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

Hypertension (SAH) 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 age 60-65, more than half of the population has been diagnosed with hypertension. The disease is called the "silent killer", as its signs can be absent for a long time, while changes in the walls of blood vessels begin in the asymptomatic phase, greatly increasing the risk of strokes.

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.

Special 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. Its prevention is the main objective of treatment that aims to maintain normal blood pressure (BP).

An important point is to identify all possible risk factors,as well as elucidate its role in disease progression. The relationship between the degree of hypertension and existing risk factors is highlighted in the diagnosis, which simplifies the assessment of the patient's condition and prognosis.

For most patients, the numbers in the diagnosis after "HA" do not mean anything, although it is clear that the higher the degree and risk indicator, the worse the prognosis and the more severe the pathology. In this article we will try to understand how and why one or another degree of hypertension is diagnosed and what is behind determining the risk of complications.

Causes and risk factors of hypertension

The causes of high blood pressure are numerous. GovernorSpeaking of primary or essential hypertension, we andWe mean the case in which there is no specific previous disease or pathology of internal organs. In other words, this hypertension occurs by itself, involving other organs in the pathological process. Primary hypertension is responsible for more than 90% of cases of chronic hypertension.

The main cause of primary hypertension is considered to be stress and psycho-emotional overload, which contribute to the 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– manifestation of another pathology, therefore its cause is always known. It accompanies kidney, heart, brain diseases, endocrine disorders and is secondary to them. After the underlying disease is cured, hypertension also disappears, so it makes no sense to determine the risk and degree in this case. Symptomatic hypertension accounts for no more than 10% of cases.

The risk factors for hypertension are also known to everyone. Hypertension schools are being created in outpatient clinics, whose specialists transmit information to the population about the unfavorable conditions that lead to hypertension. Any therapist or cardiologist will inform the patient about the risks in the first recorded case of high blood pressure.

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

1. Smoke;
2. Excess salt in the diet, excessive fluid intake;
3. Insufficient physical activity;
4. Alcohol abuse;
5. Excess weight and fat metabolism disorders;
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 tolerate them, but without forgetting the increasing risk.

Classification of arterial hypertension and determination of risk level

The classification of hypertension involves identifying the stage, degree of the disease and the level of risk of vascular accidents.

Stage of the diseasedepends on the clinical manifestations. Emphasis:

• Pre-clinical phase, when there are no signs of hypertension and the patient is unaware of the increase in blood pressure;
• Stage 1 hypertension, when pressure is high, crises are possible, but there are no signs of target organ damage;
• Stage 2 is accompanied by damage to target organs - myocardium hypertrophy, 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 values. It must be said that normal blood pressure values also have different clinical meanings. Therefore, the indicator is up to 120/80 mm Hg. Art. accountexcellent,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. are still within the limits of normality, but are approaching the border of pathology, which is why they are called "highly normal", and the patient may be told that they have elevated normal blood pressure. These indicators may be considered prepathological, as the pressure is only "a few millimeters" away from being elevated.

From the moment blood pressure reached 140/90 mm Hg. Art. We can now talk about the presence of the disease. This indicator is used to determine the degree of hypertension itself:

• 1st degree of hypertension (HTN or HA 1st stage at diagnosis) means an increase in pressure in the range of 140-159/90-99 mmHg. Art.
• Stage 2 headache is accompanied by the numbers 160-179/100-109 mm Hg. Art.
• In stage 3 hypertension, the pressure is 180/100 mmHg. Art. It's higher.

It happens that systolic pressure values increase, reaching 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, so the doctor makes a diagnosis in favor of a higher 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 at the first diagnosis of the disease, when treatment has not yet been carried out and the patient has not taken any antihypertensive medication. During therapy, the numbers drop and, when it is interrupted, on the contrary, they can increase sharply, making it no longer possible to adequately assess the degree.

The concept of risk in diagnosis

Hypertension is dangerous because of its complications. It's no secret that the vast majority of patients die or become disabled, not because of hypertension itself, but because of the acute disorders it leads to.

Cerebral hemorrhages or ischemic necrosis, myocardial infarction and kidney failure are the most dangerous conditions caused by hypertension. 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, target organ involvement and concomitant changes in organs and systems are used.

The main risk factors that affect the prognosis include:

1. The patient's age is over 55 years for men and 65 years for women;
2. Smoke;
3. Lipid metabolism disorders (excess cholesterol, low-density lipoproteins, decrease in high-density lipid fractions);
4. Presence of cardiovascular pathology in the family among blood relatives under 65 and 55 years of age for females and males, respectively;
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 lifestyle and have anomalies in the blood coagulation system in the form of an increase in the concentration of fibrinogen. 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 for determining the risk, therefore, the patient's examination includes ECG, ultrasound of the heart to determine the degree of hypertrophy of its muscles, blood and urine tests for indicators of kidney function (creatinine, protein) .

