home Thyroid Chronic hypertension - symptoms and treatment of the disease. Hypertonic disease. Types, degrees and treatment of arterial hypertension

Chronic hypertension - symptoms and treatment of the disease. Hypertonic disease. Types, degrees and treatment of arterial hypertension

A pathology called essential hypertension is a form of arterial hypertension. If the patient complains to the doctor about isolated cases of increased upper pressure of more than 140 mm Hg. Art., then for now it makes no sense to talk about such a diagnosis. But if the pressure stays at this level quite often, then the diagnosis is confirmed. To select treatment methods, the doctor needs to determine the reasons why the patient began to suffer from this disease, as well as the form of the disease and its stage of development.

There is a difference between essential hypertension and arterial hypertension. Doctors classify hypertension as the primary form, and hypertension is a disease that develops against the background of certain chronic diseases. Essential pathology often progresses in the absence of treatment and negatively affects the condition of internal organs and systems.

Reasons for development

There is no single reason for the development of this disease. Rather, a complex of causes and actions leads to the pathology of high blood pressure. Doctors agree that an unhealthy lifestyle, genetic predisposition, reduced immunity and bad habits lead to hypertension. The disease mostly affects middle-aged and elderly people, which is associated with age-related changes in the human vascular system. Hypertension more often affects the male half of the population. According to the experience of most doctors, genetics is the main reason for the development of hypertension.

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Severity of essential hypertension

Stage	Description
I	The disease of the first stage manifests itself after prolonged exposure to stressful tension or increased physical work. High blood pressure So far it does not have too detrimental effects on the body and internal organ systems. The condition may last for more than one year.
III	Hypertension at this stage is characterized by a sustained increase in blood pressure. Medicines help correct the patient's condition. Hypertensive crises occur from time to time. The organs of the body begin to suffer from this.
III	At the third stage of essential hypertension, cure is possible only with the use of a treatment regimen that combines several medicines. At this stage, cerebral hemorrhage (stroke), angina attacks, crises and heart attacks often occur.

Depending on blood pressure indicators, hypertension is divided into three stages of development.

The disease also has 3 stages of development:

Hypertension of 1st degree of severity. In this case, the upper pressure reaches 140-160 mm Hg. Art. Lower 90-99 mm Hg. Art.
Stage 2 hypertension has values ranging from 160-180 upper pressure and 100-110 mmHg. Art. lower.
Grade 3 is determined if the upper value reaches more than 180 mm Hg. Art., and the lower one - more than 110 mm Hg. Art.

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Symptoms of the disease

Symptoms may not appear for a long time. In addition to stable high blood pressure of 140-160 by 90-95 mm Hg. Art., the patient may not be bothered by anything for a long time. Sometimes essential primary hypertension is manifested by pain in the back of the head, tachycardia, double vision and tinnitus. These symptoms intensify with a significant increase in blood pressure. After some time, in the absence of proper treatment, signs of changes in the functioning of blood vessels and internal organ systems begin to appear. First of all, the disease negatively affects the functioning of the heart, brain and kidneys.

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Target organs

Heart. In a state of hypertension, the load falls on the heart muscle, as a result, the thickness of the walls of the left cardiac ventricle increases. This complication is even more dangerous than diabetes, cholesterol plaques or smoking. When the ventricle thickens, the heart requires a more intense supply of blood, but this process is disrupted in hypertension. Because of this, patients have a high risk of developing heart attacks, heart failure, and arrhythmia. Sudden death from cardiac arrest may occur.
Brain. In the initial stages of essential hypertension, blood circulation in the brain is impaired. Patients suffer from headaches, fatigue from work, ringing in the ears, and dizziness. Microinfarcts occur in some parts of the brain. Brain weight decreases due to poor blood supply. The result is a deterioration in intelligence, memory loss, and sometimes dementia.
Kidneys. Gradual elastic atherosclerosis of blood vessels and kidney tissue occurs. With a detrimental effect on the kidneys, the water metabolism system is affected and harmful substances remain in the body. Doctors call this impaired kidney function. Moreover, the kidney filtration system is damaged, which does not allow the body to retain protein. This element is vital for humans.

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Diagnostics

To diagnose the disease, pressure is measured using a tonometer using the Korotkoff method.

Diagnosis of the disease in adults and children is carried out by measuring pressure at different conditions. The pressure is measured on a tonometer at least 3 times. The tonometer must be mercury, and the measurement itself is carried out using the Korotkoff method. To diagnose secondary hypertension, doctors refer to ultrasonography, cardiogram and blood test. In individual cases, doctors may find it necessary to use a special device to measure blood pressure throughout the day to make the most accurate diagnosis. The study makes it possible to track changes in indicators over 24 hours (or more).

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Treatment of the disease

You definitely need to reconsider your bad habits, switch to proper nutrition, bring your weight back to normal.

Treatment of essential hypertension includes several methods. Therapy is selected depending on the course of the disease. First, the doctor must determine the optimal medications to stabilize blood pressure. If you have already been diagnosed with essential hypertension, it is necessary to exclude the development of concomitant diseases: diabetes, etc. You need to remember about the presence of physical exercise on a daily basis, as well as balance sleep and periods of activity.

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Lifestyle

If essential arterial hypertension has symptoms in the initial stages, then doctors will not immediately prescribe complex treatment using various medications. First, a healthier lifestyle will be recommended, which includes the following rules:

Complete exclusion of alcoholic beverages. They negatively affect the condition of blood vessels.
Minimize the amount of salt in your diet. Salt has a detrimental effect on the human circulatory system.
To follow the rules healthy eating. Vegetables and fruits, which reduce cholesterol levels in the blood, should predominate in the diet.
It is necessary to perform at least minimal physical exercise daily.
Normalization of body weight.

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Treating hypertension with medications

The combined drug "Prestance" is used for the treatment of primary and secondary arterial hypertension.

If the disease is aggravated by more and more new symptoms from target organs, then medications are needed. The most commonly prescribed drugs are:

Angiotensin-converting enzyme inhibitors. These are substances that have a protective effect on organs susceptible to negative influence. The substance is contained in the preparations “Prestans”, “Zocardis”, “Lorista”.
Drugs “Nebilet”, “Betalok”, which bring vascular tone in order. Their active ingredients are calcium antagonists and beta blockers.
For swelling, which is reflected externally, medications with a diuretic effect are used. They remove excess water from the body.
Medicines for the treatment of complications and consequences in the form of a heart attack. stroke, etc.

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Traditional medicine against hypertension

IN folk recipes you can find a lot effective methods, which will complement drug therapy and help alleviate the course of the disease in a short time. Among them:

Mix 800 ml of beet juice and the same amount of honey in a bowl. Add 1 liter of vodka. The resulting mixture must be infused in a dark place for 14 days. Drink the infusion 3 times a day, 2 tbsp. spoons.
Before eating, drink a mixture of onion juice, honey and lemon zest. Everything in equal quantities.
Combine 100 g of cranberries and the same amount of honey and lemon juice. Take the mixture for 14 days. You should consult your doctor before taking any mixture.

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Complications of the disease

With absence necessary treatment and prevention, even in the initial stages serious complications can develop that affect internal organs:

Hypertensive crisis. Sometimes 160 mmHg is enough for the patient to feel unwell, severe persistent headache, and ringing in the ears.
Heart pathologies. The heart's ability to contract decreases. The chance of developing a heart attack increases.
Detrimental effect on kidney function.
The condition of the nervous system is deteriorating. This means a stroke may occur. As the disease progresses, the vision apparatus suffers.
Swelling in the lungs.

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How to prevent the development of hypertension?

Those at risk are those who suffer from frequent headaches, dizziness, and nosebleeds. Women of menopausal age and in the postoperative period need to be attentive to the symptoms. Those who are often under stress and have a history of kidney disease are also predisposed. To prevent the development of essential hypertension, you need to maintain a balanced diet and not overexert yourself in any physical activity. You need to lead an active lifestyle, give up alcohol and smoking, and avoid stress at work and in everyday life.

