Essential hypertension: what it is, degrees, symptoms, treatment

Essential arterial hypertension is an increase in systolic blood pressure at the time of heart contraction and blood ejection to 140 mmHg. Art. and above this mark and/or diastolic blood pressure at the moment of relaxation of the heart muscle to 90 mmHg. Art. and higher.

The Yusupov Hospital diagnoses and treats essential hypertension. The experience of highly qualified doctors and modern medical equipment make it possible to diagnose the disease at an early stage of its development and prevent complications.

Doctors at the Yusupov Hospital urge people to be attentive to their health.

Essential hypertension - what is it?

Essential hypertension is a form of arterial hypertension (AH), characterized by a stable increase in blood pressure (from 140/90 mm Hg and above) in the absence of pathological changes in the organs and systems that regulate it.
Essential hypertension accounts for approximately 90% of the total number of cases of arterial hypertension. Every year, about 9 million cases of this form of hypertension are reported worldwide, with a mortality rate of 6.5%.

Etiology of the disease

Essential hypertension is classified as a chronic disease of unknown etiology. It is generally accepted that the main factor in the development of the disease is hereditary predisposition.

There are also additional risk factors:

Insufficient physical activity. With physical inactivity, the functional and adaptive capabilities of the circulatory system are reduced.
Excess weight. Obese people have a tendency to spasm blood vessels and narrow their lumen due to cholesterol deposits.
Excessive salt intake. An adult needs only 4 grams of salt per day, but the average European resident consumes about 3 times more than this amount. Excess salt causes increased production of adrenaline and vasospasm.
Lack of magnesium and calcium. These microelements prevent spasm of the heart muscle and blood vessels, thereby stabilizing blood pressure (BP).
Alcohol consumption. If you do not exceed the recommended dose (that is, approximately 60 grams of alcoholic drinks with a strength of 40% for men and 40 grams for women), alcohol does not cause an increase in blood pressure. Exceeding this dose will lead to an increased release of norepinephrine and renin into the blood, due to which the pressure will begin to rise rapidly.
Smoking. The effect of nicotine on the functioning of the cardiovascular system is in many ways similar to the effect of alcohol: it provokes the production of adrenaline and norepinephrine, which cause vasospasm, which in turn causes an increase in blood pressure.
Age. As the body ages, the functional state of the systems that regulate normal blood pressure levels deteriorates.

Often the trigger for exacerbation is a stressful situation, which provokes the release of adrenaline and norepinephrine. That is why people who regularly experience nervous tension are more often predisposed to essential hypertension than others.

Other trigger mechanisms are also possible:

poisoning;
taking psychostimulants;
use of hormonal contraceptives;
pregnancy;
kidney diseases;
injuries, tumors and inflammatory diseases of the brain.

Causes of the disease

Essential hypertension has an unclear etiology. It has been proven that high blood pressure is associated with a psycho-emotional state. The more often a person is exposed to stress, the greater the likelihood of developing essential hypertension. A large etiological role belongs to genetic predisposition. The disease can occur under the influence of external and internal unfavorable factors:

smoking;
taking drugs, alcohol;
abuse of table salt;
lack of physical activity;
unbalanced diet (large amounts of fats, carbohydrates);
obesity;
age over 55 years;
diabetes;
living in a hot, humid climate;
taking hormonal contraceptives;
pregnancy;
vegetative-vascular dystonia.

In pediatrics, the disease occurs in 17–42% of patients. The main factors of essential arterial hypertension in children and adolescents include heredity, overweight, and obesity.

Symptoms of the disease

The manifestations of essential hypertension have much in common with other diseases of the cardiovascular system. In addition to persistently elevated blood pressure, the following symptoms are distinguished:

Headache (mainly in the temporal and occipital region).
Rapid heartbeat (over 90 beats per minute).
Dyspnea. Usually occurs as a consequence of deterioration in the functional capacity of the heart, which can lead to deterioration of blood supply to the brain and lungs.
Feeling of coldness in the extremities. This condition is caused by impaired peripheral blood supply.
Dizziness. Due to vascular spasm, the brain does not receive enough oxygen.
Swelling of the limbs. They arise due to thinning of blood vessels, which leads to the accumulation of fluid in the tissues.
Deterioration of vision. They arise due to impaired blood supply to the retina.
Noise in ears. Occurs due to impaired blood supply to the brain.
Fast fatiguability. It occurs as a result of a decrease in the functional capacity of the heart.
Facial redness. Caused by increased tone of peripheral blood vessels.

Symptoms

The disease can be benign or malignant. In the first case, the patient’s blood pressure level increases infrequently, and after taking antihypertensive drugs it quickly returns to normal. The malignant form of the disease is distinguished by the fact that blood pressure rises significantly and frequently, the patient quickly develops damage to internal organs, and medications are usually ineffective.

A long asymptomatic course of the disease is possible. Before complications develop, the only symptom of the disease is often high blood pressure, manifested by headache.

The main clinical sign of the pathology is headache of varying intensity - from a feeling of a “heavy head” to extremely intense. The pain is usually localized in the back of the head, accompanied by tinnitus and spots in front of the eyes.

The symptoms are especially pronounced during a hypertensive crisis. This is a condition caused by a rapid and significant increase in pressure, manifested by intense headache, dizziness, nausea, vomiting, pain in the heart, and weakness.

As the pathological process progresses and target organ damage occurs, patients may experience signs of coronary heart disease, hypertensive encephalopathy, and intermittent claudication.

When to see a doctor

None of the above symptoms should be ignored. If the pressure readings approach 180/110, you should call an ambulance. If even a slight increase in blood pressure is observed over the course of several days, you should make an appointment with a therapist or cardiologist.

Formally, the upper limit of normal is considered to be a blood pressure of 140/90, but it is important to understand that these are rather arbitrary figures. For example, some patients do not feel discomfort even at 150/100, while for others 135/85 causes a significant deterioration in well-being. Therefore, it is important to focus primarily on your own condition.

