Hypertension

Hypertension (HD)chronic disease, the main symptom of which is increased blood pressure (BP), excluding symptomatic hypertension

If a person's blood pressure is constantly rising (arterial hypertension is more than 140 and 90 mm Hg), then they are usually diagnosed with hypertension.And this is true in 90% of cases.Only in 10% of cases can the cause of the increase in blood pressure be identified, and often by eliminating it, a person can be freed from the symptoms of arterial hypertension - in this case, the diagnosis is symptomatic hypertension.

According to WHO recommendations, blood pressure should be considered normal if it does not exceed 140 and 90 mm Hg.Art.

Normally, blood pressure is a labile value, that is, it changes depending on what a person is doing, what position they are in, the level of physical activity, anxiety, etc.However, in a healthy person, after the end of the exposure, the blood pressure level will return to normal after a while, unlike in a patient whose blood pressure is normalized by drugs that quickly control the number of blood pressure.  

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

Epidemiology of hypertension 

Data from the Cardiology Society of the Russian Federation (2020): 30-45% of the world's population suffers from high blood pressure.47% of hypertensive patients were identified among men aged 25-65, and approximately 40% among women.After 60 years, more than 60% of patients with high blood pressure are registered.Due to an aging population, an increase in the number of sedentary and overweight people, it is predicted that 1.5 billion people will have HD in the world by 2025, representing a 15-20% increase in the number of people suffering from the disease.

According to the WHO, high blood pressure and atherosclerosis are the most common causes of premature death in the working-age population.Complications caused by these diseases, such as heart attack, chronic kidney disease or acute cerebrovascular accident, are life-threatening, but also often leave people unable to work.

Pathogenesis of hypertension

"The disease of unresponsive emotions" was called high blood pressure by Georgy Fedorovich Lang, an outstanding Soviet therapist and scientist.

Blood pressure is the force with which the blood presses against the vessel wall, and it depends on three hemodynamic parameters: the force of the cardiac output, the total volume of blood circulating in the vascular system, and the elasticity and tone of the vessels (total peripheral resistance).The upper number of the blood pressure is determined by the force of the ejection of blood from the heart - systolic pressure - and the lower number is the diastolic - the pressure during the relaxation of the heart.It reflects the level of blood vessels' resistance to blood flow.

The tone of blood vessels is regulated by the central and peripheral nervous systems and depends on the complex of mediators and biologically active substances also selected by the endocrine system, which enter the blood in various life situations: emotions, fatigue, during physical activity.The pathogenetic mechanisms of hypertension are realized through the activation of the sympathoadrenal and renin-angiotensin-aldosterone systems, the membrane transport of cations (sodium, calcium and potassium) is interrupted, and increased sodium reabsorption in the kidneys.Due to the excessive production of vasoconstricting compounds and the decrease in the production of depressant compounds, the regulation of vascular tone also occurs.These compounds affect the structure of the vessel wall, which changes as a result of non-infectious inflammations and vascular smooth muscle spasms, which results in the deterioration of microcirculation.

After that, vascular stiffness increases, total vascular resistance increases further, and the baroreceptor connection of the central blood pressure control system is disrupted.This leads to arterial hypertension, functional and organic changes in the heart, central nervous system, retina and kidneys.

Risk factors

Hypertension is a multifactorial disease.Let's look at the factors that influence the development and worsening of hypertension:

Non-modifiable factors:

• Cases of hypertension recorded in close relatives (inheritance).
• Elevated blood pressure is more often seen at an older age (age).
• Sexual pressure is noticed earlier in men than in women.Women are at an increased risk of developing high blood pressure during menopause (60% of women suffer from high blood pressure during this period).This is due to hormonal imbalance and aggravation of emotional and nervous reactions. 
• Negroid race (these people get sick more often and have more serious complications of hypertension).
• Influence of weather conditions (weather dependent people).

Modifiable factors:

• Obese people are 2-6 times more likely to develop high blood pressure than the general population.This is due to the fact that intraperitoneal fat is hormonally active, helps suppress sex hormones, prevents glucose from being absorbed by other tissues, supports inflammatory reactions, increases vasoconstriction and swelling of the vessel wall.
• Reduced physical activity increases the risk of disease by 29-50% compared to more fit people.
• Excessively salty foods, an imbalance of fats and alcohol consumption also contribute to an increase in blood pressure.
• Smoking is an undeniable factor that has a very bad effect on the walls of the arteries and contributes to the development and worsening of arterial hypertension.A smoked cigarette can raise 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 vascular tone-regulating systems and disrupt their adaptation to stress.
• Metabolic disorders: lipid metabolism - hypercholesterolemia and, as a result, arteriosclerosis - always accompany high blood pressure;carbohydrate metabolism and developing diabetes mellitus - affect the severity of hypertension and the resulting mortality.

Symptoms of hypertension

It is important to note that high blood pressure sometimes causes no symptoms.Therefore, people with risk factors for high blood pressure should have their blood pressure checked systematically.

High blood pressure hastarget organs.Exactly these organs suffer when blood pressure rises: heart, brain, kidneys, peripheral arteries, retina.Given that the increase in A/D is primarily associated with spasm of small arteries, which impairs blood circulation, and these organs are extremely sensitive to impaired blood flow, symptoms are also caused by changes in these.

