Hypertension

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

If a person constantly exhibits an increase in blood pressure (arterial hypertension is more than 140 and 90 mmHg), then he is usually diagnosed with hypertension.And in 90% of cases this is true.Only in 10% of cases is it possible to identify the cause of the increase in blood pressure and often, by eliminating it, rid the person of the symptom of arterial hypertension - in this case, the diagnosis is symptomatic hypertension.

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

Normally, blood pressure is a labile value, that is, it changes depending on what a person is doing, what position he is in, the degree of physical activity, anxiety, etc.But after the end of exposure in a healthy person, blood pressure levels return to normal after some time on their own, in contrast to a patient whose blood pressure is normalized under the influence of drugs that quickly regulate blood pressure numbers.  

It is assumed that the basis of the disease is a violation of the mechanisms of blood pressure regulation.

Epidemiology of hypertension 

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

WHO considers hypertension and atherosclerosis to be the most common causes of early death in the working-age population.Complications caused by these diseases, such as myocardial infarction, chronic kidney disease or acute cerebrovascular accident, are life-threatening, but also quite often disable people, making them unable to work.

Pathogenesis of hypertension

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

Blood pressure is the force with which blood presses on the walls of the vessel and it depends on three hemodynamic parameters: the force of cardiac output, the total volume of blood that circulates in the vascular bed and how elastic the vessels are and what their tone is (total peripheral resistance).The upper number of blood pressure is determined by the force of blood ejection from the heart - systolic pressure, and the lower number indicates the pressure at the time of diastole - relaxation of the heart.It reflects the degree of resistance of blood vessels to blood flow.

Vascular tone, in turn, is regulated by the central and peripheral nervous systems, and depends on the complex of mediators and biologically active substances released into the blood, also secreted by the endocrine system, in various life situations: during emotions, fatigue, physical activity.The pathogenetic mechanisms of hypertension are realized through the activation of the sympathoadrenal and renin-angiotensin-aldosterone systems, the membrane transport of cations (sodium, calcium and potassium) is disrupted with increased sodium reabsorption in the kidneys.Due to the excessive production of vasoconstrictor compounds and decreased production of depressor compounds, dysregulation of vascular tone also occurs.These compounds affect the structure of the vascular wall, it undergoes changes due to non-infectious inflammation, due to spasm of vascular smooth muscles, resulting in impaired microcirculation.

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

Risk factors

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

Non-modifiable factors:

• Recorded cases of hypertension in close relatives (heredity).
• Elevated blood pressure is detected more often at older ages (age).
• Sexual - pressure is detected earlier in men than in women.Women have an increased risk of developing hypertension during menopause (it is during this period that 60% of women suffer from high blood pressure).This is due to hormonal imbalance and exacerbation of emotional and nervous reactions. 
• Negroid race (these people get sick more often and have more severe complications of hypertension).
• Influence of weather conditions (weather-dependent people).

Modifiable factors:

• People who are obese are susceptible to hypertension 2-6 times more often than the general population.This is due to the fact that intraperitoneal fat is hormonally active, it helps suppress sex hormones, prevents the absorption of glucose by other tissues, supports inflammatory reactions, increases vasoconstriction and swelling of the vascular wall.
• Reduced physical activity increases the risk of disease by 29-50%, compared with more trained people.
• Excess salty foods, imbalance of fats, and alcohol abuse also contribute to increased blood pressure.
• Smoking is an undeniable factor that has a very bad effect on the walls of the arteries and contributes to the occurrence and aggravation of arterial hypertension.A smoked cigarette can raise blood pressure by 10-30 mmHg.Art., it promotes spasm and supports the inflammatory process of the vessel wall.
• Emotional overload and chronic stress affect the systems regulating vascular tone and disrupt their adaptation to stress.
• Metabolic disorders: lipid metabolism - hypercholesterolemia and resulting atherosclerosis of the arteries - always accompanies hypertension;carbohydrate metabolism, and developing diabetes mellitus - affect the severity of hypertension and mortality from it.

Symptoms of hypertension

It is important to note that sometimes hypertension does not cause symptoms.Therefore, people with risk factors for hypertension should systematically monitor their blood pressure.

Hypertension hastarget organs.These are exactly the organs that suffer if blood pressure rises: heart, brain, kidneys, peripheral arteries, retina.Due to the fact that an increase in A/D is associated with spasm primarily of small arteries, which impairs blood circulation, and these organs are super sensitive to deterioration of blood flow, the symptoms are also caused by changes in them.

The main subjective complaints from a patient whose blood pressure rises are: headaches, tinnitus, frequent dizziness, “spots” before the eyes.Later, when persistent changes in the arteries develop, complaints of poor sleep, deterioration in performance, memory, that is, signs of encephalopathy, will appear.From the heart side, rapid heartbeat, shortness of breath, pain or discomfort in the left side of the chest, rhythm disturbances are detected, and then later manifestations of heart failure are noticed in the form of shortness of breath and swelling.

