Hypertension - Treatment, Stages, Degrees, Classification

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Hypertonic disease

The content of the article:

1. Causes and risk factors
2. Classification of hypertension
3. Stages of hypertension
4. Symptoms
5. Diagnostics
6. Treatment of hypertension
7. Possible complications and consequences
8. Forecast
9. Prevention

Hypertension (essential arterial hypertension, primary arterial hypertension) is a chronic disease characterized by a long-term persistent increase in blood pressure. The diagnosis of hypertension is usually made by excluding all forms of secondary hypertension.

Source: neotlozhnaya-pomosch.info

According to the recommendations of the World Health Organization (WHO), blood pressure is considered normal if it does not exceed 140/90 mm Hg. Art. Exceeding this indicator is over 140-160 / 90-95 mm Hg. Art. at rest when measured twice during two medical examinations indicates the presence of hypertension in the patient.

Hypertension makes up about 40% of the total structure of cardiovascular diseases. In women and men, it occurs with the same frequency, the risk of developing increases with age.

Causes and risk factors

Among the main factors contributing to the development of hypertension are violations of the regulatory activity of the higher parts of the central nervous system, which control the work of internal organs. Therefore, the disease often develops against the background of repeated psycho-emotional stress, exposure to vibration and noise, and work at night. An important role is played by a genetic predisposition - the likelihood of hypertension increases in the presence of two or more close relatives suffering from this disease. Hypertension often develops against the background of pathologies of the thyroid gland, adrenal glands, diabetes mellitus, atherosclerosis.

Risk factors include:

• menopause in women;
• overweight;
• lack of physical activity;
• elderly age;
• the presence of bad habits;
• excessive consumption of table salt, which can cause spasm of blood vessels and fluid retention;
• unfavorable ecological situation.

Classification of hypertension

There are several classifications of hypertension.

The disease can be benign (slowly progressive) or malignant (rapidly progressive).

Depending on the level of diastolic blood pressure, hypertension of the lung (diastolic blood pressure less than 100 mm Hg), moderate (100-115 mm Hg) and severe (more than 115 mm Hg) course is distinguished.

Depending on the level of increased blood pressure, three degrees of hypertension are distinguished:

1. 140-159 / 90-99 mm Hg. Art.;
2. 160-179 / 100-109 mm Hg. Art.;
3. more than 180/110 mm Hg. Art.

Classification of hypertension:

Blood pressure (BP)	Systolic blood pressure (mm Hg)	Diastolic blood pressure (mmHg)
Normal	<130	<85
High normal	130-139	85–89
I degree of hypertension (mild)	140-159	90–99
II degree of hypertension (moderate)	160-179	100-109
III degree of hypertension (severe)	≥ 180	≥ 110

Stages of hypertension

In the clinical picture of hypertension, depending on the target organ damage and the development of concomitant pathological processes, three stages are distinguished:

1. Preclinical, or stage of mild to moderate hypertension.
2. Stage of common arterial changes, or severe hypertension.
3. The stage of changes in target organs, which are caused by changes in arteries and impaired intraorgan blood flow, or very severe hypertension.

Symptoms

The clinical picture of hypertension varies depending on the duration of the course, the degree of increase in blood pressure, as well as the organs involved in the pathological process. Hypertension may not manifest itself clinically for a long time. The first signs of the disease in such cases appear several years after the onset of the pathological process in the presence of pronounced changes in the vessels and target organs.

At the preclinical stage, transient hypertension develops (a periodic temporary increase in blood pressure, usually associated with some external cause - emotional upheavals, a sharp change in the weather, other diseases). Manifestations of hypertension are headaches, usually localized in the occiput, with a bursting character, a feeling of heaviness and / or pulsation in the head, as well as dizziness, tinnitus, lethargy, fatigue, sleep disturbances, palpitations, nausea. At this stage, target organ damage does not occur.