The main subjective complaints of patients with high blood pressure are: headache, tinnitus, frequent dizziness, "spots" before the eyes.Later, when permanent changes develop in the arteries, symptoms of poor sleep, impaired performance, memory, or encephalopathy appear.On the heart side, rapid heartbeat, shortness of breath, pain or discomfort on the left side of the chest, rhythm disorders can be detected, and later manifestations of heart failure are detected in the form of shortness of breath and swelling.

Kidney damage begins very unnoticed, but leads to nephrosclerosis and dysfunction.Hypertensive angiopathy develops in the retina, which the ophthalmologist detects in the early stages of the disease and in some cases allows to confirm the diagnosis.

Exacerbation of high blood pressure sometimes occurs latently, but this does not mean that it is safe.Even regardless of the pressure level, high blood pressure can manifest itself with serious complications: heart attack and stroke.Sometimes the exacerbation manifests itself as a hypertensive crisis.It is characterized by a sharp rise in blood pressure, severe headache, facial redness, chills, and vomiting. In this condition, an ambulance should be called.

Diagnosis of high blood pressure

Correctly collected anamnesis data play an important role in the diagnosis of hypertension.Information on the onset of the disease is carefully clarified, all possible risk factors and the patient's complaints are examined, with the main emphasis placed on complaints that characterize the involvement of target organs in the process.A history of heart failure, kidney failure, stroke, diabetes mellitus, retinal angiopathy, and aortic aneurysm are of particular importance.

In addition to the blood pressure measurement performed during the consultation, the examination also includes the assessment of physical data on the target organs.This approach makes it possible to calculate the level of risk, thanks to which the prognosis of the disease is established.In case of weight gain, the body mass index must be calculated.

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

Instrumental examination:

1. 24-hour monitoring of blood pressure and ECG in 12 leads.
2. Ultrasound examination of the heart (ECHO).It gives an image of the condition of the heart cavities and the movement of the blood inside them.
3. Ultrasound Dopplerography of the arteries of the kidneys and neck.
4. Urinalysis to detect albuminuria and biochemical blood parameters.
5. Thyroid stimulating hormone and free T4.To assess thyroid function.
6. Ophthalmological examination to assess the condition of the fundus vessels.

When clarifying the diagnosis, the cardiologist or therapist (if the patient is treated by a therapist) prescribes drug therapy after analyzing the test data and all possible risk factors.

Treatment of high blood pressure 

The aim of the treatment is to achieve the normal (target) blood pressure level and prevent complications.Treatment is divided into drug and non-drug treatment.

Drug treatment of headache 

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

In the medical arsenal today there are quite a few drugs that lower blood pressure.They affect the known pathogenetic mechanisms of the disease and eliminate or reduce their effect.These are several groups of drugs, such as diuretics, renin channel blockers, beta blockers, calcium channel blockers, ACE inhibitors.It is the responsibility of the attending physician to select these for the particular patient, and this may take some time, as each drug group has its own characteristics and side effects, and the effect of the drug is not always quick;sometimes it is necessary to select them in combination with each other.

In order for the treatment to be effective and its long-term goals to be realized, it is necessary for the interaction between the patient and the doctor, as well as for the patient to fully comply with the treatment regimen.

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 his doctor to change the medication intake.
3. Do not stop taking medications on your own without consulting a doctor, even if your blood pressure and health are normal.
4. Blood pressure measurement when choosing therapy in the morning and evening (keeping a diary), in case of deterioration of health (filling in a diary);if you feel well, for 7-10 days in the morning and in the evening to ensure stability, monthly.
5. Doctor's visit for minimal examination, selected treatment and normal health condition 2 times a year (ambulance visit).  

Non-pharmacological measures to treat high blood pressure

At any stage of high blood pressure, modifiable risk factors must be worked with.This is to prevent high blood pressure.

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

• Avoid the accumulation of fat deposits.Weight correction is the most important way to adjust A/D.A 10 kg weight gain leads to a 10 mm Hg increase in blood pressure.Art. 
• Eat smart.The diet should contain calories corresponding to your body weight, should be rich in foods containing potassium, magnesium and unsaturated fats, while saturated fats and simple carbohydrates should be limited.   
• Don't eat a lot of salt.It causes arterial spasm and fluid retention in the body.It has been proven that if a person consumes more than 5 g of salt per day, the risk of developing high blood pressure increases significantly. 
• Try to exercise a lot, but don't overdo it.Physical therapy, swimming or walking, and taking at least 10,000 steps each day are helpful. 
• Avoid nervous tension: Find a way to switch if you often experience extreme anxiety or nervous shock (fitness, yoga, long walks). 
• Avoid excessive tensionis related to intellectual activity. 
• Do not work at nightbecause it disrupts biological rhythms. 
• Do not operate in a location with significant vibration or noise, they affect the central and peripheral nervous and vascular systems. 
• Monitor your blood pressure, especially if your immediate family members (parents, siblings) suffered or suffer from arterial hypertension, so that you can take action in time. 
• Consult a gynecologistto eliminate hormonal imbalance in the premenopausal period and postmenopausal period. 
• Treat concomitant diseases in a timely mannerkidneys and adrenal glands, atherosclerosis, diabetes mellitus, thyroid disease, obesity, chronic infections (for example, tonsillitis).If you suffer from them, remember that they worsen the course of the headache. 
• Do not drink too much alcohol or smoke. 

We recommend that you take the prescribed medications systematically and for a long time under the control of blood pressure and the dynamic supervision of a cardiologist or therapist.

Remember, a happy heart is a healthy heart.Take care of your health every day, follow the recommendations of doctors.