Hypertension

Hypertension (HD)The subject of exclusion of symptomatic hypertension is a chronic disease with increased blood pressure (BP).

If a person has a constant increase in blood pressure (arterial hypertension is more than 140 and 90 mmHg), then hypertension is usually diagnosed.And in 90% of cases this is true.Only in 10% of cases, by identifying and often eliminating the cause of the increase in blood pressure, it is possible to get rid of a person with signs of arterial hypertension - in this case, the diagnosis is symptomatic hypertension.

According to Kim's recommendation, blood pressure should be considered normal if it does not exceed 140 and 90 mmHg.Art.

Normally, blood pressure changes depending on what a person is doing, what position he is in, physical activity, level of anxiety, etc.  

The basis of the disease is a violation of blood pressure regulation mechanisms.

Epidemiology of hypertension 

Data from the Cardiology Society of the Russian Federation (2020): 30-45% of the world's population suffers from hypertension.Among men aged 25-65, 47% of patients with hypertension, among women, about 40%.More than 60% of patients with hypertension were registered after 60 years.Due to the aging population, the increase in sedentary and overweight people, according to the forecast, there will be 1.5 billion people in the world in 2025, which means a 15-20% increase in this disease with HD.

Hypertension and atherosclerosis are the most common causes of premature death in the working elderly population.Complications caused by these diseases, such as myocardial infarction, chronic kidney disease, or acute cerebrovascular accident, are life-threatening, force people to work, and at the same time put people out of work.

Pathogenesis of hypertension

"A disease of inexperienced emotions," Georgy Fedorovich Lang, a prominent Soviet therapist and scientist called hypertension.

Blood pressure is the force of blood pressure on the vessel walls and depends on three hemodynamic parameters: the heart output, the volume of blood in the vascular bed and the elasticity of the vessels and their tone (total peripheral resistance).The upper number of blood pressure is determined by the force of blood pumping from the heart - the systolic pressure, and the lower number indicates the pressure in the diastole - the pressure when the heart relaxes.It reflects the degree of resistance of blood vessels to blood flow.

Vascular tone, in turn, is regulated by the central and peripheral nervous systems and depends on mediators and biologically active substances released by the selcrine system in various life situations, during heat, fatigue, and physical activity.The pathogenetic mechanisms of hypertension are carried out through the activation of the sympathoadrenal and Renin-Angiotensin-Aldosterone systems, the membrane transport of cations (sodium, calcium and potassium) is disturbed by increased sodium reabsorption in the kidneys.Dysregulation of vascular tone also occurs due to excessive production of vasoconstrictor compounds and decreased production of depressor compounds.These compounds affect the structure of the vascular wall, which undergoes changes due to vascular smooth muscle spasm, infectious inflammation resulting in microcirculation.

Subsequently, the vascular stiffness increases, the general vascular resistance increases, and the baroreceptor of the central regulatory system of the blood pressure system is disturbed.This leads to arterial hypertension, functional and organic changes in the central nervous system, retina and kidneys.

Risk factors

Hypertension is a multifactorial disease.Let's look at the factors affecting the development and exacerbation of hypertension:

Modifiable factors:

• Cases of hypertension in close relatives (heredity) were noted.
• High blood pressure is more common in older age (age).
• Gender - pressure was detected earlier in women than in men.Women have an increased risk of developing hypertension during menopause (60% of women suffer from high blood pressure during this period).This is due to hormonal imbalance and aggravation of emotional and nervous reactions. 
• Negroid race (these people get sick more often and have more severe complications of hypertension).
• Influence of weather conditions (weather dependent people).

Variables:

• Obese people are 2-6 times more susceptible to hypertension than the general population.Because intraperitoneal fat is hormonally active, it helps to suppress sex hormones, prevents the absorption of glucose by other tissues, supports inflammatory reactions, increases the swelling of the vascular wall.
• Reduced physical activity increases the risk of disease by 29-50% compared to people who exercise more.
• Excessively 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 blood vessels and contributes to the occurrence and aggravation of arterial hypertension.A single cigarette can raise blood pressure by 10-30 mmHg.Art., promotes spasm and supports the inflammatory process of the vessel wall.
• Emotional overload and chronic stress affect the systems that regulate vascular tone and disrupt their adaptation to stress.
• Metabolic disorders: Lipid metabolism - hypercholesterolemia and atherosclerosis of arteries - is always accompanied by hypertension;Carbohydrate metabolism and diabetes mellitus to develop - it affects the severity of hypertension and death.

Symptoms of hypertension

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

I have hypertensiontarget organs.These are the organs that suffer if blood pressure rises: heart, brain, kidneys, peripheral arteries, retina.An increase in A / D is primarily caused by changes in the blood circulation, which disrupts blood circulation and is super sensitive to the deterioration of blood flow in these organs.

