Hypertension

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

If a person constantly has an increase in blood pressure (high blood pressure is more than 140 and 90 mmHg), they are 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 the person is doing, the position they are in, the degree of physical activity, anxiety, etc.But after exposure ends in a healthy person, blood pressure levels return to normal after some time on their own, unlike in a patient whose blood pressure is normalized under the influence of medications that quickly regulate blood pressure numbers.  

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

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, 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 means an increase in 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 disease or acute stroke, are potentially fatal, but they also often disable people, making them unable to work.

Pathogenesis of hypertension

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

Arterial pressure is the force with which the blood presses on 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 blood pressure number is determined by the force of ejection of blood from the heart - systolic pressure, and the lower number indicates the pressure at the time of diastole - relaxation of the heart.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 the complex of mediators and biologically active substances released into the blood, also secreted by the endocrine system, in different life situations: during emotions, fatigue, 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 interrupted with an increase in sodium reabsorption in the kidneys.Due to the excessive production of vasoconstrictor compounds and the 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 compromised microcirculation.

Subsequently, vascular stiffness increases, further increasing overall vascular resistance, and the baroreceptor linkage of the central blood pressure regulation system is disturbed.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 (heredity).
• High blood pressure is detected more frequently at older ages (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 hypertension).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 from hypertension).
• Influence of weather conditions (weather-dependent people).

Modifiable factors:

• Obese people are susceptible to hypertension 2 to 6 times more often than the general population.This is due to the fact that intraperitoneal fat is hormonally active, helps to suppress sexual hormones, prevents the absorption of glucose by other tissues, assists in inflammatory reactions, increases vasoconstriction and swelling of the vascular wall.
• Reducing physical activity increases disease risk by 29-50% 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 greatly damages the walls of the arteries and contributes to the onset and worsening of high blood pressure.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 consequent 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's important to note that sometimes high blood pressure causes no 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.Due to the fact that the increase in A/D is associated with spasm mainly of small arteries, which impairs blood circulation, and these organs are supersensitive to deterioration in blood flow, the symptoms are also caused by changes in them.

The main subjective complaints of a patient with elevated 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 and 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 are detected, and later manifestations of heart failure in the form of shortness of breath and swelling are noted.

Kidney damage begins imperceptibly, but leads to nephrosclerosis and disruption of its functions.Hypertensive angiopathy develops in the retina, which is detected by the ophthalmologist in the early stages of the disease and, in some cases, allows the diagnosis to be confirmed.

Exacerbations of hypertension 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 sharp increase in blood pressure, which can lead to 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 patient complaints are studied, with the main emphasis on complaints that characterize 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 strokes, detection of diabetes mellitus, retinal angiopathy and aortic aneurysm.

The exam, in addition to measuring blood pressure during the consultation, also includes the evaluation of physical data from 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 establishes a preliminary diagnosis, if it has not already been made previously.Then an examination is required.

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 heart cavities and the movement of blood in them.
3. Ultrasound Dopplerography of the kidney and neck arteries.
4. Urine analysis 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 being treated with a therapist) prescribes drug therapy after analyzing the examination data and all possible risk factors.

Treatment of hypertension 

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

Headache medication treatment 

When selecting therapy, 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.There 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 specific patient, which may take some time, as each group of medications has its own characteristics and side effects, in addition, the effect of the medication is not always quick;sometimes it is necessary to select them in combination.

For treatment to be effective and its long-term goals to be achieved, interaction between the patient and 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 medicines 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. Measure blood pressure when selecting therapy in the morning and evening (keeping a diary), in case of deterioration in health (filling out a diary);if you feel good, for 7 to 10 days, morning and evening, to make sure you are stable, monthly.
5. Visit to the doctor for a minimum examination with selected treatment and normal health 2 times a year (dispensary visit).  

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 not have high blood pressure, given the existing risk factors for hypertension?

• Avoid the accumulation of fat 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 by 10 mm Hg.Art. 
• Eat wisely.Your diet should have adequate calories for your weight, be rich in foods that contain 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 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's helpful to practice 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 feel extreme anxiety or nervous shock (fitness, yoga, long walks). 
• Avoid excess tensionassociated with intellectual 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 members (parents, brothers and sisters) have had or have high blood pressure, to act in time. 
• Contact a gynecologistin the pre-menopausal and post-menopausal period to eliminate hormonal imbalance. 
• Treat concomitant illnesses in a timely mannerkidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (e.g. tonsillitis).If you suffer from them, remember that they worsen the course of the headache. 
• Don't drink excessive alcohol and don't smoke. 

It is recommended to take prescribed medications systematically and for a long time, under blood pressure control and dynamic supervision by a cardiologist or therapist.

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