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

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

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

Much attention to the problem of arterial hypertension is caused not so much by its clinical manifestations as by complications in the form of acute vascular disorders in the brain, heart and kidneys. Their prevention is the main goal of treatment aimed at maintaining normal blood pressure (BP).

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

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

Causes and risk factors for hypertension

The causes of arterial hypertension are numerous. GovSpeaking about primary, or essential hypertension, we andWe mean the case when there is no specific previous disease or pathology of internal organs. In other words, such hypertension occurs on its own, involving other organs in the pathological process. Primary hypertension accounts for more than 90% of cases of chronic high blood pressure.

The main cause of primary hypertension is considered to be stress and psychoemotional overload, which contribute to the disruption of the central mechanisms of pressure regulation in the brain, then the humoral mechanisms suffer, and the target organs (kidneys, heart, retina) are also affected.

Secondary hypertension– a manifestation of another pathology, so its cause is always known. It accompanies diseases of the kidneys, heart, brain, endocrine disorders and is secondary to them. After curing the underlying disease, hypertension also disappears, so it makes no sense to determine the risk and degree in this case. Symptomatic hypertension accounts for no more than 10% of cases.

The risk factors for hypertension are also well known. Schools for hypertension are being created in clinics, whose experts convey information to the population about adverse conditions that lead to hypertension. Any therapist or cardiologist will tell the patient about the risks at the first recorded case of high blood pressure.

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

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

If we can exclude the mentioned factors or at least try to reduce their impact on health, then such characteristics as gender, age, heredity cannot be changed, so we will have to come to terms with them, but not forgetting the increasing risk.

Classification of arterial hypertension and determination of risk level

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

Stage of diseaseit depends on the clinical manifestations. Highlight:

• Preclinical stage, when there are no signs of hypertension, and the patient is not aware of the increase in blood pressure;
• 1st stage of hypertension, when the pressure is elevated, crises are possible, but there are no signs of damage to the target organ;
• Phase 2 is accompanied by damage to the target organs - the myocardium hypertrophies, changes are noticeable in the retina of the eyes, and the kidneys suffer;
• In stage 3, stroke, myocardial ischemia, vision pathology, changes in large vessels (aortic aneurysm, atherosclerosis) are possible.

Degree of hypertension

Determining the degree of hypertension is important in risk assessment and prognosis and is based on pressure readings. It must be said that normal blood pressure values also have different clinical significance. So, the indicator is up to 120/80 mm Hg. Art. countoptimally,normallythe pressure will be between 120-129 mmHg. Art. systolic and 80-84 mm Hg. Art. diastolic. Pressure numbers 130-139/85-89 mmHg. Art. they still lie within the limits of normality, but approach the borderline of pathology, which is why they are called "very normal", and the patient can be said to have high normal blood pressure. These indicators can be considered pre-pathology, because the pressure is only "a few millimeters" of elevation.

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

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

It happens that the systolic pressure figures increase up to 140 mm Hg. Art. and more, while the diastolic value is within normal values. In this case they are talking aboutisolated systolic formhypertension. In other cases, the indicators of systolic and diastolic pressure correspond to different degrees of the disease, then the doctor makes a diagnosis in favor of a higher degree, and it does not matter whether the conclusions are drawn on the basis of systolic or diastolic pressure.

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

The concept of risk in diagnosis

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

Cerebral hemorrhages or ischemic necrosis, myocardial infarction, kidney failure are the most dangerous conditions caused by high blood pressure. In this regard, for each patient after a thorough examinationthe risk is determined, indicated in the diagnosis by numbers 1, 2, 3, 4. Thus, the diagnosis is based on the degree of hypertension and the risk of vascular complications (eg hypertension/hypertension stage 2, risk 4).

Risk stratification criteriaIn patients with hypertension, external conditions, the presence of other diseases and metabolic disorders, involvement of target organs and accompanying changes in organs and systems are used.

