Hypertension: causes, treatment, prognosis, stages and risk levels

Hypertension (HTN) is one of the most common diseases of the cardiovascular system, which only according to estimated data affects one third of the world's population. At the age of 60-65 years, more than half of the population has been diagnosed with hypertension. This disease is called the "silent killer", because its signs may not be present for a long time, while changes in the walls of blood vessels begin already at an asymptomatic stage, greatly increasing the risk of vascular accidents.

In Western literature, this disease is called arterial hypertension (AH). Others have adopted this formulation, although both "hypertension" and "hypertension" are still commonly used.

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

The important thing is to identify all possible risk factors,and explain their role in the development of this disease. The relationship between the level of hypertension and existing risk factors is displayed in the diagnosis, which facilitates the assessment of the patient's condition and prognosis.

For most patients, the number in the diagnosis after "AH" does not mean anything, although it is clear that the higher the level and risk indicators, the worse the prognosis and the more serious the pathology. In this article we will try to understand how and why one or another level of hypertension is diagnosed and what underlies the determination of the risk of complications.

Causes and risk factors of hypertension

There are many causes of arterial hypertension. GovSpeaking of primary hypertension, or essential, we andWe mean the case when there is no previous disease or pathology of certain internal organs. In other words, such hypertension occurs by itself, involving other organs in the pathological process. Primary hypertension accounts for more than 90% of chronic high blood pressure cases.

The main cause of primary hypertension is considered to be stress and psycho-emotional load, which contributes to the disruption of the central pressure regulation mechanism in the brain, then the humoral mechanism suffers, and the target organs are involved (kidneys, heart, retina).

Secondary hypertension– other pathological manifestations, so the cause is always known. It accompanies kidney disease, heart, brain, endocrine disorders and is secondary to them. After the underlying disease is cured, hypertension also disappears, so it makes no sense to determine the risk and level in this case. Symptomatic hypertension accounts for no more than 10% of cases.

Hypertension risk factors are also known to everyone. A hypertension school is being created in the clinic, whose experts convey information to the population about the adverse conditions that lead to hypertension. Any therapist or cardiologist will inform the patient about the already existing risk at the first recorded case of high blood pressure.

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

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

If we can exclude the factors listed or at least try to reduce their impact on health, then characteristics such as gender, age, heredity cannot be changed, and therefore we have to be patient with them, but not forget the increasing risk.

Classification of arterial hypertension and determination of risk levels

The classification of hypertension involves identifying the stage, extent of the disease and the level of risk of vascular accidents.

Disease stagedepending on the clinical manifestations. Highlight:

• Preclinical stage, when there are no signs of hypertension and the patient is not aware of the increase in blood pressure;
• Stage 1 hypertension, when the pressure is raised, a crisis may occur, but there are no signs of target organ damage;
• Stage 2 is accompanied by damage to target organs - myocardial hypertrophy, changes in the retina of the eye are noticeable, and the kidneys suffer;
• At stage 3, stroke, myocardial ischemia, vision pathology, changes in large vessels (aortic aneurysm, atherosclerosis) are possible.

Hypertension level

Determining the degree of hypertension is important in assessing risk and prognosis and based on pressure figures. It must be said that normal blood pressure values also have different clinical significance. So, the indicator is up to 120/80 mm Hg. Art. countedoptimum,normalpressure will be between 120-129 mmHg. Art. systolic and 80-84 mm Hg. Art. diastolic. Pressure number 130-139/85-89 mmHg. Art. still within normal limits, but approaching the border with pathology, that is why they are called "very normal", and the patient may be told that he has high normal blood pressure. This indicator can be considered a pre-pathology, because the pressure is only "a few millimeters" from being raised.

From the moment the blood pressure reaches 140/90 mm Hg. Art. we can already talk about the presence of the disease. These indicators are used to determine the level of hypertension itself:

• The first stage of hypertension (HTN or first stage AH in diagnosis) means an increase in pressure in the range of 140-159/90-99 mmHg. Art.
• Stage 2 headache is accompanied by a number of 160-179/100-109 mm Hg. Art.
• With stage 3 hypertension, the pressure is 180/100 mmHg. Art. and higher.

It happens that the systolic pressure figure increases, amounting to 140 mm Hg. Art. and higher, while diastolic values are within normal values. In this case they are talking aboutisolated systolic formhypertension. In other cases, the systolic and diastolic pressure indicators correspond to different levels of the disease, so the doctor makes a diagnosis in favor of the higher level, and it does not matter whether the conclusion is made on the basis of systolic or diastolic pressure.

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

The concept of risk in diagnosis

Hypertension is dangerous because of its complications. It is no secret that the majority of patients die or become disabled not from the fact of high blood pressure itself, but from the acute disorders that lead to it.

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

Risk stratification criteriaFor hypertensive patients, external conditions, the presence of other diseases and metabolic disorders, target organ involvement, and concomitant changes in organs and systems are used.

The main risk factors that affect the prognosis include:

1. The patient's age is after 55 years for men and 65 years for women;
2. Smoking;
3. Disorders of lipid metabolism (exceeding the cholesterol norm, low-density lipoprotein, high-density lipid fraction decreased);
4. The presence of cardiovascular pathology in the family among blood relatives under the age of 65 and 55 years for women and men, respectively;
5. Overweight, when the abdominal circumference exceeds 102 cm in men and 88 cm in women.