What is arterial hypertension: causes and treatment of hypertension

Arterial hypertension is chronic illness, which affects a large number of modern people.

The difficulty is that many patients neglect preventive measures and a healthy lifestyle.

It is necessary to know what arterial hypertension is in order to start it in a timely manner. therapeutic procedures, without allowing large-scale complications fraught with death.

The body's vascular system is like a tree, where the aorta is the trunk, which branches into arteries, which are divided into small branches - arterioles.

Their task is to carry blood to capillaries that supply nutrients and oxygen to every cell of the human body. After oxygen is transferred to the blood, they are again returned to the heart through the venous vessels.

In order for blood to flow through the system of veins and arteries, a certain amount of energy must be expended. The force acting on the walls of blood vessels during blood flow is pressure.

Pressure depends on the functioning of the heart and on the arterioles, which are able to relax if it is necessary to lower blood pressure, or to contract if it is necessary to increase it.

Arterial hypertension is a condition that is defined by a persistent increase in systolic pressure up to 140 mmHg. century or more; and diastolic pressure up to 90 mm Hg. Art. and more.

There are such periods of changes in blood pressure:

decreases from 1 to 5 am,
rises from 6 to 8 am,
decreases from 23 to 00 o'clock at night.

Blood pressure changes with age:

indicators in children are 70/50 mm Hg. Art.,
indicators in older people are more than 120/80.

Causes of arterial hypertension

In many cases, it is not possible to understand how arterial hypertension arose. In this case, they talk about primary essential hypertension. Some doctors believe that the stimulating factors of primary hypertension are:

accumulation of salt in the kidneys,
the presence of vasoconstrictor substances in the blood,
hormonal imbalance.

About 10% of people have severe hypertension due to taking certain medications or developing another disease. Such arterial hypertension is called secondary hypertension.

The most common causes of hypertension are:

Kidney diseases,
Renovascular hypertension,
Adrenal tumor
Pheochromocytoma,
Side effects of drugs
Increased blood pressure during pregnancy.

If the kidneys retain a lot of salt, the volume of fluid in the body increases. As a result, blood pressure and volume increase. The kidneys also produce the enzyme renin, which plays a key role in determining blood pressure levels.

Renin also increases the production of aldosterone, a hormone responsible for reverse suction water and salt.

Severe renovascular hypertension is quite rare and affects the following groups of people:

aged people,
smokers,
Small children.

Renovascular hypertension is diagnosed by injecting a contrast agent into an artery or vein and then examining the blood flow in the kidneys using X-rays.

The adrenal glands are two glands that secrete many hormones, including aldosterone, located at the top of each kidney. Aldosterone, produced by the adrenal glands, regulates salt and water balance in the body.

In extremely rare cases, a tumor of the adrenal glands provokes an increase in the production of aldosterone, which promotes the retention of water and salt in the body, thereby increasing blood pressure. This type of arterial hypertension most often affects young women. There are additional symptoms:

strong thirst
excessive urination.

Another rare type of hypertension is pheochromytoma, which is caused by another type of adrenal tumor. At the same time, the pancreas produces more of the hormone adrenaline.

Adrenaline is a hormone that helps the body respond fully to stressful situations. This hormone has the following properties:

accelerates heart rate,
increases blood pressure
promotes blood transport to muscles lower limbs.

With pheochromocytoma, adrenaline causes:

rapid heartbeat,
trembling,
heat.

Some drugs and substances can increase blood pressure, for example:

steroids,
antipyretics,
glyceric acid.

Symptoms of arterial hypertension

As you know, arterial hypertension has the second name “silent killer”, since its symptoms do not appear for a long time. Chronic hypertension is one of the main causes of strokes and heart attacks.

Arterial hypertension syndrome has the following symptoms:

Pressing headache that occurs periodically,
Whistling or ringing in the ears
Fainting and dizziness,
"Floaters" in the eyes,
Cardiopalmus,
Pressing pain in the region of the heart.

With hypertension, symptoms of the underlying disease may be expressed, especially for kidney diseases. Only a doctor can choose medications for the treatment of hypertension.

Arterial hypertension largely contributes to the hardening of the arteries. Great pressure on the walls of blood vessels leads to their susceptibility to the accumulation of fatty elements. This process called vascular atherosclerosis.

Over time, the appearance of atherosclerosis provokes a narrowing of the lumen of the arteries and angina pectoris. Narrowing of the arteries of the lower extremities causes the following symptoms:

pain,
stiffness while walking.

Also, blood clots occur due to hypertension. So, if a blood clot is in coronary artery, then it leads to a heart attack, and if it is in the carotid artery, to a stroke.

Arterial hypertension, which has not been treated for a long time, often leads to the formation of a dangerous complication - an aneurysm. Thus, the wall of the artery bulges. An aneurysm often ruptures, causing:

internal bleeding,
brain bleeding,
stroke.

A persistent increase in blood pressure is the cause of deformation of the arteries. The muscle layer that makes up the walls of the arteries begins to thicken, compressing the vessel. This prevents blood from circulating inside the vessel. Over time, thickening of the walls of the blood vessels in the eyes leads to partial or complete blindness.

The heart is always affected due to prolonged arterial hypertension. High blood pressure stimulates the heart muscle to work harder to ensure adequate oxygenation to the tissues.

This condition causes an enlargement of the heart. In the early stages, the enlarged heart has more strength to pump blood optimally into the arteries under high pressure.

But over time, the enlarged heart muscle can weaken and become rigid, no longer supplying oxygen fully. The circulatory system must ensure a constant supply of nutrients and oxygen to the brain.

If the human body senses a decrease in the amount of blood that enters the brain, then compensatory mechanisms quickly turn on, they increase pressure, and blood from systems and organs is transferred to the brain. The following changes occur:

the heart starts beating faster,
blood vessels of the lower extremities and abdominal region contract,
More blood flows to the brain.

As you know, with hypertension, the arteries that supply the brain with oxygen can narrow due to the accumulation of fat-like substances in them. This increases the risk of strokes.

If the arteries of the brain are blocked for a short time, then there is a break in the blood supply to a separate part of the brain. This phenomenon in medicine they call it a microstroke.

Even if the condition lasts only a minute, it requires immediate medical attention. If treatment is not carried out, this is fraught with the development of a full-fledged stroke. Repeated micro-strokes lead to weakening of brain functions. This is how dementia develops in people with arterial hypertension.

Each kidney is made of millions of small filters called nephrons. Every day, over one and a half thousand liters of blood passes through the kidneys, where waste and toxins are filtered and excreted in the urine. Useful material go into the bloodstream.

High blood pressure causes the kidneys to work harder. In addition, damage small vessels inside the nephrons, it reduces the volume of filtered blood. After some time, this leads to a reduction in the filtering function of the kidneys.

Thus, the protein is excreted in the urine before returning to the bloodstream. Waste that needs to be eliminated can enter the bloodstream. This process leads to uremia, and then to renal failure, which requires constant dialysis and blood purification.

As mentioned earlier, at the bottom of the eyeball there are a large number of blood vessels that are very sensitive to increased blood pressure. After several years of hypertension, the process of destruction of the retina may begin. Deformation may be due to:

accumulation of cholesterol in blood vessels,
insufficient blood circulation,
local bleeding.

The diagnosis of arterial hypertension, as a rule, is not made after a single pressure measurement, except when it is above 170-180/105-110 mm Hg. Art.

Measurements are taken over a specified period to confirm the diagnosis. It is necessary to take into account the circumstances during which measurements are taken. The pressure gets higher:

after smoking or drinking coffee,
against a background of stress.

