Hypertension: causes, treatment, prognosis, stages and degrees of risk

Hypertension (HTN) is one of the most common diseases of the cardiovascular system, which only according to approximate data affects one third of the world's population. At the age of 60-65, more than half of the population has been diagnosed with hypertension. The disease is called a "silent killer", because its signs can be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, significantly increasing the risk of vascular accidents.

In Western literature, the disease is called arterial hypertension (AH). Others have adopted this wording, although both "hypertension" and "hypertension" are still in common use.

The great 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 the clarification of their role in the progression of the disease. The relationship between the degree of hypertension and the existing risk factors appears 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 many. Gov.Speaking of primary hypertension, or essential, we andWe mean the case when there are no specific previous diseases or pathologies of internal organs. In other words, such hypertension occurs by itself, 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 the breakdown of the central mechanisms of pressure regulation in the brain, then the humoral mechanisms suffer and the target organs (kidneys, heart, retina) are involved.

Secondary hypertension- 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. Once the underlying disease is cured, the 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 that lead to hypertension. Any therapist or cardiologist will tell the patient about the dangers from the first case of high blood pressure registered.

Among the conditions that predispose to hypertension, the most important are:

1. Smoking;
2. Excessive salt in food, excessive fluid intake;
3. Insufficient physical activity;
4. Alcohol abuse;
5. Excess weight and disorders of fat metabolism;
6. Chronic psycho-emotional and physical overload.

If we can exclude the listed factors or at least try to reduce their impact on health, then characteristics such as gender, age, heredity cannot be changed and therefore we will have to endure them, but notforget the growing danger.

Classification of arterial hypertension and determination of risk level

The classification of hypertension includes the identification of the stage, the degree of the disease and the level of risk of vascular accidents.

Stage of the diseasedepends on the clinical manifestations. I emphasize:

• 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, seizures are possible, but there are no signs of damage to the target organ;
• Stage 2 is associated with damage to the target organs - myocardial hypertrophy, changes in the retina of the eyes are visible and the kidneys suffer;
• In stage 3, strokes, myocardial ischemia, vision pathology, changes in large vessels (aortic aneurysm, atherosclerosis) are possible.

The degree of hypertension

Determining the degree of hypertension is important in risk assessment and prognosis and is based on pressure readings. It should be said that normal blood pressure values also have different clinical significance. So, the indicator is up to 120/80 mm Hg. Art. countsoptimum,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 remain within normal limits, but are approaching the borderline of pathology, that's why they are called "very normal", and the patient can be told that he has high normal blood pressure. These indicators can be considered as pre-pathology, because the pressure is only "a few millimeters" from elevation.

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:

• The first degree of hypertension (HTN or AH stage 1 of the diagnosis) means an increase in pressure in the range of 140-159/90-99 mmHg. Art.
• Stage 2 headache is associated with numbers 160-179/100-109 mm Hg. Art.
• With stage 3 hypertension, the pressure is 180/100 mmHg. Art. and above.

It happens that the systolic pressure figures increase, reaching 140 mm Hg. Art. and higher, while the diastolic value is within normal values. In this case they are talking 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 the conclusions are drawn on the basis of systolic or diastolic pressure.

The most accurate diagnosis of the degree of hypertension is possible when the disease is diagnosed for the first time, when the treatment has not yet been carried out and the patient has not received any antihypertensive medication. During therapy, the numbers fall and when it is stopped, on the contrary, they can increase significantly, so it is no longer possible to adequately assess the degree.

The concept of risk in diagnosis

Hypertension is dangerous because of 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 complete examinationthe risk is determined, indicated in the diagnosis with 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, the involvement of target organs and accompanying changes in organs and systems are used.

The main risk factors that affect the prognosis include:

1. The patient's age is after 55 years for men and 65 for women;
2. Smoking;
3. Disorders of lipid metabolism (exceeding the norm of cholesterol, low-density lipoproteins, reduction of high-density lipid fractions);
4. The presence of cardiovascular pathology in the family among blood relatives under 65 and 55 years of age, respectively for women and men;
5. 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 increased fibrinogen concentration. These factors are taken into accountextra, increasing the possibility of complications.

Target organ damage characterizes hypertension, starting from stage 2, and serves as an important criterion by which the risk is determined, therefore the patient's examination includes an ECG, ultrasound of the heart to determine the degree of muscle hypertrophy, 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 increases progressively. A characteristic feature that is taken into account when considering risk stratificationmyocardial hypertrophy, which can be suspected by ECG, can be determined by ultrasound examination.

Involvement of the kidney as a target organ is indicated by increased 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 a related pathology, namely hypertension.Among the accompanying diseases, the most important for prognosis are strokes, transient ischemic attacks, heart attack and angina, nephropathy due to diabetes, kidney failure, retinopathy (retinal damage) due to hypertension.

So, the reader surely understands how you can even independently determine the degree of headache. This is not difficult, you just need to measure the pressure. Then, you can think about the presence of some 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 observed are smoking and age on the background of fairly good health, then the risk will be moderate - 1 tbsp. (2 tablespoons), risk 2.

