What is dangerous high blood pressure: symptoms, causes and treatment

Arterial hypertension (AH, hypertension) is one of the most important socioeconomic and medical problems of our time.

This is due not only to the wide spread of this disease among different age groups of the population, but also to the high rates of serious complications, disabilities and mortality from arterial hypertension in the absence of timely treatment.

People prone to high blood pressure are advised to take measurements on both hands. Recent studies have shown that high blood pressure can be confirmed with a difference in readings in different hands of 10 to 15 mm Hg. This sign (difference in indications) has a probability of determining hypertension of up to 96%.

What is that?

In simple terms, high blood pressure is a disease of the cardiovascular system, in which the blood pressure in the arteries of the systemic (large) circulation constantly increases.

Blood pressure is divided into systolic and diastolic:

1. systolic. According to the first upper number, the blood pressure level is determined at the time of compression of the heart and expulsion of blood from the artery. This indicator depends on the force with which the heart contracts, the resistance of the blood vessel walls and the frequency of contractions.
2. diastolic. The second, lower number determines the blood pressure at the moment the heart muscle relaxes. Indicates the level of peripheral vascular resistance.

Normally, blood pressure readings are constantly changing. They physiologically depend on the age, sex and condition of the person. During sleep, pressure decreases, physical activity or stress leads to its increase.

The average normal blood pressure in a twenty-year-old is 120/75 mm Hg. Art. , forty years - 130/80, over fifty - 135/84. With persistent numbers of 140/90, we're talking high blood pressure. Statistics show that around 20-30 percent of the adult population is affected by this disease. With age, the prevalence rate inexorably increases and at age 65, 50-65 percent of the elderly suffer from this disease.

Classification

Given the origin of the pathology, the following types are distinguished:

1. Essential (primary) arterial hypertension. It is difficult to determine the exact cause of development due to the lack of visible prerequisites;
2. Symptomatic (secondary). An increase in pressure is considered a consequence of the development of a certain disease, it is one of its signs. The secondary type of the disease, depending on the cause of development, is divided into the following types: endocrine, renal, drug-induced, hemodynamic, neurogenic.

If we take into account the level of blood pressure, the pathology is divided into the following types:

1. Border. Pressure periodically increases to 140 - 149/90, then decreases, normalizes;
2. Isolated systolic. There is an increase in the upper indicator (reaches 140 and above). At the same time, the bottom remains within 90 and below.

Taking into account the nature of the pathology, experts have identified the following types:

1. Transitional. The patient has occasional high blood pressure. This state can last for hours or days. The pressure returns to normal without the use of medication;
2. Labile. It manifests itself at the initial stage of the development of the pathology. This state is considered borderline, because pressure surges are insignificant, unstable. Pressure normally normalizes on its own;
3. Stable arterial hypertension. The increase in pressure is persistent and supportive therapy is needed to reduce it;
4. Crisis. Periodic hypertensive crises are characteristic;
5. Malignant. The pressure rises to severe levels, hypertension develops rapidly, causing serious complications. Possible death.

Risk factors

Currently, the severity of the disease described depends directly on the risk facts. The risk lies in the formation of cardiovascular complications against the background of high blood pressure. Taking into account the complications presented, the prognosis of the consequences of arterial hypertension is diagnosed. There are the following risk factors that worsen the course of the disease and its prognosis:

• age - in men after 50 years, in women after 60 years;
• smoke;
• high cholesterol;
• hereditary factor;
• obesity;
• hypodynamia;
• diabetes.

The risk factors presented may be eliminated (correctable) and may not be correctable. The first type of risk factors is characterized by the presence of diabetes mellitus, high cholesterol, smoking, physical inactivity. Uncorrected risk factors include race, family history, and age.

Gravity

There is also an international classification of the disease, developed according to the degree of arterial hypertension:

1st degree arterial hypertension

This stage of the disease is characterized by a mild disease course: daytime pressure increases by 20-30 units and usually does not exceed 180/115 mm Hg. Art. Hypertensive crises occur infrequently and are usually provoked by a sudden change in atmospheric pressure or emotional overload. There are no complications of target organ work.