Figure 1. How to protect yourself from hypertension. Source: MedPortal

How to prevent disease

Prevention of essential hypertension is no less important than timely initiation of treatment. If the body is genetically prone to pathology, this will be more difficult to do, but taking into account epigenetic modifications, it is still possible to reduce the risk of developing EAH. To do this you need to do the following:

moderate physical activity, try to walk daily or perform a set of simple exercises in the morning;
beware of stress and conflict situations;
eat right, introducing vitamins, protein, fiber into the diet;
give up cigarettes, alcohol, and drugs;
regularly measure blood pressure;
Avoid significant excess body weight.

These simple rules will help you avoid early manifestations of hypertension. And even if it develops due to hereditary causes, its symptoms will be mild and easily treatable.

Many people have heard about the dangers of arterial hypertension - heart attacks and strokes, atherosclerosis, loss of vision and other serious consequences, but not everyone is in a hurry to go to the doctor if blood pressure increases. While monitoring blood pressure and maintaining it within normal limits, even with the help of medications, guarantees long life for the brain, nervous system, blood vessels, kidneys and heart. In order to prevent hypertension, you should not only regularly visit a doctor and get examined, but also avoid stress, chronic fatigue and eat right - then the disease will not be terrible.

Target organs for essential hypertension

This definition is usually understood to mean those organs that are most susceptible to the negative effects of the disease (in this case, persistently elevated blood pressure). Target organs for essential hypertension:

Heart. With increased load on this organ, hypertrophy of the left ventricle occurs. This creates the preconditions for insufficient oxygen supply to the myocardium, which can lead to the development of heart failure.
Kidneys. Impairments in blood flow and glomerular filtration can eventually lead to renal failure, a syndrome in which the functional state of the kidneys significantly deteriorates. Over time, they may stop removing waste products normally, so it is important to start treatment on time.
Vessels. Due to constant tension, they lose the ability to relax, which can lead to atherosclerosis of the arteries and peripheral vessels. A feeling of coldness in the extremities with high blood pressure occurs precisely for this reason.
Brain. Stroke is a common complication of essential hypertension. They can be either hemorrhagic (bleeding in the brain) or ischemic (local disruption of the blood supply to the brain, leading to the death of its cells).
Eyes. Impaired blood supply to the retina can lead to irreversible visual impairment, so the sooner treatment is started, the better the prognosis.

Reasons for the development of pathology

Unfortunately, modern medicine does not know the exact reasons for the development of the disease in question. However, scientists were still able to prove that a significant contribution to the development of the disease can be made by: an incorrect lifestyle, bad habits, a decrease in the body’s immune forces, as well as genetics.

It is generally accepted that essential hypertension most often affects people reaching middle or old age, when the pathology is caused by certain age-related changes in the vascular bed. In addition, scientists have proven that hypertension more often affects men than the fairer sex.

And yet, the largest number of doctors are of the opinion that the main cause of the development of hypertension can be considered a hereditary predisposition to vascular tone disorders!

Diagnosis of hypertension

First of all, the patient himself should pay attention to the regularity of the appearance of symptoms associated with arterial hypertension and the level of increase in blood pressure. Results above 140/90 more than 3 times within 2 weeks should be cause for concern.

The doctor begins the diagnosis by collecting an anamnesis, that is, the history of the patient’s life and illness. As a rule, he clarifies the following points:

Does the patient or his close relatives have kidney disease?
How often does a person use pharmacological drugs (particular attention is paid to anti-inflammatory drugs, nasal sprays, contraceptives, antibiotics, hematopoietic drugs, as well as any psychostimulants).
Does the patient have sudden episodes of muscle weakness, cramps, headaches, or paresthesia (nerve sensation such as tingling, burning, etc.)

After this, laboratory and hardware diagnostics are prescribed:

Urine tests: general
according to Nechiporenko
according to Zimnitsky
detection of free cortisol in daily urine.

Blood tests:

general

determination of creatinine level

determination of antibodies to thyroglobulin

study of renin and aldosterone levels

detection of cortisol in blood serum

Kidney ultrasound

CT or MRI of the kidneys and adrenal glands

EchoCG

Angiography (to assess the condition of blood vessels)

Diagnostics

Types of diagnosis of essential hypertension are as follows:

analysis of patient complaints. The doctor clarifies how long ago the patient had problems with blood pressure, what measures he took, and whether he went to the hospital for treatment. It is also important to clarify what the patient’s working pressure is. Each person’s body is individual, therefore, in some cases, pressure indicators in one person are higher or lower than accepted standards, but do not carry any pathology;
lifestyle analysis: a specialist must conduct research regarding the patient’s diet, physical activity, exposure to harmful production factors, etc.;
the presence of essential hypertension in the patient’s relatives is analyzed;
during the examination, the doctor identifies heart murmurs, wheezing in the lungs, signs of an increase in the mass and size of the left ventricle of the heart, insufficiency of the contractile function of the left ventricle, loss of elasticity and hardening of the arterial walls;
general blood analysis. Allows you to identify signs of inflammation in the body. This fact is evidenced by an increased level of leukocytes in the blood;
blood chemistry. Its results make it possible to assess the state of lipid, protein, carbohydrate, and mineral metabolism. Based on the level of microelements in the blood, one can assess the functioning of many systems and organs;
urinalysis: low urine density is determined, indicating problems with the kidneys;
ECG (electrocardiography): reveals an increase in the size of the left ventricle of the heart, as well as the degree of its “overload”;
EchoCG (echocardiography): makes it possible to assess the size of the heart, the condition of the valves, the presence of disorders of the contractile function of the heart;
ABPM (24-hour blood pressure monitoring): the examination is carried out using a special device. It is attached to the patient's belt and connected to a cuff placed on the shoulder using a thin flexible hose. At certain intervals, the device pumps air into the cuff and measures blood pressure. All research results are stored in the device’s memory. Such measures make it possible to accurately determine changes in pressure during the day and evaluate the effectiveness of treatment;
X-ray examination of the chest organs: detect pathologies in the lungs, expansion of the cavity of the left ventricle, changes caused by thickening of the walls of blood vessels and a number of other complications;
Ultrasound examination of the kidneys: makes it possible to track pathological processes caused by the disease;
examination of the fundus using an ophthalmoscope. The method allows you to identify changes in blood vessels that are a consequence of high blood pressure.

