Stages of blood pressure. Hypertension - classification

Hypertonic disease

Hypertonic disease (GB) -(Essential, primary arterial hypertension) is a chronic disease, the main manifestation of which is an increase in blood pressure (Arterial Hypertension). Essential arterial hypertension is not a manifestation of diseases in which an increase in blood pressure is one of the many symptoms (symptomatic hypertension).

HD classification (WHO)

Stage 1 - there is an increase in blood pressure without changes in internal organs.

Stage 2 - an increase in blood pressure, there are changes in internal organs without dysfunction (LVH, coronary artery disease, changes in the fundus). Availability by at least one of the following symptoms

target organs:

Left ventricular hypertrophy (according to ECG and echocardiography);

Generalized or local narrowing of the retinal arteries;

Proteinuria (20-200 mcg / min or 30-300 mg / l), creatinine more

130 mmol/l (1.5-2 mg/% or 1.2-2.0 mg/dl);

Ultrasound or angiographic features

atherosclerotic lesions of the aorta, coronary, carotid, iliac or

femoral arteries.

Stage 3 - increased blood pressure with changes in internal organs and violations of their functions.

Heart: angina pectoris, myocardial infarction, heart failure;

Brain: transient disorder cerebral circulation, stroke, hypertensive encephalopathy;

Fundus of the eye: hemorrhages and exudates with swelling of the nipple

optic nerve or without it;

Kidneys: signs of CKD (creatinine more than 2.0 mg/dl);

Vessels: dissecting aortic aneurysm, symptoms of occlusive lesions of peripheral arteries.

Classification of GB according to the level of blood pressure:

Optimal BP: DM<120 , ДД<80

Normal blood pressure: SD 120-129, DD 80-84

Elevated normal blood pressure: SD 130-139, DD 85-89

AG - 1 degree of increase SD 140-159, DD 90-99

AG - 2nd degree of increase SD 160-179, DD 100-109

AH - 3rd degree increase DM >180 (=180), DD >110 (=110)

Isolated systolic AH DM>140(=140), DD<90

If SBP and DBP fall into different categories, then the highest reading should be taken into account.

Hypertension in children may be asymptomatic and then discovered incidentally during routine checkups. In children with more severe forms of hypertension, clinical manifestations are more common, especially headaches, epistaxis, fatigue, or increased sweating.

When examining a child with hypertension, we have four main objectives. The goal of hypertension treatment is not only to normalize blood pressure, that is, to lower blood pressure below a percentile, but also to prevent or normalize pre-existing hypertensive target organ damage and reduce cardiovascular morbidity and mortality. In children, such interventions do not exist because cardiovascular morbidity and especially mortality in children is minimal.

Clinical manifestations of GB

Subjective complaints of weakness, fatigue, headaches of various localization.

visual impairment

Instrumental Research

Rg - slight left ventricular hypertrophy (LVH)

Changes in the fundus of the eye: dilation of the veins and narrowing of the arteries - hypertensive angiopathy; with a change in the retina - angioretinopathy; in the most severe cases (swelling of the nipple of the optic nerve) - neuroretinopathy.

Kidneys - microalbuminuria, progressive glomerulosclerosis, secondarily wrinkled kidney.

Etiological causes of the disease:

1. Exogenous causes of the disease:

Psychological stress

Nicotine intoxication

Alcohol intoxication

Excess intake of NaCl

Hypodynamia

Binge eating

2. Endogenous causes of the disease:

Hereditary factors - as a rule, 50% of descendants fall ill with hypertension. Hypertension in this case proceeds more malignantly.

Disease pathogenesis:

Hemodynamic mechanisms

Cardiac output

Since about 80% of the blood is deposited in the venous bed, even a slight increase in tone leads to a significant increase in blood pressure, i.e. the most significant mechanism is an increase in total peripheral vascular resistance.

Dysregulation leading to the development of HD

Neurohormonal regulation in cardiovascular diseases:

A. Pressor, antidiuretic, proliferative link:

SAS (norepinephrine, adrenaline),

RAAS (AII, aldosterone),

arginine vasopressin,

Endothelin I,

growth factors,

cytokines,

Plasminogen activator inhibitors

B. Depressor, diuretic, antiproliferative link:

Natriuretic Peptide System

Prostaglandins

Bradykinin

Tissue plasminogen activator

Nitrogen oxide

Adrenomedullin

An increase in the tone of the sympathetic nervous system (sympathicotonia) plays an important role in the development of GB.