2nd degree arterial hypertension

It is characterized by an increase in blood pressure to the level of 160-179 / 100-109 mm Hg. Art. It is with these indicators that patients usually go to the doctor for the first time, as considering them as the norm is the height of carelessness. 2nd degree high blood pressure usually manifests as severe headaches, weakness, dizziness, and deterioration of well-being during episodes of increased blood pressure.

3rd degree arterial hypertension

It is characterized by an increase in blood pressure to the level of 180/110 or more mm Hg. Art. Sometimes these numbers can be quite prohibitive (250/160 mm Hg and above), but in this case there is a real threat to human health and life. A patient with 3rd degree high blood pressure must be under the supervision of a physician, take all antihypertensive medications prescribed to him and have a tonometer (mechanical or electronic) at home.

Symptoms of high blood pressure

High blood pressure itself has no symptoms. Most adult patients with this disease do not complain at all, high blood pressure is detected by chance.

The clinical manifestations of high blood pressure depend on which organs are currently affected. Adults with benign hypertension may complain of the following symptoms:

1. Headache - may be the first and main symptom. There are several types of headaches:
   • dull, not intense, characterized by a feeling of heaviness in the forehead and occiput. It appears most often at night or in the morning, increases with a sudden change in head position and even light physical exertion. Such pain is caused by a violation of the venous flow of blood from the vessels of the skull, their overflow and stimulation of pain receptors;
   • liquor - bursting diffused throughout the head, can be pulsating. Any tension causes an increase in pain. It occurs most often in the late stages of hypertension or in the presence of pulse hypertension. As a result of this, the vessels are very full of blood and its exit is difficult;
   • ischemic - dull or bursting in nature, accompanied by dizziness and nausea. It occurs with a sharp increase in blood pressure. There is marked vasospasm, as a result of which the blood supply to the brain tissues is disturbed.
2. Pain in the heart region - cardialgia, not ischemic in nature, the coronary vessels are in order, while the pain is not stopped by the sublingual use of nitrates (nitroglycerin under the tongue) and can occur both at rest and during emotional stress. Sports activities are not a provocation factor.
3. Shortness of breath - at first it occurs only during sports, with the progression of hypertension, it can also occur at rest. Characterizes heart dysfunction.
4. Edema - most often found in the legs due to stagnation of blood in the systemic circulation, sodium and water retention, or impaired kidney function. The appearance in children simultaneously with edema of hematuria and hypertension is characteristic of glomerulonephritis, which is very important to remember when making a differential diagnosis.
5. Visual impairment - manifests itself in the form of blurred vision, the appearance of a veil or flickering flies. It occurs due to damage to the vessels of the retina.

Chronic arterial hypertension causes damage to the kidneys with the development of renal failure and the corresponding complaints of renal genesis, which will be discussed below. Chronic hypertension also leads to the development of circulatory encephalopathy, characterized by impaired memory, attention and performance, sleep disturbances (increased daytime sleepiness combined with insomnia at night), dizziness, tinnitus, and depressed mood.

When collecting an anamnesis, in the medical history it is necessary to record the family history and causes of arterial hypertension in close relatives, clarify the time of appearance of the first clinical symptoms, observe concomitant diseases.

Hypertension crisis

This is an emergency condition, which consists of a sharp rise in blood pressure to high numbers and is characterized by a marked deterioration in the blood supply to all internal organs, in particular vital ones.

It occurs when the body is exposed to various adverse factors, it cannot be predicted, which is why uncontrolled hypertension is dangerous. The urgency of the problem also resides in the fact that, in the absence of timely emergency care, a fatal outcome is possible. To provide emergency care, the patient must be taken immediately to the hospital, where the blood pressure is quickly reduced with medication.

Students at medical institutes study first aid for hypertensive crisis in the Department of Propaedeutics of Internal Diseases, and therefore it would be better for a random passerby not to try to provide assistance, but to call an ambulance.

Diagnosis

The three main diagnostic methods that allow you to determine the presence of hypertension in a person are:

1. blood pressure measurement,
2. physical exam,
3. Recording an electrocardiogram.

Blood pressure control

Blood pressure measurement is carried out using a special device - a tonometer, which is a combination of a sphygmomanometer with a phonendoscope. In addition, there are currently special electronic devices that measure blood pressure, pulse rate, and also allow you to enter blood pressure indicators into the device's memory.

