Hypertension

Hypertension (HD)a chronic disease, the main symptom of which is increased blood pressure (BP), subject to the exclusion of symptomatic hypertension

If a person consistently has increased blood pressure (high blood pressure is greater than 140 and 90 mmHg), he or she is usually diagnosed with hypertension.And in 90% of cases this is true.Only in 10% of cases is it 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 exposure ends in a healthy person, blood pressure levels return to normal after a while on their own, unlike a patient whose blood pressure normalizes under the influence of medications that quickly regulate blood pressure values.  

It is assumed that the basis of the disease is a violation of the mechanisms of blood pressure regulation.

Epidemiology of hypertension 

Data from the Society of Cardiology 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, around 40%.After 60 years, more than 60% of patients with hypertension are registered.Due to the aging of the population, the increase in sedentary and overweight people, according to forecasts in 2025 there will be 1.5 billion people with HD in the world, which represents an increase in patients with this disease between 15-20%.

The WHO considers that hypertension and atherosclerosis are the most common causes of premature death in the working-age population.Complications caused by these diseases, such as myocardial infarction, chronic kidney disease or acute stroke, endanger people's lives, but often also disable them, preventing them from working.

Pathogenesis of hypertension.

“A disease of unreacted emotions,” Georgy Fedorovich Lang, a prominent Soviet therapist and scientist, called hypertension.

Blood pressure is the force with which blood presses on the walls of the vessel and depends on three hemodynamic parameters: the strength of cardiac output, the total volume of blood circulating in the vascular bed, and how elastic the vessels are and what their tone is (total peripheral resistance).The upper blood pressure number is determined by the force of blood ejection from the heart (systolic pressure), and the lower number 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, in turn, is regulated by the central and peripheral nervous systems, and depends on a 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 pathogenic 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 altered with increased sodium reabsorption in the kidneys.Due to excessive production of vasoconstrictor compounds and decreased 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 spasm of vascular smooth muscles, resulting in impaired microcirculation.

Subsequently, vascular stiffness increases, which further increases overall vascular resistance and the baroreceptor linkage of the central blood pressure regulation system is impaired.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:

Non-modifiable factors:

• Recorded cases of hypertension in close relatives (inheritance).
• High blood pressure is detected more frequently at older ages (age).
• Sexual: pressure is detected earlier in men than in women.Women are at 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 exacerbation of emotional and nervous reactions. 
• Negroid race (these people get sick more often and have more serious complications of hypertension).
• Influence of climatic conditions (climate-dependent people).

Modifiable 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, helps to suppress sex hormones, prevents the absorption of glucose by other tissues, promotes inflammatory reactions, increases vasoconstriction and swelling of the vascular wall.
• Reducing physical activity increases the risk of disease by 29 to 50%, compared to more trained people.
• Excess salty foods, fat imbalance and alcohol abuse also contribute to increased blood pressure.
• Smoking is an undeniable factor that very negatively affects the walls of the arteries and contributes to the appearance and worsening of high blood pressure.A smoked cigarette can increase blood pressure by 10 to 30 mmHg.Art., promotes spasms and supports the inflammatory process of the vessel wall.
• Emotional overload and chronic stress affect the systems that regulate vascular tone and alter their adaptation to stress.
• Metabolic disorders: lipid metabolism (hypercholesterolemia and resulting atherosclerosis of the arteries) always accompanies hypertension;Carbohydrate metabolism and the development of diabetes mellitus affect the severity of hypertension and mortality from this cause.

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.

Hypertension hastarget organs.These are exactly the organs that suffer if blood pressure increases: heart, brain, kidneys, peripheral arteries, retina.Because increased A/D is associated with spasms primarily of small arteries, which impairs blood circulation, and these organs are very sensitive to impaired blood flow, symptoms are also caused by changes in them.

The main subjective complaints of a patient whose blood pressure increases are: headaches, tinnitus, frequent dizziness, "spots" before the eyes.Later, when persistent changes in the arteries develop, complaints of lack of sleep, deterioration in performance, memory, that is, signs of encephalopathy, will appear.From the side of the heart, tachycardia, shortness of breath, pain or discomfort in the left side of the chest, rhythm disturbances are detected, and then subsequent manifestations of heart failure are noted in the form of shortness of breath and swelling.