Our clinic performs any type of diagnostics. The experience of doctors and modern medical equipment make it possible to diagnose the disease at an early stage of its development and prevent complications.

Classification of hypertension by stages

The stage of arterial hypertension is determined based on the severity of symptoms and involvement of target organs.

First stage. Symptoms are mild and sometimes completely absent. As a rule, the onset of the disease is signaled only by a slight increase in blood pressure. There is no evidence of end-organ involvement.

Second stage. Symptoms characteristic of hypertension regularly occur, pathological changes in the blood vessels and moderate hypertrophy of the heart muscle are noted, which at this stage does not yet affect the functional state.

Third stage. It is also called the stage of organ changes, since in addition to pronounced symptoms, pathological changes in target organs are noted.

Classification of the disease

It is quite understandable that practicing doctors are accustomed to distinguishing many forms and types of hypertension. At the same time, various types of pathology can be either practically safe for the patient’s health or extremely dangerous, provoking the development of the most complex emergency conditions.

The classification of the disease in question divides the pathology according to the degree of increase in blood pressure. Thus, doctors can distinguish between headaches:

First degree. Pressure indicators reach a level of 140-159 at 90-99 mm of mercury.
Second degree. With blood pressure readings from 160 to 179 per 100-109 mmHg.
Third degree. With blood pressure readings higher than 180 to 110 mmHg.

Pathology is also divided into stages - into diseases of the I, II and, accordingly, III stages.

Treatment of essential hypertension

Treatment tactics will be primarily aimed at eliminating the cause that provoked the disease. In addition, it is important to take into account the age, general condition of the patient and the severity of hypertension.

Drugs

Treatment should begin with small doses, taking into account possible contraindications (which is why the attending physician should prescribe drugs).

Diuretics

Drugs with a diuretic effect are prescribed for hypertension in order to reduce the total volume of fluid circulating in the body and eliminate edema. In addition, diuretics have a direct vasodilatory effect. Most often, thiazide diuretics are prescribed for essential hypertension:

indapamide
hydrochlorothiazide.

Loop diuretics have a rapid, pronounced, but short-term effect. Therefore, they are used much less frequently - as a rule, during hypertensive crises, as well as in patients with chronic renal and/or heart failure. The most common drugs in this group:

furosemide;
torasemide;
ethacrynic acid.

Beta blockers

The hypotensive effect when using drugs in this group is achieved primarily by suppressing the activity of beta-adrenaline receptors and the production of renin by the kidneys, which prevents vasospasm and an increase in pressure. Typically, the following drugs are used in the treatment of hypertension:

propranolol;
nadolol;
atenolol;
metoprolol

Angiotensin-converting enzyme (ACE) inhibitors

These drugs block the work of ACE, which converts biologically inactive angiotensin I into the hormone angiotensin II, which has a pronounced vasoconstrictor effect. This helps to lower the concentration of angiotensin II in the blood, which causes an increase in blood pressure. They also help reduce the secretion of aldosterone and vasopressin, which narrow the lumen of blood vessels. For patients suffering from metabolic syndrome, ACE inhibitors are considered the drugs of choice as they improve lipid and carbohydrate metabolism. For hypertension, the following are indicated:

captopril;
enalapril;
spirapril;
ramipril

Sartans

The action of sartans (angiotensin II receptor antagonists) is in many ways similar to ACE inhibitors - they block angiotensin receptors. The key difference in the action of these two groups of drugs is that sartans block the final phase of the reaction, when angiotensin tries to cause vasospasm, but the body simply ignores its signals. As a result, this helps to avoid vasospasm and an increase in blood pressure. Preparations:

candesartan;
losartan;
eprosartan;
valsartan.

Calcium channel blockers

When treating hypertension, calcium receptor blockers help reduce vasospasm, reduce the oxygen demand of the heart muscle and reduce the heart rate.

Important! These are effective but potent drugs, the advisability of which can only be determined by a specialist, since if used incorrectly, calcium receptor blockers can cause cardiac arrhythmias and cardiac arrest.

It is recommended to use the following drugs in this group:

amlodipine;
verapamil;
felodipine;
nicardipine.

Non-drug treatments

Despite the apparent simplicity of recommendations for lifestyle changes, the importance of non-drug treatment can hardly be overestimated, since it largely determines the effectiveness of the main therapy. That is why it is always prescribed to all patients with hypertension, regardless of the severity of the disease. Only a complex effect will give a noticeable result with a persistent increase in blood pressure.

Basic recommendations:

Regular dynamic loads. Most often, walking is recommended (at least 30 minutes a day). With moderate severity of hypertension (if the pressure does not exceed 150/100 mm Hg), exercises with free weights (dumbbells or barbell) of medium intensity are allowed, without using maximum working weights.
Normalization of body weight. If the patient is overweight, then it will be important to get rid of it. This is achieved both by physical exercise and by following a proper diet.
Minimizing stress. Conflict situations and excessive experiences should be avoided, since the success of treatment will largely depend on this. You also need to sleep at least 8.5 hours a day.
Rejection of bad habits. Patients who are prone to drinking alcohol and/or smoking need to wean themselves from these habits. A doctor can help with this.

Publications in the media

Arterial hypertension (AH, systemic hypertension) is a condition in which systolic blood pressure exceeds 140 mm Hg. and/or diastolic blood pressure exceeds 90 mmHg. (as a result of at least three measurements made at different times against the background of a calm environment; the patient should not take drugs that either increase or decrease blood pressure) • If the causes of hypertension can be identified, then it is considered secondary (symptomatic) • In the absence obvious cause of hypertension, it is called primary, essential, idiopathic, and in our country - hypertension • Isolated systolic hypertension is diagnosed when systolic blood pressure increases more than 140 mm Hg. and diastolic blood pressure less than 90 mm Hg • Hypertension is considered malignant when diastolic blood pressure is more than 120 mm Hg.

