Hypertension

Hypertension is a systemic disease that represents a persistent increase in blood pressure above 140/90 mm Hg.Art.

Causes of hypertension

In clinical cardiology, hypertension is divided into primary, which occurs as an independent disease, and secondary, which develops as a complication of other pathologies.

The causes of primary hypertension can be the following factors:

• dysregulation of vascular pressure;
• excessive cardiogenic reactivity (sudden change in blood pressure on the background of external stimuli);
• increased tone of arterioles;
• disorder of the process of excretion of sodium by the urinary system.

Secondary hypertension develops as a complication of certain pathologies, including:

• Diseases of the kidneys and adrenal glands - chronic glomerulonephritis, pyelonephritis, tumors of the kidneys and adrenal glands, obstruction of the renal artery, etc.These diseases lead to the inhibition of the intensity of blood circulation in the kidneys, as a result of which the organs for compensation secrete a substance that
• Endocrine diseases - diabetes mellitus, hyperthyroidism, myxedema, tumors, metabolic disorders, hormonal imbalance, etc.
• Cardiovascular pathologies - atherosclerotic narrowing of blood vessels, aortic lumen, valve defects, etc.

In addition, provoking factors such as:

• diet with excessive consumption of fat, salt, sugar and insufficient amounts of plant products in the menu;
• age over 55 years;
• hereditary predisposition;
• physical inactivity;
• smoking, alcohol abuse;
• chronic stress.

Hypertension can also develop when taking certain medications (glucocorticosteroids, anabolic steroids, antidepressants).

Types of diseases

Depending on the cause and nature of the lesion, the following are distinguished:

• primary hypertension;
• hypertensive disease with primary heart damage;
• hypertension with predominant kidney damage;
• arterial hypertension with predominant heart and kidney damage;
• secondary hypertension.

Taking into account the degree of influence of the pathology on the internal organs, the following is diagnosed:

• I stage (uncomplicated) - there is no damage to the target organs, but there is a persistent increase in blood pressure;
• Phase II (asymptomatic) - characterized by damage to target organs, but no signs of a pathological process;
• III - organ damage occurs, which is accompanied by severe clinical symptoms.

According to severity, hypertension is divided into:

• mild - elevated blood pressure in the range of 140/90-159/99 mm Hg.Art.;
• moderate - indicators within 160/100-179/109 mm Hg.Art.;
• severe - blood pressure greater than 180/110 mm Hg.Art.

Isolated hypertension is also distinguished, the peculiarity of which is an increase only in systolic pressure.

Symptoms

Clinical manifestations of hypertension depend on the cause of the pathology and the degree of increase in blood pressure.In the initial stages, the disease may be asymptomatic, and then patients complain of:

• headache, dizziness;
• noise, ringing in the ears;
• the appearance of "flies" and spots before the eyes;
• feeling of an active heartbeat, pulsation in the temples, the back of the head;
• facial redness;
• pressing pain in region of heart;
• shortness of breath;
• swelling of the face, hands;
• excessive sweating;
• loss of appetite, nausea.

Other manifestations depend on the form and presence of complications of hypertension.These may include blurred vision, tremors, numbness in the limbs, impaired coordination, fine motor skills, etc.

Very often, with a long course of the disease, the patient is initially troubled by the above-mentioned symptoms, but then they disappear.This is due to the fact that receptors lose sensitivity and the body adapts to elevated blood pressure parameters.However, it is necessary to regularly measure blood pressure, record indicators and adhere to medical recommendations.

Possible complications of hypertension

In advanced forms of the disease, complications such as:

• hypertensive crisis;
• stroke;
• myocardial infarction;
• encephalopathy (reduced cognitive abilities with later development of vascular dementia);
• renal, chronic heart failure;
• atherosclerosis;
• dissecting aortic aneurysm;
• hypertensive retinopathy (retinal damage);
• nephrosclerosis (primarily shriveled kidney).

The risk of complications depends on a combination of different provoking factors, but even a slight increase in blood pressure can have negative consequences.

Disease diagnosis

If symptoms of hypertension appear, you should consult a doctor or cardiologist.During the consultation, the doctor asks about the complaints, their characteristics, and also studies the medical history in detail in order to identify the factors of the development of the disease.After that, the specialist conducts an examination that includes a general examination, auscultation, percussion, palpation, measurement of heart rate and blood pressure. 

At least 3 isolated blood pressure measurements (on different days in a medical facility) or ABPM data (24-hour blood pressure monitoring) are required to confirm the diagnosis. 

As part of the initial diagnosis, the patient is prescribed:

• clinical analysis of blood, urine;
• blood test for hormone and glycated hemoglobin content.

In order to clarify the provoking factors and detect already existing pathological processes, the patient can undergo the following diagnostic methods:

• electrocardiography;
• echocardiography;
• duplex ultrasound examination of the brachiocephalic, renal and iliofemoral arteries;
• Ultrasound of the heart, urinary system;
• ophthalmological examination.

Depending on the cause of the disease, the general practitioner may refer the patient to a cardiologist, endocrinologist, nephrologist, neurologist or ophthalmologist for further treatment and diagnostic measures.

Treatment of hypertension

The goal of treating hypertension is to normalize heart function, eliminate disease symptoms and prevent the development of complications.The treatment regimen is selected on an individual basis.

Therapy without drugs

It implies a change of lifestyle.To do this you need:

• regularly engage in therapeutic exercises;
• weight control;
• give up bad habits and coffee drinks;
• exclude fatty, spicy, canned food, fast food and confectionery products from the diet;
• reduce salt and sugar consumption;
• eat more seasonal vegetables, fruits, fish, low-fat dairy products;
• normalize the drinking regime (daily fluid volume should be 1-1.5 liters).

Drug therapy

Several groups of drugs are used to treat hypertension:

• diuretics;
• beta-blockers;
• angiotensin-converting enzyme inhibitors;
• calcium channel antagonists, as well as angiotensin II receptors;
• substances of central action. 

According to the indications, renin inhibitors, vasodilators, lipid-lowering drugs, sedatives, etc. can be prescribed.Specific drugs, dosage and frequency of administration are determined by the doctor.

Prevention of hypertension

There is no specific prevention of the disease.To reduce the risk of developing hypertension and dangerous complications, it is necessary to adhere to a number of general preventive measures:

• maintain optimal body weight;
• exercise regularly;
• adhere to a dietary diet;
• give up bad habits;
• treat endocrine, nephrological and heart diseases in a timely manner;
• minimize stressful situations;
• control blood pressure levels.

It is also important to undergo regular preventive examinations and follow all medical recommendations.If your blood pressure increases, you should make an appointment with your doctor.

In the multidisciplinary medical center you can get advice from highly qualified specialists.Experienced therapists and cardiologists will prescribe the necessary examination and select an effective treatment for each patient.