Hypertension: causes, treatment, prognosis, stages and degrees of risk

Hypertension (HTN) is one of the most common diseases of the cardiovascular system, which only according to approximate data affects one third of the world's population. By the age of 60-65, more than half of the population has been diagnosed with hypertension. The disease is called the "silent killer" because its signs can be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, greatly increasing the risk of vascular accidents.

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

Much attention to the problem of arterial hypertension is caused not so much by its clinical manifestations as 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).

An important point is to identify all possible risk factors,as well as clarifying their role in the progression of the disease. The relationship between the degree of hypertension and the existing risk factors appears in the diagnosis, which simplifies the assessment of the patient's condition and prognosis.

For most patients, the numbers in the diagnosis after "AH" mean nothing, although it is clear that the higher the grade and risk index, the worse the prognosis and the more serious the pathology. In this article we will try to understand how and why one or another degree of hypertension is diagnosed and what is the basis for determining the risk of complications.

Causes and risk factors of hypertension

The causes of arterial hypertension are many. GovernorSpeaking of primary, or basic, hypertension, we andWe mean the case where there is no specific previous disease or pathology of 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 cases of chronic high blood pressure.

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

Secondary hypertension– manifestation of another pathology, so its cause is always known. It accompanies diseases of the kidneys, heart, brain, endocrine disorders and is secondary to them. After treatment of the underlying disease, hypertension also subsides, so it makes no sense to determine the risk and degree in this case. Symptomatic hypertension accounts for no more than 10% of cases.

Risk factors for hypertension are also known to everyone. Hypertension schools are created in clinics, whose specialists convey information to the population about adverse conditions that lead to hypertension. Any therapist or cardiologist will inform the patient about the risks already in the first case of recorded high blood pressure.

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

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

If we can exclude the mentioned factors or at least try to reduce their impact on health, then characteristics such as sex, age, heredity cannot be changed and therefore we should tolerate them, but not forgetting the increased risk.

Classification of arterial hypertension and determination of risk level

The classification of hypertension includes the determination of the stage, the degree of the disease and the level of risk of vascular accidents.

Stage of the diseasedepends on the clinical manifestations. Climax:

• Preclinical stage, when there are no signs of hypertension and the patient ignores the increase in blood pressure.
• Stage 1 hypertension, when the pressure is elevated, seizures are possible, but there are no signs of target organ damage.
• Stage 2 is accompanied by damage to the target organs - the myocardium hypertrophies, changes in the retina of the eyes are noticeable, and the kidneys suffer.
• In stage 3, strokes, myocardial ischemia, vision pathology, changes in large vessels (aortic aneurysm, atherosclerosis) are possible.

Degree of hypertension

Determining the degree of hypertension is important in assessing risk and prognosis and is based on pressure numbers. It must be said that normal blood pressure values also have different clinical significance. Thus, the indicator is up to 120/80 mm Hg. Art. countsoptimal,normalthe pressure will be between 120-129 mmHg. Art. systolic and 80-84 mm Hg. Art. diastolic. Pressure numbers 130-139/85-89 mmHg. Art. they are still within normal limits, but they are approaching the borderline of pathology, which is why they are called "very normal", and the patient can be informed that he has high normal blood pressure. These indicators can be considered as a pre-pathology, because the pressure is only "a few millimeters" away from elevation.

Once the blood pressure reached 140/90 mm Hg. Art. we can already talk about the presence of the disease. This indicator is used to determine the degree of hypertension itself:

• 1st degree hypertension (HTN or AH 1st stage at diagnosis) means an increase in pressure in the range of 140-159/90-99 mmHg. Art.
• Stage 2 headache is accompanied by numbers 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 values increase, reaching 140 mm Hg. Art. and higher, while the diastolic value is within normal values. In this case they are talking aboutisolated systolic formhypertension. In other cases, systolic and diastolic pressure indicators correspond to different degrees of the disease, then the doctor makes a diagnosis in favor of a greater degree, and it does not matter whether conclusions are drawn based on systolic or diastolic pressure.

The most accurate diagnosis of the degree of hypertension is possible when the disease is diagnosed for the first time, when treatment has not yet been carried out and the patient has not received any antihypertensive medication. During treatment, the numbers fall, and when it is stopped, on the contrary, they can rise sharply, so it is no longer possible to adequately assess the grade.

The concept of risk in diagnosis

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

Brain hemorrhages or ischemic necrosis, myocardial infarction, kidney failure are the most dangerous conditions caused by high blood pressure. In this regard, for each patient after a thorough examinationthe risk is determined, it is indicated in the diagnosis with the numbers 1, 2, 3, 4. Thus, 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 patients with hypertension, external conditions, the presence of other diseases and metabolic disorders, involvement of target organs and consequent changes in organs and systems are used.

Major risk factors that affect prognosis include:

1. The age of the patient is after 55 years for men and 65 for women.
2. Smoking;
3. Disorders of lipid metabolism (exceeding the norm of cholesterol, low-density lipoproteins, reduced fractions of high-density lipids).
4. Presence of cardiovascular disease in the family among blood relatives under 65 and 55 years for women and men, respectively.
5. Excessive body weight, when the circumference of the abdomen exceeds 102 cm in men and 88 cm in women.