Statistics • 20–30% of the adult population suffers from hypertension. The prevalence increases with age and reaches 50–65% in people over 65 years of age, and in the elderly, isolated systolic hypertension is more common, which occurs in less than 5% of the population under the age of 50 years. Before the age of 50, hypertension is more common in men, and after 50 years - in women. Among all forms of hypertension, mild and moderate account for about 70–80%, in other cases severe hypertension is observed • Secondary hypertension accounts for 5–10% of all cases of hypertension, the remaining cases are essential hypertension (hypertension). However, according to specialized clinics, using complex and expensive research methods, secondary hypertension can be detected in 30–35% of patients.

Etiology and pathogenesis • The etiology of hypertension is currently far from completely clear; genetic abnormalities have been identified (see Genetic aspects below). Etiology of secondary hypertension - see Symptomatic arterial hypertension • The main factors determining the level of blood pressure are cardiac output and peripheral vascular resistance. An increase in cardiac output and/or peripheral vascular resistance leads to an increase in blood pressure and vice versa • In the development of hypertension, both internal humoral and neurogenic (renin-angiotensin system, sympathetic nervous system, baro- and chemoreceptors) and external factors (excessive consumption of table salt, alcohol, smoking, obesity) •• Prevalence of vasopressor factors - renin, angiotensin II, vasopressin, endothelin •• Vasodepressor factors - natriuretic peptides, kallikrein-kinin system, adrenomedullin, nitric oxide, Pg (PgI2, prostacyclin).

Genetic aspects. There are many known genetic abnormalities that contribute to the development of hypertension: mutations: angiotensin gene, aldosterone synthetase, b-subunit of amiloride-sensitive sodium channels of the renal epithelium, as well as a lot of loci of the so-called predisposition to the development of hypertension.

Risk factors • Complicated family history •• Lipid metabolism disorders in the patient and his parents •• Diabetes in the patient and his parents •• Kidney disease in parents (polycystic disease) • Obesity • Alcohol abuse • Excessive consumption of table salt • Stress • Physical inactivity • Smoking • Patient's personality type.

At-risk groups. Due to the involvement of various organs and systems in the pathological process, their influence on the course of the disease, groups of patients with high and very high risk are distinguished • The high-risk group includes patients with three or more risk factors, patients with target organ damage or patients with diabetes • The very high-risk group includes patients with concomitant diseases and risk factors.

Classification. Currently, two classifications are common in Russia - WHO and the International Society of Hypertension (1999) and WHO (1978).

Classification of hypertension by WHO and International Society of Hypertension (1999) • Optimal •• Systolic blood pressure: <120 mm Hg •• Diastolic blood pressure <80 mm Hg • Normal •• Systolic blood pressure <130 mm Hg •• Diastolic blood pressure < 85 mm Hg • High normal: •• Systolic blood pressure 130–139 mm Hg •• Diastolic blood pressure 85–89 mm Hg • Grade I (mild) •• Systolic blood pressure 140–159 mm Hg •• Diastolic blood pressure 90–99 mm Hg • subgroup: borderline •• Systolic blood pressure 140–149 mm Hg •• Diastolic blood pressure 90–94 mm Hg • Grade II (moderate) •• Systolic blood pressure 160–179 mm Hg .st •• Diastolic blood pressure 100–109 mm Hg • III degree (severe) •• Systolic blood pressure >180 mm Hg •• Diastolic blood pressure >110 mm Hg • Isolated systolic •• Systolic blood pressure >140 mm Hg .st •• Diastolic blood pressure <90 mm Hg • subgroup: borderline •• Systolic blood pressure 140–149 mm Hg •• Diastolic blood pressure <90 mm Hg • Note. When determining the degree, the highest blood pressure value should be used, for example 140/100 mmHg. — II degree of hypertension.

WHO classification of hypertension (1978) • Stage I - increased blood pressure more than 160/95 mm Hg. without organic changes in the cardiovascular system • stage II - high blood pressure •• with hypertrophy of the left ventricle of the heart •• either with proteinuria and/or a slight increase in the concentration of creatinine in the blood plasma (not more than 176.8 µmol/l) •• or with widespread or localized ( retina) changes in arteries • Stage III - high blood pressure with damage to the heart, brain, retina, kidneys (myocardial infarction, heart failure, cerebrovascular accident, retinal hemorrhage, renal failure).

Blood pressure measurement

• Measurement must be carried out after resting for 5 minutes. 30 minutes before this, it is not recommended to eat, drink coffee, drink alcohol, exercise, or smoke. When measuring, your legs should not be crossed, your feet should be on the floor, your back should rest on the back of the chair. A hand rest is required, and the bladder must be emptied before measurement. Failure to comply with these conditions can lead to an increase in blood pressure: after drinking coffee - by 11/5 mm Hg, alcohol - by 8/8 mm Hg, smoking - by 6/5 mm Hg, with a full urinary bladder - 15/10 mm Hg, in the absence of support for the back - systolic by 6–10 mm Hg, in the absence of support for the arm - by 7/11 mm Hg.

• The shoulder should be at the level of the IV–V intercostal space (a low elbow position increases systolic blood pressure by an average of 6 mm Hg, a high elbow position underestimates blood pressure by 5/5 mm Hg). The shoulder should not be compressed by clothing (measurement through clothing is unacceptable) - systolic pressure may be overestimated by 5–50 mmHg. The lower edge of the cuff should be 2 cm above the elbow (improper application of the cuff can lead to an overestimation of blood pressure by 4/3 mmHg), and it should fit snugly to the upper arm. The air in the cuff should be inflated to 30 mm Hg. above the disappearance of the pulse on the radial artery. The stethoscope should be placed in the cubital fossa. The moment the first sounds appear will correspond to phase I of Korotkoff sounds and shows systolic blood pressure. The rate of decrease in pressure in the cuff is 2 mm/s (slow decompression increases blood pressure by 2/6 mm Hg, fast decompression increases diastolic blood pressure). The moment of disappearance of the last sounds will correspond to the V phase of Korotkoff sounds and corresponds to diastolic blood pressure.