If an adult's blood pressure is more than 140/90 mm Hg. Art., then repeated measurements are usually performed after a year. In people whose blood pressure is from 140/90 to 160/100 mm Hg. st, a repeat measurement is carried out after a short time. With high diastolic pressure from 110 to 115 mm Hg. Art. urgent treatment is needed.

In some cases, older people develop a rare type of arterial hypertension called isolated systolic hypertension. Systolic pressure indicators exceed 140 mmHg. Diastolic pressure remains at 90 mm Hg. st or lower. This type of disease is considered dangerous because it causes strokes and heart failure.

In addition to measuring blood pressure, the doctor should check changes in other organs, especially if pressure readings are constantly at high levels.

The eyes are the only organ of the human body in which blood vessels are clearly visible. Using a bright stream of light, the doctor examines the fundus of the eye with a special device - an ophthalmoscope, which allows you to clearly see the narrowing or dilation of blood vessels.

The doctor can see small cracks and hemorrhages, which are the consequences of high blood pressure.

The inspection also includes:

listening to heart rhythm sounds with a stethoscope,
measuring heart size by palpation,
The use of an electrocardiogram helps to study the electrical activity of the heart and also estimate its size.

In addition to instrumental studies, the doctor prescribes:

examination of urine to exclude kidney infections,
blood sugar test,
blood test for cholesterol.

The fundus, kidneys and blood vessels are the target organs for pathological blood pressure.

Treatment of arterial hypertension

Around the 1950s of the last century, the pharmaceutical industry recorded an increase in the production and synthesis of new groups of antihypertensive drugs.

Previously, treatment for hypertension included:

salt-free diet
surgical interventions,
phenobarbital as a stress reducer.

There is information that at the beginning of the 1940s, every third or fourth bed in the hospital was occupied by a patient with hypertension or its consequences. IN last years A large number of studies have been conducted, which has led to an increase in the effectiveness of therapy for arterial hypertension. Now the number of deaths and serious consequences of the disease has decreased significantly.

The best in Russia and European countries medical workers worked on research and confirmed that only drug treatment high blood pressure makes it possible to reduce the risk of:

cardiovascular diseases,
strokes,
fatalities.

However, some people are convinced that arterial hypertension cannot be treated with medications, since it reduces the quality of life and leads to the development of various side effects, including depression.

Almost all drugs have side effects, but studies show that when using medications that lower blood pressure, side effects are reported in only 5-10% of patients.

The existing variety of groups of drugs that lower blood pressure allows the doctor and the patient to choose the most optimal treatment. The doctor is obliged to warn the patient about the possible side effects of the drugs used.

Diuretics or blood pressure diuretics treat blood pressure by increasing the kidneys' excretion of water and salt. This creates relaxation of the blood vessels.

Diuretics are considered the oldest group of antihypertensive drugs. These drugs began to be used in the 50s of the 20th century. They are also now widely used, often in combination with other drugs.

Beta blockers were introduced in the 1960s. The drugs were used to treat angina pectoris. Beta blockers reduce blood pressure by affecting the nervous system. They block the effect of beta nerve receptors on the cardiovascular system.

As a result, the heart rate becomes less active and the volume of blood pumped out by the heart per minute decreases, lowering blood pressure. Beta blockers also reduce the effect of certain hormones, so blood pressure also normalizes.

Because beta blockers can cause peripheral blood vessel narrowing, they are not recommended for people with circulatory problems of the upper or lower extremities.

Calcium channel blockers are part of a group of drugs that block the flow of calcium inside muscle cells. Thus, the frequency of their contractions is reduced. All muscle cells need calcium; if it is absent, the muscles cannot contract normally, the blood vessels relax and blood flow improves, which lowers blood pressure.

Angiotensin II receptor blockers are the most modern group of drugs. Angiotensin II is an effective vasoconstrictor; its synthesis is carried out under the influence of renin, a kidney enzyme. Angiotensin II has the main property of stimulating the production of aldosterone, which delays the excretion of water and salt by the kidneys.

Drugs that block angiotensin II receptors. Treatment of hypertension cannot be done without these drugs, because they:

prevent further narrowing of blood vessels,
facilitate the removal of excess water and salt from the body.

Treatment with ACE inhibitors is widely used for hypertension. With the help of drugs, the ratio of compounds changes in favor of biologically vasodilating active substances. Medicines in this group are usually prescribed to people with hypertension due to kidney disease or heart failure.

Alpha blockers act on the nervous system, but through different receptors than beta blockers. Alpha receptors promote contraction of arterioles, so they relax and blood pressure decreases. Alpha blockers have side effect– orthostatic hypotension, that is, a sharp decrease in pressure after a person assumes a vertical position.

Imidazoline receptor agonists are one of the most promising antihypertensive drugs. Treatment with medications of this group eliminates vascular spasm, as a result of which the pressure begins to decrease.

Imidazoline receptor agonists are used to treat moderate forms of hypertension and are routinely prescribed in combination treatment.

Non-drug treatment

Treatment of arterial hypertension without medications involves, first of all, reducing salt intake. It is also important to reconsider the amount of alcoholic beverages you take. It is known that drinking more than 80 grams of alcohol per day increases the risk of developing cardiovascular diseases and hypertension.

Overweight is considered overweight if it exceeds 20% or more of normal body weight depending on height. Obese people are often susceptible to developing arterial hypertension. Their blood cholesterol levels, as a rule, are increased.

Eliminating excess weight will not only help reduce blood pressure, but also help prevent dangerous diseases:

atherosclerosis,
diabetes

It is important to remember that there is no one set diet that will ensure that the lost weight will never come back.

Arterial hypertension can reduce symptoms if you adhere to the following therapy: sports activities,

limiting salt intake,
dietary diet.

Classes physical exercise for half an hour three or four times a week will allow you to achieve weight loss and normalize blood pressure. The educational video in this article will tell you about the dangers of arterial hypertension.

Arterial hypertension: why it occurs and how to cope with it

Hypertonic disease or other hypertension significantly increases the risk of stroke, heart attack, vascular disease, and chronic kidney disease. Because of its morbidity, mortality, and costs to society, the prevention and treatment of hypertension is an important public health issue. Fortunately, latest achievements and research in this area has led to an improved understanding of the pathophysiology of hypertension and the development of new pharmacological and interventional treatments for this common disease.

Development mechanisms

Why hypertension occurs is still unclear. The mechanism of its development has many factors and is very complex. It involves various chemicals, vascular reactivity and tone, blood viscosity, the functioning of the heart and nervous system. A genetic predisposition to the development of hypertension is assumed. One of the modern hypotheses is the idea of immune disorders in the body. Immune cells infiltrate target organs (vessels, kidneys) and cause persistent disruption of their functioning. This has been noted, in particular, in persons with HIV infection and in patients who have been taking immunosuppressants for a long time.

Labile arterial hypertension usually develops initially. It is accompanied by instability of pressure numbers, increased heart function, and increased vascular tone. This is the first stage of the disease. At this time, diastolic hypertension is often recorded - an increase in only the lower pressure figure. This happens especially often in young women with overweight body and is associated with edema vascular wall and increased peripheral resistance.

Subsequently, the increase in pressure becomes permanent, affecting the aorta, heart, kidneys, retina and brain. The second stage of the disease begins. The third stage is characterized by the development of complications from the affected organs - myocardial infarction, renal failure, visual impairment, stroke and other serious conditions. Therefore, even labile arterial hypertension requires timely detection and treatment.

The progression of hypertension usually looks like this:

transient arterial hypertension (temporary, only during stress or hormonal imbalances) in people 10–30 years old, accompanied by an increase in blood output from the heart;
early, often labile arterial hypertension in people under 40 years of age, who already have an increase in resistance to blood flow in small vessels;
disease with target organ damage in persons 30–50 years old;
addition of complications in the elderly; At this time, after a heart attack, the heart muscle weakens, the work of the heart decreases and cardiac output, and blood pressure often decreases - this condition is called “decapitated hypertension” and is a sign of heart failure.

