hypertension

Hypertension (HD)A chronic disease in which the main symptom is an increase in blood pressure (BP), excluding symptomatic hypertension

A person is usually diagnosed with hypertension if his blood pressure is persistently elevated (arterial hypertension above 140 to 90 mmHg).This is true 90% of the time.The cause of the elevated blood pressure can be identified in only 10% of cases, and symptoms of arterial hypertension are usually eliminated by eliminating the cause of the elevated blood pressure - in this case, symptomatic hypertension is diagnosed.

According to the recommendations of the World Health Organization, blood pressure should be considered normal if it does not exceed 140 and 90 mmHg.Art.

Typically, blood pressure is an unstable value, that is, it changes depending on what a person is doing, where they are, level of physical activity, level of anxiety, etc.However, in healthy people, blood pressure levels will return to normal on their own after a period of time after exposure, while the opposite is true in patients whose blood pressure returns to normal under the influence of drugs that quickly regulate blood pressure values.  

It is hypothesized that the basis of the disease is a disruption of blood pressure regulatory mechanisms.

Epidemiology of hypertension

Data from the Russian Federation Society of Cardiology (2020): 30-45% of the world’s population suffers from hypertension.Among men aged 25-65, 47% have high blood pressure, while among women the figure is about 40%.Sixty years later, more than 60% of hypertensive patients were registered.Due to the aging of the population and the increase in sedentary and overweight people, it is predicted that there will be 1.5 billion HD patients worldwide in 2025, which means that the number of patients with HD will increase by 15-20%.

The World Health Organization considers hypertension and atherosclerosis to be the most common causes of premature death in the working-age population.Complications caused by these diseases, such as myocardial infarction, chronic kidney disease, or acute cerebrovascular accidents, are not only life-threatening but often incapacitating and unable to work.

The pathogenesis of hypertension

The eminent Soviet therapist and scientist Georgi Fyodorovich Lang called hypertension "a disease of emotional unresponsiveness."

Blood pressure is the force with which blood presses against the walls of blood vessels and depends on three hemodynamic parameters: cardiac output, the total volume of blood circulating in the vascular bed, and the elasticity and tone of the blood vessels (total peripheral resistance).The upper number of blood pressure is determined by the force of the heart to eject blood - the systolic pressure - and the lower number represents diastolic pressure - the pressure when the heart relaxes.It reflects the degree of resistance of blood vessels to blood flow.

Vascular tone is in turn regulated by the central and peripheral nervous system and depends on the complex of mediators and bioactive substances released into the blood during various life situations (mood, fatigue, physical activity), which are also secreted by the endocrine system.The pathogenesis of hypertension is achieved through the activation of the sympathoadrenal glands and the renin-angiotensin-aldosterone system, the membrane transport of cations (sodium, calcium and potassium) is disrupted and sodium reabsorption in the kidney is increased.Dysregulation of vascular tone also occurs due to overproduction of vasoconstrictive compounds and decreased production of inhibitory compounds.These compounds affect the structure of the blood vessel wall, which undergoes changes due to non-infectious inflammation, spasm of vascular smooth muscle, leading to impairment of microcirculation.

Subsequently, vascular stiffness increases, further increasing overall vascular resistance, and baroreceptor links in the central blood pressure regulatory system are disrupted.This results in arterial hypertension, functional and organic changes in the heart, central nervous system, retina and kidneys.

risk factors

Hypertension is a multifactorial disease.Let’s take a look at the factors that influence the occurrence and aggravation of high blood pressure:

Unchangeable factors:

• Documented cases of hypertension (hereditary) in close relatives.
• Increased blood pressure is more easily detected in older age.
• Men detect sexual stress earlier than women.Women's risk of developing high blood pressure increases during menopause (60% of women develop high blood pressure during this period).This is caused by hormonal imbalances and heightened emotional and neurological reactions. 
• Black races (these people are more likely to get sick and have more serious complications from high blood pressure).
• Effects of weather conditions (weather-dependent persons).

Modifiable factors:

• Obese people are 2-6 times more likely to suffer from high blood pressure than the general population.This is because intraperitoneal fat is hormonally active, which helps suppress sex hormones, prevents glucose uptake by other tissues, supports inflammatory responses, and increases vasoconstriction and swelling of blood vessel walls.
• Reduced physical activity increases the risk of disease by 29-50% compared to highly trained individuals.
• Too much salty food, fat imbalances, and alcohol abuse can also cause elevated blood pressure.
• Smoking is an undeniable factor that has a very negative impact on the arterial wall and can lead to the occurrence and aggravation of arterial hypertension.Smoking a cigarette can increase blood pressure by 10-30 mmHg.Art., which promotes spasm and supports inflammatory processes in the walls of blood vessels.
• Emotional overload and chronic stress affect the systems that regulate vascular tone and disrupt their adaptation to stress.
• Metabolic disorders: Lipid metabolism - hypercholesterolemia and resulting atherosclerosis - always accompanies hypertension; carbohydrate metabolism and the development of diabetes - influence the severity of hypertension and mortality.

Symptoms of high blood pressure

It's important to note that sometimes high blood pressure causes no symptoms.Therefore, people with risk factors for hypertension should systematically monitor their blood pressure.

High blood pressure hastarget organ.If blood pressure increases, these organs are affected: heart, brain, kidneys, peripheral arteries, retina.Since increases in A/D are primarily associated with spasm of small arteries, thereby impairing blood circulation, and these organs are very sensitive to worsening blood flow, symptoms are also caused by changes in them.

