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

High blood pressure (AH, hypertension) is one of the most important socio-economic 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 severe complications, disability and mortality from arterial hypertension in the absence of prompt treatment.

People with 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 on different hands of 10 - 15 mm Hg. This sign (difference in indications) has a probability of up to 96% of causing hypertension.

What's this?

Put simply, arterial hypertension is a disease of the cardiovascular system, in which the blood pressure in the arteries of the systemic (wide) circulation is constantly increased.

Blood pressure is divided into systolic and diastolic:

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

Normally, blood pressure readings change constantly. Physiologically they depend on the age, sex and condition of the person. During sleep, pressure decreases, physical activity or stress leads to its increase.

The normal average blood pressure in a 20-year-old person is 120/75 mm Hg. Art. , Forties - 130/80, over 50s - 135/84. With persistent figures of 140/90, one speaks of arterial hypertension. Statistics show that around 20-30 percent of the adult population is affected by this disease. With age, the prevalence rate increases relentlessly and by the age of 65, 50-65% of older people 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. The pressure periodically rises to 140 - 149/90, then drops, normalizes;
2. Isolated systolic. There is an increase in the upper indicator (reaches 140 and above). At the same time, the lower one remains within 90 and lower.

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

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

Risk factors

At present, the severity of the described disease directly depends on the risk facts. The risk lies in the formation of cardiovascular complications against the background of hypertension. Taking into account the presented complications, 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, in women after 60;
• to smoke;
• high cholesterol;
• hereditary factor;
• obesity;
• hypodynamy;
• 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.

Severity

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 course of the disease: the pressure during the day increases by 20-30 units and usually does not exceed 180/115 mm Hg. Art. Hypertensive crises occur rarely and are provoked, as a rule, by a sharp change in atmospheric pressure or emotional overload. There are no complications from the work of the target organs.

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 such indicators that patients often go to the doctor for the first time, since considering them as the norm is the pinnacle of inattention. 2nd degree arterial hypertension usually presents with severe headache, weakness, dizziness, and deterioration in 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 figures can reach completely prohibitive values (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 arterial hypertension should be under the supervision of a physician, take all prescribed antihypertensive medications, and ensure that they have a tonometer (mechanical or electronic) at home.

Arterial Hypertension Symptoms

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

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

1. Headache: This can be the first and main symptom. There are several types of headaches:
   • opaque, 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 sharp change in the position of the head and even slight physical exertion. Such pain is caused by a violation of the venous outflow of blood from the vessels of the skull, their overflow and the stimulation of pain receptors;
   • liquor - bursting spread throughout the head, can be pulsating. Any tension causes increased pain. It occurs most often in advanced stages of hypertension or in the presence of wrist hypertension. As a result, the blood vessels are excessively filled with blood and its outflow is difficult;
   • ischemic - dull or explosive in nature, accompanied by dizziness and nausea. It occurs with a sharp increase in blood pressure. There is a strong vasospasm, due to which the blood supply to the brain tissues is disturbed.
2. Pain in the region of the heart - cardialgia, not of an ischemic 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 manifest itself both at rest and during emotional stress. Sports activities are not a provoking factor.
3. Shortness of breath - at first occurs only when playing sports, with the progression of hypertension, it can also occur at rest. Characterizes heart dysfunction.
4. Edema - is most often found on the legs due to stagnation of blood in the systemic circulation, water and sodium retention, or impaired kidney function. The appearance in children simultaneously with the edema of hematuria and hypertension is characteristic of glomerulonephritis, which is very important to remember when making a differential diagnosis.
5. Visual impairment: This occurs 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 disorders of renal genesis, which will be discussed below. Chronic hypertension also leads to the development of dyscirculatory encephalopathy, which is characterized by decreased memory, attention and performance, sleep disturbances (increased daytime sleepiness, combined with sleeplessness at night), dizziness, tinnitus and depressed mood .

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

Hypertensive crisis

This is an emergency condition, which consists of a sharp increase in blood pressure to high numbers and is characterized by a sharp deterioration in the blood supply to all internal organs, especially 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 lies in the fact that, in the absence of prompt prompt intervention, a fatal outcome is possible. To provide emergency care, the patient must be immediately taken to the hospital, where blood pressure is quickly reduced with medication.

Students of medical institutes study hypertensive crisis emergency room at the Department of Internal Disease Propaedeutics, and therefore it would be better for a casual passer-by not to try to lend assistance, but to call an ambulance.

Diagnostics

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. Registration of an ECG.

Blood pressure control

Blood pressure measurement is performed using a special device - a tonometer, which is a combination of a sphygmomanometer with a stethoscope. In addition, at the moment there are special electronic devices that measure blood pressure, heart rate, and also allow you to enter blood pressure indicators into the memory of the device.

Medical history

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

Physical examination

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

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a method that allows you to record the changes in the electrical potentials of the heart over time on a special tape. This is an indispensable method of diagnosing, first of all, various cardiac arrhythmias. In addition, the ECG allows you to determine the so-called. hypertrophy of the left ventricular wall, 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 allows you to determine the presence of defects in the structure of the heart, changes in the thickness of its walls and the condition of the valves.