It is usually caused by exogenous factors. Mechanisms for the development of sympathicotonia:

facilitation of ganglionic transmission of nerve impulses

violation of the kinetics of norepinephrine at the level of synapses (violation of the reuptake of n / a)

change in sensitivity and / or number of adrenoreceptors

desensitization of baroreceptors

The effect of sympathicotonia on the body:

Increase in heart rate and contractility of the heart muscle.

An increase in vascular tone and, as a result, an increase in the total peripheral vascular resistance.

An increase in the tone of capacitive vessels - an increase in Venous return - An increase in blood pressure

Stimulates the synthesis and release of renin and ADH

Insulin resistance develops

The endothelium is damaged

Effect of insulin:

Increases Na reabsorption - Water retention - Increased blood pressure

Stimulates hypertrophy of the vascular wall (because it is a stimulator of the proliferation of smooth muscle cells)

The role of the kidneys in the regulation of blood pressure

Regulation of Na homeostasis

Regulation of water homeostasis

synthesis of depressor and pressor substances, at the beginning of GB both pressor and depressor systems work, but then the depressor systems are depleted.

The effect of Angiotensin II on the cardiovascular system:

Acts on the heart muscle and promotes its hypertrophy

Stimulates the development of cardiosclerosis

Causes vasoconstriction

Stimulates the synthesis of Aldosterone - increased Na reabsorption - increased blood pressure

Local factors in the pathogenesis of HD

Vasoconstriction and hypertrophy of the vascular wall under the influence of local biologically active substances (endothelin, thromboxane, etc...)

During GB, the influence of various factors changes, first neurohumoral factors prevail, then when the pressure stabilizes at high numbers, local factors predominantly act.

Complications of hypertension:

Hypertensive crises - a sudden increase in blood pressure with subjective symptoms. Allocate:

Neurovegetative crises - neurogenic dysregulation (sympathicotonia). As a result, a significant increase in blood pressure, hyperemia, tachycardia, sweating. Attacks are usually short-lived, characterized by a rapid response to therapy.

Edema - retention of Na and H 2 O in the body, develops slowly (over several days). Manifested in puffiness of the face, pastosity of the lower leg, elements of cerebral edema (nausea, vomiting).

Convulsive (hypertensive encephalopathy) - Failure of the regulation of cerebral blood flow.

The fundus of the eye - hemorrhage, swelling of the nipple of the optic nerve.

Strokes - under the influence of a sharply increased blood pressure, small aneurysms of the vessels of the GM appear and, in the future, with an increase in blood pressure, they can rupture.

Nephrosclerosis.

Survey plan.

1. Measurement of blood pressure in a calm state, in a sitting position at least two times with

at intervals of 2-3 minutes, on both hands. Before the measurement for a period of

less than one hour avoid strenuous exercise, do not smoke, do not drink

coffee and strong drinks, and also do not take antihypertensive drugs.

If the patient is examined for the first time, then in order to

avoid “accidental increases”, it is advisable to re-measure in

during the day. In patients younger than 20 years and older than 50 years with newly diagnosed

Normal blood pressure is below 140/90 mm Hg. Art.

2. Complete blood count: in the morning on an empty stomach.

With a long course of hypertension, there may be an increase

hematocrit ("hypertensive polycythemia").

Normal values:

| Indicators | men | women |

| Hemoglobin | 130-160 g / l | 115-145 g / l |

| Erythrocytes | 4.0-5.5 x 1012 / l | 3.7-4.7 x 1012 / l |

| Hematocrit | 40-48% | 36-42% |

3. General analysis of urine (morning portion): with the development of nephroangiosclerosis and

CRF - proteinuria, microhematuria and cylindruria. Microalbuminuria (40-

300 mg/day) and glomerular hyperfiltration (normally 80-130 ml/min x 1.73

m2) indicate the second stage of the disease.

4. Zimnitsky's test (daily urine is collected in 8 jars with an interval of 3

hours): with the development of hypertensive nephropathy - hypo-and isosthenuria.

