Hypertension: causes, treatment, prognosis, stages and degrees of risk

Hypertension (HN) is one of the most common diseases of the cardiovascular system, which, according to approximate data, affects one third of the world's population. At the age of 60-65, more than half of the population is diagnosed with hypertension. The disease is called a "silent killer" because its signs may be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, which significantly increases the risk of vascular accidents.

In Western literature, the disease is called arterial hypertension (AH). Others have adopted this wording, although both "hypertension" and "hypertension" are still commonly used.

The great attention to the problem of arterial hypertension is due not so much to its clinical manifestations as to complications in the form of acute vascular disorders in the brain, heart and kidneys. Their prevention is the main goal of treatment aimed at maintaining normal blood pressure (BP).

It is important to identify all possible risk factors,as well as elucidating their role in disease progression. The relationship between the degree of hypertension and the existing risk factors is shown in the diagnosis, which simplifies the assessment of the patient's condition and prognosis.

For most patients, the numbers in the diagnosis after "AH" do not mean anything, although it is clear that the higher the degree and risk indicator, the worse the prognosis and the more serious the pathology. In this article we will try tounderstand how and why one or another degree of hypertension is diagnosed and what is the basis for determining the risk of complications.

Causes and risk factors for hypertension

There are many causes of arterial hypertension. managerSpeaking of primary or essential hypertension, we andWe mean the case when there is no specific previous disease or pathology of the internal organs. In other words, such hypertension occurs independently, involving other organs in the pathological process. Primary hypertension accounts for more than 90% of cases of chronic high blood pressure.

The main cause of primary hypertension is considered to be stress and psycho-emotional overload, which contribute to the disruption of the central mechanisms for regulating pressure in the brain, then the humoral mechanisms suffer and the target organs (kidneys, heart, retina) are affected.

Secondary hypertension– a manifestation of another pathology, so the cause is always known. It accompanies diseases of the kidneys, heart, brain, endocrine diseases and is secondary to them. After curing the underlying disease, hypertension also disappears, so it makes no sense to determine the risk and degree in this case. Symptomatic hypertension accounts for no more than 10% of cases.

Risk factors for hypertension are also known to all. Hypertension schools are established in the clinics, whose specialists convey to the population information about the unfavorable conditions leading to hypertension. Any therapist or cardiologist will tell the patient about the risks at the very first instance of high blood pressure being recorded.

Among the conditions predisposing to hypertension, the most important are:

1. smoking;
2. Excess salt in food, excessive fluid intake;
3. Insufficient physical activity;
4. Alcohol abuse;
5. Overweight and disorders of fat metabolism;
6. Chronic psycho-emotional and physical overload.

If we can exclude the listed factors, or at least try to reduce their impact on health, then such characteristics as gender, age, heredity cannot be changed, and therefore we will have to put up with them, but without forgetting the increasing risk.

Classification of arterial hypertension and determination of risk level

The classification of hypertension includes the identification of the stage, the extent of the disease and the level of risk of vascular accidents.

Stage of the diseasedepends on the clinical manifestations. Accent:

• Preclinical stage, when there are no signs of hypertension and the patient is not aware of the increase in blood pressure;
• 1 stage of hypertension, when the pressure is increased, crises are possible, but there are no signs of damage to the target organs;
• Stage 2 is accompanied by damage to the target organs - hypertrophy of the myocardium, noticeable changes in the retina of the eyes and the kidneys suffer;
• At stage 3, strokes, myocardial ischemia, vision pathology, changes in large vessels (aortic aneurysm, atherosclerosis) are possible.

Degree of hypertension

Determining the degree of hypertension is important in risk assessment and prognosis and is based on pressure values. It should be said that normal values of blood pressure also have different clinical significance. So, the indicator is up to 120/80 mm Hg. Art. countsoptimal,normalthe pressure will be between 120-129 mmHg. Art. systolic and 80-84 mm Hg. Art. diastolic. Pressure numbers 130-139/85-89 mmHg. Art. are still within normal limits, but approaching the borderline of pathology, which is why they are called "very normal", and the patient can be said to have high normal blood pressure. These indicators can be considered as pre-pathology, since the pressure is only "a few millimeters" from being elevated.

From the moment the blood pressure reached 140/90 mm Hg. Art. we can already talk about the presence of the disease. This indicator is used to determine the degree of hypertension itself:

• The 1st degree of hypertension (HTN or AH 1st stage in the diagnosis) means an increase in pressure in the range of 140-159/90-99 mmHg. Art.
• Stage 2 headache is accompanied by numbers 160-179 / 100-109 mm Hg. Art.
• In stage 3 hypertension, the pressure is 180/100 mmHg. Art. and higher.

It happens that the systolic pressure figures rise, reaching 140 mm Hg. Art. and higher while the diastolic value is within normal values. In this case, they are talking aboutisolated systolic formhypertension. In other cases, the indicators of systolic and diastolic pressure correspond to different degrees of the disease, then the doctor makes a diagnosis in favor of a greater degree, and it does not matter whether conclusions are drawn on the basis of systolic or diastolic pressure.