The development of the disease is closely related to hormonal disorders in the body, primarily in the “renin – angiotensin – aldosterone” system, which is responsible for the amount of water in the body and vascular tone.

Causes of the disease

Essential hypertension, which accounts for up to 95% of cases of all hypertension, occurs under the influence of external unfavorable factors in combination with genetic predisposition. However, the specific genetic abnormalities responsible for the development of the disease have never been identified. Of course, there are exceptions when a disruption in the functioning of one gene leads to the development of pathology - this is Liddle syndrome, some types of adrenal pathology.

Secondary arterial hypertension can be a symptom of various diseases.

Renal causes account for up to 6% of all cases of hypertension and include damage to the tissue (parenchyma) and blood vessels of the kidneys. Renoparenchymal arterial hypertension can occur with the following diseases:

polycystic disease;
chronic kidney disease;
Liddle's syndrome;
compression of the urinary tract by a stone or tumor;
a tumor that secretes renin, a powerful vasoconstrictor.

Renovascular hypertension is associated with damage to the vessels supplying the kidneys:

coarctation of the aorta;
vasculitis;
narrowing of the renal artery;
collagenoses.

Endocrine arterial hypertension is less common - up to 2% of cases. They can be caused by taking certain medications, such as anabolic steroids, oral contraceptives, prednisolone, or non-steroidal anti-inflammatory drugs. Alcohol, cocaine, caffeine, nicotine and licorice root preparations also increase blood pressure.

Increased pressure is accompanied by many diseases of the adrenal glands: pheochromocytoma, increased production of aldosterone and others.

There is a group of hypertension associated with brain tumors, polio, or high intracranial pressure.

Finally, do not forget about such more rare reasons diseases:

Obstructive sleep apnea syndrome is a common cause of high blood pressure. Clinically, it is manifested by periodic cessation of breathing during sleep due to snoring and the appearance of obstructions in the airways. About half of these patients have high blood pressure. Treatment of this syndrome allows normalizing hemodynamic parameters and improving the prognosis of patients.

Definition and classification

Types of blood pressure - systolic (develops in the vessels at the time of systole, that is, contraction of the heart) and diastolic (preserved in the vascular bed due to its tone during myocardial relaxation).

The classification system is important for deciding the aggressiveness of treatment or therapeutic interventions.

Arterial hypertension is an increase in blood pressure to 140/90 mm Hg. Art. and higher. Often both of these numbers increase, which is called systole-diastolic hypertension.

Besides, blood pressure for hypertension may be normal in people chronically receiving antihypertensive drugs. The diagnosis in this case is clear based on the history of the disease.

Prehypertension is considered to be a blood pressure level of up to 139/89 mm Hg. Art.

Degrees of arterial hypertension:

first: up to 159/99 mm Hg. Art.;
second: from 160/from 100 mm Hg. Art.

This division is to a certain extent arbitrary, since the same patient has different pressure readings under different conditions.

The classification given is based on the average of 2 or more values obtained at each of 2 or more visits after the initial check with the doctor. Unusually low readings should also be assessed from the point of view of clinical significance, because they can not only worsen the patient’s well-being, but also be a sign of serious pathology.

Classification of arterial hypertension: it can be primary, developed due to genetic reasons. Wherein the real reason the disease remains unknown. Secondary hypertension is caused by various diseases of other organs. Essential (without apparent cause) arterial hypertension is observed in 95% of all cases in adults and is called hypertension. In children, secondary hypertension predominates, which is one of the signs of some other disease.

Severe arterial hypertension, which cannot be treated, is often associated with an unrecognized secondary form, for example, with primary hyperaldosteronism. The uncontrolled form is diagnosed when, with a combination of three different antihypertensive medications, including a diuretic, the blood pressure does not reach normal.

Clinical signs

Symptoms of arterial hypertension are often only objective, that is, the patient does not feel any complaints until he experiences target organ damage. This is the insidiousness of the disease, because at stages II–III, when the heart, kidneys, brain, and fundus of the eye are already affected, it is almost impossible to reverse these processes.

What signs should you pay attention to and consult a doctor, or at least start measuring your blood pressure yourself using a tonometer and recording it in your self-monitoring diary:

dull pain on the left side of the chest;
heart rhythm disturbances;
pain in the back of the head;
periodic dizziness and tinnitus;
deterioration of vision, appearance of spots, “floaters” before the eyes;
shortness of breath on exertion;
cyanosis of hands and feet;
swelling or swelling of the legs;
attacks of suffocation or hemoptysis.

An important part of the fight against hypertension is a timely, comprehensive medical examination, which every person can undergo free of charge in their clinic. There are also Health Centers throughout the country, where doctors will talk about the disease and carry out its initial diagnosis.

Hypertensive crisis and its dangers

At hypertensive crisis pressure increases to 190/110 mm Hg. Art. and more. Such arterial hypertension can cause damage to internal organs and various complications:

neurological: hypertensive encephalopathy, cerebral vascular accidents, cerebral infarction, subarachnoid hemorrhage, intracranial hemorrhage;
cardiovascular: myocardial ischemia/infarction, acute pulmonary edema, aortic dissection, unstable angina;
others: spicy renal failure, retinopathy with vision loss, eclampsia in pregnant women, microangiopathic hemolytic anemia.

A hypertensive crisis requires immediate medical attention.

Gestational hypertension is part of the so-called OPG-preeclampsia. If you do not seek help from a doctor, you may develop preeclampsia and eclampsia - conditions that threaten the life of the mother and fetus.

Diagnosis

Diagnosis of arterial hypertension necessarily includes accurate measurement of the patient’s blood pressure, targeted history taking, general examination and obtaining laboratory and instrumental data, including a 12-channel electrocardiogram. These steps are necessary to determine the following provisions:

damage to target organs (heart, brain, kidneys, eyes);
probable causes of hypertension;
baseline indicators for further assessment of the biochemical effects of therapy.

Based on a certain clinical picture or if secondary hypertension is suspected, other tests may be performed - the level of uric acid in the blood, microalbuminuria (protein in the urine).

echocardiography to determine the condition of the heart;
ultrasound examination of internal organs to exclude damage to the kidneys and adrenal glands;
tetrapolar rheography to determine the type of hemodynamics (treatment may depend on this);
blood pressure monitoring on an outpatient basis to clarify fluctuations during the day and night hours;
24-hour electrocardiogram monitoring combined with determination of sleep apnea.

If necessary, an examination by a neurologist, ophthalmologist, endocrinologist, nephrologist and other specialists is prescribed, and a differential diagnosis of secondary (symptomatic) hypertension is carried out.

Treatment

Treatment of arterial hypertension as a first step involves lifestyle modification.

Lifestyle

Reducing blood pressure and heart risk is possible by following at least 2 of the following rules:

weight loss (with a loss of 10 kg, pressure decreases by 5 - 20 mm Hg);
reducing alcohol consumption to 30 mg of ethanol for men and 15 mg of ethanol for women of normal weight per day;
salt intake no more than 6 grams per day;
sufficient intake of potassium, calcium and magnesium from food;
to give up smoking;
reducing the intake of saturated fats (i.e., solid fats, animal fats) and cholesterol;
aerobic exercise for half an hour a day almost every day.

Drug treatment

If hypertension persists despite all measures, there are various drug therapy options. In the absence of contraindications and only after consultation with a doctor, the first-line drug is usually a diuretic. It must be remembered that self-medication can cause irreversible negative consequences in patients with hypertension.

If there is a risk or an additional condition has already developed, other components are included in the treatment regimen: ACE inhibitors (enalapril and others), calcium antagonists, beta blockers, angiotensin receptor blockers, aldosterone antagonists in various combinations. The selection of therapy is carried out on an outpatient basis for a long time until the optimal combination for the patient is found. It will need to be used constantly.