From a patient with high blood pressure, headache, tinnitus, frequent dizziness, "spots" before the eyes.Later, when continuous changes in the vessels develop, complaints of poor sleep, performance, memory deterioration, that is, signs of encephalopathy will appear.From the side of the heart, rapid heartbeat, shortness of breath, pain or discomfort on the left side of the chest, rhythm disturbances were detected, and then the manifestations of heart failure are noticed in the form of shortness of breath and swelling.

Kidney damage is very noticeable, but it causes nephrosclerosis and dysfunction.Hypertensive angiopathy develops in the retina, detected by an ophthalmologist in the early stages of the disease, and in some cases allows the diagnosis to be confirmed.

Exacerbations of hypertension are sometimes delayed, but this does not mean that it is safe.Regardless of the pressure level, hypertension can manifest itself with severe complications: heart attack and stroke.Sometimes an operation manifests itself as a hypertensive crisis.Blood pressure, severe headache, flushing, tremors and vomiting may occur. This situation requires an emergency call.

Diagnosis of hypertension

Correctly collected anamnesis data plays a special role in the diagnosis of hypertension.Information about the onset of the disease is carefully clarified, all possible risk factors and patient complaints, with a focus on complaints characterizing the involvement of target organs in this process.Of particular importance are heart failure, kidney failure, history of stroke, history of diabetes mellitus, retinal angiopathy, and aortic aneurysm.

In addition to measuring blood pressure during the consultation, the exam also includes an assessment of physical data on target organs.This approach makes it possible to calculate the degree of risk, as a prognosis of the disease is created.If there is weight gain, it is necessary to calculate the body mass index.

After the first consultations, the doctor makes a preliminary diagnosis if it has not been corrected before.Then you need an exam.

Instrumental examination:

1. 24-hour monitoring of blood pressure and ECG at 12.
2. Ultrasound examination of the heart (Echo).It gives an idea about the condition of the heart cavities and the movement of blood in them.
3. Ultrasound dopplerography of the kidneys and vessels of the neck.
4. Urinalysis for albuminuria and biochemical blood parameters.
5. Thyroid-stimulating hormone and free T4.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 therapy after analyzing the examination data and all possible risk factors.

Treatment of hypertension 

The goal of treatment: to reach a normal (target) blood pressure level and prevent complications.Treatment is drug and non-drug.

Drug treatment of headache 

When choosing therapy, doctors put forward international recommendations developed by medical communities for the treatment of hypertension.

There are already many drugs in the medical arsenal with blood pressure.It affects the known pathogenetic mechanisms of the disease and eliminates or reduces its effect.These are several drug groups, for example, diuretics (diuretics), Renin channel blockers, beta blockers, calcium channel blockers, Ace inhibitors.It is the responsibility of the attending physician to choose them for this particular patient, and it may take some time, because each drug group has its own characteristics and side effects, the effect of the drug is not always quick;Sometimes you have to choose them together.

Effectiveness and long-term goals of the treatment, interaction between the patient and the doctor, and absolute compliance with the course of treatment by the patient are necessary.

Rules that a patient who wants to receive effective treatment should not follow:

1. Regular intake of drugs according to the established schedule: day, evening.
2. In case of side effects or doubts, the patient should contact the attending physician to adjust the medication intake.
3. Even if your blood pressure and health are normal, you should not take medicine without consulting a doctor.
4. In case of deterioration of health, measure blood pressure when choosing therapy in the morning and evening (diary);If you feel well, make sure that the morning and evening are fixed monthly for 7-10 days.
5. Referral to a doctor for minimal health with selected treatment and normal health (Dispensary visit).  

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.

Given the existing risk factors for hypertension, a patient can or cannot have high blood pressure for himself or herself?

• Avoid accumulation of fat deposits.Weight correction is the most important way to adjust A/D.An increase in weight of 10 kg causes an increase in blood pressure by 10 mm Hg.Art. 
• Lose your mind.Your diet should be calorie-for-weight, rich in potassium and magnesium and unsaturated fats, and limited in saturated fats and simple carbohydrates.   
• Do not eat too much salt.This causes arterial spasm 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.Doing physical therapy, swimming or walking, and walking at least 10,000 steps each day are helpful. 
• Avoid nervous tension: If you often experience extreme anxiety or nervous shock (fitness, yoga, long walks), find a way to change. 
• Avoid excess tensionrelated to intellectual activity. 
• Do not work at nightBecause it disrupts biological rhythms. 
• Does not work in areas with significant vibration or noise, they affect the central and peripheral nervous and vascular systems. 
• Monitor your blood pressure level, especially if your immediate family (parents, brothers and sisters) have arterial hypertension or have arterial hypertension to take action in time. 
• Contact a gynecologistduring premenopause and postmenopause to eliminate hormonal imbalance. 
• Treat visible diseases in timeKidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (for example, tonsillitis).If you suffer from them, remember that they aggravate the course of the headache. 
• Don't drink too much alcohol and don't smoke. 

It is recommended to take prescribed drugs systematically and for a long time and under the dynamic control and dynamic control of a cardiologist or therapist.

Remember, a happy heart is a healthy heart.Take care of your health every day, follow the recommendations of doctors.