Arterial hypertension- This is perhaps the most common disease of the entire cardiovascular system. The word “hypertension” refers to persistently elevated blood pressure. Promotion blood pressure occurs when there is a narrowing of the arteries and/or their smaller branches - arterioles. Arteries are the main transport routes through which blood is delivered to all tissues of the body. In some people, the arterioles often narrow, first due to spasm, and later their lumen remains constantly narrowed due to thickening of the wall, and then, in order for the blood flow to overcome these narrowings, the work of the heart increases and more blood is released into the vascular bed. Such people, as a rule, develop hypertension.

In our country, approximately 40% of the adult population have increased level blood pressure. At the same time, about 37% of men and 58% of women know about the presence of the disease, and only 22 and 46% of them are treated. Only 5.7% of men and 17.5% of women properly control their blood pressure.

Arterial hypertension

Arterial hypertension- This chronic illness, accompanied by a persistent increase in blood pressure above acceptable limits ( systolic pressure above 139 mm Hg. or/and diastolic pressure above 89 mmHg).

In approximately one in ten hypertensive patients, high blood pressure is caused by damage to an organ. In these cases we talk about secondary or symptomatic hypertension. About 90% of patients suffer from primary or essential hypertension. The starting point for high blood pressure is at least a level of 139/89 mm Hg registered by a doctor three times. Art. and more in people not taking medications to lower blood pressure. It is important to note that a slight, even persistent increase in blood pressure does not mean the presence of the disease. If in this situation you do not have other risk factors and signs of target organ damage, hypertension at this stage is potentially treatable. However, without your interest and participation it is impossible to lower blood pressure. The question immediately arises: is it worth taking seriously? arterial hypertension, if I feel quite good? The answer to this question is clear: yes.

Arterial pressure

To understand what blood pressure is, let’s first understand some numbers and “dance” from them. It is known that total blood in the body makes up 6–8% of body weight. Using a simple calculation, you can easily find out the blood volume of each person. So, with a weight of 75 kilograms, the blood volume is 4.5 - 6 liters. And all of it is enclosed in a system of vessels communicating with each other. So, when the heart contracts, blood moves along blood vessels, puts pressure on the wall of the arteries, and this pressure is called arterial pressure. Blood pressure helps move blood through the vessels. There are two indicators of blood pressure:

Systolic blood pressure (SBP), also called “upper”, reflects the pressure in the arteries that is created when the heart contracts and releases blood into the arterial part of the vascular system;

Diastolic blood pressure (DBP), also called “lower,” reflects the pressure in the arteries at the moment the heart relaxes, during which it fills before the next contraction. Both systolic blood pressure and diastolic blood pressure are measured in millimeters of mercury (mmHg).

How to measure blood pressure correctly

You can measure your blood pressure yourself using special devices - so-called “tonometers”. Measuring blood pressure at home provides valuable information. Additional information, as in initial examination the patient, and with further monitoring of the effectiveness of treatment.

When measuring blood pressure at home, you can estimate it on different days under conditions Everyday life and eliminate the “white coat effect”. Self-monitoring of blood pressure disciplines the patient and improves adherence to treatment. Measuring your blood pressure at home can help you more accurately assess the effectiveness of treatment and potentially reduce its cost. An important factor influencing the quality of self-monitoring of blood pressure is the use of devices that comply international standards accuracy. We do not recommend using blood pressure devices on your finger or wrist. You should strictly follow the instructions for measuring blood pressure when using automatic electronic devices.

Exist mandatory rules points to be observed when measuring blood pressure:

Situation. The measurement should be carried out in a quiet, calm and comfortable stop at a comfortable temperature. You should sit in a straight-backed chair next to a desk. The height of the table should be such that when measuring blood pressure, the middle of the cuff placed on the shoulder is at the level of the heart.

Preparation for measurement and duration of rest. Blood pressure should be measured 1-2 hours after eating. You should not smoke or drink coffee for 1 hour before measurement. You should not be wearing tight, constricting clothing. The arm on which blood pressure will be measured must be bare. You should sit leaning against the back of a chair with relaxed, uncrossed legs. It is not recommended to talk while taking measurements, as this may affect your blood pressure levels. Blood pressure measurements should be taken after at least 5 minutes of rest.

Cuff size. The cuff width should be sufficient. The use of a narrow or short cuff leads to a significant false increase in blood pressure.

Cuff position. Determine with your fingers the pulsation of the brachial artery at the level of the middle of the shoulder. The center of the cuff balloon should be located exactly above the palpable artery. The bottom edge of the cuff should be 2.5 cm above the cubital fossa. Cuff tightness: a finger should fit between the cuff and the surface of the patient's shoulder.

How much to pump? Determining the maximum level of air injection into the cuff is necessary for precise definition systolic blood pressure with minimal discomfort for the patient, avoiding “auscultation failure”:

• determine the pulsation of the radial artery, the nature and rhythm of the pulse
• continuing to palpate radial artery, quickly inflate the cuff to 60 mmHg. Art., then pump 10 mm Hg. Art. until the pulsation disappears
• The air from the cuff should be deflated at a speed of 2 mmHg. Art. per second. The level of blood pressure at which the pulse appears again is recorded
• completely deflate the cuff. To determine the level of maximum air injection into the cuff, the value of systolic blood pressure determined by palpation is increased by 30 mm Hg. Art.

Stethoscope position. Using your fingers, you determine the point of maximum pulsation of the brachial artery, which is usually located immediately above the cubital fossa on inner surface shoulder The membrane of the stethoscope should be in full contact with the surface of the shoulder. Too much pressure with the stethoscope should be avoided, and the head of the stethoscope should not touch the cuff or tubes.

Inflating and deflating the cuff. Inflation of air into the cuff to the maximum level should be carried out quickly. Air is released from the cuff at a rate of 2 mmHg. Art. per second until the appearance of tones (“dull blows”) and then continue to be released at the same speed until the sounds disappear completely. The first sounds correspond to systolic blood pressure, the disappearance of sounds (last sound) corresponds to diastolic blood pressure.

Repeated measurements. Data obtained once are not true: repeated blood pressure measurements must be taken (at least twice with an interval of 3 minutes, then calculated average value). It is necessary to measure blood pressure in both the right and left arms.

Symptoms of arterial hypertension

Clinic, i.e. manifestations hypertension has no specific symptoms. Patients may not know about their illness for many years, have no complaints, and have high vital activity, although sometimes they may experience attacks of “lightheadedness,” severe weakness and dizziness. But even then everyone believes that it is due to overwork. Although it is at this moment that you need to think about blood pressure and measure it. Complaints with hypertension arise when the so-called target organs are affected; these are the organs that are most sensitive to increases in blood pressure. The patient experiences dizziness, headaches, noise in the head, decreased memory and performance indicate initial changes cerebral circulation. This is then followed by double vision, flickering spots, weakness, numbness of the limbs, difficulty speaking, but initial stage changes in blood circulation are intermittent. An advanced stage of arterial hypertension can be complicated by cerebral infarction or cerebral hemorrhage. The earliest and most permanent sign of constantly elevated blood pressure is an increase, or hypertrophy, of the left ventricle of the heart, with an increase in its mass due to the thickening of heart cells, cardiomyocytes.

First, the thickness of the wall of the left ventricle increases, and subsequently the expansion of this chamber of the heart occurs. Need to pay close attention that left ventricular hypertrophy is an unfavorable prognostic sign. A number of epidemiological studies have shown that the occurrence of left ventricular hypertrophy significantly increases the risk of developing sudden death, IHD, heart failure, ventricular arrhythmias. Progressive dysfunction of the left ventricle leads to the appearance of symptoms such as: shortness of breath on exertion, paroxysmal nocturnal dyspnea (cardiac asthma), pulmonary edema (often during crises), chronic (congestive) heart failure. Against this background, they develop more often myocardial infarction, ventricular fibrillation.

For rough morphological changes in the aorta (atherosclerosis), it expands, and its dissection and rupture may occur. Kidney damage is expressed by the presence of protein in the urine, microhematuria, and cylindruria. However renal failure for hypertension, if not malignant course, rarely develops. Eye damage can manifest itself as blurred vision, decreased light sensitivity, and development of blindness. Thus, it is clear that hypertension should be treated more carefully.

So, what are the manifestations of hypertension?

Headache, which with further progression of the disease remains one of the main manifestations of arterial hypertension. Headache does not have a clear connection with the time of day; it can occur at any time of the day, but usually at night or early in the morning, after waking up. It feels like heaviness or fullness in the back of the head and can affect other areas of the head. Typically, patients describe headaches due to arterial hypertension as a feeling of a “hoop.” Sometimes the pain intensifies when severe cough, tilting the head, straining, may be accompanied slight swelling eyelids, faces. Improving venous outflow (vertical position of the patient, muscle activity, massage, etc.) is usually accompanied by a decrease or disappearance of headaches.

Headache with increased blood pressure can be caused by tension in the muscles of the soft integument of the head or the tendon helmet of the head. It occurs against the background of pronounced psycho-emotional or physical stress and subsides after rest and resolution conflict situations. In this case, they speak of a tension headache, which is also manifested by a feeling of squeezing or tightening of the head with a “bandage” or “hoop”, and may be accompanied by nausea and dizziness. Long-term continuous pain leads to irritability, short temper, hypersensitivity to external stimuli (loud music, noise).

Pain in the heart area with arterial hypertension differ from typical attacks of angina:

• localized in the area of ​​the apex of the heart or to the left of the sternum;
• occur at rest or during emotional stress;
• usually not provoked by physical activity;
• last long enough (minutes, hours);
• are not relieved by nitroglycerin.

Shortness of breath, which occurs in patients with hypertension, first during physical activity and then at rest, may indicate significant damage to the heart muscle and the development of heart failure.

Swelling of the legs may indicate the presence of heart failure. However, moderate peripheral edema in arterial hypertension may be associated with sodium and water retention due to impaired renal excretory function or the use of certain medications.

Visual impairment typical for patients with arterial hypertension. Often, when blood pressure rises, fog, a veil, or flickering “flies” appear before the eyes. These symptoms are mainly associated with functional disorders blood circulation in the retina. Severe changes in the retina (vascular thrombosis, hemorrhages, retinal detachment) can be accompanied by a significant decrease in vision, double vision (diplopia) and even total loss vision.