The most accurate diagnosis of the degree of hypertension is possible when the disease is diagnosed for the first time, when no treatment has yet been carried out and the patient has not taken antihypertensive drugs. During therapy, the numbers fall, and when it is interrupted, on the contrary, they can increase sharply, so that it is no longer possible to adequately assess the degree.

The concept of risk in diagnostics

Hypertension is dangerous because of its complications. It is no secret that the majority of patients die or become disabled not from the fact of high blood pressure, but from the acute disorders that it leads to.

Brain hemorrhages or ischemic necrosis, myocardial infarction, kidney failure are the most dangerous conditions provoked by high blood pressure. In this regard, for each patient after a thorough examinationthe risk is determined, indicated in the diagnosis with the numbers 1, 2, 3, 4. Thus, the diagnosis is based on the degree of hypertension and the risk of vascular complications (for example, hypertension/hypertension stage 2, risk 4) .

Criteria for risk stratificationIn patients with hypertension, external conditions, presence of other diseases and metabolic disorders, involvement of target organs and accompanying changes in organs and systems are used.

The main risk factors affecting prognosis include:

1. The age of the patient is after 55 years for men and 65 years for women;
2. smoking;
3. Disorders of lipid metabolism (exceeding the norm of cholesterol, low-density lipoproteins, reduced fractions of high-density lipids);
4. Presence of cardiovascular pathology in the family among blood relatives under 65 and 55 years of age, respectively for women and men;
5. Overweight when the abdominal circumference exceeds 102 cm in men and 88 cm in women.

The listed factors are considered the main ones, but many patients with hypertension suffer from diabetes, impaired glucose tolerance, lead a sedentary life and have abnormalities in the blood coagulation system in the form of an increase in the concentration of fibrinogen. These factors take into accountadditional, which also increases the likelihood of complications.

Target organ damage characterizes hypertension starting from stage 2 and serves as an important criterion by which the risk is determined, therefore the patient's examination includes an ECG, ultrasound of the heart to determine the degree of hypertrophy of his muscles, blood and blood testsurine for indicators of kidney function (creatinine, protein).

First of all, the heart suffers from high blood pressure, which pushes blood into the vessels with increased force. As the arteries and arterioles change as their walls lose elasticity and the lumens become spasmodic, the workload on the heart progressively increases. A characteristic feature that is taken into account in risk stratification is consideredmyocardial hypertrophy, which can be suspected by ECG, can be determined by ultrasound.

The involvement of the kidney as a target organ is manifested by an increase in creatinine in the blood and urine and the appearance of protein albumin in the urine. Against the background of hypertension, the walls of large arteries thicken, atherosclerotic plaques appear, which can be detected by ultrasound (carotid, brachiocephalic arteries).

The third stage of hypertension is manifested by associated pathology, that is, associated with hypertension.Among the comorbidities most important for the prognosis are strokes, transient ischemic attacks, heart attack and angina pectoris, nephropathy due to diabetes, kidney failure, retinopathy (damage to the retina) due to hypertension.

So the reader probably understands how you can even independently determine the degree of headache. This is not difficult, you just need to measure the pressure. Then you can think about the presence of certain risk factors, take into account age, gender, laboratory parameters, ECG data, ultrasound, etc. In general, all of the above.

For example, the patient's blood pressure corresponds to stage 1 hypertension, but at the same time he had a stroke, which means that the risk will be maximum - 4, even if stroke is the only problem besides hypertension. If the pressure corresponds to the first or second degree and the only risk factors that can be noted are smoking and age against the background of fairly good health, then the risk will be moderate - 1 tbsp. (2 tablespoons), risk 2.

To make it clearer what the risk indicator means in a diagnosis, you can summarize everything in a small table. By determining your grade and "counting" the factors listed above, you can determine the risk of vascular events and complications of hypertension for a particular patient. The number 1 means low risk, 2 - moderate, 3 - high, 4 - very highrisk of complications.

Risk factors	BP 130-139/85-89, risk	GB (AH) 1, risk	GB 2, risk	GB 3, risk
none	1	2	3
1-2	1	2	2	4
more than three factors/target disability/diabetes	3	3	3	4
associated pathology	4	4	4	4

Low risk means that the probability of vascular accidents is no more than 15%, moderate - up to 20%, high risk indicates the development of complications in one third of patients of this group, with very high risk more than 30% of patients are susceptible tocomplications.

Manifestations and complications of headache

Manifestations of hypertension are determined by the stage of the disease. In the preclinical period, the patient feels well and only the tonometer readings indicate a developing disease.

As changes in the blood vessels and heart progress, symptoms appear in the form of headache, weakness, reduced work capacity, periodic dizziness, visual symptoms in the form of reduced visual acuity, flashing "spots" before the eyes. All these signs are not expressed duringstable course of the pathology, but during the development of a hypertensive crisis, the clinic becomes brighter:

• Strong headache;
• Noise, ringing in the head or ears;
• Darkening in the eyes;
• Pain in the region of the heart;
• dyspnea;
• facial hyperemia;
• Excitement and feeling of fear.