The factors listed are considered the main ones, but many hypertensive patients have diabetes, impaired glucose tolerance, lead an inactive life, and have abnormalities in the blood clotting system in the form of increased fibrinogen concentration. These factors take into accountextra, also increases the possibility of complications.

Damage to the target organs characterizes hypertension, starting from stage 2, and serves as an important criterion by which the risk is determined, therefore, the examination of the patient includes ECG, cardiac ultrasound to determine the degree of muscle hypertrophy, blood and urine tests for indicators of kidney function (creatinine, protein).

First of all, the heart experiences high blood pressure, which pushes blood into the vessels with increased force. When arteries and arterioles change, when their walls lose elasticity and the lumen becomes spasmodic, the load on the heart increases. Characteristics that are taken into account when risk stratification is consideredmyocardial hypertrophy, which can be suspected by ECG, can be determined by ultrasound examination.

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

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

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

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

To make it clearer what the risk indicators mean in the diagnosis, you can summarize everything in a small table. By determining your level and "calculating" the factors listed above, you can determine the risk of vascular accidents and complications of hypertension for a particular patient. Number 1 means low risk, 2 - moderate, 3 - high, 4 - very high risk of complications.

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

Low risk means the probability of a vascular accident is no more than 15%, medium - up to 20%, high risk indicates the development of complications in one third of patients from this group, with very high risk more than 30% of patients are prone to complications.

Manifestations and complications of headache

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

As changes in the blood vessels and heart develop, symptoms appear in the form of headaches, weakness, decreased performance, periodic dizziness, visual symptoms in the form of poor visual acuity, flashing "spots" in front of the eyes. All these signs are not expressed during a stable pathological course, but at the time of the development of a hypertensive crisis, the clinic becomes brighter:

• Strong headache;
• Noise, ringing in the head or ears;
• Darkness in the eyes;
• Pain in the heart area;
• Dyspnoea;
• Facial hyperemia;
• Excitement and fear.

A hypertensive crisis is provoked by traumatic situations, overwork, stress, the use of coffee and alcoholic beverages, so patients with an established diagnosis should avoid such influences. Against the background of a hypertensive crisis, the possibility of complications increases dramatically, including life-threatening ones:

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

How to measure blood pressure correctly?

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

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

The large selection and availability of devices for measuring blood pressure allow you to monitor it in a wide variety of people at home. Usually, hypertensive patients have a tonometer at home, on hand, so that if their health worsens, they can immediately measure blood pressure. However, it should be noted that fluctuations may also occur in completely healthy individuals without hypertension, so an excess of the norm cannot be considered a disease, and to make a diagnosis of hypertension, the pressure must be measured at different times. , in different conditions and repeatedly.

When diagnosing hypertension, blood pressure figures, electrocardiographic data and cardiac auscultation results are considered fundamental. When listening, it is possible to detect noise, increased tone, and arrhythmias. The ECG, starting from the second stage, will show signs of pressure on the left side of the heart.

Treatment of hypertension

To correct high blood pressure, treatment regimens have been developed that include drugs of different groups and different mechanisms of action. themcombinations and doses are selected by the doctor individuallytaking into account stage, concomitant pathology, and hypertensive response to certain drugs. After the diagnosis of hypertension has been established and before drug treatment begins, the doctor will suggest non-drug measures that significantly increase the effectiveness of pharmacological drugs, and sometimes allow you to reduce the dose of drugs or leave at least some of them.

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

Non-drug measures in the early stages of hypertension can have such a good effect that the need to prescribe drugs is no longer necessary. If these measures do not work, the doctor prescribes the appropriate medicine.

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

Antihypertensive drugs from the following groups are traditionally used to treat hypertension:

• Diuretics;
• Angiotensin II receptor antagonist;
• ACE inhibitors;
• Adrenergic blockers;
• Calcium channel blockers.

Every year the list of drugs that reduce blood pressure increases and at the same time becomes more effective and safer, with fewer adverse reactions. When starting therapy, one drug is prescribed in the minimum dose; if it doesn't work, it can be upgraded. If the disease progresses and the pressure does not remain at an acceptable value, then another drug from a different group is added to the first drug. Clinical observations show that the effect is better with combination therapy than with prescribing a single drug in the maximum amount.

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

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

The most widely used ACE inhibitors, calcium channel blockers,prescribed to young and old patients, with or without concomitant diseases, diuretics, sartans. Drugs in this group are suitable for initial treatment, which can then be supplemented with a third drug of a different composition.

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

Diureticno less popular. To reduce adverse reactions, they are combined with ACE inhibitors, sometimes "in one tablet. "

Beta blockersnot a priority group for hypertension, but effective for concomitant heart pathology - heart failure, tachycardia, coronary disease.

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

Angiotensin receptor antagonists– the most prescribed group of drugs for hypertension. They effectively reduce blood pressure and do not cause coughing like most ACE inhibitors. But in America it is common because of a 40% reduction in the risk of Alzheimer's disease.

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