Risk factors for arterial hypertension

Absolutely for all diseases internal organs There are both modifiable or modifiable and non-modifiable or non-modifiable risk factors for development. Arterial hypertension is no exception. For its development, there are factors that we can influence - modifiable and risk factors that we cannot influence - non-modifiable. Let's dot the i's.

Unchangeable risk factors include:

N heredity- people who have relatives with hypertension are most predisposed to developing this pathology.

Male gender - it has been established that the incidence of men arterial hypertension significantly higher than the incidence of women. But the fact is that lovely ladies are “protected” by female sex hormones, estrogens, which prevent the development of hypertension. But such protection, unfortunately, is short-lived. Coming menopause, the saving effect of estrogens ends and women become equal in morbidity to men and often overtake them.

Modifiable risk factors include:

P increased body weight- in people with overweight body, the risk of developing arterial hypertension is higher;

M sedentary lifestyle- in other words, physical inactivity, sedentary image life and low physical activity lead to obesity, which in turn contributes to the development of hypertension;

U alcohol consumption– overuse alcohol promotes arterial hypertension. As for alcohol, it is better not to drink at all alcoholic drinks. There is already a sufficient amount of ethyl alcohol produced in the body. Yes, drinking red wine, according to researchers, really has a beneficial effect on cardiovascular system. But with frequent consumption of wine under the guise of getting rid of and preventing arterial hypertension, you can easily acquire another disease - alcoholism. Getting rid of the latter is much more difficult than getting rid of high blood pressure.

U consuming a lot of salt in food– A high-salt diet increases blood pressure. Here the question arises: how much salt can you consume per day? The answer is short: 4.5 grams or a level teaspoon.

N unbalanced diet with an excess of atherogenic lipids, excess calories, leading to obesity and contributing to the progression of type II diabetes. Atherogenic, i.e., literally, “creating atherosclerosis” lipids are contained in large quantities in all animal fats, meat, especially pork and lamb.

Urine is another variable and dangerous factor in the development of arterial hypertension and its complications. The fact is that tobacco substances, including nicotine, create a constant spasm of the arteries, which, when consolidated, leads to stiffness of the arteries, which entails an increase in pressure in the vessels.

From stress – lead to activation of the sympathetic nervous system, which performs the function of an instant activator of all body systems, including the cardiovascular system. In addition, pressor hormones, i.e., those that cause spasm of the arteries, are released into the blood. All this, as with smoking, leads to stiffness of the arteries and arterial hypertension develops.

G general sleep disorders such as sleep apnea syndrome, or snoring. Snoring is truly the scourge of almost all men and many women. Why is snoring dangerous? The fact is that it causes an increase in pressure in the chest and abdominal cavity. All this is reflected in the blood vessels, leading to their spasm. Arterial hypertension develops.

Causes of arterial hypertension

The cause of the disease remains unknown in 90-95% of patients - this is essential(i.e. primary) arterial hypertension. In 5-10% of cases, an increase in blood pressure has established cause- This symptomatic(or secondary) hypertension.

Causes of symptomatic (secondary) arterial hypertension:

• Primary kidney damage (glomerulonephritis) is the most common cause of secondary arterial hypertension.
• unilateral or bilateral narrowing (stenosis) of the renal arteries.
• coarctation (congenital narrowing) of the aorta.
• pheochromocytoma (tumor of the adrenal glands that produces adrenaline and norepinephrine).
• hyperaldosteronism (tumor of the adrenal gland that produces aldosterone).
• thyrotoxicosis (increased thyroid function).
• consumption of ethanol (wine alcohol) more than 60 ml per day.
• medicines: hormonal drugs(including oral contraceptives), antidepressants, cocaine and others.

Note. In older people it is often observed isolated systolic arterial hypertension (systolic pressure > 140 mm Hg and diastolic pressure< 90 мм рт.ст.), что обусловлено снижением упругости сосудов.

Risk factors for cardiovascular complications in arterial hypertension

Basic:

• men over 55 years old;
• women over 65 years of age;
• total blood cholesterol level > 6.5 mmol/l, increased levels of low-density lipoprotein cholesterol (> 4.0 mmol/l) and low level lipoprotein cholesterol high density;
• family history of early cardiovascular diseases(among women< 65 лет, у мужчин < 55 лет);
• abdominal obesity (waist circumference ≥102 cm for men or ≥88 cm for women);
• level of C-reactive protein in the blood ≥1 mg/dl;
• diabetes mellitus (fasting blood glucose > 7 mmol/l).

Additional:

• impaired glucose tolerance;
• low physical activity;
• increased fibrinogen levels.

Note: The accuracy of determining the overall cardiovascular risk directly depends on how complete the clinical and instrumental examination of the patient was.

Consequences of arterial hypertension

Many people have asymptomatic hypertension. However, if arterial hypertension If not treated, it is fraught with serious complications. One of the most important manifestations of hypertension is damage to target organs, which include:

• Heart (left ventricular myocardial hypertrophy, myocardial infarction, development of heart failure);
• brain (dyscirculatory encephalopathy, hemorrhagic and ischemic strokes, transient ischemic attack);
• kidneys (nephrosclerosis, renal failure);
• vessels (dissecting aortic aneurysm, etc.).

Complications of arterial hypertension

The most significant complications of arterial hypertension include

• hypertensive crises,
• cerebrovascular accidents (hemorrhagic or ischemic strokes),
• myocardial infarction,
• nephrosclerosis (primarily shriveled kidney),
• heart failure,
• dissecting aortic aneurysm.

Hypertensive crisis

Hypertensive crisis- this is a sudden increase in blood pressure, accompanied by a significant deterioration in cerebral, coronary, and renal circulation, which significantly increases the risk of severe cardiovascular vascular complications: stroke, myocardial infarction, subarachnoid hemorrhage, aortic wall dissection, pulmonary edema, acute renal failure.

They arise under the influence of expressed psycho-emotional stress, alcoholic excesses, inadequate treatment of arterial hypertension, discontinuation of medications, excessive salt consumption, the influence of meteorological factors.

During a crisis, there is excitement, anxiety, fear, tachycardia, and a feeling of lack of air. Characteristic feeling “ internal trembling”, cold sweat, goose bumps, hand tremors, redness of the face. Impairment of cerebral blood flow is manifested by dizziness, nausea, and single vomiting. Weakness in the limbs, numbness of the lips and tongue, and speech impairment are often observed. In severe cases, signs of heart failure (shortness of breath, suffocation), unstable angina (chest pain) or other vascular complications appear.

Note. Hypertensive crises can develop at any stage of the disease. The development of repeated hypertensive crises in a patient with arterial hypertension often indicates the inadequacy of the therapy.

Malignant arterial hypertension

Malignant arterial hypertension is a syndrome characterized high numbers blood pressure, rapid progression of organic changes in target organs (heart, brain, kidneys, aorta) and resistance to therapy. The syndrome of malignant arterial hypertension develops in approximately 0.5–1.0% of patients, more often in men aged 40–50 years.

Prognosis of malignant syndrome arterial hypertension extremely serious. In the absence of adequate treatment, about 70–80% of patients die within 1 year. The most common cause of death is hemorrhagic stroke, chronic renal and heart failure, dissecting aortic aneurysm. Active modern treatment makes it possible to reduce the mortality rate of this category of patients several times. As a result, about half of patients survive for 5 years.

Blood pressure measurement

The following conditions are important for measuring blood pressure:

1. Patient position:
   • Sitting in a comfortable position; hand on the table;
   • The cuff is placed on the shoulder at the level of the heart, its lower edge 2 cm above the elbow.

2. Circumstances:

   • Avoid drinking coffee and strong tea within 1 hour before the test;
   • do not smoke for 30 minutes before measuring blood pressure;
   • discontinuation of sympathomimetics (medicines that increase blood pressure), including nasal and eye drops;
   • Blood pressure is measured at rest after a 5-minute rest. If the procedure for measuring blood pressure was preceded by significant physical or emotional stress, the rest period should be increased to 15-30 minutes.

3. Equipment:

   • The size of the cuff must correspond to the size of the arm: the rubber inflated part of the cuff must cover at least 80% of the circumference of the arm; for adults, a cuff 12-13 cm wide and 30-35 cm long is used ( the average size);
   • The mercury column or tonometer needle must be at zero before starting the measurement.

4. Measurement ratio:

   • to assess the blood pressure level in each arm, at least two measurements should be taken, with an interval of at least a minute; with a difference ≥ 5 mm Hg. make 1 additional measurement; the final (recorded) value is taken to be the average of the last two measurements;
   • To diagnose the disease, at least 2 measurements must be taken with a difference of at least a week.

5. Measuring technique:

   • quickly inflate the cuff to a pressure level of 20 mm Hg. exceeding systolic (upper) blood pressure (by disappearance of the pulse);
   • blood pressure is measured with an accuracy of 2 mm Hg. Art.
   • reduce the pressure in the cuff by 2 mm Hg. per second.
   • the pressure level at which the first sound appears corresponds to systolic (upper) blood pressure;
   • the pressure level at which sounds disappear - diastolic blood pressure;
   • if the tones are very weak, then you should raise your hand and perform several squeezing movements with the brush; then the measurement is repeated; you should not strongly compress the artery with the membrane of the phonendoscope;
   • The first time you should measure the pressure on both arms. Subsequent measurements are made on the arm where the blood pressure level is higher;
   • It is advisable to measure pressure in the legs, especially in patients< 30 лет; измерять артериальное давление на ногах желательно с помощью широкой манжеты (той же, что и у лиц с ожирением); фонендоскоп располагается в подколенной ямке.

Studies for arterial hypertension

All patients with arterial hypertension the following studies need to be carried out:

1. general blood and urine analysis;
2. creatinine level in the blood (to exclude kidney damage);
3. level of potassium in the blood without taking diuretics ( a sharp decline potassium level is suspicious for the presence of an adrenal tumor or stenosis renal artery);
4. electrocardiogram (signs of left ventricular hypertrophy - evidence long term arterial hypertension);
5. determination of blood glucose levels (fasting);
6. 6) the content of total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides in the blood serum, uric acid;
7. echocardiography (determining the degree of left ventricular myocardial hypertrophy and the state of cardiac contractility)
8. fundus examination.