Patient Information

Hypertension is a lifelong disease. It is impossible to get rid of it, with the exception of secondary hypertension. For optimal control over the disease, constant work on oneself and drug treatment are necessary. The patient should attend the “School for Patients with Arterial Hypertension,” because adherence to treatment reduces cardiovascular risk and increases life expectancy.

What a patient with hypertension should know and do:

support normal weight and waist circumference;
exercise regularly;
eat less salt, fat and cholesterol;
consume more minerals, in particular potassium, magnesium, calcium;
limit the consumption of alcoholic beverages;
stop smoking and using psychostimulants.

Regular blood pressure monitoring, doctor visits and behavior correction will help a patient with hypertension maintain high quality life for many years.

Arterial hypertension- This is perhaps the most common disease of the entire cardiovascular system. The word “hypertension” refers to persistently elevated blood pressure. An increase in blood pressure occurs when there is a narrowing of the arteries and/or their smaller branches, the 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. and/or 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 arterial hypertension seriously if I feel quite well? 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 the total amount of blood in the body is 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 through the 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, both during the initial examination of the patient and during further monitoring of the effectiveness of treatment.

By measuring blood pressure at home, you can evaluate it on different days in 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? Definition maximum level pumping air into the cuff is necessary to accurately determine systolic blood pressure with minimal discomfort for the patient and avoid “auscultation failure”:

determine the pulsation of the radial artery, the nature and rhythm of the pulse
While continuing to palpate the 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. Should be avoided too strong pressure stethoscope, 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: it is necessary to take repeated measurements of blood pressure (at least twice with an interval of 3 minutes, then the average value is calculated). It is necessary to measure blood pressure in both the right and left arms.

Symptoms of arterial hypertension

Clinic, i.e. manifestations of hypertension do not have 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 constant sign 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. It is necessary to pay close attention to the fact 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 shortness of breath (cardiac asthma), pulmonary edema (often during crises), chronic (congestive) heart failure. Against this background, myocardial infarction and ventricular fibrillation develop more often.

With gross 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 in hypertension, if there is no 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 that comes with further progression 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 by slight swelling of the eyelids and face. Improvement venous outflow(vertical position of the patient, muscle activity, massage, etc.) is usually accompanied by a decrease or disappearance of the headache.

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 a background of pronounced psycho-emotional or physical stress and subsides after rest and resolution of 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, and increased sensitivity 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 intake of certain medicines.

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 circulatory disorders 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 complete loss of vision.

Risk factors for arterial hypertension

For absolutely all diseases of internal organs, there are both changeable or modifiable and immutable 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. The menopause comes, 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– people with excess body weight have a higher risk of developing arterial hypertension;

M sedentary lifestyle– otherwise, physical inactivity, a sedentary lifestyle and low physical activity lead to obesity, which in turn contributes to the development of hypertension;

U alcohol consumption- Excessive alcohol consumption contributes to arterial hypertension. As for alcohol, it is better not to drink alcoholic beverages at all. 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 the 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 found 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) 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 function thyroid gland).
consumption of ethanol (wine alcohol) more than 60 ml per day.
medications: 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 level of low-density lipoprotein cholesterol (> 4.0 mmol/l) and low level of high-density lipoprotein cholesterol;
family history of early cardiovascular disease (in women< 65 лет, у мужчин < 55 лет);
abdominal obesity (waist circumference ≥102 cm for men or ≥88 cm for women);
level 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 complications: stroke, myocardial infarction, subarachnoid hemorrhage, dissection of the aortic wall, pulmonary edema, acute renal failure.

They arise under the influence of pronounced psycho-emotional stress, alcoholic excesses, Not adequate treatment arterial hypertension, discontinuation of medications, excess salt consumption, 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 by high 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:

Studies for arterial hypertension

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

general blood and urine analysis;
creatinine level in the blood (to exclude kidney damage);
potassium level in the blood when not taking diuretics (a sharp decrease in potassium level is suspicious for the presence of an adrenal tumor or renal artery stenosis);
electrocardiogram (signs of left ventricular hypertrophy - evidence of a long course of arterial hypertension);
determination of blood glucose levels (fasting);
6) blood serum content of total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides, uric acid;
echocardiography (determining the degree of left ventricular myocardial hypertrophy and the state of cardiac contractility)
fundus examination.

chest x-ray;
Ultrasound of the kidneys and adrenal glands;
Ultrasound of the brachiocephalic and renal arteries;
Serum C-reactive protein;
urine analysis for the presence of bacteria (bacteriuria), quantitative assessment of protein in the urine (proteinuria);
determination of microalbumin in urine (required if there is 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; CT scan 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 to minimize the risk of developing cardiovascular complications and death from them. This is achieved through long-term lifelong therapy aimed at:

decrease in blood pressure to normal levels (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 adverse risk factors (obesity, hyperlipidemia, carbohydrate metabolism disorders, excess salt intake, physical inactivity) that contribute 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

Non-drug treatment arterial 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 activity for 30-40 minutes. at least 4 times a week;
reducing table salt consumption to 5 g/day;
changing the diet with an increase in the consumption of plant foods, a decrease in the consumption of 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

A few 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 mm Hg), it is possible to achieve the optimal blood pressure level only with the help of non-drug 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 of these drugs. Refusal to carry out non-drug measures aimed at changing lifestyle is one of the most common reasons resistance to therapy.

Principles of drug therapy for arterial hypertension

Basic principles drug therapy arterial hypertension:

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.
The choice of drug must be justified; The antihypertensive drug should provide a stable effect throughout the day and be well tolerated by the patient.
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.
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.
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:

diuretics;
b-blockers;
calcium antagonists;
angiotensin-converting enzyme inhibitors;
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 myocardial infarction	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 of the 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 hyperplasia prostate, dyslipoproteinemia	Orthostatic hypotension	Chronic heart failure
Imidazoline receptor agonists (Physiotens)	Metabolic syndrome, diabetes mellitus		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 stop at the prehospital stage;
Hypertensive crisis with pronounced manifestations 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, difficulty speaking, or impaired mobility of limbs (possibly acute disorder cerebral circulation),
blurred vision, double vision (possibly retinal vascular thrombosis),

It is necessary to seek emergency medical help to immediately (within minutes and hours) lower 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.

Hypertension (essential arterial hypertension, primary arterial hypertension) is a chronic disease characterized by a long-term persistent increase in blood pressure. The diagnosis of hypertension is usually made by excluding all forms of secondary hypertension.

Source: neotlozhnaya-pomosch.info

According to the recommendations of the World Health Organization (WHO), blood pressure is considered normal if it does not exceed 140/90 mmHg. Art. Exceeding this indicator over 140–160/90–95 mm Hg. Art. at rest when measured twice during two medical examinations indicates the presence of hypertension in the patient.

Hypertension accounts for approximately 40% in general structure cardiovascular diseases. It occurs with equal frequency in women and men, and the risk of development increases with age.

Timely, properly selected treatment of hypertension allows you to slow down the progression of the disease and prevent the development of complications.

Causes and risk factors

Among the main factors contributing to the development of hypertension are violations of regulatory activity higher departments the central nervous system, which controls the functioning of internal organs. Therefore, the disease often develops against the background of repeated psycho-emotional stress, exposure to vibration and noise, as well as night work. Genetic predisposition plays an important role - the likelihood of hypertension increases if there are two or more close relatives suffering from this disease. Hypertension often develops against the background of pathologies of the thyroid gland, adrenal glands, diabetes mellitus, and atherosclerosis.

Risk factors include:

excess body weight;
lack of physical activity;
elderly age;
presence of bad habits;
excessive consumption of table salt, which can cause spasm of blood vessels and fluid retention;
unfavorable environmental conditions.

Classification of hypertension

There are several classifications of hypertension.

