Hypertension

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

If a person constantly shows an increase in blood pressure (blood pressure is greater than 140 and 90 mmHg), then he is usually diagnosed with hypertension.And in 90% of cases this is true.Only in 10% of cases it is possible to identify the cause of the increase in blood pressure, and often, eliminating it, relieves the person of the symptom of arterial hypertension - 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 an unstable value, that is, it changes depending on what a person is doing, his position, the degree of physical activity, stress, etc.But after the end of the exposure in a healthy person, blood pressure levels return to normal after some time on their own, unlike a patient whose blood pressure normalizes under the influence of drugs that quickly regulate the number of blood pressure.  

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 Cardiology Society of the Russian Federation (2020): 30-45% of the world's population suffers from hypertension.In men aged 25-65, 47% of patients with hypertension were identified, and among women, about 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 in the world with HD, which means an increase in patients with this disease by 15-20%.

WHO considers hypertension and atherosclerosis to be 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 cerebrovascular accident, are life-threatening, but also quite often disabling, making them unable to work.

Pathogenesis of hypertension

Georgy Fedorovich Lang, an outstanding Soviet healer and scientist, called hypertension "a disease of unresponsive emotions."

Blood pressure is the force with which the blood presses against the vessel walls and depends on three hemodynamic parameters: the strength of the 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 number of blood pressure is determined by the force of blood ejection from the heart - systolic pressure, and the lower number shows the pressure at the time of expansion - 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 system and depends on the complex of mediators and biologically active substances released into the blood, which are also secreted by the endocrine system, in various life situations: during emotions, fatigue, physical activity.Pathogenetic mechanisms of hypertension occur through the activation of the sympathoadrenal and renin-angiotensin-aldosterone systems, the membrane transport of cations (sodium, calcium and potassium) is disrupted with increased sodium reabsorption in the kidneys.Due to excessive production of vasoconstrictor compounds and reduced production of suppressive 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 the smooth muscles of the vessels, resulting in the disruption of microcirculation.

Vascular stiffness then increases, further increasing total vascular resistance, and the baroreceptor of the central blood pressure regulatory system is disrupted.This leads to arterial hypertension, 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 (heredity).
• Elevated blood pressure is more often found in older age(s).
• Sexual - pressure is detected earlier in men than in women.Women have an increased risk of developing hypertension during menopause (at this time 60% of women suffer from high blood pressure).This is due to hormonal imbalance and heightened emotional and nervous reactions. 
• Negroid race (these people get sick more often and have more serious complications of hypertension).
• Influence of weather conditions (people who depend on the weather).

Modifiable factors:

• People who are obese are prone to hypertension 2-6 times more often 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 from other tissues, supports inflammatory reactions, increases vasoconstriction and swelling of the vascular wall.
• Reduced physical activity increases the risk of disease by 29-50%, compared to more trained people.
• Excessively salty foods, an imbalance of fats and alcohol abuse also contribute to an increase in 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 arterial hypertension.One smoked cigarette can increase 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 subsequent atherosclerosis of the arteries - always accompanies hypertension.carbohydrate metabolism and the development of diabetes mellitus - affect the severity of hypertension and mortality from it.

Symptoms of hypertension

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

Hypertension hastarget organs.These are exactly the organs that suffer if blood pressure rises: heart, brain, kidneys, peripheral arteries, retina.Due to the fact that the increase in A/D is associated with spasm of mainly small arteries, which impairs blood circulation, and these organs are extremely sensitive to the deterioration of blood flow, the symptoms are also caused by changes in them.

The main subjective complaints from a patient whose blood pressure rises are: headaches, tinnitus, frequent dizziness, "spots" in front of the eyes.Later, when persistent changes in the arteries develop, there will be complaints of poor sleep, deterioration of performance, memory, that is, signs of encephalopathy.From the side of the heart, rapid heartbeats, shortness of breath, pain or discomfort on the left side of the chest, rhythm disturbances are detected, and then later manifestations of heart failure in the form of shortness of breath and swelling are observed.