With the progression of the pathological process, patients develop shortness of breath, which can manifest itself during physical exertion, running, walking, climbing stairs. Patients complain of increased sweating, hyperemia of the skin of the face, numbness of the fingers of the upper and lower extremities, chill-like tremor, prolonged dull pain in the heart, nosebleeds. Blood pressure is steadily kept at 140–160 / 90–95 mm Hg. Art. In case of fluid retention in the body, the patient has swelling of the face and hands, stiffness of movements. With a spasm of the blood vessels of the retina, flashes before the eyes, a veil, flickering of flies may appear, visual acuity decreases (in severe cases - up to its complete loss with hemorrhage into the retina). At this stage of the disease, the patient manifests microalbuminuria, proteinuria,left ventricular hypertrophy, retinal angiopathy.

Both in the first and in the second stage of the disease, uncomplicated crises may occur.

The late stage of hypertension is characterized by the presence of secondary changes in target organs, which is due to changes in blood vessels and impaired intraorgan blood flow. This can manifest itself as chronic angina pectoris, acute cerebrovascular accident (hemorrhagic stroke), hypertensive encephalopathy.

In the late stage of the disease, complicated crises develop.

Due to the prolonged increased load on the heart muscle, it thickens. At the same time, the energy supply of the heart muscle cells deteriorates, the supply of nutrients is disrupted. The patient develops oxygen starvation of the myocardium, and then ischemic heart disease, the risk of developing myocardial infarction, acute or chronic heart failure, and death increases.

With the progression of hypertension, kidney damage occurs. In the initial stages of the disease, the disorders are reversible. However, in the absence of adequate treatment, proteinuria increases, the number of erythrocytes in the urine increases, the nitrogen-excreting function of the kidneys is impaired, and renal failure develops.

In patients with long-term hypertension, there is a tortuosity of the blood vessels of the retina, an uneven caliber of vessels, their lumen decreases, which leads to disturbances in blood flow and can cause rupture of the walls of blood vessels and hemorrhages. Changes in the optic nerve head gradually increase. All this leads to a decrease in visual acuity. Against the background of a hypertensive crisis, complete loss of vision is possible.

With peripheral vascular disease, patients with essential hypertension develop intermittent claudication.

With persistent and prolonged arterial hypertension, the patient develops atherosclerosis, characterized by the widespread nature of atherosclerotic vascular changes, the involvement of muscle-type arteries in the pathological process, which is not observed in the absence of arterial hypertension. Atherosclerotic plaques in hypertension are located circularly, and not segmental, as a result of which the lumen of the blood vessel narrows faster and more significantly.

The most typical manifestation of essential hypertension is changes in arterioles, leading to plasma impregnation with the subsequent development of hyalinosis or arteriolosclerosis. This process develops due to hypoxic damage to the vascular endothelium, its membrane, as well as muscle cells and fibrous structures of the vascular wall. Arterioles and small-caliber arteries of the brain, retina, kidneys, pancreas and intestines are most susceptible to plasma impregnation and hyalinosis. With the development of a hypertensive crisis, the pathological process dominates in one or another organ, which determines the clinical specifics of the crisis and its consequences. Thus, plasma impregnation of arterioles and renal arteriolonecrosis lead to acute renal failure,and the same process in the fourth ventricle of the brain becomes the cause of sudden death.

In the malignant form of hypertension, the clinical picture is dominated by manifestations of a hypertensive crisis, which consists in a sharp increase in blood pressure caused by spasm of arterioles. This is a rare form of the disease, more often a benign, slowly progressive form of hypertension develops. However, at any stage of benign hypertension, a hypertensive crisis with its characteristic morphological manifestations may occur. A hypertensive crisis develops, as a rule, against the background of physical or emotional overstrain, stressful situations, and a change in climatic conditions. The condition is characterized by a sudden and significant rise in blood pressure, lasting from several hours to several days. The crisis is accompanied by intense headache, dizziness, tachycardia,drowsiness, a feeling of heat, nausea and vomiting that does not bring relief, pain in the heart, a feeling of fear.

Diagnostics

When collecting complaints and anamnesis in patients with suspected hypertension, special attention is paid to the patient's exposure to adverse factors contributing to hypertension, the presence of hypertensive crises, the level of increased blood pressure, and the duration of existing symptoms.

