Hypertension

Hypertension (HD)Chronic disease, the main symptom of which is increased blood pressure (BP), subject to the exclusion of symptomatic hypertension

If a person always exhibits an increase in blood pressure (arterial hypertension 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 it is possible to identify the cause of increased blood pressure and often, by eliminating it, eliminate the symptoms 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, his position, level of physical activity, anxiety, etc.  

It is believed that the basis of this disease is a violation of the blood pressure regulation mechanism.

Epidemiology of hypertension 

Data from the Cardiology Society of the Russian Federation (2020): 30-45% of the world's population suffers from hypertension.Among men aged 25-65 years, 47% of patients with hypertension have been identified, and among women, about 40%.After 60 years, more than 60% of patients with hypertension are registered.Due to the aging population, the increase of inactive and overweight people, according to the forecast in 2025 there will be 1.5 billion people in the world with HD, which means an increase of patients with this disease by 15-20%.

WHO considers hypertension and atherosclerosis to be the most common causes of premature 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 paralyze people, making them unable to work.

Pathogenesis of hypertension

"The disease of unresponsive emotions," Georgy Fedorovich Lang, the brilliant Soviet therapist and scientist, called hypertension.

Blood pressure is the force exerted by the blood on the vessel wall and it depends on three hemodynamic parameters: cardiac output force, the amount of blood circulating in the vascular bed and how elastic the vessels are and what their tone is (total peripheral resistance).The upper blood pressure number is determined by the adhesion force of the blood from the systolic pressure of the heart, and the lower number indicates the pressure during diastole - relaxation of the heart.It reflects the level of blood vessel resistance to blood flow.

Vascular tone, in turn, is controlled by the central and peripheral nervous systems, and depends on a 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.The pathogenetic mechanism of hypertension is realized through the activation of the sympathoadrenal system and renin-angiotensin-aldosterone, membrane transport of cations (sodium, calcium and potassium) is disrupted with increased sodium reabsorption in the kidney.Due to excessive vasoconstrictor production and decreased production of depressor compounds, dysregulation of vascular tone also occurs.This compound affects the structure of the vascular wall, it undergoes changes due to non-infectious inflammation, due to vascular smooth muscle spasm, resulting in impaired microcirculation.

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

Risk factors

Hypertension is a multifactorial disease.Let's look at the factors that influence the development and hunting of hypertension:

Non-modifiable factors:

• Cases of hypertension recorded in close relatives (descendants).
• High blood pressure is detected more often in older age (age).
• Sexual pressure is detected earlier in men than in women.Women have an increased risk of hypertension during menopause (during this period 60% of women experience high blood pressure).This is due to hormonal imbalance and increased emotional and nervous reactions. 
• Negroid race (these people get sicker and have more severe hypertensive complications).
• Influence of weather conditions (people who depend on the weather).

Modifiable factors:

• Obese people are exposed to hypertension 2-6 times more often than the general population.This is due to the fact that intraperitoneal fat is hormonally active, it helps to suppress sex hormones, prevents the absorption of glucose by other tissues, supports the inflammatory response, increases vasoconstriction and swelling of vascular walls.
• Reduced physical activity increases the risk of disease by 29-50%, compared to more trained people.
• Excessive salty foods, fat imbalance, and alcohol abuse also contribute to increased blood pressure.
• Smoking is an undeniable factor that has a very bad effect on the arterial walls and contributes to the occurrence and disorders of arterial hypertension.Cigarette smoke can raise blood pressure by 10-30 mmHg.Art., It promotes spasms and supports the inflammatory process of vessel walls.
• Emotional stress and chronic stress affect the systems that regulate vascular tone and disrupt their adaptation to stress.
• Metabolic disorders: Lipid metabolism - hypercholesterolemia and resulting in arterial atherosclerosis - always accompany hypertension;Carbohydrate metabolism, and developing diabetes mellitus - affects the severity of hypertension and death 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 organ.These are the organs that suffer if blood pressure increases: heart, brain, kidneys, peripheral arteries, retina.Since the increase in A/D is associated with spasms especially of small arteries, which impair blood circulation, and these organs are very sensitive to the deterioration of blood flow, symptoms are also caused by changes in them.