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

Exacerbations of hypertension sometimes occur latently, but this does not mean that it is safe.Even regardless of the level of pressure, hypertension can manifest itself with severe complications: heart attack and stroke.Sometimes an exacerbation manifests itself as a hypertensive crisis.It is characterized by a sharp rise in blood pressure, severe headaches, redness of the face, chills, and vomiting may occur. This condition requires calling an ambulance.

Diagnosis of hypertension

Correctly collected anamnesis data plays a special role in diagnosing hypertension.Information about the onset of the disease is carefully clarified, all possible risk factors and patient complaints are studied, with the main emphasis on complaints characterizing the involvement of target organs in the process.Particular importance is attached to the presence of a history of heart failure, renal failure, a history of strokes, detection of diabetes mellitus, retinal angiopathy, and aortic aneurysm.

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

After the first consultation, the doctor establishes a preliminary diagnosis, if one has not been made previously.Next, an examination is necessary.

Instrumental examination:

1. 24-hour monitoring of blood pressure and ECG in 12 leads.
2. Ultrasound examination of the heart (ECHO).It gives an idea of the state of the cavities of the heart and the movement of blood in it.
3. Ultrasound Dopplerography of the arteries of the kidneys and neck.
4. Urine analysis for albuminuria and biochemical blood parameters.
5. Thyroid-stimulating hormone and free T4.To assess thyroid function.
6. Examination by an ophthalmologist to assess the condition of the fundus vessels.

When the diagnosis is clarified, the cardiologist or therapist (if the patient is being treated by a therapist) prescribes drug therapy after analyzing examination data and all possible risk factors.

Treatment of hypertension 

Goal of treatment: achieving normal (target) blood pressure levels and preventing complications.Treatment is divided into medicinal and non-medicinal.

Drug treatment of headache 

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

There are now quite a lot of medications in the medical arsenal that lower blood pressure.They affect the known pathogenetic mechanisms of the disease and eliminate or reduce their influence.These are several groups of drugs, for example, diuretics (diuretics), renin channel blockers, beta blockers, calcium channel blockers, ACE inhibitors.It is the responsibility of the attending physician to select them for this particular patient, and it may take some time, since each group of drugs has its own characteristics and side effects, in addition, the effect of the drug is not always quick; sometimes it is necessary to select them in combination with each other.

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

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

1. Regular intake of medications according to the prescribed schedule: day, evening.
2. In case of side effects or doubts, the patient should contact the attending physician to adjust the medication intake.
3. You should not stop taking medications on your own without consulting a doctor, even if your blood pressure and health are normal.
4. Measuring blood pressure when selecting therapy in the morning and evening (keep a diary), in case of any deterioration in health (fill out a diary);if you feel well, for 7-10 days in the morning and evening to make sure it is stable, monthly.
5. Visiting a doctor for a minimal examination with selected treatment and normal health 2 times a year (dispensary visit).  

Non-pharmacological measures for the treatment of hypertension

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

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

• Avoid the accumulation of fatty deposits.Weight correction is the most important way to adjust A/D.A weight gain of 10 kg leads to an increase in blood pressure by 10 mm Hg.Art. 
• Eat wisely.Your diet should have calories appropriate for your weight, be rich in foods that contain potassium and magnesium and unsaturated fats, while saturated fats and simple carbohydrates should be limited.   
• Don't eat a lot of salt.It causes arterial spasm and fluid retention in the body.It has been proven that when a person consumes >5 g of salt per day, the risk of developing hypertension increases significantly. 
• Try to move a lot, but don't overdo it.It is helpful to engage in physical therapy, swimming or walking, and aim to walk at least 10,000 steps every day. 
• Avoid nervous tension: Find a way to switch if you often experience extreme anxiety or nervous shock (fitness, yoga, long walks). 
• Avoid excess tensionassociated with intellectual activity. 
• Don't work at nightbecause it disrupts biological rhythms. 
• Do not operate in areas with significant vibration or noise, they affect the central and peripheral nervous and vascular systems. 
• Monitor your blood pressure levels, especially if your immediate family (parents, brothers and sisters) had or have arterial hypertension, in order to take action in time. 
• Contact a gynecologistin the premenopausal period and postmenopause to eliminate hormonal imbalance. 
• Treat concomitant diseases in a timely mannerkidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (for example, tonsillitis).If you suffer from them, keep in mind that they aggravate the course of headache. 
• Do not drink excessive alcohol and do not smoke. 

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

Remember, a happy heart is a healthy heart.Pay attention to your health every day, follow the recommendations of doctors.