Hypertension (HTN) is one of the most common diseases of the cardiovascular system, which only, according to approximate data, affects one -third of the world's inhabitants.At the age of 60-65 years, more than half of the population has been diagnosed with hypertension.The disease is called "silent killer" because its signs can be absent for a long time, while changes in the walls of the blood vessels are already beginning at an asymptomatic stage, significantly increasing the risk of vascular accidents.
In Western literature, the disease is called arterial hypertension (AH).Others have adopted this formulation, although both "hypertension" and "hypertension" are still in common use.
Careful attention to the problem of arterial hypertension is caused not so much by its clinical manifestations, but by complications in the form of acute vascular disorders in the brain, heart and kidneys.Their prevention is the main purpose of treatment aimed at maintaining normal blood pressure (BP).
An important point is to identify all possible risk factors,Anyway to clarify their role in the progression of the disease.In the relationship between the degree of hypertension and existing risk factors is indicated in the diagnosis, which simplifies the patient's condition and prognosis.
For most patients, the number of diagnosis after "Ah" does not mean anything, although it is clear that the higher the indicator of the degree and risk, the more prognosis the prognosis is and the more serious the pathology.In this article, we will try to understand how and why one or another degree of hypertension is diagnosed and what is at the heart of determining the risk of complications.
Causes and risk factors of hypertension
The causes of arterial hypertension are numerous.GovWe are talking about primary or essential hypertension, we andWe mean the case where there is no specific previous disease or pathology of the internal organs.In other words, such hypertension is found on its own, including other organs in the pathological process.Primary hypertension represents more than 90% of cases of chronic high blood pressure.
The main cause of primary hypertension is considered to be stress and psycho-emotional overload, which contribute to the disruption of the central mechanisms of regulation of the pressure in the brain, then suffer humoral mechanisms and are involved in target organs (kidneys, heart, retina).
Secondary hypertension- A manifestation of another pathology, so its reason is always known.It accompanies diseases of the kidneys, heart, brain, endocrine disorders and is secondary to them.Once the underlying disease is cured, hypertension also goes away, so it makes no sense to determine the risk and extent in this case.Symptomatic hypertension represents no more than 10% of cases.
Hypertension risk factors are also known to all.Hypertension schools are created in clinics whose specialists convey information to the population about adverse conditions leading to hypertension.Each therapist or cardiologist will tell the patient about the risks already in the first case of high blood pressure recorded.
Among the conditions that predispose to hypertension, the most important are:
- Smoking;
- Excess salt in food, excessive fluid intake;
- Insufficient physical activity;
- Alcohol abuse;
- Exceeded disorders of weight and fat metabolism;
- Chronic psycho-emotional and physical overload.
If we can exclude the factors listed, or at least try to reduce their impact on health, then such characteristics such as gender, age, heredity cannot be changed and therefore we will have to put up with them, but not to forget the increasing risk.
Classification of arterial hypertension and determination of risk level
The classification of hypertension involves identifying the stage, the degree of the disease and the level of risk of vascular accidents.
StageIt depends on the clinical manifestations.Underlined:
- Preclinical stage when there are no signs of hypertension and the patient is not aware of the increase in blood pressure;
- Stage 1 of hypertension, when the pressure is elevated, crises are possible, but there are no signs of damage to the target organs;
- Stage 2 is accompanied by damage to the target organs - myocardial hypertrophy, changes in the retina of the eyes are noticeable and the kidneys suffer;
- Stage 3 is possible strokes, myocardial ischemia, vision pathology, changes in large vessels (aortic aneurysm, atherosclerosis).
Hypertension
Determining the degree of hypertension is important for assessing risk and prognosis and is based on pressure numbers.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.countoptimal.,normallyThe pressure will be between 120-129 mmHg.Art.systolic and 80-84 mm Hg.Art.diastolic.Pressure number 130-139/85-89 mmHg.Art.They still lie within normal limits, but approaching the border with pathology, which is why they are called. "extremely normal"And the patient can be told that he or she has high normal blood pressure. These indicators can be considered as before pathology, since the pressure is only a few millimeters from an increase.
From the moment the blood pressure reached 140/90 mm Hg.Art.We can now talk about the presence of the disease.This indicator is used to determine the degree of hypertension itself:
- 1st degree of hypertension (HTN or AH 1st stage in 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.
- With hypertension at stage 3, the pressure is 180/100 mmHg.Art.And higher.
It happens that the figures of systolic pressure are increased to the size of 140 mm Hg.Art.And higher, while the diastolic value is in normal values.In this case they talk aboutsystolic formHypertension.In other cases, systolic and diastolic pressure indicators correspond to different degrees of the disease, then the doctor diagnoses in favor of a greater degree and does not matter if the conclusions are made on the basis of systolic or diastolic pressure.