The main subjective complaints of patients with increased blood pressure: headache, tinnitus, frequent dizziness, "spots" in front of the eyes.Then, when the continuous 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, rapid heart rate, shortness of breath, pain or discomfort in the left side of the chest, rhythm disturbances are detected, and then manifestations of heart failure are observed in the form of shortness of breath and swelling.

Kidney damage starts very unnoticed, but leads to nephrosclerosis and disruption of their function.Hypertensive angiopathy develops in the retina, which is detected by ophthalmologists in the early stages of the disease, and in some cases allows the diagnosis to be confirmed.

Exacerbations of hypertension sometimes occur lathy, but this does not mean that it is safe.Regardless of the level of stress, hypertension can manifest itself with severe complications: heart attack and stroke.Sometimes the malaise manifests itself as a hypertensive crisis.It is characterized by a sharp increase in blood pressure, severe headache, facial redness, chills, and vomiting may occur. This situation requires calling an ambulance.

Diagnosis of hypertension

Anamnesis data collected correctly plays a special role in diagnosing hypertension.Information about the onset of the disease is carefully explained, 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, renal failure, history of stroke, detection of diabetes mellitus, retinal angiopathy, and aortic aneurysm.

Examination, in addition to measuring blood pressure during consultation, also includes assessment of physical data on target organs.This approach makes it possible to calculate the level of risk, thanks to the prognosis of the disease created.It is necessary to calculate the body mass index if there is an increase in body weight.

After the first consultation, the doctor sets a preliminary diagnosis, if a person has not been made before.Next, an exam is required.

Instrumental examination:

1. 24-hour monitoring of blood pressure and ECG in 12 leads.
2. Ultrasound examination of the heart (echo).It gives an idea of the condition of the heart cavity and the movement of blood in it.
3. Doppler ultrasound of the renal and neck arteries.
4. Urine analysis 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) prescribes drug therapy after analyzing the examination data and all possible risk factors.

Treatment of hypertension 

Treatment goals: Achieve normal (target) blood pressure levels and prevent complications.Treatment is divided into medical and non-medical.

Medication headache treatment 

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

There are now many drugs in the medical arsenal that lower blood pressure.They affect the pathogenetic mechanisms of known diseases and eliminate or reduce their influence.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, because 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 choose them in combination with each other.

In order for the treatment to be effective and its long-term goals to be achieved, the interaction between the patient and the doctor and absolute compliance with the treatment by the patient is necessary.

Rules that patients who want to receive effective treatment must comply with:

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 medication intake.
3. You should not stop taking medication on your own without consulting a doctor, even if your blood pressure and health are normal.
4. Measure blood pressure when choosing therapy in the morning and evening (keeping a diary), in case of health deterioration (filling in a diary);If you feel well, for 7-10 days in the morning and evening to keep it stable, monthly.
5. Visiting the doctor for a minimum examination with selected treatment and general health 2 times a year (dispensary visit).  

Non-pharmacological measures for the treatment of hypertension

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

What can the patient do for himself to reduce or not have high blood pressure given the existing risk factors for hypertension?

• Avoid the accumulation of fat deposits.Weight correction is the most important way to adjust an A/D.An increase in body weight of 10 kg leads to an increase in blood pressure of 10 mm Hg.Art. 
• Eat wisely.Your diet should have the right number of calories for your body weight, be rich in foods containing potassium and magnesium and unsaturated fats, while saturated fats and simple carbohydrates should be limited.   
• Do not eat a lot of salt.It causes arterial spasm 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 per day. 
• Avoid nervous tension: Find a way to switch if you often experience extreme anxiety or nervous shock (fitness, yoga, long walks). 
• Avoid excessive tensionassociated with 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 systems. 
• Monitor your blood pressure levels, especially if your immediate family (parents, brothers) has or has arterial hypertension, to take action in time. 
• Contact a gynecologistIn the premenopausal and postmenopausal period to eliminate hormonal imbalance. 
• Treat concomitant diseases in a timely mannerKidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (for example, tonsillitis).If you suffer from them, remember that they make headaches worse. 
• Do not drink excessive alcohol and do not smoke. 

It is recommended to take prescribed drugs 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.Take care of your health every day, follow the doctor's recommendations.