What is dangerous high blood pressure: symptoms, causes and treatment

Arterial hypertension (AH, hypertension) is one of the most important socioeconomic and medical problems of our time.

This is due not only to the wide dissemination of this disease among the different age groups of the population, but also to the high rates of severe complications, disability, and mortality from arterial hypertension in the absence of timely treatment.

People prone to high blood pressure are recommended to take measurements on both hands. Recent studies have shown that high blood pressure can be confirmed by a difference in readings on different hands of 10 to 15 mm Hg. This sign (difference in indications) has a probability of determining hypertension up to 96%.

What it is?

In simple terms, arterial hypertension is a disease of the cardiovascular system, in which the blood pressure in the arteries of the systemic (large) circulation constantly increases.

Blood pressure is divided into systolic and diastolic:

1. systolicAccording to the first upper number, the blood pressure level is determined at the moment of compression of the heart and expulsion of blood from the artery. This indicator depends on the force with which the heart contracts, the resistance of the blood vessel walls and the frequency of contractions.
2. diastolicThe second lowest number determines the blood pressure at the moment when the heart muscle relaxes. Indicates the level of peripheral vascular resistance.

Normally, blood pressure readings are constantly changing. They depend physiologically on the age, gender and condition of the person. During sleep, the pressure decreases, physical activity or stress lead to its increase.

The average normal blood pressure in a person in their twenties is 120/75 mm Hg. Art. , forty years - 130/80, over fifty - 135/84. With persistent figures of 140/90, we are talking about high blood pressure. Statistics show that around 20-30 percent of the adult population is affected by this disease. With age, the prevalence rate increases inexorably and by the age of 65, 50-65 percent of older people suffer from this disease.

Classification

Given the origin of the pathology, the following types are distinguished:

1. Essential (primary) arterial hypertension. It is difficult to determine the exact cause of the development due to the lack of visible prerequisites;
2. Symptomatic (secondary). An increase in pressure is considered a consequence of the development of a certain disease, it is one of its signs. The secondary type of the disease, depending on the cause of development, is divided into the following types: endocrine, renal, drug-induced, hemodynamic, neurogenic.

If we take into account the level of blood pressure, the pathology is divided into the following types:

1. Border. The pressure periodically rises to 140 - 149/90, then drops, normalizes;
2. Isolated systolic. There is an increase in the upper indicator (it reaches 140 and above). At the same time, the bottom stays in the 90s and below.

Taking into account the nature of the pathology, experts have identified the following types:

1. Transient. The patient has occasional high blood pressure. This state can last for hours or days. The pressure returns to normal without the use of medication;
2. Labile. It manifests itself at the initial stage of the development of pathology. This state is considered limit, because the pressure peaks are insignificant, unstable. The pressure usually normalizes on its own;
3. Stable arterial hypertension. The increase in pressure is persistent, supportive therapy is needed to reduce it;
4. Crisis. Periodic hypertensive crises are characteristic;
5. Evil one. The pressure rises to serious levels, hypertension develops rapidly and causes serious complications. Possible death.

Risk factor's

Currently, the severity of the described disease directly depends on the risk factors. The risk lies in the formation of cardiovascular complications against the background of high blood pressure. Taking into account the complications presented, the prognosis of the consequences of arterial hypertension is diagnosed. There are the following risk factors that worsen the course of the disease and its prognosis:

• age: in men after 50 years, in women after 60 years;
• of smoking;
• high cholesterol;
• hereditary factor;
• obesity;
• hypodynamia;
• diabetes.

The risk factors presented can be eliminated (correctable) and may not be correctable. The first type of risk factors is characterized by the presence of diabetes mellitus, high cholesterol, smoking, sedentary lifestyle. Uncorrected risk factors include race, family history, and age.

Gravity

There is also an international classification of the disease, prepared according to the degree of arterial hypertension:

1st degree arterial hypertension

This stage of the disease is characterized by a mild course of the disease: the pressure during the day increases by 20-30 units and usually does not exceed 180/115 mm Hg. Art. Hypertensive crises occur infrequently and are provoked, as a rule, by a sharp change in atmospheric pressure or emotional overload. There are no complications from the work of the target organs.

Second degree arterial hypertension

It is characterized by an increase in blood pressure to the level of 160-179 / 100-109 mm Hg. Art. It is with such indicators that patients most often go to the doctor for the first time, since to consider them as the norm is the height of carelessness. Second-degree arterial hypertension usually manifests with severe headache, weakness, dizziness, and impaired well-being during episodes of increased pressure.