• chest x-ray;
• Ultrasound of the kidneys and adrenal glands;
• Ultrasound of the brachiocephalic and renal arteries;
• Serum C-reactive protein;
• urine test for bacteria (bacteriuria), quantification protein in the urine (proteinuria);
• determination of microalbumin in urine (required in the presence of diabetes mellitus).

In-Depth Study:

• grade functional state cerebral blood flow, myocardium, kidneys;
• study of blood concentrations of aldosterone, corticosteroids, renin activity; determination of catecholamines and their metabolites in daily urine; abdominal aortography; computed tomography or magnetic resonance imaging of the adrenal glands and brain.

Degree of arterial hypertension

Classification of blood pressure levels (mm Hg)

	Systolic blood pressure	Diastolic blood pressure
Optimal blood pressure
Normal blood pressure
High normal blood pressure
Arterial hypertension I degree (mild)
Arterial hypertension II degree (moderate)
Arterial hypertension III degree (severe)
Isolated systolic arterial hypertension

Treatment of arterial hypertension

The main goal of treating patients with arterial hypertension is maximum reduction the risk of developing cardiovascular complications and death from them. This is achieved through long lifelong therapy aimed at:

• reduction in blood pressure to normal level(below 140/90 mmHg). When arterial hypertension is combined with diabetes mellitus or kidney damage, it is recommended to lower blood pressure< 130/80 мм рт.ст. (но не ниже 110/70 мм рт.ст.);
• “protection” of target organs (brain, heart, kidneys), preventing their further damage;
• active influence on unfavorable factors risk (obesity, hyperlipidemia, disorders carbohydrate metabolism, excessive salt intake, physical inactivity), contributing to the progression of arterial hypertension and the development of its complications.

Treatment of arterial hypertension should be carried out in all patients whose blood pressure level consistently exceeds 139/89 mmHg.

Non-drug treatment of arterial hypertension

Not drug treatmentarterial hypertension is aimed at eliminating or reducing the effect of risk factors that contribute to the progression of the disease and the development of complications. These measures are mandatory, regardless of the level of blood pressure, the number of risk factors and concomitant diseases.

Non-drug methods include:

• to give up smoking;
• normalization of body weight (body mass index< 25 кг/м 2);
• reducing alcohol consumption< 30 г алкоголя в сутки у мужчин и 20 г/сут у женщин;
• increasing physical activity - regular physical exercise 30-40 min. at least 4 times a week;
• reduction in consumption table salt up to 5 g/day;
• change in diet with increased consumption plant food, reducing consumption vegetable fats, an increase in the diet of potassium, calcium contained in vegetables, fruits, grains, and magnesium contained in dairy products;

How to lower blood pressure without medications

Some simple exercises for the cervical spine will help normalize blood circulation and lower blood pressure if performed systematically. It is important to do such gymnastics slowly and smoothly, without sudden movements or straining the neck. These are turning the head to the right and left, moving back and forth, alternately bending to the shoulders, raising the arms above the head.

Gymnastics that effectively reduce blood pressure

Blood pressure medications

In approximately half of patients with mild arterial hypertension (BP 140/90 - 159/99 mmHg) it is possible to achieve optimal level blood pressure only with the help of not medicinal correction risk factors. In persons with more high level blood pressure non-drug treatment carried out in parallel with the use of antihypertensive drugs, can significantly reduce drug doses and reduce the risk of side effects these medicines. Refusal to carry out non-pharmacological interventions aimed at changing lifestyle is one of the most common reasons for resistance to therapy.

Principles of drug therapy for arterial hypertension

Basic principles drug therapy arterial hypertension:

1. Drug treatment should begin with minimal doses of any class of antihypertensive drugs (taking into account relevant contraindications), gradually increasing the dose until a good therapeutic effect is achieved.
2. The choice of drug must be justified; antihypertensive drug should provide a stable effect throughout the day and be well tolerated by patients.
3. The most appropriate use of drugs long acting to achieve a 24-hour effect with a single dose. The use of such drugs provides a milder hypotensive effect with more intensive protection of target organs.
4. If monotherapy (therapy with one drug) is ineffective, it is advisable to use optimal combinations of drugs to achieve maximum hypotensive effect and minimal side effects.
5. Should be implemented long(almost lifelong) taking medications to maintain optimal blood pressure levels and prevent complications of arterial hypertension.

Selection of necessary medications:

Currently, seven classes of drugs are recommended for the treatment of arterial hypertension:

1. diuretics;
2. b-blockers;
3. calcium antagonists;
4. angiotensin-converting enzyme inhibitors;
5. angiotensin receptor blockers;

1. imidazoline receptor agonists;

Drug class Clinical situations in favor of use Absolute contraindications Relative contraindications Thiazide diuretics (hypothiazide) Chronic heart failure, isolated systolic arterial hypertension, arterial hypertension in the elderly Pregnancy, dyslipoproteinemia Loop diuretics (Furosemide, Uregit) Chronic renal failure, chronic heart failure Aldosterone blockers receptors (Veroshpiron) Chronic heart failure, after suffered a heart attack myocardium Hyperkalemia, chronic renal failure b-blockers (Atenolol, Concor, Egilok, etc.) Angina pectoris, after myocardial infarction, chronic heart failure (starting with low doses), pregnancy, tachyarrhythmias AV block II-III degree, BA. Atherosclerosis peripheral arteries, impaired glucose tolerance, chronic obstructive pulmonary disease, athletes and people who are physically active Dihydropyridine calcium antagonists (Corinfar, Amlodipine) Isolated systolic arterial hypertension, arterial hypertension in the elderly, angina pectoris, atherosclerosis of peripheral arteries, atherosclerosis carotid arteries, pregnancy. Tachyarrhythmias, chronic heart failure Non-dihydropyridine calcium antagonists (Verapamil, Diltiazem) Angina pectoris, atherosclerosis of the carotid arteries, supraventricular tachycardia AV block II-III degree, chronic heart failure Angiotensin-converting enzyme inhibitors (Captopril, Enalapril, Monopril, Prestarium, etc.) Chronic heart failure, after myocardial infarction, nephropathy, proteinuria Pregnancy, hyperkalemia, bilateral renal artery stenosis. Angiotensin receptor blockers (Losartan, Valsartan, Candesartan) Diabetic nephropathy in diabetes mellitus, diabetic proteinuria, left ventricular hypertrophy, cough caused by angiotensin-converting enzyme inhibitors Pregnancy, hyperkalemia, bilateral renal stenosis arteries α-blockers (Prazosin) Benign prostatic hyperplasia, dyslipoproteinemia Orthostatic hypotension Chronic heart failure Imidazoline receptor agonists (Physiotens) Metabolic syndrome, diabetes Severe heart failure, AV block II-III degree

Reasons for resistance (refractoriness) of arterial hypertension to therapy

Refractory or treatment-resistant arterial hypertension is called arterial hypertension in which the prescribed treatment - lifestyle changes and rational combination therapy using adequate doses of at least three drugs, including diuretics, does not lead to a sufficient reduction in blood pressure.

The main causes of refractory hypertension:

• undetected secondary forms of arterial hypertension;
• lack of adherence to treatment;
• continued use of medications that increase blood pressure;
• violation of recommendations for lifestyle changes: weight gain, alcohol abuse, continued smoking;
• volume overload caused by for the following reasons: inadequate diuretic therapy, progression of chronic renal failure, excessive consumption of table salt;

Pseudo-resistance:

• isolated office arterial hypertension (“white coat hypertension”);
• using a cuff of the wrong size when measuring blood pressure.

Cases of hospitalization for arterial hypertension

Indications for hospitalization of patients with arterial hypertension are:

• uncertainty of diagnosis and the need for special, often invasive, research methods to clarify the form of arterial hypertension;
• difficulties in selecting drug therapy - frequent hypertensive crises, refractory arterial hypertension.

Indications for emergency hospitalization:

• Hypertensive crisis that does not respond to prehospital stage;
• Hypertensive crisis with severe manifestations of hypertensive encephalopathy (nausea, vomiting, confusion);
• complications of hypertension requiring intensive care and constant medical supervision: cerebral stroke, subarachnoid hemorrhage, acute visual impairment, pulmonary edema, etc.

Emergency treatment for arterial hypertension

If the rise in blood pressure is accompanied by the following symptoms:

• severe chest pain of a pressing nature (possibly unstable angina, acute myocardial infarction),
• increase in shortness of breath, worsening in a horizontal position (possibly acute heart failure),
• severe dizziness, nausea, vomiting, speech impairment or impaired mobility of limbs (possibly acute cerebrovascular accident),
• blurred vision, double vision (possibly retinal vascular thrombosis),

need to seek emergency medical care to carry out an immediate (within minutes and hours) reduction in blood pressure using parenterally administered drugs (vasodilators, diuretics, ganglion blockers, antipsychotics).

Note. Blood pressure should be reduced by 25% in the first 2 hours and to 160/100 mm Hg. over the next 2 - 6 hours. Blood pressure should not be reduced too quickly to avoid ischemia of the brain, kidneys and myocardium. If the blood pressure level is > 180/120 mm Hg. it should be measured every 15 - 30 minutes.

Actions when sharp increase blood pressure:

A sharp increase in blood pressure, not accompanied by the appearance of symptoms from other organs, can be stopped by oral or sublingual (under the tongue) administration of drugs with relatively quick action. These include

• Anaprilin (a group of β-blockers, usually if a rise in blood pressure is accompanied by tachycardia),
• Nifedipine (its analogues - Corinfar, Cordaflex, Cordipin) (a group of calcium antagonists),
• Captopril (a group of angiotensin-converting enzyme inhibitors),
• Clonidine (its analogue is Clonidine) and others.

