Hypertension

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

If a person consistently shows increased blood pressure (high blood pressure is above 140 and 90 mmHg), he is usually diagnosed with hypertension.And in 90% of cases this is true.Only in 10% of cases is it possible to identify the cause of the increase in blood pressure and often, by eliminating it, free the person from the symptom of arterial hypertension: in this case the diagnosis is symptomatic hypertension.

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

Normally blood pressure is a labile value, that is, it changes depending on what the person does, the position they are in, the degree of physical activity, anxiety, etc.But after the end of exposure in a healthy person, blood pressure levels after some time return to normal, unlike a patient whose blood pressure normalizes under the influence of drugs that quickly regulate blood pressure values.  

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

Epidemiology of hypertension 

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

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

Pathogenesis of hypertension

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

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

Vascular tone, in turn, is regulated by the central and peripheral nervous system, and depends on the complex of mediators and biologically active substances released into the blood, also secreted by the endocrine system, in various life situations: during emotions, tiredness, physical activity.The pathogenetic mechanisms of hypertension are realized through the activation of the sympathoadrenal and renin-angiotensin-aldosterone systems, the transport across the membrane of cations (sodium, calcium and potassium) is interrupted with an increase in sodium reabsorption in the kidneys.Due to excessive production of vasoconstrictor compounds and reduced production of depressant compounds, dysregulation of vascular tone also occurs.These compounds influence the structure of the vascular wall, which undergoes changes due to non-infectious inflammation, due to spasm of the vascular smooth muscle, with consequent impairment of microcirculation.

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

Risk factors

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

Non-modifiable factors:

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

Modifiable factors:

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

Symptoms of hypertension

It is important to note that sometimes high blood pressure causes no symptoms.Therefore, people with risk factors for hypertension should systematically monitor their blood pressure.

Hypertension hastarget organs.These are precisely the organs that suffer if the pressure increases: heart, brain, kidneys, peripheral arteries, retina.Since increased A/D is mainly associated with spasm of small arteries, which impairs blood circulation, and since these organs are extremely sensitive to deterioration of blood flow, symptoms are also caused by changes in them.

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

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

Hypertension flare-ups sometimes occur latently, but that doesn't mean it's safe.Even regardless of the level of pressure, hypertension can manifest itself with serious complications: heart attack and stroke.Sometimes a flare-up manifests as a hypertensive crisis.It is characterized by a sharp increase in blood pressure, severe headache, facial redness, chills and vomiting may occur. This condition requires calling an ambulance.

Diagnosis of hypertension

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

The examination, in addition to measuring blood pressure during the consultation, also includes an evaluation of physical data on the target organs.This approach allows you to calculate the degree of risk, thanks to which a prognosis of the disease is created.You need to calculate your BMI if you experience weight gain.

After the first visit, the doctor establishes a preliminary diagnosis, if one has not been made previously.An examination is then required.

Instrumental exam:

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

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

Treatment of hypertension 

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

Pharmacological treatment of headache 

In choosing therapy, doctors are inspired by international recommendations developed by medical communities for the treatment of hypertension.

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

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

Rules that a patient who wishes to receive effective treatment must follow:

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

Non-pharmacological measures for the treatment of hypertension

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

What can a patient do to reduce or eliminate high blood pressure given existing risk factors for hypertension?

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

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

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