronic stress affect the systems regulating vascular tone and disrupt their adaptation to stress.
• Metabolic disorders: Fat metabolism - hypercholesterolemia and the resulting arteriosclerosis of the arteries - is always accompanied by high blood pressure;Carbohydrate metabolism and the development of diabetes mellitus – affect the severity of hypertension and the resulting mortality.

Symptoms of high blood pressure

It's important to note that sometimes high blood pressure doesn't cause any symptoms.Therefore, people with risk factors for high blood pressure should systematically monitor their blood pressure.

has high blood pressureTarget organs.These are the very organs that suffer when blood pressure rises: heart, brain, kidneys, peripheral arteries, retina.Due to the fact that an increase in A/D is accompanied by spasms, especially of small arteries, which impair blood circulation, and these organs are very sensitive to a deterioration in blood flow, the symptoms are also caused by changes in these organs.

The main subjective complaints of a patient with increased blood pressure are: headaches, tinnitus, frequent dizziness, “spots” in front of the eyes.Later, when persistent changes develop in the arteries, complaints of sleep disorders, performance and memory disorders, i.e. signs of encephalopathy, appear.On the cardiac side, palpitations, shortness of breath, pain or discomfort in the left side of the chest, arrhythmias and later manifestations of heart failure in the form of shortness of breath and swelling are noted.

Kidney damage begins very unnoticed but leads to nephrosclerosis and dysfunction.Hypertensive angiopathy develops in the retina, which is detected by an ophthalmologist in the early stages of the disease and in some cases allows confirming the diagnosis.

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

Diagnosis of high blood pressure

Correctly collected anamnesis data plays a special role in the diagnosis of high blood pressure.Information about the onset of the disease is carefully clarified, all possible risk factors and patient complaints are studied, with an emphasis on complaints that characterize the involvement of target organs in the process.Particular importance is attached to the presence of heart failure, renal insufficiency, a history of stroke, evidence of diabetes mellitus, retinal angiopathy and aortic aneurysm.

In addition to measuring blood pressure during the consultation, the examination also includes the assessment of physical data on the target organs.This approach makes it possible to calculate the degree of risk, thereby creating a prognosis of the disease.If you gain weight, you need to calculate your body mass index.

After the first consultation, the doctor will make a provisional diagnosis if one has not already been made.Next, an examination is necessary.

Instrumental testing:

1. 24-hour monitoring of blood pressure and ECG in 12 leads.
2. Ultrasound examination of the heart (ECHO).It gives an impression of the state of the heart cavities and the movement of blood in them.
3. Ultrasound Dopplerography of the renal and cervical arteries.
4. Urinalysis for albuminuria and biochemical blood 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 therapist (if the patient is being treated by a therapist), after analyzing the examination data and all possible risk factors, prescribes drug therapy.

Treatment of high blood pressure 

Goal of treatment: Achieve normal (target) blood pressure values and avoid complications.Treatment is divided into drug and non-drug treatments.

Drug treatment for headaches 

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

There are now a whole range of drugs in the medical arsenal that lower blood pressure.They influence the known pathogenetic mechanisms of the disease and eliminate or reduce their influence.These include several groups of drugs, for example diuretics (diuretics), renin channel blockers, beta blockers, calcium channel blockers, ACE inhibitors.It is the responsibility of the attending physician to select 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 quick;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 the patient's strict adherence to the course of treatment are necessary.

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

1. Regular intake of medications according to the prescribed schedule: day, evening.
2. In case of side effects or doubts, the patient should contact the attending physician to adjust the medication intake.
3. Even if your blood pressure and health are normal, you should not stop taking any medication without consulting a doctor.
4. Measurement of blood pressure when choosing therapy in the morning and evening (keep a diary), if the health condition worsens (keep a diary);If you feel well, morning and evening for 7-10 days to ensure it is stable, monthly.
5. A visit to the doctor twice a year for a minimal examination with selected treatment and normal health status (pharmacy visit).  

Non-pharmacological measures for the treatment of hypertension

At every stage of hypertension it is necessary to work with modifiable risk factors.This is the prevention of high blood pressure.

Given the existing risk factors for high blood pressure, what can a patient do to reduce or prevent high blood pressure?

• Avoid the accumulation of fatty deposits.Weight correction is the main method of adjusting A/D.An increase in weight of 10 kg leads to an increase in blood pressure of 10 mm Hg. Art. 
• Eat wisely.Your diet should have a calorie count appropriate to your weight, be rich in foods containing potassium and magnesium, and unsaturated fats, while saturated fats and simple carbohydrates should be limited.   
• Don't eat a lot of salt.It causes artery spasms and fluid buildup in the body.It has been proven that the risk of developing high blood pressure increases significantly if a person consumes more than 5 g of salt per day. 
• Try to move a lot, but don't overdo it.It is helpful to do physical therapy, swim or walk, and walk at least 10,000 steps daily. 
• Avoid nervous tension: Find a way to switch if you often experience extreme anxiety or nervous shock (gym, yoga, long walks). 
• Avoid excessive tensionassociated with intellectual activity. 
• Don't work at nightbecause it disrupts biological rhythms. 
• Do not operate the device in areas with strong vibrations or noiseThey affect the central and peripheral nervous and vascular systems. 
• Monitor your blood pressure, especially if your immediate family members (parents, siblings) suffered or are suffering from arterial hypertension, to take timely measures. 
• Contact a gynecologistin the premenopausal and postmenopausal phases to eliminate hormonal imbalances. 
• Treat comorbidities in a timely mannerKidneys and adrenal glands, arteriosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (e.g. tonsillitis).If you suffer from them, remember that they make the headache worse. 
• Do not drink excessive alcohol or smoke. 

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

Remember: a happy heart is a healthy heart.Take care of your health every day and follow doctors' recommendations.