• Measured parameters should be indicated with an accuracy of 2 mmHg. When measuring, it is necessary to listen to the area of the cubital fossa until the pressure in the cuff decreases to zero (you should remember about possible aortic valve insufficiency and other pathological conditions with high pulse pressure, large stroke volume of the heart). During each examination of the patient, blood pressure is measured at least twice on the same arm and the average values are recorded. During the first examination, the pressure is measured on both arms, and subsequently on the arm where it was higher. The difference in blood pressure between the left and right arms should not exceed 5 mmHg. More significant differences should be alarming regarding vascular pathology of the upper extremities.

• When measuring blood pressure with the patient lying down, his arm should be slightly elevated (but not suspended) and be at the level of the middle of the chest.

• Repeated measurements should be carried out under the same conditions. It is necessary to measure blood pressure in a patient in two positions - lying and sitting - in the elderly, with diabetes, in patients taking peripheral vasodilators (to identify possible orthostatic arterial hypotension).

Clinical manifestations are nonspecific and depend on target organ damage.

• Cerebral symptoms •• The main symptom is headache, often on awakening and usually in the occipital region •• Dizziness, blurred vision, transient cerebrovascular accident or stroke, retinal hemorrhages or papilledema, movement disorders and sensory disorders • Intellectual-mnestic disorders.

• Cardiac symptoms •• Palpitations, pain in the heart area, shortness of breath (due to pronounced changes in the heart with hypertension, every second patient has cardiac symptoms) •• Clinical manifestations of coronary artery disease •• Left ventricular dysfunction or heart failure.

• Kidney damage: thirst, polyuria, oliguria, nocturia, microhematuria.

• Peripheral arterial disease: cold extremities, intermittent claudication.

• Hypertension is often asymptomatic.

• It is possible to detect (by palpation) volumetric formations in the kidney area, as well as listen to a systolic murmur over the kidney area.

• Examination - signs of some endocrine diseases accompanied by hypertension: hypothyroidism, thyrotoxicosis, Itsenko-Cushing syndrome, pheochromocytoma, acromegaly.

• Palpation of peripheral arteries, auscultation of vessels, heart, chest, abdomen suggest vascular damage as the cause of hypertension, suspect aortic disease, suggest renovascular hypertension.

Features of collecting anamnesis • Family history of hypertension, diabetes, lipid metabolism disorders, coronary heart disease, stroke, kidney disease • Duration of hypertension and its evolution, previous blood pressure level, results and side effects of previous antihypertensive treatment • Presence and course of coronary artery disease, heart failure, stroke, other diseases in this patient (gout, bronchospastic conditions, dyslipidemia, sexual dysfunction, kidney disease) • Clarification of symptoms of presumably secondary hypertension • Detailed questioning about taking medications that increase blood pressure (GCs, oral contraceptives, NSAIDs, amphetamines, epoetin beta, cyclosporine) • Lifestyle assessment (consumption of table salt, fat, alcohol, smoking, physical activity) • Personal, psychosocial and external factors influencing blood pressure (family, work).

Laboratory and special research methods. It is necessary to exclude symptomatic hypertension, identify risk factors and the degree of target organ involvement.

• OAC (anemia, erythrocytosis, leukocytosis, increased ESR - secondary hypertension).

• OAM - leukocyturia, erythrocyturia, proteinuria, cylindruria (symptomatic hypertension), glucosuria (DM).

• Biochemical tests to determine the concentration of potassium ions, creatinine, glucose, cholesterol (secondary hypertension, risk factors). It should be remembered that a rapid decrease in blood pressure with long-term hypertension of any etiology can lead to an increase in creatinine levels in the blood.

• ECG - left ventricular hypertrophy, rhythm and conduction disturbances, electrolyte disturbances, signs of ischemic heart disease (changes in the terminal part of the ventricular complex, scar changes).

• EchoCG to detect left ventricular hypertrophy, assess myocardial contractility, and identify valvular defects as a cause of hypertension.

• Ultrasound of the kidneys, adrenal glands, renal arteries, peripheral vessels to identify secondary hypertension.

• Fundus examination: hypertensive retinopathy - narrowing and sclerosis of the arteries (symptoms of copper or silver wire), Salus phenomenon.

Diagnostic tactics. The diagnosis of hypertension (essential, primary hypertension) is established only by excluding secondary hypertension. Goals of diagnostic measures for hypertension • Determination of a possible cause • Identification of concomitant diseases • Identification of risk factors for coronary artery disease. Since hypertension itself is one of the risk factors for CHD, the presence of another risk factor further increases the likelihood of developing CHD; in addition, the prescribed treatment can seriously affect risk factors - for example, diuretics and non-selective beta-blockers in the presence of dyslipidemia and insulin resistance can aggravate these disorders • Identification of target organ involvement in the hypertensive process. Their defeat has the most serious impact on the prognosis of the disease and approaches to its treatment.

Differential diagnosis • Renoparenchymal hypertension - see Arterial hypertension, renoparenchymal • Vasorenal hypertension - see Arterial vasorenal hypertension • Endocrine hypertension constitutes approximately 0.1–1% of all hypertension (up to 12% according to specialized clinics) •• With pheochromocytoma (see Pheochromocytoma ) •• With primary hyperaldosteronism (see Hyperaldosteronism) •• With hypothyroidism - high diastolic blood pressure; other manifestations of the cardiovascular system - decreased heart rate and cardiac output •• In hyperthyroidism - increased heart rate and cardiac output, predominantly isolated systolic hypertension with low (normal) diastolic blood pressure; an increase in diastolic blood pressure in hyperthyroidism is a sign of another disease accompanied by hypertension or a sign of hypertension • Drug hypertension - vasoconstriction due to sympathetic stimulation or direct effects on vascular SMCs, increased blood viscosity, stimulation of the renin-angiotensin system, ion retention may be important in the pathogenesis sodium and water, interaction with central regulatory mechanisms - for more details, see Symptomatic Arterial Hypertension.