Major risk factors affecting prognosis include:

1. The age of the patient is after 55 for men and 65 for women;
2. Smoking;
3. Disorders of lipid metabolism (exceeding the norm of cholesterol, low-density lipoproteins, reduced fraction of high-density lipids);
4. Presence of cardiovascular pathology in the family among blood relatives under 65 and 55 years of age for women and men;
5. Excessive body weight, when the abdominal circumference exceeds 102 cm in men and 88 cm in women.

The above factors are considered the main ones, but many patients with hypertension suffer from diabetes, impaired glucose tolerance, lead a sedentary life, have abnormalities in the blood clotting system in the form of an increase in fibrinogen concentration. These factors take into accountadditionally, which also increases the likelihood of complications.

Target organ damage characterizes hypertension, starting from stage 2, and serves as an important criterion on the basis of which the risk is determined, therefore the examination of the patient includes an ECG, ultrasound of the heart to determine the degree of hypertrophy of his muscles, blood and urine tests for indicators of kidney function (creatinine, protein).

First of all, the heart suffers from high blood pressure, which pushes blood into the vessels with increased force. As the arteries and arterioles change, when their walls lose elasticity and the lumens become spasmodic, the load on the heart progressively increases. A characteristic feature that is taken into account when considering risk stratificationmyocardial hypertrophy, which can be suspected by ECG, can be determined by ultrasound examination.

The involvement of the kidney as a target organ is indicated by an increase in creatinine in the blood and urine and the appearance of albumin protein in the urine. Against the background of hypertension, the walls of large arteries thicken, atherosclerotic plaques appear, which can be detected by ultrasound (carotid, brachiocephalic arteries).

The third stage of hypertension occurs with an associated pathology, i. e. associated with hypertension.Of the associated diseases, the most important for the prognosis are stroke, transient ischemic attacks, heart attack and angina, nephropathy due to diabetes, kidney failure, retinopathy (retinal damage) due to hypertension.

So, the reader probably understands how you can even independently determine the degree of headache. This is not difficult, you just need to measure the pressure. Further, you can think about the presence of certain risk factors, take into account age, gender, laboratory parameters, ECG data, ultrasound, etc. In general, all of the above.

For example, the patient's blood pressure corresponds to the 1st degree of hypertension, but at the same time he had a stroke, which means that the risk will be maximum - 4, even if stroke is the only problem besides hypertension. If the pressure corresponds to the first or second degree, and the only risk factors that can be observed are smoking and age on the background of fairly good health, then the risk will be moderate - 1 tbsp. (2 tablespoons), risk 2.

To make it clearer to you what the risk indicator in the diagnosis means, you can summarize everything in a small table. By determining your degree and "counting" the above factors, you can determine the risk of vascular accidents and complications of hypertension for a particular patient. The number 1 means low risk, 2 - moderate, 3 - high, 4 - very high risk of complications.

Risk factors	BP 130-139/85-89, risk	GB (AH) 1, risk	GB 2, risk	GB 3, risk
none	1	2	3
1-2	1	2	2	4
more than three factors/target damage/diabetes	3	3	3	4
associated pathologies	4	4	4	4

Low risk means that the probability of vascular accidents is no higher than 15%, moderate - up to 20%, high risk indicates the development of complications in a third of patients from this group, with very high risk more than 30% of patients are susceptible to complications.

Manifestations and complications of headache

Manifestations of hypertension are determined by the stage of the disease. In the preclinical period, the patient feels well, and only tonometer readings indicate a developing disease.

As changes in the blood vessels and heart progress, symptoms appear in the form of headache, weakness, reduced working capacity, periodic dizziness, visual symptoms in the form of weakened visual acuity, flashing "spots" in front of the eyes. All these signs are not expressed during the stable course of the pathology, but during the development of a hypertensive crisis, the clinic becomes brighter:

• Severe headache;
• Noise, buzzing in the head or ears;
• Darkness in the eyes;
• Pain in the region of the heart;
• dyspnea;
• Facial hyperemia;
• Excitement and a sense of dread.