Third degree arterial hypertension

It is characterized by an increase in blood pressure to the level of 180/110 or more mm Hg. Art. Sometimes these figures can become completely prohibitive (250/160 mm Hg and above), but in this case there is a real threat to health and human life. A patient with high blood pressure of the third degree should be under the supervision of a doctor, take all prescribed antihypertensive drugs, and make sure he has a tonometer (mechanical or electronic) at home.

Symptoms of high blood pressure

High blood pressure itself has no symptoms. Most adult patients with this disease do not complain of anything, high blood pressure is detected by chance.

The clinical manifestations of arterial hypertension depend on which organs are affected at the present time. Adults with benign hypertension may complain of the following symptoms:

1. Headache: it can be the first and main symptom. There are several types of headaches:
   • dull, not intense, characterized by a feeling of heaviness in the forehead and occiput. It appears more often at night or in the morning, it increases with a sharp change in the position of the head and even with slight physical exertion. Such pain is caused by a violation of the venous outflow of blood from the vessels of the skull, its overflow and stimulation of pain receptors;
   • liquor - diffuse bursting throughout the head, may be pulsating. Any tension causes an increase in pain. It most often occurs in the later stages of hypertension or in the presence of pulse hypertension. As a result of this, the vessels are sharply filled with blood, and its outflow is difficult;
   • ischemic - dull or bursting in nature, accompanied by dizziness and nausea. It occurs with a sharp increase in blood pressure. There is an acute vasospasm, as a result of which the blood supply to the brain tissues is disturbed.
2. Pain in the region of the heart - cardialgia, not ischemic in nature, the coronary vessels are in order, while the pain does not stop with sublingual use of nitrates (nitroglycerin under the tongue) and can occur both at rest and during emotional stress. . Sports activities are not a provoking factor.
3. Shortness of breath - at first it occurs only when playing sports, with the progression of hypertension, it can also occur at rest. Characterizes heart dysfunction.
4. Edema: Most often found in the legs due to stagnation of blood in the systemic circulation, sodium and water retention, or impaired kidney function. The appearance in children simultaneously with edema of hematuria and hypertension is characteristic of glomerulonephritis, which is very important to remember when making a differential diagnosis.
5. Visual impairment - manifests itself in the form of blurred vision, the appearance of a veil or flickering flies. It occurs due to damage to the retinal vessels.

Chronic arterial hypertension causes damage to the kidneys with the development of renal failure and the corresponding complaints of renal genesis, which will be discussed below. Chronic hypertension also leads to the development of dyscirculatory encephalopathy, which is characterized by decreased memory, attention, and performance, sleep disturbances (increased daytime sleepiness, combined with nocturnal insomnia), dizziness, tinnitus, and mood swings. depressed.

When collecting an anamnesis, in the medical history it is necessary to record the family history and causes of arterial hypertension in close relatives, clarify the time of appearance of the first clinical symptoms, observe concomitant diseases.

Hypertensive crisis

This is an emergency condition, which consists of a sharp increase in blood pressure to high numbers and is characterized by a sharp deterioration in the blood supply to all internal organs, in particular, vital ones.

It occurs when the body is exposed to various adverse factors, it cannot be predicted, so uncontrolled hypertension is dangerous. The urgency of the problem also lies in the fact that in the absence of timely emergency care, a fatal outcome is possible. To provide emergency care, the patient must be rushed to the hospital, where the blood pressure is quickly lowered with medication.

Students of medical institutes study first aid for hypertensive crisis at the Department of Propaedeutics of Internal Diseases, and therefore it would be better if a random passer-by did not try to provide assistance, but rather call an ambulance.

Diagnostics

The three main diagnostic methods that allow determining the presence of hypertension in a person are:

1. blood pressure measurement,
2. Physical exam,
3. Recording of an electrocardiogram.

Control of blood pressure

Blood pressure measurement is carried out using a special device - a tonometer, which is a combination of a sphygmomanometer with a phonendoscope. In addition, today there are special electronic devices that measure blood pressure, pulse rate, and also allow you to enter blood pressure indicators into the memory of the device.

Medical history

The diagnosis of hypertension also includes a survey of the patient by a doctor. The doctor finds out from the patient what illnesses he previously suffered from or currently suffers from. Risk factors (smoking, high cholesterol, diabetes) are evaluated, in addition to those called. hereditary history, that is, if the patient's parents, grandparents and other close relatives had hypertension.