The most accurate diagnosis of the degree of hypertension is possible when the disease has been diagnosed for the first time when treatment has not yet been performed and the patient has not taken antihypertensive drugs.During therapy, the numbers fall and when it is discontinued, on the contrary, they can increase sharply, so it is no longer possible to adequately evaluate the degree.
The concept of risk in diagnosis
Hypertension is dangerous due to its complications.It is no secret that the greater part of the patients die or become disabled not by the fact of blood pressure itself, but by the acute disorders to which it leads.
Cerebral hemorrhages or ischemic necrosis, myocardial infarction, renal failure are the most dangerous conditions provoked by high blood pressure.In this regard for each patient after a thorough examinationThe risk is determined by the diagnosis of numbers 1, 2, 3, 4. Thus, the diagnosis is based on the degree of hypertension and the risk of vascular complications (eg stage of hypertension/hypertension, risk 4).
Risk strap criteriaFor patients with hypertension, external conditions, the presence of other diseases and metabolic disorders, the involvement of the target organs and concomitant changes in organs and systems are used.
The main risk factors affecting prognosis include:
- The patient's age is after 55 years for men and 65 for women;
- Smoking;
- Disorders of lipid metabolism (exceeding cholesterol norm, low density lipoproteins, decreased high -density lipid fractions);
- The presence of cardiovascular pathology in the family among blood relatives under 65 and 55 years of age for women and men respectively;
- Excess body weight when the circumference of the abdomen exceeds 102 cm in men and 88 cm in women.
The listed factors are considered to be the main but many patients with hypertension suffer from diabetes, disrupt glucose tolerance, lead a sedentary life and have anomalies in the blood coagulation system in the form of an increase in fibrinogen concentration.These factors viewfurther, also increases the likelihood of complications.
Damage to the target organs characterize hypertension, starting from stage 2, and serving as an important criterion by which the risk is determined, therefore the patient's examination includes ECG, ultrasound of the heart, to determine the degree of hypertrophy of his muscles, blood and urinary tests (creaine.
First, the heart suffers from high blood pressure, which pushes the blood into the vessels with increased force.As the arteries and arterioles change as their walls lose elasticity and lumens become spasmodic, the load of the heart progressively increases.Characteristic characteristic taken into account when examining the stratified riskMyocardial hypertrophythat can be suspected of ECG can be determined by ultrasound.
The involvement of the kidneys as a targeted organ is indicated by an increase in creatinine in the blood and urine and the appearance of protein albumin in the urine.Against the background of hypertension, the walls of large arteries appear, atherosclerotic plaques appear, which can be detected by ultrasound (carotid, brachiocephalic arteries).
The third stage of hypertension occurs with associated pathology, that is, associated with hypertension.Among the related diseases, the most important for the prognosis are strokes, transient ischemic attacks, heart attack and angina, nephropathy due to diabetes, renal failure, retinopathy (retinal damage) due to hypertension.
So, the reader probably understands how you can even independently determine the degree of headache.It's not difficult, you just have to measure pressure.Next, you can consider having certain risk factors, consider age, gender, laboratory parameters, ECG data, ultrasound and more.In general, everything listed above.
For example, the patient's blood pressure corresponds to stage 1 hypertension, but at the same time he has suffered a stroke, which means that the risk will be maximum - 4, even if the 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 noted are smoking and age against the background of fairly good health, then the risk will be moderate - 1 tbsp.(2 tbsp), risk 2.
To make you more clear what the risk indicator means in diagnosis, you can summarize everything in a small mass.By determining your degree and "counting" of the factors listed above, you can determine the risk of vascular accidents and complications of hypertension for a particular patient.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 |
|---|---|---|---|---|
| no | 1 | 2 | 3 | |
| 1-2 | 1 | 2 | 2 | 4 |
| More than three factors/target damage/diabetes | 3 | 3 | 3 | 4 |
| Associated pathology | 4 | 4 | 4 | 4 |
Low risk means that the likelihood of vascular accidents is not more than 15%, moderate - up to 20%, high risk indicates the development of complications in one third of patients in this group, with a very high risk of more than 30%of patients susceptible to complications.
Manifestations and complications of headache
The manifestations of hypertension are determined by the stage of the disease.In the preclinical period, the patient is feeling well and only Tonometer's readings show a developing disease.
Because changes in the blood vessels and the progress of the heart, the symptoms appear in the form of headache, weakness, decreased efficacy, 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 a stable course of the pathology, but during the development of a hypertensive crisis, the clinic becomes more yard:
- Severe headache;
- Noise, ring in the head or ears;
- Darkening in the eyes;
- Pain in the heart;
- Dyspnoea;
- Facial hyperemia;
- Excitement and feeling of fear.
Hypertensive crises are provoked by traumatic situations, fatigue, stress, consumption of coffee and alcoholic beverages, so patients with an already established diagnosis should avoid such influences.Against the background of the hypertonic crisis, the likelihood of complications is sharply increased, including life -threatening:
- Hemorrhage or cerebral infarction;
- Acute hypertonic encephalopathy, probably with cerebral edema;
- Pulmonary edema;
- Acute renal failure;
- A heart attack.
