A person is alive as long as his heart beats. The "pump" of the heart ensures the circulation of blood in the vessels. In this regard, there is such a thing as blood pressure. Abbreviated as AD. Any deviation from normal blood pressure levels is deadly.
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Risks of developing hypertension
The risk of developing hypertension or arterial hypertension - high blood pressure - is made up of a number of factors. Accordingly, the more there are, the greater the likelihood that a person will become hypertensive.
Risk factors for developing hypertension:
- hereditary predisposition. The risk of getting sick is higher for those suffering from hypertension among first-degree relatives: father, mother, grandmothers, grandfathers, brothers. The more close relatives suffer from high blood pressure, the greater the risk;
- age over 35 years;
- stress (stress hypertension) and mental stress. Adrenaline, the stress hormone, increases the heart rate. Instantly narrows blood vessels;
- taking certain medications, for example oral contraceptives and various food supplements (iatrogenic hypertension);
- bad habits: smoking or drinking alcohol. Tobacco components cause spasms of blood vessels - involuntary contractions of their walls. This restricts blood flow;
- atherosclerosis – blockage of blood vessels with plaques. Total cholesterol must not exceed 6. 5 mmol/l of blood;
- renal failure (nephrogenic hypertension);
- endocrinopathy of the adrenal, thyroid or pituitary glands;
- excess salt in foods. Table salt causes arterial spasm and retains fluids in the body;
- inactivity. Physical inactivity is accompanied by a slow metabolism - metabolism - and gradually weakens the organism as a whole;
- excess body weight. Each additional kilogram increases blood pressure by 2 millimeters of mercury - mmHg;
- sudden change in weather;
- chronic lack of sleep and other "provocateurs".
Most risk factors for developing hypertension are closely related. Therefore, heavy smokers in most cases develop atherosclerotic plaques, and physically passive and malnourished people quickly gain excess weight. Such combinations of factors significantly increase the risk of pathological abnormalities in the heart.
Depending on the combination and degree of manifestation of the above factors, as well as the likelihood of cardiovascular complications in the next decade, there are 4 types of risk of developing arterial hypertension:
- low (risk less than 15%);
- medium (15 to 20%);
- high (more than 20%);
- very high (more than 30%).
Risk factors for the appearance of arterial hypertension are also divided into 2 types based on the possibility of their elimination: correctable (correctable) and non-correctable. For example, a person may quit smoking, but is unable to change his ancestry. The extent of the risk is summarized by a series of indicators. A patient with stage 1 hypertension who begins to abuse alcohol will significantly increase the percentage chance of developing complications.
Hypertension is quite treatable. Much depends on the timely diagnosis of the disease, the patient's tenacity and his willingness to radically change his lifestyle.
1st degree hypertension
Arterial hypertension can be primary, i. e. develop independently, and secondary - to be a complication of another disease. In the latter case, the treatment is carried out comprehensively, since it is necessary not only to normalize the pressure, but also to cure the concomitant cause of the disease.
A blood pressure reading of 120 to 80 mm Hg is considered normal. This is the "ideal" value, as they say, for astronauts. 120 is the so-called upper blood pressure or systolic pressure (at maximum contraction of the walls of the heart muscle). And 80 is the lower indicator or the so-called diastolic pressure (at maximum relaxation). Accordingly, hypertension is divided into systolic, diastolic and mixed (systole-diastolic), depending on whether the upper or lower indicators exceed the threshold value.
When the lumen of blood flow narrows, the heart makes more effort to push blood into the vessels, wears out faster and begins to work intermittently. An increase in heart rate – heart rate – negatively affects the functioning of the entire body. The air and nutrients contained in the blood do not have time to enter the cells.
Like any disease, hypertension progresses if left untreated. The appearance of the first hypertensive symptoms is preceded by a prehypertensive state - prehypertension.
The degree of severity depends on the stage of development of the disease:
- "soft" or light;
- moderate or borderline;
- very severe or isolated systolic.
Otherwise, stage 1 arterial hypertension is called a mild form of this disease. The upper blood pressure reading ranges from 140 to 159 and the lower is 90 – 99 mm Hg. Disturbances in the functioning of the heart occur spasmodically. Attacks usually pass without consequences. This is a preclinical form of hypertension. Periods of exacerbations alternate with the complete disappearance of the symptoms of the disease. During remission, the patient's blood pressure is normal.
Diagnosis of hypertension is simple: measure blood pressure using a tonometer. For an accurate diagnosis, the procedure is performed three times a day in a quiet environment and in a relaxed state.