5. Biochemical blood test: in the morning on an empty stomach.

Accession of atherosclerosis leads most often to hyperlipoproteinemia II and

IIA: increase in total cholesterol, low density lipoproteins;

IIB: increased total cholesterol, low density lipoproteins,

triglycerides;

IV: normal or increased amount of cholesterol, increased

triglycerides.

With the development of chronic renal failure, an increase in the level of createnin, urea.

Norma- Creatinine: 44-100 µmol/l(M); 44-97 µmol/l(W)

Urea: 2.50-8.32 µmol/l.

6. ECG signs of damage to the left ventricle (hypertensive heart)

I. -Sign of Sokolov-Lyon: S(V1)+R(V5V6)>35 mm;

Cornell sign: R(aVL)+S(V3) >28 mm for men and >20 mm for

Hubner-Ungerleider sign: R1+SIII>25 mm;

Wave amplitude R(V5-V6)>27 mm.

II. Hypertrophy and / or overload of the left atrium:

PII wave width > 0.11 s;

The predominance of the negative phase of the P (V1) wave with a depth of > 1 mm and

duration > 0.04 s.

III. Romhilt-Estes scoring system (a sum of 5 points indicates

definite hypertrophy of the left ventricle, 4 points - possible

hypertrophy)

Amplitude h. R or S in limb leads > 20 mm or

amplitude h. S(V1-V2)>30 mm or amplitude h. R(V5-V6) -3 points;

Left atrial hypertrophy: negative phase Р(V1)>0.04 s - 3

Discordant shift of the ST segment and h. T in lead V6 without

application of cardiac glycosides - 3 points

against the background of treatment with cardiac glycosides - 1 point; - EOS deviation

to the left< 30о - 2 балл ширина комплекса QRS>0.09 s - 1 point; -time

internal deviation> 0.05 s in lead V5-V6 - 1 point.

7. EchoCG signs of hypertensive heart.

I. Hypertrophy of the walls of the left ventricle:

ZSLZh thickness > 1.2 cm;

IVS thickness > 1.2 cm.

II. Increase in mass of the myocardium of the left ventricle:

150-200 g - moderate hypertrophy;

>200 g - high hypertrophy.

8. Fundus changes

As left ventricular hypertrophy increases,

amplitude of the first tone at the apex of the heart, with the development of insufficiency

the third and fourth tones can be registered.

Emphasis of the second tone on the aorta, the appearance of a quiet

systolic murmur at the apex.

High vascular tone. Signs:

More gentle anacrota;

elongated top;

The incisura and decrotic tooth are displaced towards the apex;

The amplitude of the decrotic tooth is reduced.

In a benign course, the blood flow is not reduced, but in a crisis

course - the amplitude and reographic index are reduced (signs of a decrease

blood flow).

differential diagnosis.

1. Chronic pyelonephritis.

In 50% of cases, hypertension is accompanied, sometimes with a malignant course.

diagnosis takes into account:

A history of nephrolithiasis, cystitis, pyelitis, anomalies

kidney development;

Symptoms not characteristic of hypertension: dysuric

phenomena, thirst, polyuria;

Pain or discomfort in the lower back;

Permanent subfebrile condition or periodic fever;

Pyuria, proteinuria, hypostenuria, bacteriuria (diagnostic titer 105

bacteria in 1 ml of urine), polyuria, the presence of Sternheimer-Malbin cells;

Ultrasound: asymmetry in the size and functional state of the kidneys;

Isotope radiography: flattening, asymmetry of curves;

Excretory urography: expansion of the calyces and pelvis;

Computed tomography of the kidneys;

Kidney biopsy: focal nature of the lesion;

Angiography: "burned tree" view;

From common symptoms: predominant increase in diastolic pressure,

rarity of hypertensive crises, absence of coronary, cerebral

complications and relatively young age.