The mentioned factors are considered the main ones, but many patients with hypertension suffer from diabetes, reduced glucose tolerance, lead a sedentary life and have abnormalities in the blood coagulation system in the form of an increase in the concentration of fibrinogen. These factors are taken into accountadditional, also increasing the chance of complications.

Target organ damage characterizes hypertension, starting from stage 2, and serves as an important criterion by which the risk is determined, so the examination of the patient includes an ECG, ultrasound of the heart to determine the degree of hypertrophy of muscles, blood andurine tests for indicators of kidney function (creatinine, protein).

First of all, the heart suffers from high blood pressure, which pushes blood into the vessels with increased force. As the arteries and arterioles change, when their walls lose their elasticity and the lumens become spasmodic, the load on the heart increases progressively. A characteristic that is considered when risk stratification is consideredmyocardial hypertrophy, which can be suspected on the ECG, can be determined by ultrasound control.

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 the large arteries thicken, atheromatous plaques appear, which can be detected by ultrasound (carotid, brachiocephalic arteries).

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

Thus, the reader probably understands how you can even independently determine the degree of headache. This is not difficult, you just need to measure the pressure. Then you can think about the presence of certain risk factors, take into account age, gender, laboratory parameters, ECG data, ultrasound, etc. In general, everything listed above.

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

To make it clearer what the risk indicator means in a diagnosis, you can summarize everything in a small table. By determining your degree and "counting" 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, danger	GB (AH) 1, danger	GB 2, danger	GB 3, danger
no one	1	2	3
1-2	1	2	2	4
more than three factors/target lesion/diabetes	3	3	3	4
related pathology	4	4	4	4

Low risk means that the probability of vascular accidents is no more than 15%, moderate - up to 20%, high risk indicates the development of complications in a third of patients in this group, with a very high risk of more than 30% of patients prone tocomplications.

Manifestations and complications of headache

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

As changes in the blood vessels and the heart progress, symptoms appear in the form of headache, weakness, reduced performance, periodic dizziness, visual symptoms in the form of impaired visual acuity, "spots" that flash before the eyes. All these signs are not expressed during a stable course of the pathology, but at the time of the development of a hypertensive crisis, the clinic becomes brighter:

• Severe headache?
• Noise, ringing in head or ears.
• Darkness in the eyes.
• Pain in the region of the heart.
• Shortness of breath?
• Facial hyperemia?
• Excitement and feeling of fear.

Hypertensive attacks are caused by traumatic situations, overwork, stress, drinking coffee and alcoholic beverages, so patients with an already documented diagnosis should avoid such effects. In the context of a hypertensive crisis, the possibility of complications increases sharply, including life-threatening ones:

1. Bleeding or stroke.
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 could normally differ in different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. can occur due to pathology of peripheral vessels, so different pressures on the right and left hand should be treated with care.

To obtain the most reliable data, it is recommended to measure the pressure three times in each arm at short intervals, recording each resulting result. In most patients, the smallest values obtained are the most correct, but in some cases the pressure increases from measurement to measurement, which does not always speak in favor of hypertension.

The wide variety and availability of devices for measuring blood pressure make it possible to monitor it in a wide range of people at home. Typically, hypertensive patients have a tonometer at home so that if their health worsens, they can immediately measure their blood pressure. It is worth noting, however, that fluctuations are also possible in perfectly healthy people without hypertension, so an excess of the norm should not be considered a disease, and to make a diagnosis of hypertension, the pressure must be measured at different times, under different conditions and repeatedly.

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

Treatment of hypertension

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

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

Non-pharmacological measures in the initial stage of hypertension can have such a good effect that the need for prescription drugs will no longer be necessary. If these measures do not work, the doctor prescribes the appropriate drugs.

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

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

• Diuretics?
• Angiotensin II receptor antagonists.
• ACE inhibitors?
• Adrenergic blockers?
• Calcium channel blockers.

Every year the list of drugs that lower blood pressure grows and at the same time becomes more effective and safer, with fewer side effects. At the beginning of treatment, a drug is prescribed in a minimum dose; if it is ineffective, it can be increased. If the disease progresses and the pressure does not remain at acceptable values, then another drug from a different group is added to the first drug. Clinical observations show that the result is better with combination therapy than with the prescription of one drug in the maximum amount.

Reducing the risk of vascular complications is important for choosing a treatment regimen.Thus, it has been noted 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 reduces the likelihood of complications, even if there are some daily fluctuations in blood pressure.

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

The most widely used ACE inhibitors, calcium channel blockers,which are prescribed to both young and old patients, with or without accompanying diseases, diuretics, sartans. Medicines of these groups are suitable for initial treatment, which can then be supplemented with a third medicine 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 in older patients.

Diureticsno less popular. To reduce side effects, they are combined with ACE inhibitors, sometimes "in one tablet".

Beta blockersthey are not a priority group for hypertension, but they are effective for concomitant cardiac pathology - heart failure, tachycardia, coronary artery disease.

Calcium channel blockerswhich are often prescribed in combination with ACE inhibitors, are particularly good for bronchial asthma in combination with hypertension, as they do not cause bronchospasm.

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

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