Even people at low risk of developing hypertension should have their blood pressure checked regularly. One potentially dangerous factor is enough to more closely monitor the work of your heart. For those who are particularly predisposed to heart disease, it is advisable to purchase a cardiovisor - a device for performing an ECG - electrocardiogram - at home. Any disease is easier to treat at an early stage.
Symptoms of stage 1 hypertension
Symptoms of stage 1 hypertension include:
- headache that progresses with exercise;
- aching or stabbing pain on the left side of the chest, radiating to the shoulder blade and arm;
- black spots before the eyes.
We must not forget that in mild forms of hypertension all these symptoms appear occasionally. If after strenuous physical activity your pulse accelerates or it is difficult to fall asleep due to noisy neighbors, you should not panic and consider yourself hypertensive.
During periods of improvement, the patient feels great. Mild hypertension presents all the characteristic signs of heart failure. The most severe degrees of the disease differ only in the persistence of symptoms and the occurrence of complications.
Complications of 1st degree hypertension
Complications include:
- renal sclerosis - nephrosclerosis;
- hypertrophy of the cardiac muscle (left ventricle).
Most believe that mild hypertension can be treated without consequences. But the risk of complications with grade 1 is average, that is, about 15%. High pressure in the vessels due to narrowing of their lumen leads to insufficient blood supply to the tissues. Lack of oxygen and nutrients leads to the death of individual cells and entire organs. Necrosis begins with local and focal lesions. Over time, if left untreated, an ischemic stroke is inevitable.
Circulatory disorders inevitably lead to metabolic disorders. This has a detrimental effect on the respiration and nutrition of cells of any type. Pathological changes are inevitable, for example sclerosis: replacement with connective tissue. With nephrosclerosis, the walls of the kidney become pathologically denser and the organ "shrinks". In this regard, the excretory function is disrupted and urea enters the bloodstream.
If the blood vessels narrow, the heart struggles to push blood through them. This leads to pathological enlargement of the heart muscle. This hypertrophy is called true or functioning. The volume and mass of the left ventricle increase due to the thickening of its walls. This pathology is otherwise called cardiomyopathy. The heart adapts its structure to the needs of the body. The extra muscle tissue allows him to squeeze harder. It would seem, how could it be dangerous? A "swollen" heart can compress adjacent vessels, and irregular muscle growths can close off the exit from the left ventricle. Cardiac hypertrophy sometimes leads to sudden death.
Complications of grade 1 hypertension occur extremely rarely. To avoid them it is sufficient to minimize the risk of developing arterial hypertension, e. g. eliminate the conditions and causes.
Treatment of stage 1 hypertension
First, the doctor will advise the patient to change her lifestyle. The patient will be advised to have restful sleep, avoid stress, targeted relaxation exercises, a special diet, exercise, etc. If these measures are not enough, drug therapy is resorted to.
The cardiologist prescribes the following drugs: sedatives and other antihypertensive drugs.
Medicines are selected strictly individually, becauseMany hypertensive patients have concomitant diseases. The choice of drugs is influenced by the patient's age and the drugs he uses.
If it is possible to stop the disease at the initial stage and completely eliminate it, then in the future prevention cannot be neglected. Its principle is simple: avoid all risk factors for hypertension. Thanks to a healthy lifestyle it is possible to prevent the onset of hereditary pathologies.
Hypertension 2 degrees
This is hypertension in a moderate form. Upper blood pressure is between 160 and 179 mm Hg and lower blood pressure is between 100 and 109 mm Hg. At this stage of the disease, the periods of increased pressure are longer. Blood pressure rarely returns to normal.
Depending on the speed of transition of hypertension from one stage to another, benign and malignant arterial hypertension is distinguished. In the second, the disease progresses so rapidly that it is often fatal. Hypertension is dangerous because an increase in the speed of blood movement through the vessels leads to a thickening of their walls and an even greater narrowing of the lumen.
Symptoms of stage 2 hypertension
The typical signs of arterial hypertension also appear in mild forms of the disease.
In the second stage, the following symptoms join:
- throbbing sensation in the head;
- hyperemia: overflowing of blood vessels, for example, redness of the skin;
- microalbuminuria – presence of albumin proteins in the urine;
- numbness and chills of the fingers;
- fundus pathologies;
- hypertensive crisis - sudden increases in pressure (sometimes by 59 units at once);
- the appearance or worsening of signs of target organ damage.
Fatigue, lethargy and swelling appear because the kidneys are involved in the disease process. A hypertensive attack may be accompanied by vomiting, difficulty urinating and defecating, shortness of breath, and tears. Sometimes it lasts several hours. Complications of a hypertensive crisis are myocardial infarction and pulmonary or cerebral edema.