2. Chronic glomerulonephritis.

Long before the onset of arterial hypertension, a urinary syndrome appears;

In the anamnesis, an indication of the transferred nephritis or nephropathy;

Early hypo- and isostenuria, proteinuria more than 1 g/day,

hematuria, cylindruria, azotemia, renal failure;

Hypertrophy of the left ventricle is less pronounced;

Neuroretinopathy develops relatively late, while the arteries are only

slightly narrowed, veins are normal, hemorrhages are rare;

Anemia often develops;

Ultrasound scanning, dynamic synthography (size symmetry and

functional state of the kidneys);

Kidney biopsy: fibroplastic, proliferative, membranous and

sclerotic changes in the glomeruli, tubules and vessels of the kidneys, as well as

deposition of immunoglobulins in the glomeruli.

3. Vasorenal hypertension.

It is a secondary hypertensive syndrome caused by

stenosis of the main renal arteries. Characteristic:

Arterial hypertension steadily keeps on high figures, without

special dependence on external influences;

Relative resistance to antihypertensive therapy;

On auscultation, a systolic murmur may be heard in the umbilical

area, better when holding the breath after a deep exhalation, without a strong

pressing with a stethoscope;

In patients with atherosclerosis and aortoarteritis, a combination of two

clinical symptoms - systolic murmur over the renal arteries and

asymptomatic blood pressure in the arms (difference of more than 20 mm Hg);

In the fundus, a sharp widespread arteriolospasm and neuroretinopathy

occur 3 times more often than in hypertension;

Excretory urography: a decrease in kidney function and a decrease in its size by

side of the stenosis;

Sectoral and dynamic scintigraphy: asymmetry of sizes and functions

kidneys with homogeneity of the intraorgan functional state;

In 60% increased plasma renin activity ( positive test With

captopril - with the introduction of 25-50 mg, renin activity increases by more than

150% of the original value);

2 peaks of daily plasma renin activity (at 10 and 22 h), and with

hypertension 1 peak (at 10 o'clock);

Angiography of the renal arteries with aortic catheterization through the femoral

artery according to Seldinger: narrowing of the artery.

4. Coarctation of the aorta.

congenital anomaly characterized by narrowing of the isthmus of the aorta

creates different circulation conditions for the upper and lower body

In contrast to hypertension, it is characteristic:

Weakness and pain in the legs, chilliness of the feet, cramps in the muscles of the legs;

Plethora of the face and neck, sometimes hypertrophy of the shoulder girdle, and lower

limbs may be hypotrophic, pale and cold to the touch;

In the side sections chest visible pulsation of the subcutaneous vascular

collaterals, especially when the patient is sitting, leaning forward with outstretched

The pulse on the radial arteries is high and tense, and on the lower extremities

small filling and tension or not palpable;

Blood pressure on the arms is sharply increased, on the legs it is lowered (normal blood pressure on the legs is 15-

20 mmHg higher than on the hands);

Auscultatory rough systolic murmur with a maximum in the II-III intercostal space

on the left at the sternum, well carried out into the interscapular space; accent II

tone on the aorta;

Radiologically, a pronounced pulsation of a slightly expanded

aorta above the site of coarctation and distinct post-stenotic dilatation

aorta, there is a usuration of the lower edges of the IV-VIII ribs.

5. Atherosclerotic hypertension.

Associated with a decrease in the elasticity of the aorta and its large branches

due to atheromatosis, sclerosis and calcification of the walls.

Old age predominates;

Increased systolic blood pressure with normal or decreased diastolic,

pulse pressure is always increased (60-100 mm Hg);

When the patient moves from a horizontal to a vertical position

systolic blood pressure decreases by 10-25 mm Hg, and for hypertensive

the disease is characterized by an increase in diastolic pressure;

Postural circulatory reactions are characteristic;

Other manifestations of atherosclerosis: fast, high heart rate, retrosternal

pulsation, unequal filling of the pulse on the carotid arteries, expansion and

intense pulsation of the right subclavian artery, shift to the left

percussion border of the vascular bundle;

Auscultatory on the aorta accent II tone with a tympanic shade and

systolic murmur, aggravated by raised arms (symptom of Sirotinin-

Kukoverova);

X-ray and echocardiographic signs of compaction and

aortic expansion.

6. Pheochromocytoma.

Hormonally active tumor of the chromaffin tissue of the medulla

adrenal glands, paraganglia, sympathetic nodes and producing

significant amount of catecholamines.

