Hypertension

The reasons

Symptoms of arterial hypertension

Diagnostics

Hypertension treatment

Forecast

Arterial hypertension (hypertension, AH) is a condition in which the blood pressure is equal to or greater than 140 mm Hg. (as a result of at least three measurements taken at different times against the background of a calm environment; at the same time, it is not allowed to take medicines, both increasing and decreasing pressure).

If it is possible to identify the causes of hypertension, then it is considered secondary or symptomatic. In the absence of a clear cause, it is called primary or hypertensive disease. The latter is more common, it affects more than 90% of people with high blood pressure.

Hypertension affects 30-45% of the adult population. Until the age of 50, the disease is more common in men, and after 50 years in women.

The reasons

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The causes of arterial hypertension are currently far from completely clear. However, according to recent studies there are several main reasons:

  • Genetic predisposition;
  • In the development of the disease, both internal (hormonal, nervous systems) and external factors (excessive consumption of salt, alcohol, smoking, obesity ) are important;  
  • Violations of fat metabolism;
  • Diabetes mellitus; 
  • Kidney disease;
  • Stress;
  • Inactivity;
  • Smoking.

The World Health Organization has adopted the following blood pressure levels:

Blood pressure categories Systolic 
(upper)
  Diastolic 
(lower)
Optimal <120 and <80
Normal 120 – 129 and / or 80 – 84
High normal 130 – 139 and / or 85 – 89
AG 1st degree 140 – 159 and / or 90 – 99
AH 2nd degree 160 – 179 and / or 100 – 109
AG 3rd degree ≥ 180 and / or ≥ 110
Isolated Systolic AH (ISAG) ≥ 140 and <90

How to measure pressure

The ideal option for measuring blood pressure is considered to be a mechanical tonometer and a phonendoscope. This method is as accurate as possible. But for self-control at home, you can use an automatic or semi-automatic blood pressure monitor. 

  • The measurement should be carried out after a five-minute rest.
  • 30 minutes before this, do not recommend eating, drinking coffee, alcohol, exercise, smoking. 
  • When measuring, the legs should not be crossed, the feet should be on the floor, and the back should rest on the back of the chair.
  • An arm is needed for the arm, the bladder must be emptied before measurement.

Failure to comply with these conditions can lead to an increase in blood pressure.

The shoulder should not be squeezed by clothes (measurement through clothes is inadmissible). Blood pressure is measured at least two times on the same arm. When a difference in blood pressure is detected on one hand, 5 or more mmHg . conduct an additional, third, measurement. As a result, write the average value. During the first measurement, the pressure is measured on both hands, and later on that hand, where it was higher. The difference in blood pressure in the left and right hand should not exceed 10 mm Hg. Art. More significant differences should be alarming for vascular disease of the upper extremities.

Symptoms of arterial hypertension

The main symptom is headache , often on waking and, as a rule, in the occipital region. 

Also, patients may complain of dizziness, blurred vision, the appearance of “flies” in front of the eyes, tinnitus, palpitations, pain in the heart area, shortness of breath.

There is a lesion of the arteries. Then cold extremities, intermittent claudication are added to the list of complaints.

Blood pressure exceeds 140 mm Hg. Art. (as a result of at least three measurements taken at different times against the background of a calm environment; at the same time, it is not allowed to take medicines, both increasing and decreasing pressure).

Often, arterial hypertension does not have any manifestations.

A dangerous complication of hypertension is a hypertensive crisis , an acute condition characterized by a sudden marked increase in pressure. Most often, a hypertensive crisis occurs when a systolic pressure of 180 mm Hg is reached. Art. and higher or diastolic 120 mmHg. Art. and higher. This condition is accompanied by pronounced symptoms, in the flesh to the neurological and often requires calling an ambulance. 

Diagnostics

The doctor at the reception will first of all find out complaints that bother the patient, and collect anamnesis (a history of illness and life). Then he will surely measure the level of blood pressure and conduct a full inspection.

If arterial hypertension is suspected, pressure and pulse should be monitored for at least 1-2 weeks. If the blood pressure is higher than 140/90 mm Hg . more than three times when measured at different times, we can talk about hypertension.

Further, it is necessary to exclude the so-called. symptomatic hypertension when elevated pressure is a consequence of other diseases and conditions. For this you need to conduct the following laboratory and instrumental studies:

  • ECG (signs of an increase in the load on the heart, possible rhythm disturbances), complete blood count and glucose test (exclusion or confirmation of diabetes mellitus) are mandatory in any case  
  • Ultrasound of the kidneys , urinalysis, determination of the level of urea, creatinine in the blood are necessary to exclude the renal nature of the disease 
  • Ultrasound of the adrenal glands is performed if a pheochromocytoma is suspected (adrenal gland tumor that causes the most severe hypertensive crises)
  • Thyroid ultrasound, analysis of hormones T3, T4 , TSH (hypertension can be one of the symptoms of thyrotoxicosis)    
  • MRI of the brain (blood pressure rises with tumors, pituitary adenomas )   
  • You should also consult with a neurologist and an ophthalmologist for the purpose of lesions of target organs for hypertension (brain and eye vessels).