The main subjective complaints of patients with elevated blood pressure are: headaches, tinnitus, frequent dizziness, and “spots” in front of the eyes.Later, when changes in the arteries persist, symptoms of poor sleep, performance, and memory—signs of encephalopathy—can appear.From one side of the heart, a rapid heartbeat, shortness of breath, pain or discomfort in the left side of the chest, a disturbed rhythm are detected, and then subsequent manifestations of heart failure are noted in the form of shortness of breath and swelling.

Kidney damage is easily overlooked at first but can lead to nephrosclerosis and destruction of kidney function.Hypertensive vasculopathy occurs in the retina, and ophthalmologists can detect it in the early stages of the disease and, in some cases, confirm the diagnosis.

High blood pressure sometimes develops latent exacerbations, but that doesn't mean it's safe.Even regardless of stress levels, high blood pressure can manifest into serious complications: heart disease and stroke.Sometimes, exacerbations present as a hypertensive crisis.It is characterized by a sharp increase in blood pressure and may include severe headache, facial redness, chills and vomiting.This situation requires calling an ambulance.

Diagnosis of high blood pressure

Properly collected medical history data is of particular value in diagnosing hypertension.Carefully clarify information about disease onset, study all possible risk factors and patient complaints, focusing on complaints that describe the involvement of target organs in the process.Of particular importance is detection of the presence of heart failure, renal failure, history of stroke, diabetes mellitus, retinal vasculopathy, and aortic aneurysm.

In addition to measuring blood pressure during the consultation, the examination also includes the evaluation of body data on target organs.This method calculates the degree of risk and thus creates a prognosis of the disease.If you have gained weight, you will need to calculate your body mass index.

After the first consultation, the doctor will make a preliminary diagnosis if one has not been made before.Next, an inspection is required.

Instrument inspection:

1. 12-lead 24-hour monitoring of blood pressure and ECG.
2. Cardiac Ultrasound Examination (ECHO).It can give you an idea of the condition of the heart chambers and the flow of blood within them.
3. Ultrasound Doppler imaging of the kidneys and carotid arteries.
4. Urinalysis for proteinuria and biochemical blood parameters.
5. Thyrotropin and free T4.Assess thyroid function.
6. An examination is done by an ophthalmologist to evaluate the condition of the blood vessels under the eyes.

When a diagnosis is made, a cardiologist or therapist (if the patient is being treated by a therapist) will prescribe medication after analyzing the test data and all possible risk factors.

Treatment of high blood pressure

Treatment goals: to achieve normal (target) blood pressure levels and prevent complications.Treatment is divided into drug treatment and non-drug treatment.

Medication Treatment for Headaches

When choosing a treatment, doctors follow international recommendations for the treatment of high blood pressure set by the medical community.

There are quite a few blood pressure-lowering drugs in the medical arsenal now.They influence the known pathogenesis of the disease and eliminate or reduce its effects.These are several groups of drugs, for example, diuretics (diuretics), renin channel blockers, beta blockers, calcium channel blockers, ACE inhibitors.It is the treating physician's responsibility to select the drug for that particular patient, which may take some time, as each group of drugs has its own characteristics and side effects, and the effects of the drugs are not always quick; sometimes they need to be selected in combination.

In order for the treatment to be effective and achieve its long-term goals, interaction between the patient and the doctor and the patient's absolute compliance with the treatment process are necessary.

Rules that patients who want to receive effective treatment must follow:

1. Take the medication regularly according to the prescribed schedule: day, night.
2. If side effects or questions arise, patients should contact their primary care physician to adjust their medication intake.
3. Even if your blood pressure and general health are normal, you should not stop taking your medications without consulting your doctor.
4. Measure your blood pressure morning and night when choosing treatment (keep a diary) to prevent your health from getting worse (fill in a diary); if you feel well, do it morning and night for 7-10 days a month to make sure it's stable.
5. Two visits a year for selected treatments and a basic check-up of good health (pharmacy visit).  

Nonpharmacological measures to treat high blood pressure

At any stage of hypertension, modifiable risk factors must be addressed.This is to prevent high blood pressure.

Given the existing risk factors for hypertension, what can patients do for themselves to reduce or not develop hypertension?

• Avoid the accumulation of fat deposits.Weight correction is the most important way to adjust A/D.A 10 kg increase in body weight results in a 10 mm Hg increase in blood pressure.Art. 
• eat wisely.Your diet should contain calories appropriate for your weight, foods rich in potassium, magnesium, and unsaturated fats, while saturated fats and simple carbohydrates should be limited.   
• Don't eat too much salt.It can cause spasms in the arteries and fluid retention in the body.It has been shown that when a person consumes >5 grams of salt per day, the risk of developing hypertension increases significantly. 
• Try to move more, but don't overdo it.Physical therapy, swimming or walking can be helpful, and aim to walk at least 10,000 steps a day. 
• avoid mental stress: If you regularly experience extreme anxiety or catatonic shock (gym, yoga, long walks), find a way to change it. 
• avoid excessive stressRelevant to intellectual activities. 
• don't work at nightBecause it disrupts biological rhythms. 
• Do not operate in areas with obvious vibration or noise, they affect the central and peripheral nervous and vascular systems. 
• Monitor your blood pressure levelsEspecially if a member of your immediate family (parents, siblings) has or is suffering from arterial hypertension, take prompt action. 
• Contact a gynecologistEliminate hormonal imbalances before and after menopause. 
• Prompt treatment of accompanying diseasesKidneys and adrenal glands, atherosclerosis, diabetes, thyroid disease, obesity, chronic infections (e.g. tonsillitis).If you suffer from these symptoms, remember that they can worsen headaches. 
• Don't drink too much and don't smoke. 

It is recommended to take prescribed drugs systematically and long-term under the control of blood pressure and under the dynamic supervision of a cardiologist or therapist.

Remember, a happy heart is a healthy heart.Pay attention to your health every day and follow your doctor's advice.