With adrenospathetic form against the background of normal or elevated blood pressure

hypertensive crises develop, after a fall in blood pressure, profuse

sweating and polyuria; characteristic feature is an increase

urinary excretion of vanillyl-mandelic acid;

In the form with constant hypertension, the clinic resembles a malignant

variant of hypertension, but there may be significant weight loss and

development of overt or latent diabetes mellitus;

Positive tests: a) with histamine (intravenously administered histamine

0.05 mg causes an increase in blood pressure by 60-40 mm Hg. during the first 4 minutes), b)

palpation of the kidney area provokes a hypertensive crisis;

7. Primary aldosteronism (Conn's syndrome).

Associated with increased aldosterone synthesis in the glomerular cortex

adrenal glands, mostly due to solitary adenoma of the cortex

adrenal glands. The combination of hypertension with:

polyuria;

nocturia;

muscle weakness;

Neuromuscular disorders (paresthesia, increased convulsive

readiness, transient para- and tetrapligia);

In laboratory tests:

Hypokalemia, hypernatremia;

Hyporeninemia, hyperaldosteronemia;

Decreased glucose tolerance;

Alkaline urine reaction, polyuria (up to 3 l / day or more), isosthenuria (1005-

Not amenable to therapy with aldosterone antagonists.

Positive tests for the renin-angiotensin-aldosterone system:

The stimulating effect of a two-hour walk and a diuretic (40 mg

furosemide intravenously);

With the introduction of DOCA (10 mg per day for 3 days), the level of aldosterone

remains high, while in all other cases of hyperaldosteronism its

level is decreasing.

For topical tumor diagnosis:

Retropneumoperitoneum with tomography;

scintigraphy of the adrenal glands;

Aortography;

CT scan.

8. Itsenko-Cushing's syndrome.

Hypertension, severe obesity and hyperglycemia develop simultaneously;

Features of fat deposition: moon-shaped face, powerful torso, neck, abdomen;

arms and legs remain thin;

Disorders of sexual functions;

Crimson-violet striae on the skin of the abdomen, thighs, mammary glands, in the area

armpits;

The skin is dry, acne, hypertrichosis;

Decreased glucose tolerance or overt diabetes mellitus;

Acute ulcers of the gastrointestinal tract;

Polycythemia (more than 6 erythrocytes (1012/l), thrombocytosis, neutrophilic

leukocytosis with lympho- and eosinopenia;

Increased excretion of 17-hydroxycorticosteroids, ketosteroids,

aldosterone.

9.Centrogenic hypertension.

Lack of hereditary predisposition to hypertension;

Chronological relationship between skull trauma or brain disease

brain and the occurrence of hypertension;

Signs of intracranial hypertension (strong, not corresponding to the level

BP headaches, bradycardia, congestive optic nipples).

Formulation of the diagnosis:

Name of the disease - Hypertonic disease

The stage of the disease (I, IIorIIIstage)

The degree of increase in blood pressure - 1,2 or 3 degree of increase in blood pressure

Degree of risk - low, medium, high or very high

Example: Hypertension stage II, 3 degrees of increased blood pressure, very high risk.

Goals of treatment of arterial hypertension.

Maximize the risk of developing cardiovascular complications and mortality from them by means of:

Normalization of the level of blood pressure,

Correction of reversible risk factors (smoking, dyslipidemia, diabetes),

Protection of the organs of the meshes (organoprotection),

Treatment of comorbidities (associated conditions and comorbidities).

Target BP levels:

General patient population<140/90мм РТ ст

Diabetes mellitus without proteinuria<(=)130/80 мм рт ст

Diabetes mellitus with proteinuria<130/80 мм рт ст

AH with chronic renal failure<125/75 мм рт ст

Treatment tactics:

Non-drug therapy -reducing risk factors:

alcohol intoxication

nicotine intoxication

overweight (mainly android-type obesity)

increased physical activity (concomitant diseases must be taken into account)

restrictions on the use of NaCl - 40% salt-dependent hypertension. No more than 5g/day.

emotional peace

Patient education, increased adherence to treatment.

Increase consumption of foods rich in potassium.

Restriction of animal fats and easily digestible carbohydrates.

In 80% of patients with a mild form of hypertension, non-drug therapy leads to recovery.