Symptomatic arterial hypertension– a secondary hypertensive condition that develops as a result of pathology of the organs that regulate blood pressure. Symptomatic arterial hypertension is distinguished by its persistent course and resistance to antihypertensive therapy, the development of pronounced changes in target organs (heart and kidney failure, hypertensive encephalopathy, etc.). Determining the causes arterial hypertension requires ultrasound, angiography, CT, MRI (kidneys, adrenal glands, heart, brain), research biochemical parameters and blood hormones, blood pressure monitoring. Treatment consists of medication or surgery to address the underlying cause.

General information

Unlike independent essential (primary) hypertension, secondary arterial hypertension serves as symptoms of the diseases that cause them. Arterial hypertension syndrome accompanies the course of over 50 diseases. Among total number hypertensive conditions, the proportion of symptomatic arterial hypertension is about 10%. The course of symptomatic arterial hypertension is characterized by signs that allow them to be differentiated from essential hypertension (hypertension):

• The age of patients is up to 20 years and over 60 years;
• Sudden development of arterial hypertension with persistently high blood pressure levels;
• Malignant, rapidly progressing course;
• Development of sympathoadrenal crises;
• A history of etiological diseases;
• Poor response to standard therapy;
• Increased diastolic pressure in renal arterial hypertension.

Classification

According to the primary etiological link, symptomatic arterial hypertension is divided into:

Neurogenic(caused by diseases and lesions of the central nervous system):

• central (trauma, brain tumors, meningitis, encephalitis, stroke, etc.)
• peripheral (polyneuropathies)

Nephrogenic(renal):

• interstitial and parenchymal (chronic pyelonephritis, glomerulonephritis, amyloidosis, nephrosclerosis, hydronephrosis, systemic lupus erythematosus, polycystic disease)
• renovascular (atherosclerosis, renal vascular dysplasia, vasculitis, thrombosis, renal artery aneurysms, tumors compressing the renal vessels)
• mixed (nephroptosis, congenital anomalies of the kidneys and blood vessels)
• renoprinic (condition after kidney removal)

Endocrine:

• adrenal (pheochromocytoma, Conn's syndrome, adrenal hyperplasia)
• thyroid (hypothyroidism, thyrotoxicosis) and parathyroid
• pituitary (acromegaly, Itsenko-Cushing's disease)
• menopausal

Hemodynamic(caused by damage to the great vessels and heart):

• aortosclerosis
• stenosis of the vertebrobasilar and carotid arteries
• caorctation of the aorta

Dosage forms when taking mineralo- and glucocorticoids, progesterone- and estrogen-containing contraceptives, levothyroxine, salts heavy metals, indomethacin, licorice powder, etc.

Depending on the magnitude and persistence of blood pressure, the severity of left ventricular hypertrophy, and the nature of changes in the fundus, 4 forms of symptomatic arterial hypertension are distinguished: transient, labile, stable and malignant.

Transient arterial hypertension is characterized by an unstable increase in blood pressure, changes in the fundus vessels are absent, and left ventricular hypertrophy is practically undetectable. With labile arterial hypertension, there is a moderate and unstable increase in blood pressure that does not decrease on its own. There is mild hypertrophy of the left ventricle and narrowing of retinal vessels.

Stable arterial hypertension is characterized by persistent and high blood pressure, myocardial hypertrophy and pronounced vascular changes fundus (angioretinopathy I - II degrees). Malignant arterial hypertension is distinguished by sharply increased and stable blood pressure (especially diastolic > 120-130 mm Hg), sudden onset, fast development, the risk of severe vascular complications from the heart, brain, fundus, determining poor prognosis.

Forms

Nephrogenic parenchymal arterial hypertension

Most often, symptomatic arterial hypertension is of nephrogenic (renal) origin and is observed in acute and chronic glomerulonephritis, chronic pyelonephritis, polycystic and hypoplastic kidneys, gouty and diabetic nephropathy, trauma and renal tuberculosis, amyloidosis, SLE, tumors, nephrolithiasis.

The initial stages of these diseases usually occur without arterial hypertension. Hypertension develops with severe damage to the tissue or apparatus of the kidneys. Features of renal arterial hypertension are predominantly the young age of patients, the absence of cerebral and coronary complications, the development of chronic renal failure, the malignant nature of the course (with chronic pyelonephritis– in 12.2%, chronic glomerulonephritis– in 11.5% of cases).

In the diagnosis of parenchymal renal hypertension use ultrasound of the kidneys, urine examination (proteinuria, hematuria, cylindruria, pyuria, hyposthenuria - low specific gravity of urine are detected), determination of creatinine and urea in the blood (azotemia is detected). To study the secretory-excretory function of the kidneys, isotope renography and urography are performed; additionally - angiography, ultrasound of renal vessels, MRI and CT of the kidneys, kidney biopsy.

Nephrogenic renovascular (vasorenal) arterial hypertension

Renovascular or vasorenal arterial hypertension develops as a result of unilateral or bilateral disturbances of arterial renal blood flow. In 2/3 of patients, the cause of renovascular arterial hypertension is atherosclerotic damage to the renal arteries. Hypertension develops when the lumen of the renal artery narrows by 70% or more. Systolic blood pressure is always above 160 mm Hg, diastolic blood pressure is always above 100 mm Hg.

Renovascular hypertension is characterized by sudden onset or sharp deterioration flow, insensitivity to drug therapy, high proportion of malignant course (in 25% of patients).

Diagnostic signs of vasorenal arterial hypertension are: systolic murmurs over the projection of the renal artery, determined by ultrasonography and urography - a decrease in one kidney, a slowdown in the removal of contrast. Ultrasound shows echoscopic signs of asymmetry in the shape and size of the kidneys, exceeding 1.5 cm. Angiography reveals a concentric narrowing of the affected renal artery. Duplex ultrasound scanning of the renal arteries determines a violation of the main renal blood flow.

In the absence of treatment for renovascular arterial hypertension, the 5-year survival rate of patients is about 30%. Most common reasons death of patients: cerebral strokes, myocardial infarction, acute renal failure. In the treatment of vasorenal arterial hypertension, both drug therapy and surgical techniques are used: angioplasty, stenting, traditional operations.

With significant stenosis long-term use drug therapy is unjustified. Drug therapy gives a short and inconsistent effect. The main treatment is surgical or endovascular. For vasorenal arterial hypertension, an intravascular stent is installed to expand the lumen of the renal artery and prevent its narrowing; balloon dilatation of a narrowed section of a vessel; reconstructive interventions on the renal artery: resection with anastomosis, prosthetics, vascular bypass anastomoses.

Pheochromocytoma

Pheochromocytoma, a hormone-producing tumor that develops from chromaffin cells of the adrenal medulla, accounts for 0.2% to 0.4% of all occurring forms of symptomatic arterial hypertension. Pheochromocytomas secrete catecholamines: norepinephrine, adrenaline, dopamine. Their course is accompanied by arterial hypertension, with periodically developing hypertensive crises. In addition to hypertension, pheochromocytomas cause severe headaches, increased sweating and heartbeat.

Pheochromocytoma is diagnosed when detected high content catecholamines in the urine, by conducting diagnostic pharmacological tests (tests with histamine, tyramine, glucagon, clonidine, etc.). Ultrasound, MRI or CT scan of the adrenal glands allows you to clarify the location of the tumor. By performing a radioisotope scan of the adrenal glands, it is possible to determine the hormonal activity of pheochromocytoma, identify tumors of extra-adrenal localization, and metastases.

Pheochromocytomas are treated exclusively with surgery; before surgery, arterial hypertension is corrected with α- or β-adrenergic blockers.

Primary aldosteronism

Arterial hypertension in Conn's syndrome or primary hyperaldosteronism is caused by an aldosterone-producing adenoma of the adrenal cortex. Aldosterone promotes the redistribution of K and Na ions in cells, fluid retention in the body and the development of hypokalemia and arterial hypertension.

Hypertension is practically not amenable to drug correction; attacks of myasthenia gravis, convulsions, paresthesia, thirst, and nictruria are noted. Hypertensive crises with the development of acute left ventricular failure (cardiac asthma, pulmonary edema), stroke, and hypokalemic cardiac paralysis are possible.

Diagnosis of primary aldosteronism is based on determining plasma levels of aldosterone and electrolytes (potassium, chlorine, sodium). Noted high concentration aldosterone in the blood and its high excretion in the urine, metabolic alkalosis (blood pH - 7.46-7.60), hypokalemia (<3 ммоль/л), гипохлоремия, гипернатриемия. При исследовании крови из надпочечниковых вен обнаруживается 2-3-кратное увеличение уровня альдостерона со стороны поражения. Проведение радиоизотопного исследования и ультразвукового сканирования надпочечников выявляет увеличение пораженного альдостеромой надпочечника или двустороннюю гиперплазию коры надпочечников.

For malignant arterial hypertension caused by aldosteroma, surgical treatment is performed to normalize or significantly reduce blood pressure in 50-70% of patients. Before surgical intervention, a hyposodium diet is prescribed, treatment with an aldosterone antagonist - spironolactone, which relieves hypokalemia and arterial hypertension (25-100 mg every 8 hours).

Itsenko-Cushing's syndrome and disease

Endocrine arterial hypertension develops in 80% of patients with the disease and Cushing's syndrome. Hypertension is caused by hypersecretion of glucocorticoid hormones by the adrenal cortex (hypercortisolism) and is characterized by a stable, crisis-free course, resistance to antihypertensive therapy, and a proportional increase in systolic and diastolic blood pressure. Another characteristic manifestation of the disease is Cushingoid obesity.

With Itsenko-Cushing's syndrome/disease, the level of 11 and 17-OCS, corticotropin, and hydrocortisone increases in the blood. Excretion of 17-KS and 17-OX is increased in urine. For differential diagnosis between corticosteroma and pituitary adenoma, MRI and CT scanning of the adrenal glands, pituitary gland, ultrasound and radioisotope scanning of the adrenal glands, and craniogram are performed. Treatment of hypercortisolism and the arterial hypertension caused by it can be medication, surgery or radiation.

Coarctation of the aorta

Coarctation of the aorta is a congenital malformation of the aorta, manifested by its segmental narrowing, which impedes systemic blood flow. Coarctation of the aorta is a rare form of hypertension.