Forms of hypertensive crisis:
- autonomic nervous system (increased heart rate, overexcitement, hand tremors, unmotivated panic, dry mouth);
- edematous (lethargy, swelling of the eyelids, inhibited consciousness);
The symptoms of stage 2 hypertension are more difficult for patients to tolerate. He constantly suffers from pathological manifestations of hypertension. The disease at this stage reluctantly recedes and often returns.
Complications of hypertension 2 degrees
Complications of stage 2 hypertension include the following diseases: aortic aneurysm - a pathological protrusion of its wall.
To affect organs, e. g. Internal organs affected due to hypertension include:
- Hemorrhages in various organs occur because the walls of the blood vessels become increasingly thicker, lose elasticity and become fragile. Increased blood flow easily destroys such vessels. The reverse process occurs with the development of aneurysms. Here the walls lengthen and thin due to increased blood circulation. They are so weakened that they tear easily.
- A pathologically narrow lumen increases the likelihood of developing atherosclerosis - fatty deposits on the walls - and thrombosis - their blockage with a blood clot. Bleeding of brain cells leads to oxygen starvation and their death. This phenomenon is called encephalopathy. Ischemia is the lack of oxygen in the heart. Angina pectoris is constant chest pain.
Pathological processes associated with the underlying disease develop in relation to it. As a result, if you do not start treatment in a timely manner or violate medical prohibitions, there will be more and more target organs and it will become almost impossible to restore health.
2nd degree hypertension disability
Hypertensive patients are constantly monitored at the dispensary and are periodically visited. In addition to daily blood pressure measurement, an ECG is regularly prescribed. In some cases, ultrasound may be necessary: ultrasound examination of the heart, urine tests, blood tests and other diagnostic procedures. Hypertensive patients with a moderate form of the disease are less productive than healthy people.
If there is persistent impairment of body functions caused by hypertension, the patient is sent to the office for examination to obtain a medical and social examination report. In rare cases, hypertensive patients are examined at home, in hospital or even in absentia. Sometimes an additional exam program is drawn up. For disabled people, specialists from the Office of Medical and Social Competence develop a mandatory individual rehabilitation program.
To determine the disability group, the expert commission, along with the degree of hypertension, takes into account the following factors:
- information from the history of hypertensive crises;
- patient's working conditions.
The procedure for establishing a group of disabled people is necessary for proper employment. Whether it will be easy to find an employer willing to put up with the work of an "inferior" employee is another question. If an applicant for employment submits documents confirming her disability, then, in accordance with federal legislation, he must be provided with the necessary working conditions.
Employers are reluctant to hire people with disabilities because. . . for them the working hours were reduced while maintaining full pay (for groups 1 and 2). Furthermore, they are forced to go on sick leave more often than other employees and their annual leave has been increased. In this regard, most people with group 3 disabilities hide their illness to get a well-paid job. Violation of medical instructions regarding working conditions leads to worsening of the disease over time.
People with group 3 disabilities receive cash benefits and can carry out professional activities with some restrictions:
- strong vibrations and noises are contraindicated;
- It is not possible to work overtime, on weekends or on night shifts without the employee's consent;
- Constant physical or psycho-emotional stress is not permitted;
- ban on working at high altitudes, in hot shops, near dangerous mechanisms;
- reduce the duration of work that requires a high concentration of attention;
- seven-hour working day.
A special case is stage 2 malignant arterial hypertension. Its development is so rapid and the patient's condition is severe that the commission assigns him a group 2 disability. This is no longer a working group. For disability levels 2 and 3, a medical and social examination is carried out annually. Disabled people belonging to the following categories are exempt from the review:
- men over the age of 60;
- women over 55 years of age;
- people with irreversible anatomical defects.
The assignment of a disability group is caused by the need for social protection of hypertensive patients. His ability to engage in work activities is limited.
Treatment of stage 2 hypertension
At this stage of the disease it is not possible to do without drugs. The tablets are taken regularly, if possible at the same time of day. The patient should not think that to get rid of the disease it will be enough to simply take drugs. If you do this by getting carried away, for example, with fatty foods and alcohol, the positive effect of the therapy will quickly disappear. The disease will move to the next stage, in which any treatment will no longer be effective.
Hypertension 3 degrees
Why are doctors alarmed by deviations of blood pressure values from the norm, even by just one? The fact is that when the pressure increases by several units, the risk of developing cardiovascular complications increases by the same percentage. For example, if a person suffers from mild hypertension and blood pressure deviates from the normal 120-80 mm Hg. of 39 units, then there is a very high probability of pathological abnormalities occurring in various organs (39%). What then about the 3rd degree of the disease, in which the deviation is at least 60 units?