Hypertensive crises are provoked by traumatic situations, overwork, stress, consumption of coffee and alcoholic beverages, so patients with an already established diagnosis should avoid such influences. Against the background of a hypertensive crisis, the likelihood of complications increases sharply, including life-threatening:

1. Hemorrhage or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute renal failure;
5. Heart attack.

How to measure blood pressure correctly?

If there is reason to suspect high blood pressure, the first thing the specialist will do is measure it. Until recently, it was believed that blood pressure values can usually differ in different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. can occur due to pathology of the peripheral vessels, so the differential pressure on the right and left arms should be treated with caution.

To get the most reliable figures, it is recommended to measure the pressure three times on each arm with short time intervals, recording each result obtained. In most patients, the smallest values obtained are the most correct, but in some cases the pressure increases from measurement to measurement, which does not always speak in favor of hypertension.

The large selection and availability of devices for measuring blood pressure allow you to monitor it in a wide range of people at home. Patients with hypertension usually have a tonometer at hand at home, so that if their health deteriorates, they can immediately measure their blood pressure. It is worth noting, however, that fluctuations are also possible in absolutely healthy individuals without hypertension, so a single exceedance of the norm should not be considered a disease, and in order to make a diagnosis of hypertension, the pressure should be measured at different times, at differentconditions and repeatedly.

In the diagnosis of hypertension, blood pressure values, electrocardiographic data and the results of cardiac auscultation are considered basic. When listening, it is possible to detect noise, increased tones, arrhythmias. The ECG, starting from the second stage, will show signs of stress on the left side of the heart.

Treatment of hypertension

To correct high blood pressure, treatment regimens have been developed that include drugs from different groups and different mechanisms of action. Theirsthe combination and dosage are selected by the doctor individuallytaking into account the stage, comorbidity and response of hypertension to a particular drug. After establishing the diagnosis of hypertension and before starting drug treatment, the doctor will suggest non-drug measures that significantly increase the effectiveness of pharmacological drugs and sometimes allow you to reduce the dose of drugs or abandon at least some of them.

First of all, it is recommended to normalize the regime, eliminate stress and ensure physical activity. The diet is aimed at reducing salt and fluid intake, eliminating alcohol, coffee and beverages and substances that stimulate the nervous system. If you are overweight, you should limit calories and avoid fatty, floury, fried and spicy foods.

Non-pharmacological measures in the initial stage of hypertension can have such a good effect that the need to prescribe drugs disappears. If these measures do not help, the doctor prescribes appropriate drugs.

The goal of treating hypertension is not only to reduce blood pressure, but also to eliminate, if possible, its cause.

Traditionally, antihypertensive drugs from the following groups are used to treat hypertension:

• diuretics;
• angiotensin II receptor antagonists;
• ACE inhibitors;
• Adrenergic blockers;
• Calcium channel blockers.

Every year, the list of drugs that reduce blood pressure increases and at the same time becomes more effective and safer, with fewer side effects. At the beginning of therapy, one drug is prescribed in a minimum dose, if it is ineffective, it can be increased. If the disease progresses and the pressure is not maintained at acceptable values, then another drug from a different group is added to the first drug. Clinical observations show that the effect is better with combined therapy than with the prescription of one drug in the maximum amount.

Reducing the risk of vascular complications is important when choosing a treatment regimen.Thus, it has been noted that some combinations have a more pronounced "protective" effect on the organs, while others allow better pressure control. In such cases, experts prefer a combination of drugs that reduces the likelihood of complications, even if there are some dailyfluctuations in blood pressure.

In some cases, it is necessary to take into account the accompanying pathology, which makes adjustments to the headache treatment regimens. For example, men with prostate adenoma are prescribed alpha-blockers, which are not recommended for permanent use to lower blood pressure in other patients.

The most widely used ACE inhibitors, calcium channel blockers,which are prescribed to both young and elderly patients, with or without accompanying diseases, diuretics, sartans. Medicines from these groups are suitable for initial treatment, which can then be supplemented with a third medicine with a different composition.

ACE inhibitors reduce blood pressure and at the same time have a protective effect on the kidneys and myocardium. They are preferable in young patients, women taking hormonal contraceptives indicated for diabetes, as well as in older patients.

Diureticsno less popular. To reduce side effects, they are combined with ACE inhibitors, sometimes "in one tablet".

Beta blockersare not a priority group for hypertension, but are effective for concomitant heart pathology - heart failure, tachycardia, coronary disease.

Calcium channel blockersare often prescribed in combination with ACE inhibitors, they are especially good for bronchial asthma in combination with hypertension, as they do not cause bronchospasm.

Angiotensin receptor antagonists– the most prescribed group of drugs for hypertension. They effectively reduce blood pressure and do not cause coughing like many ACE inhibitors. But in America, they are especially common due to a 40% reduction in the risk of Alzheimer's disease.

In the treatment of hypertension, it is important not only to choose an effective scheme, but also to take the drugs for a long time, even a lifetime. Many patients believe that when the pressure reaches normal levels, the treatment can be stopped, but they grab the pills until the moment of the crisis. It is known that the unsystematic use of antihypertensive drugs is even more harmful to health than the complete absence of treatment, therefore informing the patient about the duration of treatment is one of the important tasks of the doctor.