TREATMENT

The goal is to reduce cardiovascular morbidity and mortality by normalizing blood pressure, protecting target organs, eliminating risk factors (smoking cessation, compensation for diabetes, reducing the concentration of cholesterol in the blood and excess body weight).

• Recommendations of WHO and IAH (International Society of Arterial Hypertension; 1999) •• In young and middle-aged people, as well as in patients with diabetes, it is necessary to maintain blood pressure at the level of 130/85 mm Hg •• In elderly people, the target blood pressure level is £140 /90 mmHg

• Excessive rapid decrease in blood pressure with significant duration and severity of the disease can lead to hypoperfusion of vital organs - the brain (hypoxia, stroke), heart (exacerbation of angina, myocardial infarction), kidneys (renal failure).

Treatment plan • Control of blood pressure and risk factors • Lifestyle changes • Drug therapy.

Non-drug treatment is indicated for all patients. In 40–60% of patients with the initial stage of hypertension with low blood pressure values, it is normalized without the use of drugs. In case of severe hypertension, non-drug therapy in combination with medication helps to reduce the dose of drugs taken and thereby reduces the risk of their side effects. The mechanisms leading to a decrease in blood pressure are considered to be a decrease in cardiac output, a decrease in peripheral vascular resistance, or a combination of both mechanisms.

• Diet •• Limiting table salt intake to less than 6 g/day (but not less than 1–2 g/day, since in this case compensatory activation of the renin-angiotensin system may occur) •• Limiting carbohydrates and fats, which is very important in the prevention of coronary heart disease , the likelihood of which is increased in hypertension (risk factor). A decrease in excess body weight by 1 kg leads to a decrease in blood pressure by an average of 2 mm Hg •• An increase in the content of potassium and calcium ions in the diet •• Refusal or significant limitation of alcohol intake (especially if it is abused).

• Physical activity - sufficient cyclic activity (walking, light jogging, skiing) in the absence of contraindications from the heart (coronary artery disease), blood vessels of the legs (atherosclerosis obliterans), central nervous system (cerebrovascular accidents) reduces blood pressure, and at low levels it can normalize his. Moderation and gradual dosing of physical activity is recommended. Physical activity with a high level of emotional stress (competition, gymnastics), as well as isometric efforts (weight lifting) are undesirable.

• Other methods - psychological (psychotherapy, autogenic training, relaxation), acupuncture, massage, physiotherapeutic methods (electrosleep, diadynamic currents, hyperbaric oxygenation), water procedures (swimming, shower, including contrast), herbal medicine (chokeberry, tincture of hawthorn, motherwort, mixtures with marsh cudweed, hawthorn, immortelle, sweet clover).

Drug therapy

Basic principles: • It is necessary to begin treatment of mild hypertension with small doses of drugs • Combinations of drugs should be used to increase their effectiveness and reduce side effects • It is preferable to use long-acting drugs (12–24 hours with a single dose).

• b-blockers •• Preference should be given to b-blockers when hypertension is combined with coronary artery disease (angina pectoris and unstable angina, post-infarction cardiosclerosis, heart failure), tachyarrhythmias, extrasystoles •• After abrupt withdrawal of b-blockers, withdrawal syndrome may develop, manifested by tachycardia, arrhythmias, increased blood pressure, exacerbation of angina, development of myocardial infarction, and in some cases even sudden cardiac death. To prevent withdrawal syndrome, a gradual reduction in the dose of the b-blocker is recommended for at least 2 weeks. There is a high-risk group for the development of withdrawal syndrome - these are people with hypertension in combination with angina pectoris, as well as with ventricular arrhythmias •• Drugs ••• Non-selective (blockade of b1- and b2-adrenergic receptors): propranolol 40–240 mg/day at 3 doses, pindolol 5–15 mg 2 times/day, timolol 10–40 mg/day in 2 divided doses ••• Selective (cardioselective) b1-blockers: atenolol 25–100 mg 2 times/day, metoprolol 50–200 mg/day in 2 doses, nadolol 40–240 mg/day, betaxolol 10–20 mg/day.

• Diuretics •• Varieties ••• Thiazides and thiazide-like diuretics (used most often in the treatment of hypertension) are diuretics of moderate potency, suppress the reabsorption of 5–10% of sodium ions (drugs: hydrochlorothiazide 12.5–50 mg/day, cyclopenthiazide 0, 5 mg/day, chlorthalidone 12.5–50 mg/day) ••• Loop diuretics (characterized by the rapid onset of action when administered parenterally) are strong diuretics, suppress the reabsorption of 15–25% of sodium ions (the main drug is indapamide 2.5 mg /day in one dose; furosemide at a dose of 20–320 mg/day is rarely prescribed for continuous use for antihypertensive purposes) ••• Potassium-sparing diuretics are weak diuretics, cause additional excretion of no more than 5% of sodium ions (drugs: spironolactone 25–100 mg / day, triamterene 50–100 mg 4 times / day.) •• Preference for diuretics in the treatment of hypertension is given if there is a tendency to edema and in old age.

• ACE inhibitors •• Preferred for the treatment of hypertension with the following concomitant conditions (diseases): ••• left ventricular hypertrophy (ACE inhibitors are most effective in its regression) ••• hyperglycemia ••• hyperuricemia ••• hyperlipidemia (ACE inhibitors do not aggravate these conditions) ••• history of myocardial infarction ••• heart failure (ACE inhibitors are among the most effective drugs for the treatment of heart failure; they not only weaken its clinical manifestations, but also increase the life expectancy of patients) ••• older age •• Drugs ••• captopril 25–150 mg/day ••• enalapril 2.5–40 mg/day ••• fosinopril 10–60 mg/day ••• lisinopril 2.5–40 mg/day ••• ramipril 2, 5–10 mg/day ••• benazepril 10–20 mg/day.