Stage 3 hypertension is a severe and chronic form of the disease. Blood pressure rises above 180/110 mm Hg, never drops to the normal 120/80. Pathological changes are already irreversible.
Symptoms of stage 3 hypertension
Symptoms of stage 3 hypertension include:
- impaired coordination of movements;
- persistent visual impairment;
- paresis and paralysis due to cerebral circulation disorders;
- prolonged hypertensive crises with speech disturbances, blurred consciousness and acute heart pain;
- significant limitation of the ability to move independently, communicate and care for oneself.
In more severe cases, hypertensive patients can no longer cope without external help; they require constant attention and care. The above signs of hypertension show that the patient's well-being is gradually worsening, the disease is spreading to new organ systems, and there are more and more complications.
Complications of grade 3 hypertension
Complications of grade 3 hypertension include the following diseases:
- myocardial infarction – the middle muscular layer of the heart;
- cardiac asthma - suffocation attacks;
- damage to peripheral arteries;
- hypertensive retinopathy affects the retina of the eyes;
- scotoma ("darkness") is a defect, a blind spot in the field of vision.
Complications of grade 3 arterial hypertension are otherwise called associated clinical conditions. When cerebral circulation is impaired, a stroke develops, accompanied by loss of sensation in the limbs and fainting. Heart failure is a whole complex of heart pathologies. The kidneys gradually fail. If hypertension is a secondary disease and occurs against the background of diabetes mellitus, nephropathy is inevitable.
The more advanced the disease, the more terrible and serious its consequences. The circulatory system is so important for the life of the body that the slightest deviation in its functioning has a powerful destructive effect.
3rd degree hypertension disability
In severe cases of the disease, disability group 1 is established. At this stage, patients are practically unable to work. Sometimes they are recognized as partially fit for work and continue to work, but only at home or in particular conditions.
But even with the most severe degree of disability the patient must undergo rehabilitation procedures. In this state of affairs, this is necessary to prevent death.
Treatment of stage 3 hypertension
As the course of the disease worsens, more and more powerful drugs are prescribed or their list remains the same, but the dosage increases. At this stage of hypertension, the effect of drug therapy is minimal. Chronic hypertensive patients are condemned to take pills for life.
When the disease becomes severe, surgery may be necessary. The operation is indicated for some pathologies of the blood vessels and the heart. The method of stem cell therapy for stage 3 arterial hypertension is considered innovative.
Hypertension 4 degrees
Some experts also identify stage 4 of the disease, which is very serious. In most cases, death is near. They try to alleviate the patient's suffering as much as possible and provide first aid for every hypertensive crisis. The patient is lying down, raising his head. He is urgently given drugs that dramatically lower his blood pressure.
Without treatment, new complications appear. Some of them provoke others, and diseases increasingly overtake a person. To stop this destructive process in time, it is enough to monitor the dynamics of changes in blood pressure, at least using an ordinary tonometer.
Example of risk calculation based on the stage of hypertension
Stages of hypertension Other risk factors, POM or disease BP (mmHg)
| High normal | Grade 1 | Grade 2 | Grade 3 | ||
| GARDEN 130-139 DBP 85-89 |
GARDEN 140-159 DBP 90-99 |
GARDEN 160-179 DBP 100-109 |
SBP ≥180 PAD ≥110 |
||
| Phase I | No other FRs | Low risk (risk 1) |
Low risk (risk 1) | Moderate risk (risk 2) |
High risk (risk 3) |
| 1-2 FR | Low risk (risk 1) |
Moderate risk (risk 1) |
Moderate / high risk |
High risk (risk 3) |
|
| ≥3 FR | Short / moderate risk (risk 1) |
Moderate / high risk |
High risk (risk 3) |
High risk (risk 3) |
|
| Phase II | POM, CKD stage 3 or DM without organ damage |
Moderate / high risk |
High risk (risk 3) |
High risk (risk 3) |
High / very high risk |
| Phase III | Established CVD, CKD stage ≥4 or diabetes with organ damage |
Very high risk (risk 4) |
Very high risk (risk 4) |
Very high risk (risk 4) |
Very high risk (risk 4) |
GB - hypertension
SBP - systolic blood pressure
DBP - diastolic blood pressure
RF is a risk factor
CVD - cardiovascular disease
CKD - chronic kidney disease
DM – diabetes mellitus
POM: target organ damage
Once the risk category is determined, the doctor can identify factors that can be influenced to reduce it. Among these modifiable features:
- Obesity (with a BMI above 30), as well as central or visceral obesity, determined by waist circumference.
- Social isolation.
- Chronic stress.
Left ventricular hypertrophy, chronic kidney disease, serious heart rhythm disorders such as atrial fibrillation, and others may also increase the risk.