Physical exam

The physical examination of the patient includes, in the first place, the study of the heart through a stethoscope. This method allows you to detect the presence of heart murmurs, changes in characteristic tones (amplification or, conversely, weakening), as well as the appearance of uncharacteristic sounds. These data, first of all, speak of changes that occur in the heart tissue due to increased blood pressure, as well as the presence of defects.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a method that allows you to record changes in the electrical potentials of the heart over time on a special tape. This is an indispensable method for diagnosing, first of all, various cardiac arrhythmias. Also, the ECG allows you to determine the so-called. hypertrophy of the wall of the left ventricle, which is typical of arterial hypertension.

echocardiography

In addition to these diagnostic methods, other methods are also used, for example, echocardiography (ultrasound examination of the heart), which allows you to determine the presence of defects in the structure of the heart, changes in the thickness of its walls, and the state of the valves.

arteriography

Arteriography, including aortography, is an X-ray method of examining the condition of the walls of the arteries and their lumen. This method makes it possible to identify the presence of atherosclerotic plaques in the wall of the coronary arteries (coronary angiography), the presence of coarctation of the aorta (congenital narrowing of the aorta in a certain area), etc.

dopplerography

Dopplerography is an ultrasound method of diagnosing the state of blood flow in the vessels, both in the arteries and in the veins. With arterial hypertension, first of all, the doctor checks the condition of the carotid arteries and cerebral arteries. Ultrasound is widely used for this, as it is absolutely safe to use and does not lead to complications.

blood chemistry

A biochemical blood test is also used in the diagnosis of hypertension. First of all, it turns out the level of cholesterol and lipoproteins of high, low and very low density, since they are an indicator of a tendency to atherosclerosis. In addition, the level of sugar in the blood is determined.

In the diagnosis of hypertension, a study of the state of the kidneys is also used, for which such methods as a general urinalysis, a biochemical blood test (for the level of creatinine and urea), as well as an ultrasound scan of the kidneys and their boats are used.

Thyroid ultrasound

Ultrasound of the thyroid gland and blood tests for thyroid hormones. These research methods help identify the role of the thyroid gland in causing high blood pressure.

How to treat high blood pressure?

Effective treatment for hypertension is selected based on the severity of the disease and the patient's overall risk of cardiovascular disease. To assess this risk, it takes into account certain factors:

• age: 50 years for men, 60 years for women;
• family history: sudden heart attack or death of a parent (before age 55 in men, before age 65 in women) or stroke before age 45, regardless of parental sex;
• smoking (or not smoking in the last three years);
• diabetes;
• LDL cholesterol level greater than 1. 60 g/l or LDL cholesterol level less than 0. 40 g/l;
• abdominal obesity, kidney failure, lack of regular exercise or excessive alcohol consumption.

General principles for the treatment of high blood pressure at home, which should be followed by all adults with high blood pressure:

With a mild first degree of the disease, non-pharmacological methods are used:

• limit salt intake to 5 g / day (more information on proper nutrition with high blood pressure can be found in our separate article),
• normalization of weight with its excess,
• moderate physical activity 3-5 times a week (walking, running, swimming, physiotherapy exercises),
• give up smoking,
• reduction of alcohol consumption,
• the use of herbal sedatives to increase emotional excitability (for example, a decoction of valerian).

In the absence of the effect of the above methods in the treatment of arterial hypertension of 1 degree, as well as in patients with 2 and 3 degrees of hypertension, they switch to taking medication.

It should be noted that pharmacies today offer a wide range of different drugs for the treatment of high blood pressure, both new and known for many years. Under different trade names, preparations with the same active substance can be produced. It is quite difficult for a non-specialist to understand them.

Diuretics are the drugs of choice for the treatment of hypertension, especially in the elderly. The most common are the thiazides.

Likewise, in the treatment of arterial hypertension it is important to correct the risk factors:

• antiplatelet agents - acetylsalicylic acid, are used according to indications,
• statins in the presence of atherosclerosis, also in the absence of contraindications;
• Medications that lower blood glucose levels in the presence of diabetes.