To make it clearer what the risk indicator means in a diagnosis, 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. Number 1 means low risk, 2 - moderate, 3 - high, 4 - very high risk of complications.

Risk factors	BP 130-139/85-89, danger	GB (AH) 1, danger	GB 2, danger	GB 3, danger
NONE	1	2	3
1-2	1	2	2	4
more than three factors/target lesions/diabetes	3	3	3	4
related pathology	4	4	4	4

Low risk means that the probability of vascular accidents is not more than 15%, moderate - up to 20%, high risk indicates the development of complications in one third of patients from this group, with a very high riskmore 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 the blood vessels and heart progress, symptoms appear in the form of headache, weakness, decreased performance, periodic dizziness, visual symptoms in the form of weakened visual acuity, burning "spots" before the eyes. All these signs are not expressed during a stable course of pathology, but at the time of the development of a hypertensive crisis, the clinic becomes brighter:

• Severe headache;
• Tinnitus, ringing in the head or ears;
• Darkness in the eyes;
• Pain in the area of the heart;
• Dyspnea;
• Facial hyperemia;
• Excitement and feeling of fear.

Hypertensive crises are provoked by traumatic situations, excessive work, 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 significantly, including life-threatening ones:

1. Hemorrhage or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute kidney failure;
5. 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 can vary normally in different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. it can occur due to the pathology of peripheral vessels, so the different pressures in the right and left hand should be treated with care.

To get the most reliable figures, it is recommended to measure the pressure three times in each arm with short time intervals, recording any results obtained. In most patients, the smallest values obtained are more accurate, 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 makes it possible to monitor it in a wide range of people at home. Typically, patients with hypertension have a tonometer at home, so that if their health deteriorates, they can immediately measure their blood pressure. However, it is worth noting that fluctuations are possible even in absolutely healthy individuals without hypertension, so a single excess of the norm should not be considered a disease, and to establish a diagnosis of hypertension, the pressure should be measured at different times. , under different conditions and repeatedly.

When diagnosing hypertension, blood pressure figures, electrocardiography data and cardiac auscultation results are considered essential. When listening, it is possible to detect murmurs, raised tones and arrhythmias. The EKG, starting from the second phase, 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 from different groups and different mechanisms of action. Theirscombination and dosage are chosen by the doctor individuallytaking into account the stage, comorbidity and 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 aims to reduce salt and fluid intake, eliminate alcohol, coffee and beverages and substances that stimulate the nervous system. If you are overweight, you should limit calories and avoid fatty, floury, fried and spicy foods.

Drug-free 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 the appropriate medications.

The goal of treating hypertension is not only to reduce blood pressure, but also to eliminate, if possible, its cause.

Traditionally, antihypertensive drugs from the following groups are used for the treatment of hypertension:

• Diuretics;
• Angiotensin II receptor antagonists;
• ACE inhibitors;
• Adrenergic blockers;
• Calcium channel blockers.

Every year the list of drugs that lower blood pressure grows and at the same time becomes more effective and safe, with fewer adverse reactions. During the beginning of therapy, a drug is prescribed in a minimum dose, if it is ineffective, it can be increased. If the disease progresses and the pressure does not remain within acceptable values, then another drug from another group is added to the first drug. Clinical observations show that the effect is better with combined therapy than with the prescription of a drug in the maximum amount.

Reducing the risk of vascular complications is important in choosing a treatment regimen.Thus, it has been observed that some combinations have a more pronounced "protective" effect on organs, while others allow better pressure control. In such cases, experts prefer a combination of drugs that reduce the likelihood of complications, even if there are several daily fluctuations in blood pressure.

In some cases, it is necessary to take into account the accompanying pathology, which makes adjustments to the headache treatment regimens. For example, men with prostate adenoma are prescribed alpha-blockers, which are not recommended for continuous use to lower blood pressure in other patients.

The most commonly used ACE inhibitors, calcium channel blockers,which are prescribed to both young and old patients, with or without concomitant diseases, diuretics, sartan. The drugs of these groups are suitable for the initial treatment, which can then be supplemented with a third drug of a different composition.

ACE inhibitors lower blood pressure and at the same time have a protective effect on the kidneys and myocardium. They are preferred in young patients, in women taking hormonal contraceptives, indicated for diabetes, as well as in elderly patients.

Diureticsno less popular. To reduce negative reactions, they are combined with ACE inhibitors, sometimes "in one tablet".

Beta blockersare not a priority group for hypertension, but are effective for accompanying cardiac pathology - heart failure, tachycardia, coronary disease.

Calcium channel blockersoften prescribed in combination with ACE inhibitors, they are particularly good for bronchial asthma in combination with hypertension, as they do not cause bronchospasm.

Angiotensin receptor antagonists- the group of drugs most prescribed for hypertension. They effectively lower blood pressure and do not cause coughing like many ACE inhibitors. But in America they are especially common because of 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 medication for a long time, even for life. Many patients believe that when the pressure reaches normal levels, the treatment can be stopped, but they grab the pills in times of 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 duties of the doctor.