With secondary arterial hypertension caused by coarctation of the aorta, there is a difference in blood pressure measured in the arms (high) and legs (normal or low), an increase in blood pressure at the age of 1-5 years and its stabilization after 15 years, weakening or absence of pulsation in the femoral arteries , increased cardiac impulse, systolic murmurs over the apex, base of the heart, and on the carotid arteries. The diagnosis of coarctation of the aorta is based on radiography of the lungs and chest organs, aortography, and echocardiography. If the degree of stenosis is severe, surgical treatment is performed.

Dosage forms of arterial hypertension

The development of medicinal forms of arterial hypertension can cause vascular spasm, increased blood viscosity, sodium and water retention, the effect of drugs on the renin-angiotensin system, etc. Intranasal drops and cold remedies containing adrenomimetics and sympathomimetics in their composition (pseudoephedrine, ephedrine , phenylephrine) may cause hypertension.

Taking non-steroidal anti-inflammatory drugs causes the development of arterial hypertension due to fluid retention and suppression of the synthesis of prostaglandins, which have a vasodilating effect. Oral contraceptives containing estrogens have a stimulating effect on the renin-angiotensin system and cause fluid retention. Secondary arterial hypertension develops in 5% of women using oral contraception.

The stimulating effect of tricyclic antidepressants on the sympathetic nervous system can cause the development of arterial hypertension. The use of glucocorticoids increases blood pressure due to increased vascular reactivity to angiotensin II.

To establish the cause and form of secondary arterial hypertension, the cardiologist needs a detailed collection of the patient’s medical history, analysis of the coagulogram, and determination of blood renin.

Neurogenic arterial hypertension

Arterial hypertension of the neurogenic type is caused by lesions of the brain or spinal cord due to encephalitis, tumors, ischemia, traumatic brain injury, etc. In addition to increased blood pressure, they are typically characterized by severe headaches and dizziness, tachycardia, sweating, salivation, vasomotor skin reactions, abdominal pain, nystagmus, convulsive seizures.

Diagnostics include angiography of cerebral vessels, CT and MRI of the brain, and EEG. Treatment of arterial hypertension of the neurogenic type is aimed at eliminating brain pathology.

Arterial hypertension (arterial hypertension) is a prolonged increase in blood pressure greater than 140/90 mm Hg. It can lead to the development of heart attacks and. However, by changing your lifestyle, giving up bad habits and taking medications prescribed by your doctor, you can normalize your blood pressure and reduce the risk of complications.

Causes

Arterial hypertension can be a symptom of certain diseases (secondary arterial hypertension) or an independent disease ─ hypertension.

The exact causes of hypertension are unknown, but factors that contribute to its development have been identified:

• Heredity

Some people already have a predisposition to the disease in their genes, but it does not always develop. It can be avoided by controlling the factors listed below.

• Excess body weight

We are not talking about weight, but about body mass index (BMI). It is calculated taking into account height and weight. If your BMI is higher than normal, then you should consider losing weight to reduce the risk of hypertension, as well as other diseases.

• Excessive consumption of table salt

Eating foods with a lot of salt increases blood pressure.

Smoking leads to thickening of the walls of blood vessels, and also increases the risk of heart attacks and strokes.

• Alcohol

Increased blood pressure is associated with alcohol consumption. Drinking more than one glass of wine or one bottle of beer per day can lead to high blood pressure.

• Passive lifestyle

Blood pressure increases in people who move little. Daily half-hour walks can reduce the risk of hypertension.

• Stress

Conflicts, worries, work overload, lack of rest and sleep can lead to increased blood pressure.

Secondary arterial hypertension occurs in many diseases:

• Kidney diseases
• Adrenal diseases
• Hormonal disorders
• Vascular diseases
• Obstructive sleep apnea syndrome
• Taking certain medications

Tests prescribed by your doctor will help determine the cause of the increase in blood pressure. This could be blood or more complex studies. In each case the approach is individual.

Symptoms of arterial hypertension

There is no increase in blood pressure. Flashing spots before the eyes or pain in the back of the head, which are often written about, are not symptoms of arterial hypertension. The only way to identify it is to periodically measure your blood pressure.

Complications

What can you do

It is important not only to take medications, but also to change your lifestyle.

• Try to adjust your weight in accordance with BMI standards.
• Give preference to fruits, vegetables, seafood and limit the consumption of animal fats and fast carbohydrates (cakes, cookies, etc.).
• You should not eat foods with a high salt content (smoked meats, canned food, semi-finished products, etc.) You should try to reduce your salt intake to 5 grams per day (half a teaspoon).
• You need to try to quit smoking.
• Alcohol should be consumed in moderation.
• Need to move more. Spend at least 30 minutes a day on physical activity. If possible, go swimming or ride a bike.
• It is important to avoid, do not forget to rest and get enough sleep.

It is important to take your medications as your doctor tells you to. If you think you have developed any side effects due to your treatment, do not stop it yourself, but tell your doctor.

Continue taking the medications after your blood pressure normalizes. After all, it was precisely because of taking the drugs that it returned to normal. The goal of treatment is to maintain normal blood pressure, and not to reduce high blood pressure.

Don’t forget to come to see your doctor and contact your doctor if you feel any deterioration in your health.

What your doctor can do

The doctor will examine you, determine the type of arterial hypertension, determine its severity and select the necessary treatment.

What is arterial hypertension? We will discuss the causes, diagnosis and treatment methods in the article by Dr. Zafiraki V.K., a cardiologist with 18 years of experience.

Definition of disease. Causes of the disease

Main criterion arterial hypertension (or arterial hypertension) as a whole group of diseases - stable, that is, an increase in blood pressure (BP) detected through repeated measurements on different days. The question of what kind of blood pressure is considered elevated is not as simple as it might seem. The fact is that among practically healthy people the range of blood pressure values ​​is quite wide. The results of long-term observation of people with different blood pressure levels showed that already starting from the level of 115/75 mm Hg. Art., each additional increase in blood pressure by 10 mm Hg. Art. is accompanied by an increased risk of developing diseases of the cardiovascular system (primarily coronary heart disease and stroke). However, the benefits of modern methods of treating arterial hypertension have been proven mainly only for those patients whose blood pressure exceeded 140/90 mm Hg. Art. It is for this reason that it was agreed to consider this threshold value as a criterion for identifying arterial hypertension.

An increase in blood pressure can be accompanied by dozens of different chronic diseases, and hypertension is only one of them, but the most common: approximately 9 cases out of 10. The diagnosis of hypertension is established in cases where there is a stable increase in blood pressure, but no other diseases that lead to an increase in blood pressure, is not detected.

Hypertension is a disease for which a stable increase in blood pressure is its main manifestation. Risk factors that increase the likelihood of its development have been established through observations of large groups of people. In addition to the genetic predisposition that some people have, these risk factors include:

• obesity;
• inactivity;
• excessive consumption of table salt, alcohol;
• chronic stress;
• smoking.

In general, all those features that accompany the modern urban lifestyle in industrialized countries. This is why hypertension is considered a lifestyle disease, and targeted changes for the better should always be considered as part of a hypertension treatment program on a case-by-case basis.

What other diseases are accompanied by increased blood pressure? These are many kidney diseases (pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, stenosis (narrowing) of the renal arteries, etc.), a number of endocrine diseases (adrenal tumors, hyperthyroidism, Cushing's disease and syndrome), obstructive sleep apnea syndrome, some others, more rare diseases. Regular use of medications such as glucocorticosteroids, non-steroidal anti-inflammatory drugs, and oral contraceptives can also lead to a persistent increase in blood pressure. The diseases and conditions listed above lead to the development of so-called secondary, or symptomatic, arterial hypertension. The doctor makes a diagnosis of hypertension if, during a conversation with the patient, ascertaining the history of the disease, examination, as well as based on the results of some, mostly simple laboratory and instrumental research methods, the diagnosis of any of the secondary arterial hypertension seems unlikely.

Symptoms of arterial hypertension

High blood pressure itself does not manifest itself in any subjective sensations for many people. If high blood pressure is accompanied by symptoms, this may include a feeling of heaviness in the head, headache, flashing before the eyes, nausea, dizziness, unsteadiness when walking, as well as a number of other symptoms that are rather nonspecific for high blood pressure. The symptoms listed above manifest themselves much more clearly during a hypertensive crisis - a sudden significant increase in blood pressure, leading to a clear deterioration in condition and well-being.

It would be possible to continue to list the possible symptoms of hypertension, separated by commas, but there is no particular benefit in this. Why? Firstly, all these symptoms are non-specific for hypertension (i.e. they can occur either individually or in various combinations in other diseases), and secondly, to establish the presence of arterial hypertension, the very fact of a stable increase in blood pressure is important . And this is revealed not by assessing subjective symptoms, but only by measuring blood pressure, moreover, repeatedly. This means, firstly, that “in one sitting” one should measure blood pressure twice or three times (with a short break between measurements) and take the arithmetic mean of two or three measured values ​​as true blood pressure. Secondly, the stability of the increase in blood pressure (a criterion for diagnosing hypertension as a chronic disease) should be confirmed by measurements on different days, preferably with an interval of at least a week.

If a hypertensive crisis develops, there will definitely be symptoms, otherwise it is not a hypertensive crisis, but simply an asymptomatic increase in blood pressure. And these symptoms can be either those listed above or others, more serious - they are discussed in the “Complications” section.

Symptomatic (secondary) arterial hypertension develops as part of other diseases, and therefore their manifestations, in addition to the actual symptoms of high blood pressure (if any), depend on the underlying disease. For example, with hyperaldosteronism, this can be muscle weakness, cramps, and even transient (lasting hours - days) paralysis in the muscles of the legs, arms, and neck. With obstructive sleep apnea syndrome - snoring, sleep apnea, daytime sleepiness.

If hypertension over time - usually many years - leads to damage to various organs (in this context they are called “target organs”), then this can manifest itself as a decrease in memory and intelligence, a stroke or a transient cerebrovascular accident, an increase in the thickness of the walls of the heart, accelerated development of atherosclerotic plaques in the vessels of the heart and other organs, myocardial infarction or angina pectoris, decreased rate of blood filtration in the kidneys, etc. Accordingly, clinical manifestations will be caused by these complications, and not by increased blood pressure as such.