If the effect is insufficient, it may be necessary to add a second or third drug. Rational combinations:

• diuretic + beta-blocker
• diuretic + ACE inhibitor (or sartan)
• diuretic + calcium antagonist
• dihydropyridine calcium antagonist + beta-blocker
• calcium antagonist + ACE inhibitor (or sartan)

Invalid combinations:

• non-dihydropyridine calcium antagonist + beta-blocker (possible development of heart blocks until death)
• ACE inhibitor + sartan

For the treatment and examination of hypertension, you should consult a doctor. Only a specialist after a thorough examination and analysis of the test results will be able to correctly diagnose and prescribe competent treatment.

Why is hypertension dangerous?

High blood pressure is one of the main causes of serious CVS pathologies.

Although there are currently a large number of antihypertensive drugs that allow maintaining blood pressure at an adequate level, the incidence of hypertensive crises and complications such as heart failure (HF) and renal failure (RI), aortic and mitral valve regurgitation , cardiac aneurysm and aorta, myocardial infarction (heart attacks), strokes, etc. in patients with hypertension it remains extremely high.

This is mainly due to the fact that many patients do not want to take antihypertensive therapy systematically, believing that the hypertensive crisis that developed in them was unique and this will not happen again.

According to statistics, of the patients who know that they have high blood pressure, only about 40% of women and 35% of men receive drug treatment. At the same time, only 15% of women and about five percent of men reach the required levels of pressure due to the systematic use of antihypertensive therapy, control of blood pressure indicators and regular visits to the doctor and following their recommendations.

Despite the fact that arterial hypertension is one of the controllable risk factors for the formation of cardiovascular pathologies, these unfortunate indicators are due to the trivial misunderstanding of the patient about the seriousness of his diagnosis and, consequently, to the lack of an approach serious and responsible. treatment.

The most frequent serious complications that develop due to hypertensive crises are:

• stroke (about thirty percent of patients);
• pulmonary edema (twenty-three percent);
• hypertensive encephalopathy (16%);
• acute heart failure (fourteen percent);
• brain hemorrhage (five percent of cases);
• dissecting aortic aneurysm (2. 5%), etc.

It should be noted that in the absence of adequate and systematic treatment of hypertension, heart and kidney failure within three years after suffering a severe (complicated) hypertensive crisis, 30 to 40% of patients die.

Comprehensive treatment, a responsible approach to health, the systematic use of medications against arterial hypertension and pressure control allow these alarming figures to be reduced to a minimum.

Prevention of high blood pressure

For people with a hereditary predisposition to high blood pressure and burdened by risk factors, prevention of the disease is of great importance.

1. First of all, this is a regular examination by a cardiologist and compliance with the rules of a proper lifestyle, which will help delay and often eliminate the disease of arterial hypertension. If you have a family history of hypertension, you should rethink your lifestyle and radically change many of the habits and lifestyle that are risk factors.
2. You need to reconsider your dietary principles, stop eating salty and fatty foods, switch to a low-calorie diet that includes a large amount of fish, shellfish, fruits and vegetables. Do not get carried away by alcoholic beverages and, especially, beer. They contribute to obesity, uncontrolled consumption of table salt, negatively affect the heart, blood vessels, liver and kidneys.
3. It is necessary to lead an active lifestyle, move more, depending on age, this is ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually, without overloading the body. Outdoor exercise is especially beneficial. Physical exercise strengthens the heart muscle and nervous system and helps prevent stress.
4. Try to have a favorable psycho-emotional environment around you. If possible, avoid conflicts, remember that a broken nervous system very often triggers the mechanism for the development of high blood pressure.
5. Stop smoking, the substances contained in nicotine cause changes in the walls of the arteries, increase their rigidity, therefore, they can be to blame for high blood pressure. Also, nicotine is very dangerous for the heart and lungs.

Thus, we can briefly say that the prevention of high blood pressure includes regular examinations by a cardiologist, the appropriate lifestyle and a favorable emotional framework for your environment.

lifetime prognosis

The prognosis of arterial hypertension is determined by the nature of the course (malignant or benign) and the stage of the disease. Factors that worsen the prognosis are:

• rapid progression of signs of target organ damage;
• Stage III and IV of arterial hypertension;
• severe damage to blood vessels.

An extremely unfavorable course of arterial hypertension is observed in young people. They have a high risk of stroke, myocardial infarction, heart failure, sudden death.

With early treatment of high blood pressure and subject to careful compliance by the patient with all recommendations of the treating physician, it is possible to slow the progression of the disease, improve the quality of life of patients, and sometimes achieve remission. long-term. .