Hypertensive crises are provoked by traumatic situations, overload, stress, consumption of coffee and alcoholic beverages, so patients with an already established diagnosis should avoid such influences. Against the background of a hypertensive crisis, the likelihood of complications increases sharply, including life-threatening ones:

1. Bleeding or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute renal failure;
5. Heart attack.

How to measure blood pressure correctly?

If there is reason to suspect high blood pressure, the first thing a specialist will do is measure it. Until recently, it was believed that blood pressure numbers can normally differ in different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. it can occur due to the pathology of peripheral blood vessels, so you should be careful with different pressures on the right and left hand.

To get the most reliable figures, it is recommended to measure the pressure three times on each arm at short time intervals, recording each result obtained. In most patients, the lowest values obtained are the most accurate, but in some cases the pressure increases from measurement to measurement, which does not always speak in favor of hypertension.

The large selection and availability of blood pressure measuring devices allow it to be monitored by a wide range of people at home. Typically, hypertensive patients have a tonometer at home, close at hand, so that if their health worsens, they can immediately measure their blood pressure. However, it is worth noting that fluctuations are possible even in absolutely healthy people without hypertension, so one excess of the norm should not be considered a disease, and in order to make a diagnosis of hypertension, the pressure must be measured at different times. , under different conditions and multiple times.

When diagnosing hypertension, blood pressure values, electrocardiography data, and heart auscultation results are considered basic. When listening, it is possible to notice noise, increased tones and arrhythmias. The EKG, starting with the second phase, will show signs of stress on the left side of the heart.

Treatment of hypertension

For the correction of high blood pressure, treatment regimens have been developed that include drugs from different groups and with different mechanisms of action. Theirthe combination and dose are chosen individually by the doctortaking into account the stage, the accompanying pathology and the response of hypertension to a certain drug. After determining the diagnosis of hypertension and before starting drug treatment, the doctor will suggest non-medical measures that significantly increase the effectiveness of pharmacological drugs, and sometimes allow you to reduce the dose of drugs or abandon at least some of them.

First of all, it is recommended to normalize the regime, eliminate stress and ensure physical activity. The diet aims to reduce salt and liquid intake, eliminate alcohol, coffee and drinks and substances that stimulate the nervous system. If you are overweight, you should limit calories and avoid fatty, floury, fried and spicy foods.

Non-drug measures in the initial phase of hypertension can have such a good effect that the need to prescribe drugs will no longer be necessary. If these measures do not produce results, the doctor prescribes appropriate drugs.

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

Antihypertensives from the following groups are traditionally used for the treatment of hypertension:

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

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

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

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

The most common ACE inhibitors, calcium channel blockers,which are prescribed to both young and elderly patients, with or without accompanying diseases, diuretics, sartans. Medicines from these groups are suitable for initial treatment, which can then be supplemented with a third medicine of a different composition.

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

Diureticsno less popular. In order to reduce side effects, they are combined with ACE inhibitors, sometimes "in one pill".

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

Calcium channel blockersThey are often prescribed in combination with ACE inhibitors, they are especially good for bronchial asthma in combination with hypertension, because they do not cause bronchospasm.

Antagonists of angiotensin receptors- the most prescribed group of drugs for hypertension. They effectively lower blood pressure and do not cause coughing like many ACE inhibitors. But in America they are especially common because of the 40% reduction in the risk of Alzheimer's disease.

When treating hypertension, it is important not only to choose an effective regimen, but also to take medication for a long time, even for life. Many patients believe that when the pressure reaches normal levels, the treatment can be stopped, but they take pills until the crisis. It is known that unsystematic use of antihypertensive drugs is even more harmful to health than the complete absence of treatment, therefore informing the patient about the duration of treatment is one of the important tasks of the doctor.