How to properly measure blood pressure?
If there is a reason to suspect high blood pressure, the first thing a specialist will do is measure it.Until recently, the number of blood pressure was thought to be usually different in different hands, but as practice showed, even a difference of 10 mm Hg.Art.It can occur due to pathology of the peripheral vessels, so that different pressures from the right and left hands should be treated with caution.
In order to obtain the most reliable figures, it is recommended to measure the pressure three times on each hand with short intervals, recording each result.In most patients, the smallest values obtained are the most correct, but in some cases the pressure is increased from measurement to measurement, which does not always speak in favor of hypertension.
The high selection and the presence of blood pressure measurement devices allow it to be observed in a wide range of people at home.Usually hypertonic patients have a tonometer at home, by hand, so if their health worsens, they can immediately measure blood pressure.However, it is worth noting that fluctuations are also possible in absolutely healthy individuals without hypertension, so an excess of normal should not be considered as a disease and a diagnosis of hypertension should be made, the pressure should be measured at different periods, under different conditions and repeatedly.
When diagnosing hypertension, blood pressure data, electrocardiography data and cardiac auscultation results are considered to be basic.When listening, it is possible to detect noise, increased tones and arrhythmias.ECG, starting from the second stage, will show signs of stress on the left side of the heart.
Hypertension
To correct high blood pressure, treatment regimens have been developed, which include medicines of different groups and different mechanisms of action.TheirThe combination and dose is chosen by the doctor individuallyConsidering the scene, the accompanying pathology and the reaction of the hypertension of a particular drug.Once the diagnosis of hypertension has been detected and before starting medication, the doctor will offer medicine measures that significantly increase the effectiveness of pharmacological medicines and sometimes allow you to reduce the dose of medicines or abandon at least some of them.
First, it is recommended to normalize the regimen, to eliminate stress and to guarantee physical activity.The diet is aimed at reducing the intake of salt and fluids, eliminating alcohol, coffee and drinks and substances that stimulate the nervous system.If you are overweight, you should limit your calories and avoid fat, flour, fried and spicy foods.
Measures that are not medication in the initial stage of hypertension can have such a good effect that the need to prescribe medication will no longer be necessary.If these measures do not work, the doctor prescribes appropriate medicines.
The purpose of treating hypertension is not only to reduce blood pressure, but also to eliminate, if possible, its cause.
The antihypertensive drugs of the following groups are traditionally used to treat hypertension:
- Diuretics;
- Antagonists of angiotensin II receptors;
- ACE inhibitors;
- Adrenergic blockers;
- Calcium channel blockers.
Each year, the list of drugs that reduce blood pressure increases and at the same time becomes more effective and safe, with less side effects.When initiating therapy, one drug is prescribed at a minimum dose;If it is ineffective, it can be increased.If the disease progresses and the pressure does not remain at acceptable values, then another medicine is added to the first medicine from another group.Clinical observations show that the effect is better for combination therapy than in prescribing a medicine in the maximum amount.
Reducing the risk of vascular complications is important when choosing a treatment regimen.This notes that some combinations have a more pronounced "protective" effect on organs, while others allow better pressure control.In such cases, experts prefer a combination of drugs that reduces the likelihood of complications, even if there are some daily fluctuations in blood pressure.
In some cases, it is necessary to take into account the concomitant pathology, which makes adjustments to the treatment regimens.For example, men with prostate adenoma are prescribed alpha-blockers, which are not recommended for constant use for reducing blood pressure in other patients.
The most widely used ACE inhibitors, calcium channel blockers,who are prescribed for both young and elderly patients, with or without concomitant diseases, diuretics, sartans.The drugs in these groups are suitable for initial treatment, which can then be supplemented with a third medicine with different composition.
ACE inhibitors reduce blood pressure and at the same time have a protective effect on the kidneys and myocardium.They are preferable to young patients, women receiving hormonal contraceptives indicated for diabetes and for older patients.
DiureticsNo less popular.To reduce side effects, they are combined with ACE inhibitors, sometimes "in one tablet".
Beta blockersThey are not a priority group for hypertension, but they are effective for concomitant cardiac pathology - heart failure, tachycardia, coronary disease.
Calcium channel blockersOften prescribed in combination with ACE inhibitors, they are especially good for bronchial asthma in combination with hypertension as they do not cause bronchospasm.
Antagonists of angiotensin receptors- The most prescribed group of medicines for hypertension.They effectively reduce blood pressure and do not cause cough like many ACE inhibitors.But in America, they are especially common because of a 40% reduction in the risk of Alzheimer's disease.
When treating hypertension, it is important not only to choose an effective regimen, but also to take medicines for a long time, even for life.Many patients believe that when the pressure reaches normal levels, treatment can be stopped, but they catch the pills until the crisis.The non -systematic use of antihypertensive drugs is known to be 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.