Medical therapy

indications: with rigidity to non-drug therapy; when target organs are involved in the pathological process; with hereditary GB; with a significant increase in blood pressure.

Principles of drug therapy:

Treatment should begin with the lowest dose of the drug. With good tolerability of a low dose of the drug and insufficient control of blood pressure, the dose should be increased,

Rational combinations of drugs should be used. It is preferable to add another drug than to add a dose

In case of poor response to the drug or poor tolerability, the drug should be replaced

It is advisable to use long-acting drugs that provide an effect within 24 hours with a single dose.

The initial drug can be any hypertensive drug.

Diuretics - hydrochlorothiazide 6.25-25.0 mg, indapamide - 2.5 mg, indapamide - RETARD (arifon) 1.5 mg / day

B-blockers - metaprolol tartart 50-100 mg, metaprolol retard 75-100 mg, metaprolol succinate 100-20 mg, bisaprolol 5-20 mg, betaxolol 10-40 mg, nebivolol - 5-10 mg / day

(atenolol is not used for systemic treatment)

Calcium antagonists - malodipine 5-10 mg, nefidipine retard 10-40 mg. Felodipine 5-20 mg

ACE inhibitor - (enalapril 10-40 mg, perindopril 4-8 mg, zofenopril 10-20 mg / day)

ARB II - losartan 50-100 mg, valsartan 80-160 mg / day,

DIURETICS

Drugs that increase urination by reducing the reabsorption of sodium and water.

Thiazide diuretics

They act on the distal nephron. They are well absorbed in the gastrointestinal tract, so they are prescribed during or after meals, once in the morning or 2 times in the morning. The duration of the hypotensive effect is 18-24 hours. During treatment, a diet rich in potassium and low in sodium chloride is recommended.

Arifon, in addition to the diuretic effect, also has the effect of peripheral vasodilation when used in patients with hypertension and edema, a dose-dependent effect is observed. Thiazide diuretics have a calcium-sparing effect, they can be prescribed for osteoporosis, and they are contraindicated for gout and diabetes mellitus.

Potassium-sparing diuretics.

Potassium-sparing diuretics reduce blood pressure by reducing the volume of fluid in the patient's body, and this is accompanied by a decrease in total peripheral resistance.

Amiloride from 25 to 100 mg / day in 2-4 doses for 5 days.

Triamterene is prescribed similarly

Veroshpiron is currently rarely used for the treatment of hypertension. With prolonged use, digestive disorders are possible, the development of gynecomastia, especially in the elderly.

Loop diuretics

They are strong diuretic drugs, cause a quick, short-term effect. Their hypotensive effect is much less pronounced than that of thiazide drugs, increasing the dose is accompanied by dehydration. Tolerance quickly sets in, so they are used in urgent conditions: pulmonary edema, hypertensive crisis.

Furosemide 40 mg. Applied inside. For parenteral administration, Lasix is ​​used in the same dosage.

BLOCKERS OF BETA-ADRENORECEPTORS.

The main indications for the appointment of this group of drugs are angina pectoris, arterial hypertension and cardiac arrhythmias.

There are beta-blockers of cardio-nonselective action, blocking beta-1 and beta-2 adrenoreceptors and cardioselective, having beta-1 inhibitory activity.

As a result of the blockade of beta-receptors of the heart, the contractility of the myocardium decreases, the number of heart contractions decreases, the level of renin decreases, which reduces the level of systolic and then diastolic pressure. In addition, the low peripheral vascular resistance associated with the intake of beta-blockers maintains the hypotensive effect for a long time (up to 10 years) when sufficient doses are taken. Addiction to beta-blockers does not occur. A stable hypotensive effect occurs after 2-3 weeks.

Side effects of beta-blockers are manifested by bradycardia, atrioventricular blockade, arterial hypotension. Violation of sexual function in men, drowsiness, dizziness, weakness may occur.

Beta-blockers are contraindicated in bradycardia less than 50 beats / min, severe obstructive respiratory failure, peptic ulcer, diabetes mellitus, pregnancy.

Inderal is a representative of non-selective beta-blockers. It does not last long, so you need to take 4-5 times a day. When selecting the optimal dose, blood pressure and heart rate should be measured regularly. It should be canceled gradually, since a sharp cessation of taking it can cause a withdrawal syndrome: a sharp rise in blood pressure, the development of myocardial infarction.