• Slow calcium channel blockers •• Preferred in the treatment of hypertension in combination with angina (especially vasospastic), dyslipidemia, hyperglycemia, broncho-obstructive diseases, hyperuricemia, supraventricular arrhythmias (verapamil, diltiazem), left ventricular diastolic dysfunction, Raynaud's syndrome •• With bradycardia or predisposition to it, a decrease in myocardial contractility, conduction disturbances, verapamil or diltiazem, which have pronounced negative inotropic, chronotropic and dromotropic effects, should not be prescribed, and, conversely, the use of dihydropyridine derivatives is indicated •• Due to the different sensitivity of patients to slow calcium channel blockers, treatment begins with small doses •• Drugs ••• Diltiazem 120–360 mg/day ••• Isradipine 2.5–15 mg/day ••• Nifedipine (extended dosage form) 30–120 mg/day ••• Nitrendipine 5–40 mg /day ••• Verapamil 120–480 mg/day ••• Amlodipine 2.5–10 mg/day ••• Felodipine 2.5–10 mg/day.

• Angiotensin II receptor blockers •• These drugs are preferable when a dry cough appears during treatment with ACE inhibitors, renal failure (especially in diabetes mellitus) •• Drugs ••• losartan 25–100 mg in 1 or 2 doses ••• valsartan 80 mg 1 time / day ••• eprosartan 600 mg 1 time / day ••• candesartan.

• a-blockers •• For long-term treatment of hypertension, selective a1-blockers are mainly used (prazosin 1–20 mg/day, doxazosin 1–16 mg/day, terazosin) •• This group of drugs is widely used in urology in the treatment of benign hyperplasia prostate gland •• Despite many positive effects, drugs in this group are rarely used as monotherapy. Apparently, this is due to disadvantages and side effects, although the danger of most of them is most likely exaggerated. The main indications are combination therapy •• Disadvantages: “first dose phenomenon” (pronounced decrease in blood pressure after the first dose), orthostatic arterial hypotension, long-term selection of the drug dose, development of tolerance (effect evasion), withdrawal syndrome. To prevent the “first dose phenomenon”, it is recommended to take an a-blocker in bed, followed by staying in a lying position for several hours (it is better to take it at night).

• Centrally acting drugs (in recent years they have gradually lost their importance) •• Centrally acting drugs cause a decrease in blood pressure due to inhibition of the deposition of catecholamines in central and peripheral neurons (reserpine), stimulation of central a2-adrenergic receptors (clonidine, guanfacine, methyldopa, moxonidine) and I1 -imidazoline receptors (clonidine and especially the specific agonist moxonidine), which ultimately weakens the sympathetic influence and leads to a decrease in peripheral vascular resistance, a decrease in heart rate and cardiac output •• Drugs in this group are mainly used orally for the treatment of hypertension. Preference should be given to imidazoline receptor agonists as first-line agents for diabetes and hyperlipidemia (they do not aggravate metabolic disorders), COPD (the drugs do not affect bronchial patency), severe hypersympathicotonia, left ventricular hypertrophy (they cause its regression). Methyldopa is most often used in the treatment of hypertension in pregnant women •• Drugs: reserpine and combination drugs containing it (reserpine + dihydralazine + hydrochlorothiazide, reserpine + dihydroergocristine + clopamide), methyldopa up to 2 g / day (when combined with other antihypertensive drugs, no more than 500 mg /day), clonidine at an initial dose of 0.075 3 times / day in 2 divided doses, moxonidine up to 0.4 mg / day in 2 divided doses, guanfacine 1-3 mg / day.

Combination therapy. According to international multicenter studies, the need for combination therapy occurs in 54–70% of patients. Indications for combination therapy are as follows: • Ineffectiveness of monotherapy. Monotherapy with an antihypertensive drug is effective on average in 50% of patients with hypertension (a higher result can be achieved, but then the risk of side effects will increase). To treat the remaining part of the patients, it is necessary to use a combination of two or more antihypertensive drugs • The need for additional protection of target organs, primarily the heart and brain.

Rational combinations of drugs. The most common combination of a diuretic and some other class of drug is used. In some countries, combination therapy with a diuretic is considered a mandatory step in the treatment of hypertension • The most effective combination is a combination of a diuretic and an ACE inhibitor (possibly a fixed combination, for example, capozide, Korenitek) • The combination of a diuretic and an angiotensin II receptor blocker is rational • Approximately the same additive effect has a combination of a diuretic and a beta-blocker (this combination is not the most successful, since both the diuretic and the beta-blocker affect the metabolism of glucose and lipids).

Irrational combinations of antihypertensive drugs can lead to both increased side effects and an increase in the cost of treatment if there is no effect. A striking example of an irrational combination is the combination of beta-blockers and slow calcium channel blockers (verapamil, diltiazem), since both groups of drugs worsen both myocardial contractility and AV conduction (increased side effects), while the combination of beta-blockers with dihydropyridines (for example, nifedipine) is positive.

Treatment of certain types of hypertension

• Resistant (refractory) hypertension - the inability to achieve a reduction in blood pressure to target values (less than 140/90 mm Hg) for more than 1 month in patients with hypertension during combination therapy with two or three antihypertensive drugs in sufficient dosages •• To confirm the diagnosis, it is necessary to test all rational combinations of drugs (primarily including diuretics, the combination “ACE inhibitor + slow calcium channel blocker” is also effective), then prescribe a triple combination in a variety of options, then a combination of four drugs (usually minoxidil is used as one of the components) • • One should remember about possible pseudo-resistance, the cause of which may be symptomatic hypertension, non-compliance with the rules of taking medications, inappropriate dosage, irrational combination of drugs, taking alcohol and drugs that increase blood pressure, weight gain, increased blood volume (for example, in heart failure), deliberate administration the patient misleads the doctor (simulation) •• In each case of resistant hypertension, a thorough examination of the patient is necessary, preferably in a specialized hospital to exclude symptomatic hypertension.