Medical history

The diagnosis of hypertension also includes a survey of the patient by a physician. The doctor finds out from the patient what diseases he has previously suffered or is currently suffering from. Risk factors (smoking, high cholesterol, diabetes) are evaluated, in addition to the so-called. hereditary history, that is, whether the patient's parents, grandparents, and other close relatives suffered from hypertension.

Physical exam

The physical examination of the patient first includes a study of the heart using a stethoscope. This method makes it possible to detect the presence of heart murmurs, changes in characteristic tones (amplification or, conversely, weakening), as well as the appearance of uncharacteristic sounds. These data, first of all, speak of changes that occur in heart tissue due to increased blood pressure, as well as the presence of defects.

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a method of recording changes in the heart's electrical potentials over time on a special tape. This is an indispensable method for diagnosing various cardiac arrhythmias in the first place. In addition, the ECG makes it possible to determine the call. left ventricular wall hypertrophy typical of arterial hypertension.

echocardiography

In addition to these diagnostic methods, other methods are also used, for example, echocardiography (ultrasound examination of the heart), which makes it possible to determine the presence of defects in the structure of the heart, changes in the thickness of its walls and the state of the valves.

arteriography

Arteriography, including aortography, is an X-ray method of examining the condition of the artery walls and their lumen. This method makes it possible to identify the presence of atheromatous plaques on the wall of the coronary arteries (coronary angiography), the presence of coarctation of the aorta (congenital narrowing of the aorta in a certain area), etc.

dopplerography

Dopplerography is an ultrasound method for diagnosing the state of blood flow in vessels, both in arteries and veins. With high blood pressure, first of all, the doctor checks the condition of the carotid arteries and cerebral arteries. Ultrasound is widely used for this as it is absolutely safe to use and causes no complications.

blood chemistry

A biochemical blood test is also used in diagnosing hypertension. First, the level of cholesterol and high, low and very low density lipoproteins is checked, as they are an indicator of atherosclerosis tendency. Also, the blood sugar level is determined.

In the diagnosis of hypertension, a study of the condition of the kidneys is also used, for which methods such as general urinalysis, biochemical blood test (to measure creatinine and urea), as well as ultrasound of the kidneys and their vessels are used.

Thyroid ultrasound

Ultrasound of the thyroid gland and a blood test for thyroid hormones. These research methods help identify the role of the thyroid gland in causing high blood pressure.

How to treat high blood pressure?

Effective treatment for hypertension is selected depending on the severity of the disease and the patient's overall risk of cardiovascular disease. To assess this risk, it takes into account a few factors:

• age: 50 years for men, 60 years for women;
• family history: sudden heart attack or death of a parent (before age 55 in men, before age 65 in women) or stroke before age 45, regardless of the sex of the parents;
• smoking (or not smoking in the last three years);
• diabetes;
• LDL cholesterol level above 1. 60 g/l or LDL cholesterol level below 0. 40 g/l;
• abdominal obesity, kidney failure, lack of regular exercise or excessive alcohol consumption.

General principles for treating high blood pressure at home, which should be followed by all adults with hypertension:

With a mild, first degree of the disease, non-drug methods are used:

• limit salt intake to 5g/day (more on proper nutrition with high blood pressure can be found in our separate article),
• normalization of weight with its excess,
• moderate physical activity 3-5 times a week (walking, running, swimming, physical therapy exercises),
• stop smoking,
• reducing alcohol consumption,
• the use of herbal sedatives to increase emotional excitability (eg a decoction of valerian).

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

It should be noted that pharmacies currently offer a wide range of different drugs for the treatment of high blood pressure, both new and known for many years. Under different trade names, preparations with the same active substance can be produced. It is very difficult for a non-expert to understand them.

Diuretics are the drugs of choice for the treatment of hypertension, especially in the elderly. The most common are thiazides.

In addition, in the treatment of high blood pressure, it is important to correct the risk factors:

• antiplatelet agents - acetylsalicylic acid, are used according to indications,
• statins in the presence of atherosclerosis - also in the absence of contraindications;
• medicines that reduce blood glucose levels in the presence of diabetes.