Hypertension: causes, treatment, prognosis, stages and degrees of risk

All materials on the site are published under the authorship or editorship of professional physicians,
but are not a prescription for treatment. Contact the experts!

Hypertension (AH) is one of the most common diseases of the cardiovascular system, which, according to only approximate data, affects a third of the world's inhabitants. By the age of 60-65, more than half of the population has a diagnosis of hypertension. The disease is called the "silent killer", because its signs may be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, greatly increasing the risk of vascular accidents.

In Western literature, the disease is called. Domestic experts adopted this wording, although both “hypertension” and “hypertension” are still in common use.

Close attention to the problem of arterial hypertension is caused not so much by its clinical manifestations as by complications in the form of acute vascular disorders in the brain, heart, and kidneys. Their prevention is the main task of treatment aimed at maintaining normal numbers.

An important point is the identification of various risk factors, as well as elucidation of their role in the progression of the disease. The ratio of the degree of hypertension to the existing risk factors is displayed in the diagnosis, which simplifies the assessment of the patient's condition and prognosis.

For most patients, the numbers in the diagnosis after "AH" do not mean anything, although it is clear that the higher the degree and risk indicator, the worse the prognosis and the more serious the pathology. In this article, we will try to understand how and why this or that degree of hypertension is set and what underlies the determination of the risk of complications.

Causes and risk factors for hypertension

The causes of arterial hypertension are numerous. Gov yelling oh we and We mean the case when there is no specific previous disease or pathology of the internal organs. In other words, such hypertension occurs by itself, involving other organs in the pathological process. Primary hypertension accounts for more than 90% of cases of chronic hypertension.

The main cause of primary AH is considered stress and psycho-emotional overload, which contribute to the disruption of the central mechanisms of pressure regulation in the brain, then humoral mechanisms suffer, target organs (kidneys, heart, retina) are involved.

The third stage of hypertension occurs with an associated pathology, that is, associated with hypertension. Among the associated diseases, the most important for the prognosis are strokes, heart attack and nephropathy due to diabetes, kidney failure, retinopathy (retinal damage) due to hypertension.

So, the reader probably understands how even one can independently determine the degree of GB. This is not difficult, just measure the pressure. Next, you can think about the presence of certain risk factors, take into account age, gender, laboratory parameters, ECG data, ultrasound, etc. In general, everything that is listed above.

For example, in a patient, the pressure corresponds to grade 1 hypertension, but at the same time he had a stroke, which means that the risk will be maximum - 4, even if stroke is the only problem besides hypertension. If the pressure corresponds to the first or second degree, and of the risk factors, smoking and age can only be noted against the background of quite good health, then the risk will be moderate - GB 1 tbsp. (2 tbsp.), risk 2.

For clarity, understanding what the risk indicator in the diagnosis means, you can summarize everything in a small table. By determining your degree and “counting” the factors listed above, you can determine the risk of vascular accidents and complications of hypertension for a particular patient. The number 1 means low risk, 2 - moderate, 3 - high, 4 - very high risk of complications.

Low risk means the probability of vascular accidents is not more than 15%, moderate - up to 20%, a high risk indicates the development of complications in a third of patients from this group; at a very high risk, more than 30% of patients are susceptible to complications.

Manifestations and complications of GB

Manifestations of hypertension are determined by the stage of the disease. In the preclinical period, the patient feels well, and only the indicators of the tonometer speak of a developing disease.

Hypertensive crises are provoked by traumatic situations, overwork, stress, drinking coffee and alcoholic beverages, so patients with an already established diagnosis should avoid such influences. Against the background of a hypertensive crisis, the likelihood of complications increases sharply, including life-threatening ones:

1. Hemorrhage or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute renal failure;
5. Heart attack.

How to measure pressure correctly?

If there is reason to suspect high blood pressure, then the first thing a specialist will do is measure it. Until recently, it was believed that blood pressure numbers can normally differ on different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. may occur due to the pathology of peripheral vessels, therefore, different pressures on the right and left hands should be treated with caution.