Pathogenesis of arterial hypertension

In hypertension, dysregulation of vascular tone and increased blood pressure are the main content of this disease, so to speak, its “quintessence”. Factors such as genetic predisposition, obesity, inactivity, excessive consumption of table salt, alcohol, chronic stress, smoking and a number of others, mainly related to lifestyle characteristics, lead over time to disruption of the functioning of the endothelium - the inner layer of arterial vessels, which is thick one cell layer that is actively involved in the regulation of tone, and therefore the lumen of blood vessels. The tone of microvasculature vessels, and hence the volume of local blood flow in organs and tissues, is autonomously regulated by the endothelium, and not directly by the central nervous system. This is a system of local blood pressure regulation. However, there are other levels of blood pressure regulation - the central nervous system, the endocrine system and the kidneys (which also realize their regulatory role largely due to the ability to participate in hormonal regulation at the level of the whole organism). Violations in these complex regulatory mechanisms lead, in general, to a decrease in the ability of the entire system to finely adapt to the constantly changing needs of organs and tissues for blood supply.

Over time, a persistent spasm of small arteries develops, and subsequently their walls change so much that they are no longer able to return to their original state. In larger vessels, due to constantly elevated blood pressure, atherosclerosis develops at an accelerated pace. The walls of the heart become thicker, myocardial hypertrophy develops, and then dilation of the cavities of the left atrium and left ventricle. Increased pressure damages the glomeruli, their number decreases and, as a result, the ability of the kidneys to filter blood decreases. In the brain, due to changes in the blood vessels supplying it, negative changes also occur - small foci of hemorrhages appear, as well as small areas of necrosis (death) of brain cells. When an atherosclerotic plaque ruptures in a sufficiently large vessel, thrombosis occurs, the lumen of the vessel is blocked, and this leads to a stroke.

Classification and stages of development of arterial hypertension

Hypertension, depending on the magnitude of elevated blood pressure, is divided into three degrees. In addition, taking into account the increase in the risk of cardiovascular diseases on a “year-decade” scale, already starting from a blood pressure level above 115/75 mm Hg. Art., there are several more gradations of blood pressure levels.

If the values ​​of systolic and diastolic blood pressure fall into different categories, then the degree of arterial hypertension is assessed by the highest of the two values, and it does not matter - systolic or diastolic. The degree of increase in blood pressure when diagnosing hypertension is determined by repeated measurements on different days.

In our country, stages of hypertension continue to be distinguished, while the European recommendations for the diagnosis and treatment of arterial hypertension do not mention any stages. The identification of stages is intended to reflect the phasing of the course of hypertension from its onset to the appearance of complications.

There are three stages:

• Stage I implies that there is still no obvious damage to those organs that are most often affected by this disease: there is no enlargement (hypertrophy) of the left ventricle of the heart, there is no significant decrease in the filtration rate in the kidneys, which is determined taking into account the level of creatinine in the blood, protein is not detected in the urine albumin, thickening of the walls of the carotid arteries or atherosclerotic plaques in them, etc. is not detected. Such damage to internal organs is usually asymptomatic.
• If there is at least one of the listed signs, diagnose Stage II hypertension.
• Finally, about Stage III hypertension is said when there is at least one cardiovascular disease with clinical manifestations associated with atherosclerosis (myocardial infarction, stroke, angina pectoris, atherosclerotic damage to the arteries of the lower extremities), or, for example, serious kidney damage, manifested by a pronounced decrease in filtration and /or significant loss of protein in the urine.

These stages do not always naturally replace one another: for example, a person suffered a myocardial infarction, and after a few years an increase in blood pressure occurred - it turns out that such a patient immediately has stage III hypertension. The purpose of staging is mainly to rank patients according to their risk of cardiovascular complications. Treatment measures also depend on this: the higher the risk, the more intensive the treatment. When formulating a diagnosis, risk is assessed in four gradations. At the same time, the 4th gradation corresponds to the greatest risk.

Complications of arterial hypertension

The goal of treatment for hypertension is not to “bring down” high blood pressure, but to maximally reduce the risk of cardiovascular and other complications in the long term, since this risk - again, when assessed on a “year-decade” scale - increases for every additional 10 mmHg Art. already from a blood pressure level of 115/75 mm Hg. Art. This refers to complications such as stroke, coronary heart disease, vascular dementia (dementia), chronic renal and chronic heart failure, atherosclerotic vascular lesions of the lower extremities.

Most patients with hypertension do not worry about anything for the time being, so they do not have much motivation to be treated, regularly taking a certain minimum of medications and changing their lifestyle to a healthier one. However, in the treatment of hypertension there are no one-time measures that would allow you to forget about this disease forever without doing anything more to treat it.

Diagnosis of arterial hypertension

With the diagnosis of arterial hypertension as such, everything is usually quite simple: this requires only repeatedly recorded blood pressure at the level of 140/90 mm Hg. Art. and higher. But hypertension and arterial hypertension are not the same thing: as already mentioned, an increase in blood pressure can manifest itself in a number of diseases, and hypertension is only one of them, although the most common. When conducting a diagnosis, the doctor, on the one hand, must verify the stability of the increase in blood pressure, and on the other hand, assess the likelihood of whether the increase in blood pressure is a manifestation of symptomatic (secondary) arterial hypertension.

To do this, at the first stage of the diagnostic search, the doctor finds out at what age blood pressure first began to rise, whether there are symptoms such as, for example, snoring with breathing stops during sleep, attacks of muscle weakness, unusual impurities in the urine, attacks of sudden heartbeat with sweating and headache. pain, etc. It makes sense to clarify what medications and dietary supplements the patient is taking, because in some cases, they can lead to an increase in blood pressure or aggravation of an already elevated one. Several routine (performed in almost all patients with high blood pressure) diagnostic tests, along with information obtained during a conversation with a doctor, help assess the likelihood of some forms of secondary hypertension: a general urine test, determination of blood concentrations of creatinine and glucose, and sometimes potassium and other electrolytes. In general, taking into account the low prevalence of secondary forms of arterial hypertension (about 10% of all its cases), further search for these diseases as a possible cause of high blood pressure must have good reasons. Therefore, if at the first stage of the diagnostic search no significant data are found in favor of the secondary nature of arterial hypertension, then in the future it is considered that blood pressure is increased due to hypertension. This judgment may sometimes be subsequently revised as new data about the patient becomes available.

In addition to searching for data on the possible secondary nature of the increase in blood pressure, the doctor determines the presence of risk factors for cardiovascular diseases (this is necessary to assess the prognosis and a more targeted search for damage to internal organs), as well as, possibly, pre-existing diseases of the cardiovascular system or their asymptomatic damage - this affects the assessment of the prognosis and stage of hypertension, the choice of therapeutic measures. For this purpose, in addition to talking with the patient and examining him, a number of diagnostic studies are performed (for example, electrocardiography, echocardiography, ultrasound examination of the vessels of the neck, and, if necessary, some other studies, the nature of which is determined by the medical data already obtained about the patient).

Daily blood pressure monitoring using special compact devices allows you to assess changes in blood pressure during the patient’s usual lifestyle. This study is not necessary in all cases - mainly, if the blood pressure measured at a doctor’s appointment differs significantly from that measured at home, if it is necessary to evaluate nighttime blood pressure, if episodes of hypotension are suspected, sometimes to assess the effectiveness of the treatment.

Thus, some diagnostic methods when examining a patient with high blood pressure are used in all cases; the use of other methods is more selective, depending on the data already obtained about the patient, to check the assumptions that the doctor made during the preliminary examination.

Treatment of arterial hypertension

With regard to non-drug measures aimed at treating hypertension, the most convincing evidence has accumulated on the positive role of reducing salt intake, reducing and maintaining body weight at this level, regular physical training (exercise), no more than moderate alcohol consumption, as well as increasing the content of vegetables and fruits in the diet. Only all these measures are effective as part of long-term changes in the unhealthy lifestyle that led to the development of hypertension. For example, a decrease in body weight by 5 kg led to a decrease in blood pressure by an average of 4.4/3.6 mm Hg. Art. - it seems like a little, but in combination with the other measures listed above to improve your lifestyle, the effect can be quite significant.

Improving lifestyle is justified for almost all patients with hypertension, but drug treatment is indicated, although not always, in most cases. If patients with increased blood pressure of 2 and 3 degrees, as well as with hypertension of any degree with a high calculated cardiovascular risk, drug treatment is mandatory (its long-term benefit has been demonstrated in many clinical studies), then with hypertension of 1 degree with a low and average calculated cardiovascular risk, the benefit of such treatment has not been convincingly proven in large clinical trials. In such situations, the possible benefit of drug therapy is assessed individually, taking into account the patient's preferences. If, despite improving lifestyle, the increase in blood pressure in such patients persists for a number of months during repeated visits to the doctor, it is necessary to re-evaluate the need for medication use. Moreover, the magnitude of the calculated risk often depends on the completeness of the patient’s examination and may turn out to be significantly higher than initially thought. In almost all cases of treatment of hypertension, they strive to achieve stabilization of blood pressure below 140/90 mm Hg. Art. This does not mean that in 100% of measurements it will be below these values, but the less often the blood pressure, when measured under standard conditions (described in the “Diagnostics” section), exceeds this threshold, the better. Thanks to this treatment, the risk of cardiovascular complications is significantly reduced, and hypertensive crises, if they occur, are much less common than without treatment. Thanks to modern medications, those negative processes that, in hypertension, inevitably and latently destroy internal organs over time (primarily the heart, brain and kidneys), these processes are slowed down or suspended, and in some cases they can even be reversed.

Of the medications for the treatment of hypertension, the main ones are 5 classes of drugs:

• diuretics (diuretics);
• calcium antagonists;
• angiotensin-converting enzyme inhibitors (names ending in -adj);
• angiotensin II receptor antagonists (names ending in -sartan);
• beta blockers.

Recently, the role of the first four classes of drugs in the treatment of hypertension has been especially emphasized. Beta blockers are also used, but mainly when their use is required by concomitant diseases - in these cases, beta blockers serve a dual purpose.

