Hypertension

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

Causes of hypertension

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

The causes of primary hypertension may be the following factors:

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

Secondary hypertension develops as a complication in 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 inhibition of the intensity of blood circulation in the kidneys, as a result of which the organs secrete a substance to compensate for the pathological condition.
• Endocrinological 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:

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

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

Types of disease

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

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

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

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

According to severity, hypertension is classified into:

• mild - increased 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 more than 180/110 mm Hg.Art.

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

Symptoms

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

• headache, dizziness;
• noise, ringing in the ears;
• the appearance of “flies” and spots before the eyes;
• feeling of active heartbeat, pulsation in the temples, back of the head;
• facial redness;
• squeezing pain in the heart area;
• 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.This may include blurred vision, tremors, numbness in the limbs, impaired coordination, fine motor skills, etc.

Quite often, with a long course of the disease, the patient is initially bothered by the above symptoms, but then they go away.This is due to the fact that the receptors lose sensitivity and the body adapts to increased blood pressure parameters.However, it is necessary to regularly measure blood pressure, record indicators and follow medical recommendations.

Possible complications of hypertension

In advanced forms of the disease, complications such as:

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

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

Diagnosis of the disease

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

To confirm the diagnosis, a minimum of 3 isolated blood pressure measurements (on different days in a medical facility) or ABPM data (24-hour blood pressure monitoring) is required. 

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

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

To clarify the provoking factors and detect pre-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 causes of the disease, the general practitioner may refer the patient for further treatment and diagnostic measures to a cardiologist, endocrinologist, nephrologist, neurologist, or ophthalmologist.

Treatment of hypertension

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

Non-drug therapy

Implies a change in lifestyle.To do this you need:

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

Drug therapy

Several groups of drugs are used to treat hypertension:

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

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

Prevention of hypertension

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

• maintain optimal body weight;
• exercise regularly;
• adhere to dietary nutrition;
• give up bad habits;
• promptly treat endocrine, nephrological, and heart diseases;
• 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 a multidisciplinary medical center you can get advice from highly qualified specialists.Experienced therapists and cardiologists will prescribe the necessary examination and select effective treatment for each patient.