Kidney damage begins very unnoticed, but leads to nephrosclerosis and disruption of their functions.Hypertensive vasculopathy develops in the retina, which is identified by an ophthalmologist in the initial stages of the disease and in some cases allows the diagnosis to be confirmed.

Exacerbations of high blood pressure sometimes occur latently, but this does not mean that it is safe.Even regardless of the pressure level, 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 sudden increase in blood pressure, severe headaches, facial redness, chills and vomiting. This situation requires calling an ambulance.

Diagnosis of hypertension

Correctly collected data play a special role in the diagnosis of hypertension.Information on the onset of the disease is carefully clarified, all possible risk factors and patient complaints are studied, with the main emphasis on complaints characterizing 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 vasculopathy and aortic aneurysm.

The examination, in addition to the blood pressure measurement during the consultation, also includes an evaluation of physical data in 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 an increase in weight.

After the first consultation, the doctor makes a preliminary diagnosis, if it has not been done before.An examination is then required.

Instrumental examination:

1. 24-hour blood pressure and ECG monitoring in 12 leads.
2. Ultrasound examination of the heart (ECHO).It gives an idea about the condition of the heart cavities and the movement of blood in it.
3. Ultrasound Dopplerography of the renal and neck arteries.
4. Urinalysis for albuminuria and blood biochemical 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 therapy after analyzing the test data and all possible risk factors.

Treatment of hypertension 

Treatment goal: achieving normal (target) blood pressure levels and preventing complications.Treatment is divided into pharmaceutical and non-pharmacological.

Pharmaceutical treatment of headache 

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

Now there are many drugs in the medical arsenal that lower blood pressure.They affect the known pathogenic mechanisms of the disease and eliminate or reduce their effect.These are various groups of drugs, for example, diuretics (diuretics), renin channel blockers, β-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, as each group of drugs has its own characteristics and side effects, in addition, the effect of the drug is not always quick.sometimes it is necessary to choose them in combination with each other.

For the treatment to be effective and to achieve its long-term goals, patient interaction with the doctor and absolute compliance with the course of treatment by the patient is necessary.

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

1. Regular intake of medication according to the prescribed schedule: day, night.
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 medication on your own without consulting a doctor, even if your blood pressure and health are normal.
4. Measurement of blood pressure when choosing treatment in the morning and evening (keep a diary), in case of any deterioration of health (fill in a diary).if you feel well, for 7-10 days in the morning and at night to make sure it is stable, monthly.
5. Doctor's visit for minimal examination with selected treatment and normal health 2 times a year (office visit).  

Non-pharmacological measures for the treatment of hypertension

At any stage of hypertension, it is essential to work with modifiable risk factors.This is the prevention of hypertension.

What can a patient do for himself to reduce or not have high blood pressure given the existing risk factors for hypertension?

• Avoid fat accumulation.Weight correction is the most important way to adjust the A/D.A 10 kg increase in weight results in a 10 mm Hg increase in blood pressure.Art. 
• Eat wisely.Your diet should have calories appropriate for 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 spasm 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 participate in physical therapy, swimming or walking and aim to walk at least 10,000 steps each day. 
• Avoid nervous tension: Find a way to change if you often experience extreme anxiety or nervous shock (exercise, yoga, long walks). 
• Avoid excessive tensionassociated with mental activity. 
• Don't work at nightbecause it disrupts biological rhythms. 
• Do not operate in areas with significant vibration or noise, affect the central and peripheral nervous and vascular systems. 
• Monitor your blood pressure levels, especially if your immediate family (parents, brothers and sisters) had or have arterial hypertension, in order to take early measures. 
• Contact a gynecologistin the pre-menopausal period and in the post-menopausal period to eliminate hormonal imbalance. 
• Treat comorbidities earlykidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (for example, tonsillitis).If you suffer from them, be aware that they worsen the course of the headache. 
• Don't drink too much alcohol and don't smoke. 

Systematic and long-term taking of the prescribed drugs under the control of blood pressure and dynamic supervision of a cardiologist or therapist is recommended.

Remember, a happy heart is a healthy heart.Pay attention to your health every day, follow the recommendations of doctors.