Increased blood pressure is possible

  • with anomalies of vascular development, for example, coarctation – aortic stenosis, or vasoconstriction, for example, subclavian arteries, with atherosclerotic plaques in varying degrees (in these cases, the pressure on the right and left arms may be different),
  • while taking certain medications ( glucocorticosteroids , oral contraceptives),
  • in women in menopause.

In the case of symptomatic hypertension, treatment is aimed at eliminating its cause.

Before starting therapy, it is recommended to perform several more examinations:

  • Determination of cholesterol level (+ lipid spectrum), liver indices ( ALT , AST ) – to decide on the appointment of statins (these are drugs for the treatment of atherosclerosis)   
  • Know the indicators of K and Na in the blood – it is necessary for the appointment of diuretics
  • Analysis of microalbuminuria (earliest sign of renal lesions in arterial hypertension)
  • ECG will help to identify contraindications for taking certain groups of drugs (beta-blockers, calcium antagonists)
  • Echocardiography (ultrasound of the heart) in the detection of noise in the heart, as well as to identify various changes in the body;
  • Ultrasound of brachiocephalic vessels (arteries and veins of the neck and head) for atherosclerosis
  • Ultrasound of the renal arteries to identify contraindications to the appointment of essential drugs for high blood pressure (ACE inhibitors)

Hypertension treatment

The goal of treating hypertension is to reduce the risk of target organ damage (heart, brain, kidney), because these organs suffer from high blood pressure in the first place, even if subjectively there are no unpleasant sensations.

In young and middle-aged people, as well as in patients with diabetes mellitus, it is necessary to maintain a pressure of up to 140/90 mm Hg . In the elderly, the target level of pressure is up to 150/90 mm Hg .

The general principles of treatment of arterial hypertension are as follows:

For easy, first degree disease, non-drug methods are used:

  • limiting the consumption of salt to 5g / day (for more information about proper nutrition with elevated pressure, see our separate article ),  
  • normalization of weight with its excess,
  • moderate exercise 3-5 times a week (walking, jogging, swimming, physical therapy),
  • to give up smoking,
  • reducing alcohol consumption
  • the use of herbal sedatives with increased emotional excitability (for example, valerian decoction).

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

It should be noted that currently a wide range of various medicines for the treatment of arterial hypertension, both new and known for many years, is presented in pharmacies. Under different trade names, drugs with the same active ingredient may be produced. It is rather difficult for a non-expert to understand them, but, despite the abundance of drugs, one can identify their main groups, depending on the mechanism of action:

Diuretics are the drugs of choice for treating hypertension, especially in the elderly. The most common are thiazides ( indapamide 1.5 or 2, 5 mg per day, hypothiazide from 12.5 to 100 mg per day in a single dose in the morning) 

ACE inhibitors have been used for many years, are well studied and effective. These are popular drugs like

  • Enalapril (trade names Enap , Renipril , Renitec ),
  • fosinopril ( Fozinap , Fozikard )
  • Perindopril ( Prestarium , Perineva )
  • ramipril ( Amprilan , Hart ) et al.

Sartans (or angiotensin II receptor blockers) are similar in mechanism of action to ACE inhibitors: 

  • losartan ( Lazap , Lorista )
  • valsartan ( waltz ),
  • irbesartan ( Aprovel )
  • telmisartan ( telmista ).

Beta blockers . Currently used highly selective drugs with minimal side effects: 

  • bisoprolol ( Concor , Niperten ),
  • metoprolol ( Egilok , Betalok ),
  • Nebivolol ( Nebilet , is considered the most selective of modern beta-blockers), etc.

Calcium antagonists on the mechanism of action are divided into 2 main groups, which is of practical importance:

  • dihydropyridine ( amlodipine , felodipine , nifedipine , nitrendipine , etc.)
  • non-dihydropyridine ( verapamil , diltiazem ).

Other drugs for the treatment of arterial hypertension are used strictly according to indications and with the ineffectiveness of the above-described classes of medicinal substances:

  • Moxonidine (trade name Physiotens , Tenzotran ).
  • doxazosin / prazosin ( Kardura / Prazosin).

Also in the treatment of hypertension, it is important to carry out the correction of risk factors.

  • antiplatelet agents – acetylsalicylic acid (for example, Cardiomagnyl , Thromboc- ACC) are used according to indications,
  • statins in the presence of atherosclerosis – also in the absence of contraindications;
  • drugs that reduce blood glucose in the presence of diabetes.

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

  • diuretic + beta blocker
  • diuretic + iapf (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 up to death)
  • IAPP + Sartan

Currently, there are a large number of so-called. fixed combinations (2 or 3 active ingredients in one tablet, well combined with each other). The use of combination drugs increases treatment adherence and eases blood pressure control. These include the following:

  • Lorista N, Lozap plus ( lazartan + hydrochlorothiazide )
  • Walz N ( valsartan + hydrochlorothiazide )
  • Prestanz , Dalneva ( perindopril + amlodipine in various dosages)
  • Exforge ( valsartan + amlodipine ) and Co – exforge ( valsartan + amlodipine + hydrochlorothiazide ), etc.

For treatment and examination for hypertension, you need to consult a doctor. Only a specialist after a full examination and analysis of the results of the examinations will be able to correctly diagnose and prescribe proper treatment.

Forecast

The prognosis essentially depends on the adequacy of the prescribed therapy and patient compliance with the medical recommendations.

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