• Hypertension in the elderly •• Treatment should begin with non-drug measures, which in this case quite often reduce blood pressure to the target level. Of great importance is limiting the consumption of table salt and increasing the content of potassium and magnesium salts in the diet •• Drug treatment is based on the pathogenetic features of hypertension at a given age. In addition, it should be remembered that various concomitant diseases often occur in the elderly ••• It is necessary to start treatment with smaller doses (often half the standard) ••• The dose should be increased gradually over several weeks ••• The dose is selected under constant monitoring of blood pressure, and it is better to measure it in a standing position to identify possible orthostatic arterial hypotension ••• It is advisable to use a simple treatment regimen (1 tablet - 1 time / day) ••• You should use medications with caution that can cause orthostatic arterial hypotension (methyldopa, prazosin, labetalol) , and centrally acting drugs (clonidine, methyldopa, reserpine), the use of which in old age is quite often complicated by depression or pseudodementia. When treating with diuretics and/or ACE inhibitors, it is advisable to monitor renal function and blood electrolyte composition.

• Endocrine hypertension - see Symptomatic arterial hypertension.

• “Alcoholic” hypertension - see Symptomatic arterial hypertension.

Complications of hypertension: • MI • acute cerebrovascular accident • heart failure • renal failure • hypertensive encephalopathy • hypertensive retinopathy • hypertensive crisis • dissecting aortic aneurysm.

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

Reduction. AH - arterial hypertension.

ICD-10 • I10 Essential (primary) hypertension • I11 Hypertensive heart disease [hypertensive disease with predominant damage to the heart] • I12 Hypertensive [hypertensive] disease with predominant damage to the kidneys • I13 Hypertensive [hypertensive] disease with predominant damage to the heart and kidneys • I15 Secondary hypertension • O10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium • O11 Pre-existing hypertension with associated proteinuria

Traditional medicine against hypertension

It is quite difficult to draw clear conclusions regarding the effectiveness of traditional methods in the treatment of essential hypertension, since along with safe and effective methods you can find a lot of recommendations that, at best, will be useless.

For example, eating a variety of seeds and nuts is a safe and relatively effective method. These foods contain large amounts of omega-3 fatty acids. Due to this, they help prevent the formation of cholesterol and narrow the lumen of blood vessels.

As for mustard plasters on the shin and other “home-grown” procedures, the advisability of their use should always be discussed with a doctor, since sometimes there are contraindications, and the methods themselves often do more harm than good.

Diet

Source: freepik.com/senivpetro
If you are prone to hypertension, you must first limit the amount of salt consumed (to about 4 g per day). The calorie content of the daily diet should not exceed 2500 kcal for men and 1800 kcal for women. You should give up sweets or at least minimize their consumption. Foods rich in carbohydrates are best consumed in the first half of the day.

Eating before bed is allowed, but in such cases, preference should be given to low-fat protein foods (for example, cottage cheese with yogurt or a small piece of boiled chicken fillet with salad).

Avoid eating spicy, fatty and fried foods. It is important to limit your consumption of coffee, as well as sugary drinks and canned foods.

Prevention

Disease prevention measures include:

correct lifestyle;
giving up bad habits - smoking and alcohol abuse;
maintaining a proper diet and nutrition regimen. You should eat more foods containing fiber and minimize fatty, spicy and fried foods;
physical activity. In this case, we are not talking about the fact that every person should exhaust himself with daily physical activity in the gym. To keep the body normal, it is enough to take daily walks in the fresh air at a moderate pace for thirty minutes;
regularly undergo preventive medical examinations, during which the patient’s blood pressure level is necessarily measured.

To avoid complications, you need to promptly seek help from the Yusupov Hospital, where the pathology will be diagnosed and treated.

The quality of services provided in the hospital is at the European level. All diagnostic and treatment procedures are performed using the latest medical equipment. The rooms are equipped with maximum comfort for patients.

Do not put off going to the doctor and for any manifestations of increased intracranial pressure, seek help from highly qualified doctors at the Yusupov Hospital. Call by phone and the coordinating doctor will answer all your questions.

Complications of the disease

Complications associated with essential hypertension affect the target organs that we described above - the kidneys, cardiovascular system, brain and eyes.

Heart: angina pectoris, heart failure, myocardial infarction.
Central nervous system: stroke, cerebrovascular insufficiency.
Kidneys: hypertensive nephropathy and renal failure.
Eyes: retinal damage, hypertensive retinopathy.
Vascular: In addition to hypertonicity of the peripheral blood vessels, there is a risk of dissecting aortic aneurysm, a condition that can be fatal.

Such complications must be avoided, as they can significantly impair the quality of life. To do this, it is important to comply with the doctor’s requirements regarding taking medications, adjusting your diet and lifestyle.

Complications and consequences of the problem

We have already noticed that long-term headache can gradually progress and be complicated by more serious and dangerous pathological conditions. Thus, against the background of long-term hypertension, the patient may experience the following diseases or emergency conditions:

coronary heart disease, in its various manifestations;
acute myocardial infarction;
condition of acute cerebral stroke;
conditions of congestive or acute heart failure;
hemorrhages in various organs;
formation of dissecting cardiac aneurysm, etc.

Unfortunately, complications of primary hypertension can often lead to severe disability or even death of patients. That is why doctors insist that it is important for all people over forty to think about reasonable prevention of hypertension in a timely manner.

Patient Dmitry, 52 years old. The man consulted a doctor complaining of constant excruciating headaches, dizziness, and a sensation of pulsation in his temples. After a full diagnosis, the man was diagnosed with a condition of essential (primary) arterial hypertension of the second degree. The man was recommended for hospitalization and full therapeutic treatment in the cardiology department.

Summing up briefly, I would like to say that hypertension may seem to the average person to be an absolutely harmless condition that can be eliminated independently. In fact, this statement is fundamentally false.

Unfortunately, headache can be incredibly dangerous for the health and even the life of patients, since it can slowly but steadily progress, complicated by the most dangerous pathological conditions.

It is strictly unacceptable to leave hypertension without proper attention or self-medicate it.

Take care of your health, trust your doctors and everything will be fine!

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