Nowadays, preference is given to combinations of drugs, since treatment with any one of them rarely leads to achieving the desired level of blood pressure. There are also fixed combinations of drugs that make treatment more convenient, since the patient takes only one tablet instead of two or even three. The selection of the necessary classes of medications for a particular patient, as well as their doses and frequency of administration, is carried out by the doctor, taking into account such data about the patient as blood pressure level, concomitant diseases, etc.

Thanks to the multifaceted positive effects of modern drugs, treatment of hypertension involves not only lowering blood pressure as such, but also protecting internal organs from the negative effects of those processes that accompany high blood pressure. In addition, since the main goal of treatment is to minimize the risk of its complications and increase life expectancy, it may be necessary to correct blood cholesterol levels, take medications that reduce the risk of blood clots (which leads to myocardial infarction or stroke), etc. Refusal Smoking, no matter how trivial it may sound, allows you to significantly reduce the risks of stroke and myocardial infarction associated with hypertension, and slow down the growth of atherosclerotic plaques in blood vessels. Thus, treating hypertension involves addressing the disease in many ways, and achieving normal blood pressure is only one of them.

Forecast. Prevention

The overall prognosis is determined not only and not so much by the fact of high blood pressure, but by the number of risk factors for cardiovascular diseases, the degree of their severity and the duration of the negative impact.

These risk factors are:

1. smoking;
2. increased blood cholesterol levels;
3. high blood pressure;
4. obesity;
5. sedentary lifestyle;
6. age (with each decade lived after 40 years, the risk increases);
7. male gender and others.

In this case, not only the intensity of exposure to risk factors is important (for example, smoking 20 cigarettes a day is undoubtedly worse than 5 cigarettes, although both are associated with a worse prognosis), but also the duration of their exposure. For people who do not yet have obvious cardiovascular diseases other than hypertension, the prognosis can be assessed using special electronic calculators, one of which takes into account gender, age, blood cholesterol level, blood pressure and smoking. The SCORE electronic calculator is suitable for estimating the risk of death from cardiovascular diseases in the next 10 years from the date of risk assessment. At the same time, the risk obtained in most cases, which is low in absolute numbers, can produce a misleading impression, because The calculator allows you to calculate the risk of cardiovascular death. The risk of non-fatal complications (myocardial infarction, stroke, angina pectoris, etc.) is many times higher. The presence of diabetes mellitus increases the risk compared to that calculated using a calculator: for men by 3 times, and for women - even by 5 times.

With regard to the prevention of hypertension, we can say that since the risk factors for its development are known (inactivity, excess weight, chronic stress, regular lack of sleep, alcohol abuse, increased consumption of table salt and others), then all lifestyle changes that reduce the impact of these factors reduce the risk of developing hypertension. However, it is hardly possible to reduce this risk completely to zero - there are factors that do not depend on us at all or depend little on us: genetic characteristics, gender, age, social environment, and some others. The problem is that people begin to think about the prevention of hypertension mainly when they are already unhealthy, and blood pressure is already increased to one degree or another. And this is not so much a question of prevention as of treatment.

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• 10. Diagnosis and treatment of arterial hypertension: clinical recommendations of the Russian Medical Society on arterial hypertension. Cardiological Bulletin. 2015. 1: 5-30

Many people around the world suffer from a disease called hypertension. Other common names for the disease are hypertension, hypertension, essential hypertension. Unfortunately, this pathology is very often detected in pregnant women. With timely treatment, it is possible to improve the condition of patients and prevent serious complications.

Arterial hypertension (AH) - definition of increased systolic (more than 139 mm Hg) and/or diastolic (more than 89 mm Hg) for a long time. It can occur for no apparent reason or against the background of other diseases (kidney pathologies). Often develops after myocardial infarction or stroke.

“The boundary between normal and elevated blood pressure is determined by the level above which interventions have been shown to reduce the risk of adverse health effects.” WHO Expert Committee on the Control of Hypertension, 1999.

During the examination of patients with suspected hypertension, a number of studies are carried out (initial examination, instrumental and laboratory). The diagnosis is made based on sphygmomanometry. After confirmation of the diagnosis, antihypertensive therapy is prescribed, the absence of which leads to disability, and in the worst case, death.

Video Live great! Arterial hypertension 18 05 12

What is arterial hypertension?

The level of blood pressure directly depends on cardiac output and total peripheral vascular resistance. To create a prerequisite for arterial hypertension, the following must be observed:

• increased cardiac output (CO);
• increased total peripheral vascular resistance (TPVR);
• simultaneous increase in CO and OPSS.

In most cases, patients with hypertension experience an increase in OPSS and a slight increase in CO. Not so common, but still encountered, is another model for the development of hypertension: CO increases, while TPSS values ​​remain at a normal level or do not correspond to changes in CO. A persistent increase in only systolic pressure, which is accompanied by a reduced or normal CO, can also be determined. In other cases, diastolic pressure increases against the background of decreased CO.

The following pathological mechanisms may be involved in the development of arterial hypertension:

• Violation of Na transport. Due to complex metabolic processes and various microcirculatory disorders, the Na concentration inside the cell may increase, which helps to increase sensitivity to stimulation by the sympathetic nervous system. As a result, myocardial cells begin to contract more often, and this leads to an increase in cardiac output and the development of hypertension.
• Sympathicotonia. Provokes an increase in blood pressure. This is especially common in patients with prehypertension, when systolic blood pressure can reach 139 mm Hg, and diastolic blood pressure can reach 89 mm Hg. Art.
• Renin-angiotensin-aldosterone system. Quite complex in its work, its main task is to regulate the volume of circulating blood due to water and Na retention, which in turn increases blood pressure. The key mechanisms for regulating this system are located in the kidneys, so hypertension can occur in diseases of these organs.
• Lack of vasodilators. Substances such as nitric oxide and bradykinin promote vasodilation. When they are deficient in the blood, hypertension occurs. A similar disorder occurs in kidney disease, which produces vasodilators, and endothelial dysfunction, since endothelial cells also produce substances that dilate blood vessels.

Why is the problem of arterial hypertension so urgent?

• After 65 years, two thirds of people suffer from hypertension.
• After 55 years, even if normal blood pressure is determined, the risk of its increase is 90%.
• The harmlessness of high blood pressure is imaginary, since this disease increases the risk of mortality against the background of the development of conditions such as coronary artery disease, myocardial infarction, and stroke.
• Hypertension can rightfully be considered an expensive disease. For example, in Canada, hypertension accounts for up to 10% of the healthcare budget.

Some statistics:

• In Ukraine, 25% of adults suffer from hypertension.
• High blood pressure is detected in 44% of the adult population of Ukraine.
• On average, 90% of patients with hypertension have a primary form of the disease.
• In America, about 75 million people suffer from hypertension. Of this number, 81% are those who are aware of their disease, with more than 70% receiving treatment and just over 50% having adequate blood pressure control.

Classification

Since 1999, levels of increased blood pressure have been taken as the basis for the division of arterial hypertension. The data presented applies to patients over 18 years of age.

Classification of hypertension by blood pressure level (WHO, 1999), where SBP is systolic blood pressure, DBP is diastolic blood pressure:

• The optimal level is SBP no more than 120 mmHg. Art., DBP - no more than 80 mm Hg. Art.
• Normal level - SBP - no more than 130 mm Hg. Art., DBP - 85 mm Hg. Art.
• High normal blood pressure - SBP - 130-139 mm Hg. Art., DBP - 85-89 mm Hg. Art.
• First degree of hypertension (mild) - SBP - 140-159 mm Hg. Art., DBP - 90-99 mm Hg. Art.
• The second degree of hypertension - SBP - 160-179 mm Hg. Art., DBP - 100-109 mm Hg. Art.
• The third degree of hypertension - SBP - more than 180 mm Hg. Art., DBP - more than 110 mm Hg. Art.
• Isolated systolic hypertension - SBP more than 140 mm Hg. Art., DBP - not higher than 90 mm Hg. Art.

In 2003, the American National Joint Committee proposed a more simplified classification of hypertension:

• Normal blood pressure is not higher than 120/80.
• Prehypertension - SBP - 120-139 mm Hg. Art., DBP - 80-89 mm Hg. Art.
• First degree hypertension - SBP - 140-159 mm Hg. Art., DBP - 90-99 mm Hg. Art.
• Second degree hypertension - SBP - more than 160 mm Hg. Art., DBP - more than 100 mm Hg. Art.

With a long course of arterial hypertension, various organs and systems can be affected. Based on this, a classification has been formed taking into account the affected target organs (WHO, 1993):

• The first stage (III) - the organs are not affected.
• Second stage (II) - symptoms of involvement of one or more organs in the process (left ventricle, retinal arteries, kidneys, large vessels) are determined.
• Third stage (III) - the course of the disease is complicated by clinically significant diseases of the heart, kidneys, brain, retina, and blood vessels.

The diagnosis indicates the stage of arterial hypertension and the affected target organ. If, against the background of hypertension, a heart attack or angina occurs, which is confirmed by research, this is also indicated in the diagnosis.

Causes

In almost 90% of cases, the exact cause of arterial hypertension cannot be determined. Then a disorder of the central nervous system is suspected, which can occur as a result of exposure to various predisposing factors (stress, increased body weight, physical inactivity, etc.).

In the remaining 10% of cases, hypertension develops against the background of other diseases, which are often associated with the kidneys, tumor processes, improper use of medications, etc.

Kidney diseases

Kidney pathology combined with arterial hypertension accounts for 4% of all cases of hypertension. Most often, hypertension develops when:

• glomerulonephritis;
• pyelonephritis;
• polycystic kidney disease;
• renal failure.

Sometimes defects in the renal artery, whether congenital or acquired, lead to narrowing of the vessel, which also causes hypertension.

Adrenal diseases

If the activity of this organ is disrupted, the production of mineralocorticoids, which affect the functioning of the kidneys, may change. In particular, increased levels of aldosterone lead to narrowing of small-caliber arteries and retention of salts by the kidneys. Such processes lead to increased blood pressure. A benign tumor known as pheochromocytoma can also form in the adrenal glands, which increases the synthesis of adrenaline and, as a result, leads to narrowing of the arteries. This causes hypertension.