If the effect is insufficient, it may be necessary to add a second or third drug. rational combinations:

• diuretic + beta blocker
• diuretic + ACE inhibitor (or sartan)
• diuretic + calcium antagonist
• dihydropyridine calcium antagonist + beta-blocker
• calcium antagonist + ACE inhibitor (or sartan)

Invalid combinations:

• non-dihydropyridine calcium antagonist + beta-blocker (possible development of heart blocks to death)
• ACE inhibitor + sartan

For treatment and examination of hypertension, you need to consult a doctor. Only a specialist after a thorough examination and analysis of the test results will be able to correctly diagnose and prescribe competent treatment.

Why is hypertension dangerous?

Arterial hypertension is one of the main causes of serious CVS pathologies.

Despite the fact that there are currently a large number of antihypertensive drugs that allow you to maintain blood pressure at an adequate level, the incidence of hypertensive crises and complications such as heart failure (HF) and renal failure (RI), aortic and valve regurgitation mitral valve, cardiac and aorta aneurysm, MI (heart attacks), strokes, etc. in patients with hypertension remains extremely high.

This is mainly due to the fact that many patients do not want to systematically undergo antihypertensive therapy, believing that the hypertensive crisis that developed in them was unique and it will not happen again.

According to statistics, of patients who know they have high blood pressure, only about 40% of women and 35% of men receive drug treatment. At the same time, only 15% of women and about five percent of men reach the necessary blood pressure levels due to the systematic use of antihypertensive therapy, monitoring of blood pressure indicators and regular visits to the doctor and following his recommendations.

Although arterial hypertension is one of the controllable risk factors for the formation of cardiovascular pathologies, such unfortunate indicators are due to the common misunderstanding of the patient about the severity of his diagnosis and, consequently, the lack of a serious and responsible approach to treatment.

The most common serious complications that develop due to hypertensive crises are:

• stroke (about thirty percent of patients);
• pulmonary edema (twenty-three percent);
• hypertensive encephalopathy (16%);
• acute heart failure (fourteen percent);
• cerebral hemorrhage (five percent of cases);
• dissecting aortic aneurysm (2. 5%), etc.

It should be noted that in the absence of adequate and systematic treatment of hypertension, heart and kidney failure within three years after experiencing a severe (complicated) hypertensive crisis, 30 to 40% of patients die.

Comprehensive treatment, responsible health care, the systematic use of medication against high blood pressure and blood pressure control allow these frightening numbers to be reduced to a minimum.

Prevention of high blood pressure

For people with a hereditary predisposition to high blood pressure and burdened by risk factors, disease prevention is of great importance.

1. First of all, this is a regular examination by a cardiologist and adherence to the rules of a proper lifestyle, which will help to delay and often eliminate the disease of high blood pressure. If you have a family history of hypertension, you should reconsider your lifestyle and radically change many of the habits and lifestyle that are risk factors.
2. You should reconsider your eating principles, stop eating salty and fatty foods, switch to a low-calorie diet that includes a lot of fish, seafood, fruits and vegetables. Don't get carried away with alcohol and especially beer. They contribute to obesity, uncontrolled consumption of table salt, negatively affect the heart, blood vessels, liver and kidneys.
3. It is necessary to lead an active lifestyle, move around more, depending on age, this is ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually, without overloading the body. Outdoor exercise is especially beneficial. Physical exercise strengthens the heart muscle and nervous system and helps prevent stress.
4. Try to have a supportive psycho-emotional environment around you. If possible, avoid conflicts, remember that a broken nervous system often triggers the mechanism for the development of high blood pressure.
5. Quitting smoking, the substances contained in nicotine cause changes in the walls of the arteries, increase their stiffness, therefore, they can be the culprits of high blood pressure. In addition, nicotine is very dangerous for the heart and lungs.

Thus, we can briefly say that the prevention of arterial hypertension includes regular examinations by a cardiologist, an adequate lifestyle and an emotional context favorable to your environment.

forecast for life

The prognosis of arterial hypertension is determined by the nature of the course (malignant or benign) and the stage of the disease. Factors that worsen the prognosis are:

• rapid progression of signs of damage to target organs;
• III and IV stages of arterial hypertension;
• severe damage to blood vessels.

An extremely unfavorable course of arterial hypertension is observed in young people. They have a high risk of stroke, myocardial infarction, heart failure, sudden death.

With the early treatment of arterial hypertension and subject to the patient's careful observance of all the recommendations of the attending physician, it is possible to delay the progression of the disease, improve the patients' quality of life and, sometimes, achieve long-term remission .