Arteriography

Arteriography, including aortography, is an X-ray method of examining the condition of the walls of the arteries and their lumen. This method allows you to identify the presence of atheromatous plaques in 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 the vessels, both in the arteries and in the veins. With arterial hypertension, first of all, the doctor checks the condition of the carotid arteries and cerebral arteries. Ultrasound is widely used for this, as they are absolutely safe to use and cause no complications.

Blood chemistry

A biochemical blood test is also used in the diagnosis of hypertension. First, it turns out the level of high, low and very low density cholesterol and lipoproteins, as they are an indicator of a tendency to atherosclerosis. In addition, 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 a general urinalysis, a biochemical blood test (for the level of creatinine and urea), as well as ultrasound of the kidneys and the their ships are used.

Thyroid ultrasound

Thyroid ultrasound and blood test for thyroid hormones. These research methods help identify the role of the thyroid gland in causing hypertension.

How to treat high blood pressure?

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

• age: 50 for men, 60 for women;
• family history: sudden heart attack or death of one of the parents (before the age of 55 in men, before the age of 65 in women) or stroke before the age of 45, regardless of the gender of the parent;
• smoking (or not smoking in the past 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 the home treatment of arterial hypertension, which should be followed by all adults with high blood pressure:

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

• limit salt intake to 5 g / day (more information 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, physiotherapy exercises),
• stop smoking,
• reduction of alcohol consumption,
• the use of herbal sedatives for increased emotional excitability (for example, a decoction of valerian).

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

It should be noted that pharmacies currently offer a wide range of different drugs for the treatment of arterial hypertension, both new and known for many years. Products prepared with the same active substance can be produced under different trade names. It is quite difficult for a non-specialist 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 arterial hypertension, it is important to correct the risk factors:

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

If the effect is insufficient, a second or third drug may need to be added. Rational combinations:

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

Invalid combinations:

• non-dihydropyridine calcium channel blocker + beta blocker (development of heart blockages and death possible)
• ACE inhibitor + sartan

For the treatment and examination of hypertension, it is necessary to consult a doctor. Only a specialist after a comprehensive examination and analysis of the results of the examinations will be able to correctly diagnose and prescribe competent treatment.

Why is hypertension dangerous?

High blood pressure is a leading cause of severe CVS disease.

Although there are currently a huge number of antihypertensive drugs that allow to maintain blood pressure at an adequate level, the incidence of hypertensive crises and complications such as heart failure (HF) and renal failure (RF), aortic and mitral valve regurgitation, cardiac aneurysm and aorta, myocardial infarction (heart attack), stroke, etc. in patients with hypertension it remains extremely high.

This is mainly due to the fact that many patients do not want to systematically take antihypertensive therapy, believing that the hypertensive crisis that developed in them was only one and this will not be repeated.

According to statistics, of the patients who are aware that 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 required blood pressure levels due to the systematic use of antihypertensive therapy, monitoring of blood pressure indicators and regular visits to the doctor and following the recommendations of he.

Despite the fact that arterial hypertension is one of the controllable risk factors for the formation of cardiovascular pathologies, such unfortunate indicators are due to the patient's banal misunderstanding of the severity of his diagnosis and, consequently, to 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);
• dissection of the aortic aneurysm (2. 5%), etc.

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

Comprehensive treatment, a responsible approach to one's health, the systematic use of drugs against arterial hypertension and the control of one's blood pressure, allow these frightening figures to be reduced to a minimum.

Prevention of arterial hypertension

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 compliance with the rules of a correct lifestyle, which will help to delay and often eliminate the disease of arterial hypertension. If you have a history of relatives with hypertension, you should reconsider your lifestyle and fundamentally change many of the habits and lifestyle that are risk factors.
2. You should reconsider your dietary principles, stop eating salty and fatty foods, switch to a low-calorie diet that includes a large amount of fish, seafood, fruits and vegetables. Don't get carried away by alcoholic beverages and, above all, 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 more, depending on the age, this is ideal for running, swimming, walking, cycling and skiing. Physical activity should be introduced gradually, without overloading the body. Exercise outdoors is especially helpful. Exercise strengthens the heart muscle and nervous system and helps prevent stress.
4. Try to have a favorable psycho-emotional environment around you. If possible, avoid conflicts, remember that a shattered nervous system very often triggers the mechanism for the development of arterial hypertension.
5. Quitting smoking, the substances contained in nicotine cause changes in the walls of the arteries, increase their stiffness, so they can be guilty of hypertension. Furthermore, nicotine is very dangerous for the heart and lungs.

Therefore, we can briefly say that the prevention of high blood pressure includes regular examinations by a cardiologist, the right lifestyle and an emotional background conducive 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;
• Stage III and IV of arterial hypertension;
• severe damage to blood vessels.

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

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