The disease can take a benign (slowly progressive) or malignant (rapidly progressive) form.

Depending on the level of diastolic blood pressure, hypertension is classified into mild (diastolic blood pressure less than 100 mm Hg), moderate (100–115 mm Hg) and severe (more than 115 mm Hg).

Depending on the level of increase in blood pressure, three degrees of hypertension are distinguished:

140–159/90–99 mm Hg. Art.;
160–179/100–109 mm Hg. Art.;
more than 180/110 mmHg. Art.

Classification of hypertension:

Stages of hypertension

IN clinical picture Hypertension, depending on the damage to target organs and the development of accompanying pathological processes, is divided into three stages:

Preclinical, or stage of mild and moderate hypertension.
Stage of widespread arterial changes, or severe hypertension.
The stage of changes in target organs, which are caused by changes in the arteries and disruption of intraorgan blood flow, or very severe hypertension.

Symptoms

The clinical picture of hypertension varies depending on the duration of the course, the degree of increase in blood pressure, as well as the organs involved in the pathological process. Hypertension may not manifest itself clinically for a long time. The first signs of the disease in such cases appear several years after the onset of the pathological process in the presence of pronounced changes in the vessels and target organs.

According to the recommendations of the World Health Organization (WHO), blood pressure is considered normal if it does not exceed 140/90 mm Hg. Art.

At the preclinical stage, transient hypertension develops (a periodic temporary increase in blood pressure, usually associated with some external cause - emotional shocks, sudden changes in weather, other diseases). Manifestations of hypertension are headaches, usually localized in the back of the head, of a bursting nature, a feeling of heaviness and/or pulsation in the head, as well as dizziness, tinnitus, lethargy, fatigue, sleep disorders, palpitations, nausea. At this stage, target organ damage does not occur.

As the pathological process progresses, patients experience shortness of breath, which can manifest itself during physical activity, running, walking, or climbing stairs. Patients complain of increased sweating, hyperemia of the skin of the face, numbness of the fingers of the upper and lower extremities, chill-like tremor, prolonged dull pain in the heart, and nosebleeds. Blood pressure remains stable at 140–160/90–95 mmHg. Art. In case of fluid retention in the body, the patient experiences swelling of the face and hands, and stiffness of movements. With a spasm of the blood vessels of the retina, flashes may appear before the eyes, a veil, flickering spots, and visual acuity decreases (in severe cases, up to its complete loss due to hemorrhage in the retina). At this stage of the disease, the patient exhibits microalbuminuria, proteinuria, left ventricular hypertrophy, and retinal angiopathy.

On late stage diseases develop complicated crises.

A hypertensive crisis is a sudden, sharp rise in blood pressure, accompanied by a deterioration in health, dangerous complications.

Due to prolonged increased load on the heart muscle, it thickens. At the same time, the energy supply to the heart muscle cells deteriorates, the supply of nutrients. The patient develops oxygen starvation of the myocardium, and then coronary heart disease, increasing the risk of developing myocardial infarction, acute or chronic heart failure, and death.

As hypertension progresses, kidney damage occurs. In the initial stages of the disease, the disorders are reversible. However, in the absence of adequate treatment, proteinuria increases, the number of red blood cells in the urine increases, the nitrogen excretory function of the kidneys is impaired, and renal failure develops.

In patients with long-term hypertension, there is tortuosity of the blood vessels of the retina, uneven caliber of the vessels, their lumen decreases, which leads to disturbances in blood flow and can cause rupture of the vessel walls and hemorrhages. Changes in the optic nerve head gradually increase. All this leads to a decrease in visual acuity. Against the background of a hypertensive crisis, complete loss of vision is possible.

With peripheral vascular damage, patients with hypertension develop intermittent claudication.

With persistent and prolonged arterial hypertension, the patient develops atherosclerosis, characterized by the widespread nature of atherosclerotic changes in blood vessels, the involvement of muscular arteries in the pathological process, which is not observed in the absence of arterial hypertension. Atherosclerotic plaques in hypertension are located circularly rather than segmentally, as a result of which the lumen of the blood vessel narrows faster and more significantly.

The most typical manifestation of hypertension is changes in arterioles, leading to plasmatic impregnation with the subsequent development of hyalinosis or arteriolosclerosis. This process develops as a result of hypoxic damage to the vascular endothelium, its membrane, as well as muscle cells and fibrous structures of the vascular wall. Arterioles and small-caliber arteries of the brain, retina, kidneys, pancreas and intestines are most susceptible to plasma impregnation and hyalinosis. With the development of a hypertensive crisis, the pathological process dominates in one or another organ, which determines the clinical specificity of the crisis and its consequences. Thus, plasma impregnation of arterioles and renal arteriolonecrosis lead to acute renal failure, and the same process in the fourth ventricle of the brain causes sudden death.

In the malignant form of hypertension, the clinical picture is dominated by manifestations of a hypertensive crisis, which consists of a sharp increase in blood pressure caused by spasm of arterioles. This is a rare form of the disease; a benign, slowly progressive form of hypertension develops more often. However, at any stage of benign hypertension, a hypertensive crisis with its characteristic morphological manifestations may occur. A hypertensive crisis usually develops against the background of physical or emotional stress, stressful situations, changes in climatic conditions. The condition is characterized by a sudden and significant rise in blood pressure, lasting from several hours to several days. The crisis is accompanied by intense headache, dizziness, tachycardia, drowsiness, feeling of heat, nausea and vomiting that does not bring relief, pain in the heart area, and a feeling of fear.

Hypertension occurs with equal frequency in women and men, and the risk of development increases with age.

Diagnostics

When collecting complaints and medical history from patients with suspected hypertension, special attention is paid to the patient’s exposure to adverse factors that contribute to hypertension, the presence of hypertensive crises, the level of increase in blood pressure, and the duration of existing symptoms.

The main diagnostic method is dynamic measurement of blood pressure. To obtain undistorted data, you should measure your blood pressure in a quiet environment, stop exercising, eating, drinking coffee and tea, smoking, and taking medications that can affect your blood pressure levels an hour before. Blood pressure can be measured while standing, sitting, or lying down, with the arm on which the cuff is placed at the same level as the heart. When you first see a doctor, blood pressure is measured in both arms. Repeated measurement is carried out after 1-2 minutes. In case of asymmetry of blood pressure more than 5 mm Hg. Art. subsequent measurements are carried out on the arm where higher values were obtained. If the data of repeated measurements differ, the arithmetic mean is taken as the true value. In addition, the patient is asked to measure blood pressure at home over a period of time.

Laboratory examination includes a general blood and urine test, a biochemical blood test (determination of glucose levels, total cholesterol, triglycerides, creatinine, potassium). For the purpose of studying renal function It may be advisable to conduct urine samples according to Zimnitsky and Nechiporenko.

Instrumental diagnostics includes magnetic resonance imaging of the vessels of the brain and neck, ECG, echocardiography, ultrasound of the heart (enlargement of the left side is determined). You may also need aortography, urography, computed tomography or magnetic resonance imaging of the kidneys and adrenal glands. An ophthalmological examination is carried out to identify hypertensive angioretinopathy and changes in the optic nerve head.

With prolonged course of hypertension in the absence of treatment or in case of malignant form Diseases in patients damage the blood vessels of target organs (brain, heart, eyes, kidneys).

Treatment of hypertension

The main goals of treatment for hypertension are to lower blood pressure and prevent the development of complications. A complete cure for hypertension is not possible, however adequate therapy disease makes it possible to stop the progression of the pathological process and minimize the risk of hypertensive crises, which can lead to the development severe complications.

Drug therapy for hypertension mainly consists of the use of antihypertensive drugs that inhibit vasomotor activity and the production of norepinephrine. Also, patients with hypertension may be prescribed antiplatelet agents, diuretics, lipid-lowering and hypoglycemic agents, and sedatives. If treatment is insufficiently effective, it may be advisable combination therapy several antihypertensive drugs. If a hypertensive crisis develops, blood pressure should be reduced within an hour, otherwise the risk of severe complications, including death, increases. In this case, antihypertensive drugs are administered by injection or in a drip.