Firstly, the heart suffers from high blood pressure, which pushes blood into the vessels with greater force. As arteries and arterioles change, as their walls lose elasticity and their lumens become spasmodic, the load on the heart progressively increases. A characteristic taken into account when risk stratification is consideredmyocardial hypertrophy, which can be suspected by ECG, can be determined by ultrasound examination.

Involvement of the kidneys 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 associated pathology, that is, associated with hypertension.Among the associated diseases, the most important for prognosis are strokes, transient ischemic attacks, heart attack and angina, nephropathy due to diabetes, kidney failure, retinopathy (damage to the retina) due to hypertension.

Therefore, the reader probably understands how you can independently determine the degree of headache. This is not difficult, just 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.

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 the stroke is the only problem besides the hypertension. If the pressure corresponds to the first or second degree, and the only risk factors that can be observed are smoking and age in a context of good health, the risk will be moderate - 1 tbsp. (2 tablespoons), risk 2.

To make it clearer what the risk indicator in a diagnosis means, you can summarize everything in a small table. By determining its degree and "counting" the factors listed above, you can determine the risk of strokes 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	PA 130-139/85-89, risk	GB (AH) 1, risk	GB 2, risk	GB 3, risk
none	1	two	3
1-2	1	two	two	4
more than three factors/target damage/diabetes	3	3	3	4
associated pathology	4	4	4	4

Low risk means that 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 in this group, with very high risk, more than 30% of patients are susceptible to complications.

Manifestations and complications of headache

The 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 the development of the 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 the stable course of the pathology, but at the time of development of a hypertensive crisis, the clinic becomes clearer:

• Splitting headache;
• Noise, ringing in the head or ears;
• Darkening in the eyes;
• Pain in the heart region;
• Dyspnea;
• Facial hyperemia;
• Excitement and feeling of fear.

Hypertensive crises are caused by traumatic situations, overwork, stress, consumption of coffee and alcoholic beverages, therefore 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:

1. Hemorrhage or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute renal 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 could normally differ in different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. may occur due to the pathology of peripheral vessels, therefore, different pressures in the right and left hands should be treated with caution.

To obtain more reliable values, it is recommended to measure the pressure three times in each arm at short intervals., recording each result obtained. In most patients, the lowest 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 blood pressure measuring devices allows you to monitor it in a wide range of people at home. Typically, hypertensive people have a tonometer at home, so that, if their health condition worsens, they can immediately measure their blood pressure. It is worth noting, however, that fluctuations are also possible in absolutely healthy individuals without hypertension, therefore, a single excess of the norm should not be considered a disease, and to diagnose hypertension, pressure must be measured at different times. , under different conditions and repeatedly.

In the diagnosis of hypertension, blood pressure values, electrocardiogram data and cardiac auscultation results are considered fundamental. When listening, it is possible to detect noises, increased tones and arrhythmias. The ECG, from the second stage onwards, will show signs of stress on the left side of the heart.

Treatment of hypertension

To correct hypertension, treatment regimens have been developed that include drugs from different groups and different mechanisms of action. From themthe combination and dosage are chosen by the doctor individuallytaking into account the stage, concomitant pathology and the response of hypertension to a specific medication. After the diagnosis of hypertension has been established and before starting drug treatment, the doctor will suggest non-drug measures that significantly increase the effectiveness of pharmacological medications and, sometimes, make it possible 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, 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 early stage of hypertension can have such a good effect that prescription medication will no longer be necessary. If these measures do not work, the doctor prescribes appropriate medications.

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

Antihypertensive medications 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 medications that reduce blood pressure grows and at the same time becomes more effective and safe, with fewer adverse reactions. At the beginning of therapy, a medication 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, another medicine from a different group is added to the first medicine. Clinical observations show that the effect is better with combined therapy than with prescribing a drug in the maximum amount.

Reducing the risk of vascular complications is important when choosing a treatment regimen.Thus, it was noted that some combinations have a more pronounced "protective" effect on the organs, while others allow better pressure control. In these cases, experts prefer a combination of medications 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, the constant use of which is not recommended to reduce blood pressure in other patients.

The most commonly used ACE inhibitors, calcium channel blockers,which are prescribed for young and elderly patients, with or without concomitant diseases, diuretics, sartans. Medicines from these groups are suitable for initial treatment, which can then be supplemented with a third medicine with 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 in 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 heart pathologies - heart failure, tachycardia, coronary heart 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 group of medications 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 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 medications for a long time, even for the rest of your life. Many patients believe that when their blood pressure reaches normal levels, treatment can be stopped, but they take the pills at the time of the crisis. It is known that the systematic 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.