Kidney damage begins very imperceptibly, but leads to nephrosclerosis and impairment of its functions.Hypertensive angiopathy develops in the retina, which is detected by an ophthalmologist in the early stages of the disease and, in some cases, makes it possible to confirm the diagnosis.

Exacerbations of hypertension sometimes occur latently, but this does not mean that it is 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 headaches, redness of the face, chills and vomiting. This condition requires calling an ambulance.

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 complaints of patients are studied, focusing mainly on complaints that characterize the involvement of target organs in the process.Particular importance is attached to the presence of a history of heart failure, renal failure, 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 the physical data of 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 if there is weight gain.

After the first consultation, the doctor establishes a preliminary diagnosis, if one has not been made previously.Next, an examination is necessary.

Instrumental examination:

1. 24-hour blood pressure monitoring and 12-lead ECG.
2. Ultrasound examination of the heart (ECO).It gives an idea of the state of the heart chambers and the movement of blood in them.
3. Ultrasonic dopplerography of the arteries of the kidneys and neck.
4. Urine analysis for albuminuria and biochemical blood parameters.
5. Thyroid stimulating hormone and free T4.To evaluate thyroid function.
6. Examination by an ophthalmologist to evaluate the condition of the vessels of the fundus.

When the diagnosis is clarified, the cardiologist or therapist (if the patient is being treated by a therapist) prescribes drug treatment after analyzing the examination data and all possible risk factors.

Hypertension treatment 

Goal of treatment: achieve normal (target) blood pressure levels and prevent complications.Treatment is divided into medicinal and non-medicinal.

Pharmacological treatment of headache. 

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

Currently, there are quite a few medications that reduce blood pressure in the medical arsenal.They affect the known pathogenic mechanisms of the disease and eliminate or reduce their influence.These are various groups of drugs, for example, diuretics (diuretics), renin channel blockers, beta blockers, calcium channel blockers, ACE inhibitors.It is the responsibility of the treating doctor to select them for this particular patient, and it 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 fast;sometimes it is 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 intake of medications according to the prescribed schedule: day, night.
2. In case of side effects or doubts, the patient should contact their treating doctor to adjust the intake of the medication.
3. You should not stop taking medications on your own without consulting a doctor, even if your blood pressure and health are normal.
4. Measure blood pressure when selecting therapy in the morning and evening (keep a diary), in case of any deterioration in health (fill out a diary);if you feel well, for 7 to 10 days in the morning and evening to make sure you are stable, monthly.
5. Visit a doctor for a minimal examination with selected treatment and normal health 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 on his or her own to reduce or avoid high blood pressure given existing risk factors for hypertension?

• Prevents the accumulation of fatty deposits.Weight correction is the most important way to adjust A/D.A weight gain of 10 kg causes an increase in blood pressure of 10 mm Hg.Art. 
• Eat wisely.Your diet should have calories appropriate to your weight, be rich in foods containing potassium and magnesium, and unsaturated fats, while saturated fats and simple carbohydrates should be limited.   
• Don't eat too much salt.It causes arterial spasms and fluid retention in the body.It has been shown 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 is helpful to do physical therapy, swim or walk, and try to walk at least 10,000 steps every day. 
• Avoid nervous tension.: Find a way to change if you often experience extreme anxiety or nervous shock (fitness, yoga, long walks). 
• Avoid excess tensionassociated with intellectual activity. 
• Don't work at nightbecause it alters biological rhythms. 
• Do not operate in areas with significant vibration or noise., affect the central and peripheral nervous and vascular systems. 
• Control your blood pressure levels, especially if your immediate family (parents, brothers and sisters) had or has high blood pressure, in order to take action in time. 
• Contact a gynecologistin the premenopausal and postmenopausal period to eliminate hormonal imbalance. 
• Treat concomitant diseases in a timely manner.kidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (eg, tonsillitis).If you suffer from them, keep in mind that they aggravate the course of the headache. 
• Do not drink alcohol excessively and do not smoke. 

It is recommended to take the prescribed medications systematically and for a long time under the control of blood pressure and the 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.