Regardless of the stage of the disease, one of the important treatment methods for patients is diet therapy. The diet includes foods rich in vitamins, magnesium and potassium, the consumption of table salt is sharply limited, alcoholic drinks, fatty and fried foods are excluded. If you are obese, calories daily ration should be reduced, sugar, confectionery, and baked goods are excluded from the menu.

Patients are prescribed moderate physical activity: physical therapy, swimming, hiking. Massage has therapeutic effectiveness.

Patients with hypertension should stop smoking. It is also important to reduce exposure to stress. For this purpose, psychotherapeutic practices that increase stress resistance and training in relaxation techniques are recommended. Balneotherapy provides a good effect.

The effectiveness of treatment is assessed by achieving short-term (reducing blood pressure to a level of good tolerance), medium-term (preventing the development or progression of pathological processes in target organs) and long-term (preventing the development of complications, prolonging the patient’s life) goals.

Chronic hypertension is a disease that can affect anyone. It may have difficult character course and bring with it complications. Timely consultation with a doctor and comprehensive treatment will help cope with this disease.

High blood pressure caused by vascular spasms, impeding blood flow, is medically called arterial hypertension. This disease can affect the functioning of almost all internal organs, which leads to disruption of their functions. To avoid serious consequences and maintain your health, you need to follow the treatment regimen prescribed by your doctor and adhere to a proper diet. It is also worth giving up habits that can lead to hypertension.

Hypertension and its types

There are several risk factors for developing this unpleasant disease- this is age, frequent consumption of salt in large quantities, low activity, bad habits, poor diet or obesity, diseases acquired or inherited.

There are several various classifications hypertension. They divide it into types based on differential parameters.

By origin

Primary or essential hypertension is the most common type, the development of which is influenced by unfavorable heredity. The exact causes of this disease have not been established to date. Doctors distinguish 3 forms of primary arterial hypertension, depending on how affected the vessels are and what the clinical manifestations of the disease are.

Secondary or symptomatic arterial hypertension occurs due to the influence of another disease and damage to the organs responsible for blood pressure.

The main diseases are:

renal;
endocrine;
cardiovascular;
neurogenic;
blood diseases.

According to the course of the disease

There are 2 types: benign and malignant hypertension.

The first form occurs slowly, and its symptoms develop gradually. There is a high risk that the disease will be detected at a late stage.

In the second case, arterial hypertension occurs rapidly, and if treatment is not started on time, it can lead to fatal outcome.

By blood pressure level

There are three degrees of the disease:

Soft degree. Frequent and sudden changes in pressure are characteristic. Treated without the use of medications. The patient is recommended to reconsider his lifestyle and change habits.
Moderate degree. The pressure remains at a high level and drops extremely rarely. Treatment occurs with the help of medications. Complex or monotherapy is prescribed.
Severe degree. Blood pressure readings remain high and do not decrease. Subsequently, complex diseases develop and some organs are affected.

Causes of hypertension

Blood pressure never rises “just like that.”

Hypertension always develops under the influence of certain factors. There may be one reason or several at once, and to identify them you need to seek help from specialists. The factors that provoke the development of the disease can be roughly divided into internal and external.

Internal factors

Metabolic dysfunction or obesity.
Malfunction of the cardiovascular system.
Atherosclerotic damage to the arteries.
Hormonal imbalance.
High levels of calcium in the blood.
Apnea.
Excessive levels of “bad” cholesterol.
Renal dysfunction and adrenal insufficiency.
Chronic infectious diseases.
Hereditary diseases.

Very often, arterial hypertension develops in women during menopause. This occurs due to a decrease in estrogen levels. The disease can accompany women throughout menopause.

External factors

Alcohol abuse.
Smoking.
Frequent use of salt and large amounts of it.
Poor nutrition.
Taking medications that provoke the disease.
Inactivity.
Frequent stress.
Insomnia.
Mental and emotional stress.

Arterial hypertension often occurs during pregnancy, at the time of restructuring of hormone production. Weather-dependent people are also at risk. The disease can also be caused by swipe head or concussion.

Hypertension is much less common among women than among men, since estrogens (hormones), present in large quantities in the female body, prevent the development of the disease.

Symptoms

Since hypertension is divided into 3 degrees (mild, moderate and severe), respectively, each of them is accompanied by different symptoms, which help determine the severity of the disease and prescribe the correct treatment.

1st degree:

constant headache that increases with exercise;
severe dizziness and fainting;
increased heart rate;
pain in the area of the left side of the chest, which radiates to the shoulder blade or arm;
the appearance of black spots before the eyes;
noise in ears;
insomnia or sleep disturbances.

When improvement occurs, the patient feels great. Stage 1 hypertension has all the symptoms of heart failure, and as for more severe forms, then they are characterized by persistence and the occurrence of complications.

Each subsequent degree of pathology includes the symptoms of the previous one.

2nd degree:

pulsating sensations in the head;
hyperemia;
increased sweating;
microalbuminuria;
loss of clarity of vision;
vascular insufficiency;
chronic fatigue;
numbness or chills in the fingers;
symptoms of damage to vulnerable organs appear;
numerous swelling;
nausea and vomiting;
hypertensive crises;
narrowing of arterioles;
convulsions;
fainting;
pathology of the fundus.

Despite treatment, the disease, which has reached this stage, goes away extremely rarely and often recurs.

3rd degree:

persistent loss of vision;
arrhythmia;
loss of coordination and changes in gait;
paralysis;
paresis;
hypertensive crises that last for a long time, as a result - speech is impaired, sharp heart pain occurs;
hemoptysis;
complete or partial loss of the ability to move independently.

How advanced disease, the more terrible it is, since any disruption in the functioning of the circulatory system entails severe consequences and destruction of the body.

When such a diagnosis was made before the start of pregnancy or before half of its term, this indicates that the woman suffers from chronic hypertension during pregnancy. This diagnosis can be made even if only one indicator is above normal.

If hypertension is detected in the second half of the pregnancy, it is already gestational hypertension.

Arterial hypertension during pregnancy threatens the development of preeclampsia. High blood pressure also harms the baby's development, reducing the amount of oxygen supplied to the fetus and delaying the child's growth. Hypertension can also cause premature birth and placental abruption.

During pregnancy, your doctor may recommend medications that do not affect the development of the child. After the first trimester, the pressure may return to normal on its own, then treatment and medications are stopped. The patient's condition is monitored throughout pregnancy.

Visits to a gynecologist for women registered for hypertension occur much more often, since constant monitoring of the level of fetal development is necessary. They are prescribed additional tests and ultrasound (to determine abnormalities).

Deviations that you should pay attention to during pregnancy:

pounding in the temples and severe pain in the head;
increased heart rate;
dizziness;
severe swelling (often this is the face and area around the eyes, limbs);
significant weight gain (over 2 kg in one week);
blurred vision;
nausea and vomiting (except toxicosis);
cramps in the upper abdomen.

Arterial hypertension can manifest itself in different ways, so if you experience these symptoms, you should seek medical help.

Consequences of the disease

If there is no treatment, arterial hypertension entails a number of serious complications that affect the functioning of individual organs and the body as a whole.

First of all, when the pressure rises, the following are affected:

kidneys,
heart,
blood vessels,
brain,
eyes.

Hypertension of the second and third stages can lead to a heart attack and the development of heart failure. As a result, a person may become completely incapacitated, limited in movement and self-care.

Poor blood circulation in the brain often results in a stroke (both hemorrhagic and ischemic). In some cases this leads to death, often to disability.

If arterial hypertension affects the functioning of the kidneys, then due to damage to their vessels, a kidney infarction may occur or renal failure may occur. This occurs due to insufficient oxygen entering the organ.