To obtain the most reliable figures, it is recommended to measure the pressure three times on each arm with small time intervals, fixing each result obtained. The most correct in most patients are the smallest values ​​obtained, however, in some cases, from measurement to measurement, the pressure increases, which does not always speak in favor of hypertension.

A large selection and availability of devices for measuring pressure make it possible to control it in a wide range of people at home. Usually, hypertensive patients have a tonometer at home, at hand, so that if they feel worse, they can immediately measure blood pressure. However, it should be noted that fluctuations are possible in absolutely healthy individuals without hypertension, therefore, a single excess of the norm should not be regarded as a disease, and in order to make a diagnosis of hypertension, pressure must be measured at different times, under different conditions and repeatedly.

When diagnosing hypertension, blood pressure numbers, electrocardiography data and the results of auscultation of the heart are considered fundamental. When listening, it is possible to determine noise, amplification of tones, arrhythmias. , starting from the second stage, will show signs of stress on the left side of the heart.

Treatment of hypertension

To correct high blood pressure, treatment regimens have been developed that include drugs of different groups and different mechanisms of action. Them the combination and dosage is chosen by the doctor individually taking into account the stage, comorbidity, response of hypertension to a specific drug. Once the diagnosis of HD has been established and prior to starting drug treatment, the doctor will suggest non-drug measures that greatly increase the effectiveness of pharmacological agents, and sometimes allow you to reduce the dose of drugs or refuse at least some of them.

First of all, it is recommended to normalize the regimen, eliminate stress, and ensure physical activity. The diet is aimed at reducing the intake of salt and liquid, the exclusion of alcohol, coffee and drinks and substances stimulating the nervous system. With a high weight, you should limit calories, give up fatty, floury, fried and spicy foods.

Non-drug measures at the initial stage of hypertension can give such a good effect that the need for prescribing drugs will disappear by itself. If these measures do not work, then the doctor prescribes the appropriate drugs.

The goal of treating hypertension is not only to reduce blood pressure, but also to eliminate, if possible, its cause.

The importance of choosing a treatment regimen is given to reducing the risk of vascular complications. So, it is noticed that some combinations have a more pronounced "protective" effect on the organs, while others allow better control of pressure. In such cases, experts prefer a combination of drugs that reduces the likelihood of complications, even if there will be some daily fluctuations in blood pressure.

In some cases, it is necessary to take into account comorbidity, which makes its own adjustments to the treatment regimens for GB. For example, men with prostate adenoma are prescribed alpha-blockers, which are not recommended for constant use to reduce pressure in other patients.

The most commonly used are ACE inhibitors, calcium channel blockers, which are prescribed for both young and elderly patients, with or without concomitant diseases, diuretics, sartans. The drugs of these groups are suitable for initial treatment, which can then be supplemented with a third drug of a different composition.

ACE inhibitors (captopril, lisinopril) reduce blood pressure and at the same time have a protective effect on the kidneys and myocardium. They are preferred in young patients, women taking hormonal contraceptives, indicated for diabetes, for age patients.

Diuretics no less popular. Effectively reduce blood pressure hydrochlorothiazide, chlorthalidone, torasemide, amiloride. To reduce adverse reactions, they are combined with ACE inhibitors, sometimes “in one tablet” (Enap, Berlipril).

Beta blockers(sotalol, propranolol, anaprilin) ​​are not a priority group for hypertension, but are effective in concomitant cardiac pathology - heart failure, tachycardia, coronary disease.

Calcium channel blockers often prescribed in combination with ACE inhibitors, they are especially good for bronchial asthma in combination with hypertension, as they do not cause bronchospasm (rhyodipine, nifedipine, amlodipine).

Angiotensin receptor antagonists(losartan, irbesartan) is the most prescribed group of drugs for hypertension. They effectively reduce pressure, do not cause cough like many ACE inhibitors. But in America, they are especially common due to a 40% reduction in the risk of Alzheimer's disease.

In the treatment of hypertension, it is important not only to choose an effective regimen, but also to take drugs for a long time, even for life. Many patients believe that when normal pressure figures are reached, treatment can be stopped, and tablets are already grabbed by the time of the crisis. It is known that the unsystematic use of antihypertensive drugs is even more harmful to health than the complete absence of treatment, therefore, informing the patient about the duration of treatment is one of the important tasks of the doctor.