Hypertension

Hypertension (HD)a chronic disease whose main symptom is an increase in blood pressure (BP), subject to the exclusion of symptomatic hypertension

If a person constantly has an increase in blood pressure (high blood pressure is above 140 and 90 mmHg), they are usually diagnosed with hypertension.And this is true in 90% of cases.Only in 10% of cases it is possible to identify the cause of increased blood pressure and often, by eliminating it, rid the person of the symptom of high blood pressure.In this case, the diagnosis is symptomatic hypertension.

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

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

It is assumed that the disease is caused by 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, about 40%.After 60 years, more than 60% of hypertensive patients are registered.Due to the aging of the population, the increase in the number of sedentary and overweight people, according to forecasts, in 2025 there will be 1.5 billion people in the world with HD, which means an increase in the number of patients with this disease by 15-20%.

The WHO considers hypertension and atherosclerosis to be the most common causes of early death in the working age population.The complications caused by these diseases, such as myocardial infarction, chronic kidney failure or acute stroke, are life-threatening, but they also often incapacitate people, making them unable to work.

Pathogenesis of hypertension

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

Blood pressure is the force with which the blood presses on the walls of the vessel and it depends on three hemodynamic parameters: the force of cardiac output, the total volume of blood circulating in the vascular bed and the elasticity of the vessels and their tone (total peripheral resistance).The upper figure of blood pressure is determined by the force of ejection of blood from the heart - systolic pressure, and the lower figure 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, for its part, is regulated by the central and peripheral nervous systems, 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, fatigue, physical activity.The pathogenetic mechanisms of hypertension are carried out through the activation of the sympatho-adrenal and renin-angiotensin-aldosterone systems, the membrane transport of cations (sodium, calcium and potassium) is disrupted with increased reabsorption of sodium in the kidneys.Due to excessive production of vasoconstrictor compounds and a decrease in the production of depressant compounds, dysregulation of vascular tone also occurs.These compounds affect the structure of the vascular wall, it undergoes changes due to non-infectious inflammation, due to spasms of vascular smooth muscles, leading to impaired microcirculation.

Subsequently, vascular stiffness increases, further increasing overall vascular resistance, and the baroreceptor link of the central blood pressure regulatory system is disrupted.This leads to high blood pressure, 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:

Unchangeable factors:

• Recorded cases of hypertension in close relatives (heredity).
• High blood pressure is detected more often in old age (age).
• Sexual - pressure is detected earlier in men than in women.Women have an increased 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 an 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 (people dependent on weather).

Changeable factors:

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

Symptoms of hypertension

It is important to note that sometimes hypertension does not cause any symptoms.Therefore, people with risk factors for hypertension should routinely monitor their blood pressure.

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

The main subjective complaints of a patient with increased blood pressure are: headaches, tinnitus, frequent dizziness, “spots” before the eyes.Later, when persistent changes in the arteries develop, complaints of poor sleep, deterioration in 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, and then subsequent manifestations of heart failure in the form of shortness of breath and swelling are detected.

Kidney damage 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 helps confirm the diagnosis.

Exacerbations of hypertension sometimes occur latently, but this does not mean that they are safe.Even regardless of the level of pressure, hypertension can manifest itself with serious complications: heart attack and stroke.Sometimes an exacerbation manifests itself as a hypertensive crisis.It is characterized by a sharp increase in blood pressure, severe headache, facial flushing, chills and vomiting may occur. This condition requires calling an ambulance.

Diagnosis of hypertension

Correctly collected anamnesis data play a special role in the diagnosis of hypertension.Information on the occurrence of the disease is carefully clarified, all possible risk factors and patient complaints are studied, with emphasis on complaints characterizing the involvement of target organs in the process.Particular importance is given to the presence of a history of heart failure, renal failure, a 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 makes it possible to calculate the degree of risk, thanks to which a prognosis of the disease is created.It is necessary to calculate the body mass index in case of weight gain.

After the first consultation, the doctor makes a preliminary diagnosis, if it has not been made before.Then an examination is necessary.

Instrumental examination:

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

When the diagnosis is clarified, the cardiologist or therapist (if the patient is treated by a therapist) prescribes drug treatment 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 drug and non-drug.

Drug treatment of headaches 

When choosing treatment, doctors are guided by international recommendations developed by medical communities for the treatment of hypertension.

There are now many drugs in the medical arsenal that lower blood pressure.They affect the known pathogenetic mechanisms of the disease and eliminate or reduce their influence.These are several 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, in addition, the effect of the drug is not always quick;it is sometimes necessary to select them in combination with each other.

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

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

1. Regular taking of medications according to the prescribed schedule: day, evening.
2. In case of side effects or doubts, the patient should contact the attending physician to adjust the medication intake.
3. You should not stop taking medicines on your own without consulting a doctor, even if your blood pressure and health are normal.
4. Measure blood pressure when choosing treatment in the morning and evening (keep a diary), in case of deterioration in health (fill out a diary);if you feel well, for 7 to 10 days in the morning and evening to make sure your condition is stable, once a month.
5. Consult a doctor for a minimal examination with selected treatment and normal health status 2 times a year (visit to the dispensary).  

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 avoid high blood pressure, given existing risk factors for hypertension?

• Avoid the accumulation of fatty 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 contain calories appropriate for your weight, be rich in foods containing potassium, magnesium and unsaturated fats, while saturated fats and simple carbohydrates should be limited.   
• Don't eat a lot of salt.It causes arterial spasms and fluid retention in the body.It has been proven that when a person consumes >5 g of salt per day, the risk of developing hypertension increases significantly. 
• Try to move a lot, but don't overdo it.It helps to get physical therapy, swim or walk, and try to take at least 10,000 steps each day. 
• Avoid nervous tension: Find a way to change if you often feel 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 use in areas with significant vibration or noise, they affect the central and peripheral nervous and vascular systems. 
• Monitor your blood pressure, especially if your immediate family (parents, brothers and sisters) have had or suffer from high blood pressure, in order to act in time. 
• Contact a gynecologistduring the premenopausal and postmenopausal period to eliminate hormonal imbalance. 
• Treat concomitant diseases in a timely mannerkidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (eg, tonsillitis).If you suffer from them, keep in mind that they worsen the progression of headaches. 
• Do not drink alcohol excessively or smoke. 

It is recommended to take prescribed medications 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.