Toxicosis in pregnant women

Due to hormonal and immunobiological changes in the body of a pregnant woman, blood pressure may increase in the later stages. Such circumstances disrupt the process of gestation. In severe cases, premature delivery is performed, most often through cesarean section.

Video HYPERTENSION. High blood pressure - causes. How to remove forever

Risk factors

There are modified and unmodified risk factors, that is, those that are extremely difficult to influence.

Unmodified:

• Hereditary predisposition.
• Age.
• Race.

Modified:

• Climatic conditions.
• Poor nutrition.
• Poor quality water.
• Poor housing microclimate.
• Increased body weight.
• Reduced activity.
• Frequent stress.
• Bad habits.
• Deficiency of microelements and vitamins.
• Hormonal disorders.

With unfavorable heredity, a defect in cell membranes, a defect in the kinin system, and a pathological ability of smooth muscle cells to increase and change can be observed.

The race factor also plays an important role, since among adult African Americans hypertension is detected in 41% of cases, and among Europeans, as well as Mexican Americans, in 28% of cases.

Kinds

Based on their origin, hypertension is divided into primary and secondary. The primary form of arterial hypertension is also known as essential hypertension.

The concept of “essential hypertension” is recommended by WHO (1978) to define a condition in which there is high blood pressure without an obvious cause. It corresponds to the term “hypertension”, which is common in our country.

The concept of “secondary hypertension” was adopted by WHO (1978) to define hypertension, the cause of which can be identified. It corresponds to the term “symptomatic hypertension”, which is common in our country.

Primary hypertension

It is determined in patients in 90% of cases, since its development is associated with numerous factors, including heredity. To date, geneticists have been able to identify more than a dozen genes that are responsible for the development of hypertension. There are several forms of primary hypertension, which differ in the specific clinical features:

1. Hypo- and normorenine form. It is more often detected in the elderly and middle-aged people. It develops against the background of excessive retention of water and salts in the body due to the activity of renin and increased concentrations of aldosterone.
2. Hyperrenin form. Occurs in 20% of all cases of primary hypertension. It is more often detected in young male patients. It is quite difficult, since blood pressure can rise sharply and high. Before the development of this form of hypertension, periodic increases in blood pressure could be observed.
3. Hyperadrenergic form. Its occurrence is 15%. It is often detected in young people who have not previously complained of hypertension. It is characterized by an increased amount of norepinephrine and adrenaline in the blood. It often progresses into a hypertensive crisis, especially in the absence of adequate treatment.

Secondary hypertension

The second known definition of the disease - symptomatic hypertension - indicates its connection with diseases that may be complicated by high blood pressure. The following forms of secondary hypertension exist:

• Cardiovascular. They develop against the background of diseases such as complete AV block, coarctation of the aorta, and heart defects.
• Neurogenic. Occurs when brain structures are damaged due to vascular atherosclerosis, tumor process, encephalitis and encephalopathy.
• Endocrine. Often associated with thyroid dysfunction, when there is increased or decreased production of thyroid hormones. Other disorders of the endocrine glands such as pheochromocytoma, acromegaly, and hypothalamic syndrome may also occur.
• Renal. It develops against the background of various kidney diseases in the form of renal failure, diabetic nephropathy, transplanted organ, etc.
• Medicinal. Chronic use of certain medications leads to the development of secondary hypertension.
• Blood diseases. Some pathologies are accompanied by an increase in the number of red blood cells in the blood, resulting in hypertension.

The course of the disease may also vary. In some cases it is slow, there are no sharp rises in blood pressure, then they talk about benign hypertension. Often it develops unnoticed by both the patient and the doctor, as a result of which it is detected at a late stage.

Malignant hypertension characterized by pronounced progression of all pathological processes. The patient’s well-being is getting worse every day, so the lack of appropriate treatment can lead to his death.

Clinic

Patients may respond differently to increased blood pressure. Some note pronounced signs, others do not notice the changed condition at all.

Symptoms characteristic of arterial hypertension:

• Headaches that can be perceived as bursting, aching or pressing. They are most often localized in the back of the head and occur early in the morning.
• The heartbeat quickens, and there may be interruptions in the functioning of the heart.
• Autonomic disorders are manifested by tinnitus, dizziness, the appearance of spots before the eyes,
• Astheno-neurotic syndrome is expressed in weakness, bad mood, sleep and memory disturbances. Increased fatigue may also occur.

Depending on the course of the disease, hypertensive crises may be absent or detected. These pathological conditions extremely worsen the course of the disease.

Hypertensive crisis is a sharp increase in blood pressure, which is accompanied by disruption of target organs and the appearance of disorders of the autonomic nervous system.

The course of a hypertensive crisis can occur with or without complications. Complications include heart attacks, strokes, unstable angina, eclampsia, bleeding, arrhythmias, and renal failure. An uncomplicated hypertensive crisis can be expressed in an uncomplicated cerebral form, an uncomplicated cardiac crisis, an increase in blood pressure up to 240/140 mm Hg. Art.

Diagnostics

There are three ways to determine high blood pressure:

1. Objective examination of the patient.
2. Blood pressure measurement.
3. Registration of an electrocardiogram.

Objective examination of the patient

During the medical examination, the heart is listened to using a phonendoscope. This method determines heart murmurs, weakened tones or, conversely, enhanced ones. In some cases, it is possible to hear other sounds uncharacteristic of cardiac activity, which is associated with increased pressure in the circulatory system.

The doctor must interview the patient to determine complaints, life history and illness. Special attention is paid to the assessment of risk factors and hereditary predisposition. In particular, if close relatives have arterial hypertension, the risk of developing this disease in the patient himself is high. A physical examination can also determine the patient's height, weight, and waist circumference.

Blood pressure measurement

Correct measurement of blood pressure makes it possible to avoid errors that may affect subsequent treatment tactics. For diagnostics, a working device is taken. Today, electronic and mechanical tonometers are more often used, but when using them, annual calibration must be carried out.

Rules for measuring blood pressure:

• The patient must be in a calm state for at least 5 minutes before measuring blood pressure.
• The patient should take a sitting position, on a chair or armchair, with his back resting on the backrest, and the hand on which blood pressure will be measured should be placed freely, palm up. In extreme cases, the patient’s blood pressure is measured while standing or lying down, but the main thing is that the arm is positioned freely
• The cuff is installed at the level of the heart, 2-3 cm above the bend of the elbow, not tightened too much, but leaving room for the free passage of two fingers.
• During mechanical measurement, air is pumped until the pulse in the radial artery can no longer be felt. After this, the cuff is inflated a little more and the air begins to be released little by little.

Systolic pressure is determined by the first knocking sounds (phase I of Korotkoff sounds), which appear and then gradually intensify.

Diastolic pressure is registered in the V phase of Korotkoff sounds, when the knocking sounds completely stop.

For normal blood pressure, the measurement is carried out once. If the pressure is above 120/80, then blood pressure testing is carried out two to three times with an interval of five minutes.

Video Algorithm for measuring blood pressure

Electrocardiogram registration

In arterial hypertension, left ventricular hypertrophy is often observed. Such a change can be recorded with maximum accuracy using electrocardiography. This non-invasive diagnostic method takes only a few minutes, after which the doctor deciphers the data obtained.

The following studies are mandatory:

• General blood and urine tests.
• Biochemical blood test with determination of microelements, sugar, cholesterol, creatinine.
• Determination of hormone levels (aldosterone, adrenaline).
• Fundus ophthalmoscopy.
• Echocardiography.

If necessary, the diagnosis can be supplemented by Dopplerography, arteriography, ultrasound of the thyroid gland and internal organs (liver, kidneys).

Treatment

In accordance with the recommendations of the American National Joint Committee for 2003, patients with a high and extremely high risk of developing arterial hypertension are subject to mandatory medication treatment. At moderate levels, patients are observed from several weeks to six months in order to obtain additional clinical data, which will help in making decisions on drug treatment. Low-risk patients are observed for longer - up to 12 months.

Drug treatment is prescribed to reduce the risk of developing heart and vascular disease, as well as to prevent death. Additionally, methods are used to improve the quality of life of patients.

Main components of treatment:

1. Lifestyle changes.
2. Drug therapy.

Lifestyle change

First of all, patients with hypertension should give up bad habits such as smoking and drinking alcohol, which have a toxic effect on internal organs.

Body weight must be normalized, which can be greatly helped by increasing physical activity.

Dietary nutrition is an important component of the treatment of hypertension. In particular, salt intake should be limited to 6 g per day or less. The diet should be rich in foods rich in calcium and magnesium. Fatty foods and those that increase cholesterol should be completely excluded.

It is worth pointing out that it is important to avoid stressful situations, then the likelihood of dysfunction of the nervous system will be minimized.

Drug therapy

The algorithm for treating patients with arterial hypertension with medications largely depends on the severity of the disease.

• In the first and second degrees, changes are made to the patient’s lifestyle and his condition is monitored. If a high or very high absolute risk is determined, treatment begins immediately.
• In the third degree, drug therapy begins immediately, risk factors are additionally assessed, and target organs are determined. Lifestyle changes are used.

Prescription of drugs is carried out “not blindly”, but using an acute pharmacological test. It consists of the patient taking an average dose of the drug after a preliminary measurement of blood pressure. Then, after a short wait, blood pressure is measured again. If the drug is effective, it is used in long-term therapy.

The following drugs are used in the first line of therapy:

• Diuretics.
• Calcium antagonist
• ACE inhibitors
• Angiotensin II receptor antagonists
• Beta blockers

In the second line, direct vasodilators, central alpha2 receptor agonists, and rauwolfia alkaloids can be prescribed.

In antihypertensive therapy, combinations of drugs from various pharmacological groups can be used. Which one to choose is the decision of the attending physician, who knows the individual characteristics of a particular patient.

Prognosis and prevention

In arterial hypertension, a favorable prognostic conclusion can be made in cases where the disease was identified at an early stage of development, correct risk stratification was carried out and adequate treatment was prescribed.

Prevention of arterial hypertension can be of two types:

• The primary one is to correct the lifestyle.
• Secondary - based on the use of antihypertensive drugs; in addition, the patient must undergo clinical observation.