Complications can also include diseases such as thrombophlebitis, phlebothrombosis and others. They arise as a result of the formation of atherosclerotic plaques, which impair blood circulation in the vessels.

Blindness can also develop as a result. It can be absolute or partial (depending on the degree of damage to the ocular vessels).

Complications can be prevented if you start timely treatment and fully follow the doctor’s instructions, as well as by following a special diet.

Treatment of hypertension

Arterial hypertension is a serious disease, which means that treatment requires special attention and proper medical supervision. Independent solutions, especially during pregnancy, can lead to dire consequences.

Treatment of this disease is complex: it’s like drug therapy, and compliance with special diets.

The drugs are prescribed by the doctor individually for each patient. It is especially important to follow the recommendations during pregnancy, since taking medications incorrectly can harm not only the woman, but also the growing fetus.

Drug therapy is carried out using such means as:

diuretics, which remove excess salt and fluid from the body. Can be prescribed during pregnancy;
calcium channel blockers. Treatment with their help involves relaxation of the walls of blood vessels, and this leads to a decrease in pressure;
alpha/beta blockers affect cardiac function and normalize rhythm;
ACE inhibitors. Relaxing muscle tissue, they improve heart rhythm and heart function;
Angiotensin blockers reduce the number of attacks of hypertension and stabilize blood pressure levels. These drugs are not recommended for use during pregnancy, as treatment with them can lead to impaired fetal development.

In addition to medications, it is necessary to include in the diet a maximum of foods that naturally lower blood pressure. These are nuts, tomatoes, fresh fruits, dried fruits, grapefruit, garlic, cabbage and others. It is necessary to exclude strong drinks containing caffeine from the diet, as they contribute to increased blood pressure.

Prevention of chronic hypertension

The main method of preventing chronic hypertension is healthy diet. Proper nutrition will help maintain health and reduce the risk of sudden surges in blood pressure. It should be remembered that with obesity, the possibility of developing chronic hypertension increases several times. Therefore, it is necessary not only to eliminate foods that are harmful to health, but also to reduce the amount of food consumed.

The diet should include:

lean meat (steam or stew without adding oil);
low-fat fermented milk products;
vegetable soups or with added cereals;
oatmeal, buckwheat and pearl barley porridge;
vegetables, whether cooked or not;
fruits with high levels of magnesium.

It is necessary to significantly limit the amount of salt, fast carbohydrates (sweets), animal fats and white flour products in the diet.

In addition, you should completely stop using:

smoked meats;
caffeine;
fat-containing products;
offal;
carbonated or alcoholic drinks.

In addition to diet, you need to avoid stressful conditions and observe correct mode sleep. When experiencing negative emotions or stress, the production of adrenaline increases, which leads to increased blood pressure and disruption of the nervous system.

Disease of the cardiovascular system with constantly high blood pressure. The diagnosis of chronic hypertension is made in the case of systematic excess of 140/90 mm. rt. Art. The disease can cause damage internal organs. Its targets are: blood vessels, heart, kidneys, brain, eyes. Complications of hypertension are serious conditions that pose a danger to health and life. To maintain normal vital activity, it is important for patients to adhere to a healthy lifestyle and follow the doctor’s recommendations.

If blood pressure readings above 140/90 mm are recorded on the tonometer for a week. rt. Art., it is necessary to visit a doctor for timely detection of the disease and initiation of treatment
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Causes of chronic arterial hypertension

Blood pressure rises due to spasm of the arteries and arterioles. The constantly narrowed lumen of the vessel complicates the blood flow, and the heart is loaded more intensely. Multiple Causes Consistently high blood pressure is divided into two groups: internal and external. Environmental factors and human lifestyle are considered external causes, and pathological processes in the body itself - to internal ones.

External primary sources of chronic hypertension:

smoking and frequent drinking;
overstrain of the nervous system;
passive lifestyle;
diet with big amount salt;
medications that increase blood pressure;
long lack of sleep;
head injury and concussion.

Due to the narrowing of arterioles, atherosclerosis develops, which leads to chronic hypertension.

Internal:

narrowing of arterioles by cholesterol plaques;
abundance of calcium in the blood;
genetic predisposition;
diabetes;
failure of the kidneys and adrenal glands;
obesity;
congenital heart defects;
chronic infections;
hormonal imbalance of the body;
snoring and stopping breathing movements during sleep;
sensitivity to changes in atmospheric pressure.

Symptoms and extent of the disease

Hypertension in initial stage does not cause concern and resembles simple overwork. Periodically, severe weakness, dizziness, tinnitus, insomnia, headache, numbness of the arms and legs, rapid heartbeat, and anxiety appear. A person takes a variety of medications to relieve symptoms and postpones a visit to the doctor. The disease continues to develop and moves into more complex stages. In total, there are 3 degrees of hypertension, each of which is accompanied by different symptoms:

Degrees of manifestation and symptoms of hypertension
Degree	Symptoms
1st (soft)	Increasing with load, throbbing pain in the head; tachycardia; dizziness, fainting; flickering of black “flies” in the field of view; pain on the left side of the chest radiates to the shoulder blade or arm; failure in sleep mode; blood pressure rises frequently and sharply; characterized by improvements with the patient feeling well.
2nd (moderate)	Throbbing headache; increased sweating; increased levels of albumin protein in the urine; constant fatigue; numbness of fingers; swelling of the legs, especially severe in the morning; decreased clarity of vision, damage to fundus vessels; convulsions; symptoms of target organ damage; frequent increase in blood pressure.
(heavy)	Vision decreases significantly; uncoordinated movements; paralysis and paresis; frequent hypertensive crises; speech disorders; loss of ability to move is possible.

Signs of exacerbation of hypertension

A hypertensive crisis is an exacerbation of hypertension.

An exacerbation is manifested by a sharp jump in pressure to high numbers - a hypertensive crisis. At the same time, blood flow in the coronary, renal, and cerebral arteries is disrupted, as well as the functioning of the autonomic nervous system. The causes of a sudden exacerbation are: nervous overload, sudden withdrawal of antihypertensive drugs, generous reception salty foods, hormonal anti-inflammatory drugs, change of weather or season of the year.

Any one worsens in the form of a crisis. It is characterized by a sudden onset. Blood pressure numbers during a hypertensive crisis vary from person to person. The duration of the crisis is from 3 hours ( mild degree) up to several days (severe degree). In the case of a severe crisis with the likely occurrence of complications, the person must be hospitalized. Signs:

Hypertensive crisis is a life-threatening condition, the consequences of which can be vascular rupture, cerebral hemorrhage, myocardial infarction, pulmonary edema, and acute encephalopathy.

Features of arterial hypertension during pregnancy

Severe hypertension can trigger premature birth.

Hypertension in chronic form may complicate the course of pregnancy. Vascular spasm of the uterus and placenta complicates the delivery of oxygen and nutrition to the fetus, which leads to hypoxia and inhibition of development. The diagnosis during pregnancy is usually made before the 20th week, even if only one of the blood pressure indicators exceeds the norm. Frequent increases in blood pressure after the 20th week are called “gestational hypertension.” With a mild degree of the disease, pregnancy and childbirth occur without complications. Severe hypertension carries a risk of miscarriage or fetal death. Due to the synthesis of the hormone progesterone, which reduces vascular tone, at 15-16 weeks the pressure decreases and even returns to normal. After the 24th week, blood pressure increases in all women, regardless of the degree of hypertension. A common complication is preeclampsia - the level of protein in the urine increases and edema appears.

Complex treatment

A chronic disease such as hypertension requires lifelong therapy. First degree hypertension can be treated by changing diet and lifestyle. Moderate to severe disease requires medical intervention. Treatment is approached in a comprehensive manner: pharmacological agents combined with correction of nutrition and regimen.