The main diagnostic method is the dynamic measurement of blood pressure. To obtain undistorted data, blood pressure should be measured in a calm atmosphere, stop physical activity, eating, coffee and tea, smoking, and taking medications that can affect the level of blood pressure in an hour. Blood pressure measurements can be taken while standing, sitting, or lying down, with the arm to be cuffed on the same level as the heart. When you first see a doctor, blood pressure is measured on both arms. The repeated measurement is carried out in 1-2 minutes. In case of asymmetry of blood pressure more than 5 mm Hg. Art. subsequent measurements are taken on the arm where the higher values were obtained. If the repeated measurements are different, the arithmetic mean is taken as true. In addition, the patient is asked to take blood pressure measurements at home for some time.

Laboratory examination includes a general blood and urine test, a biochemical blood test (determination of glucose, total cholesterol, triglycerides, creatinine, potassium). For the purpose of studying renal function, it may be advisable to conduct urine samples according to Zimnitsky and according to Nechiporenko.

Instrumental diagnostics includes magnetic resonance imaging of the vessels of the brain and neck, ECG, echocardiography, ultrasound of the heart (an increase in the left sections is determined). You may also need aortography, urography, computed tomography or magnetic resonance imaging of the kidneys and adrenal glands. An ophthalmological examination is carried out in order to identify hypertensive angioretinopathy, changes in the optic nerve head.

Treatment of hypertension

The main goals of hypertension treatment are to lower blood pressure and prevent the development of complications. A complete cure of hypertension is not possible, however, adequate therapy of the disease makes it possible to stop the progression of the pathological process and minimize the risk of hypertensive crises, fraught with the development of severe complications.

Drug therapy for hypertension mainly consists in the use of antihypertensive drugs that inhibit vasomotor activity and the production of norepinephrine. Also, patients with hypertension may be prescribed antiplatelet agents, diuretics, lipid-lowering and hypoglycemic agents, sedatives. If the effectiveness of treatment is insufficient, it may be advisable to combine therapy with several antihypertensive drugs. With the development of a hypertensive crisis, blood pressure should be lowered within an hour, otherwise the risk of severe complications, including death, increases. In this case, antihypertensive drugs are administered by injection or in a dropper.

Regardless of the stage of the disease for patients, one of the important methods of treatment is diet therapy. The diet includes foods rich in vitamins, magnesium and potassium, the use of table salt is sharply limited, alcoholic beverages, fatty and fried foods are excluded. In the presence of obesity, the calorie content of the daily diet should be reduced, sugar, confectionery, and baked goods are excluded from the menu.

Patients are shown moderate physical activity: physiotherapy exercises, swimming, walking. Massage has therapeutic efficacy.

Patients with essential hypertension should stop smoking. It is also important to reduce your exposure to stress. For this purpose, psychotherapeutic practices are recommended that increase stress resistance, training in relaxation techniques. Balneotherapy provides a good effect.

The effectiveness of treatment is assessed by achieving short-term (lowering blood pressure to a level of good tolerance), medium-term (preventing the development or progression of pathological processes in target organs) and long-term (preventing the development of complications, prolonging the patient's life) goals.

Possible complications and consequences

With a prolonged course of hypertension in the absence of treatment or in the case of a malignant form of the disease, the blood vessels of target organs (brain, heart, eyes, kidneys) are damaged in patients. Unstable blood supply to these organs leads to the development of angina pectoris, cerebrovascular accident, hemorrhagic or ischemic stroke, encephalopathy, pulmonary edema, cardiac asthma, retinal detachment, aortic dissection, vascular dementia, etc.

Source: centr-zdorovja.com

Forecast

Timely, correctly selected treatment of hypertension can slow the progression of the disease and prevent the development of complications. In the case of the onset of hypertension at a young age, rapid progression of the pathological process and severe course of the disease, the prognosis worsens.

Prevention

In order to prevent the development of hypertension, it is recommended:

• correction of excess weight;
• balanced diet;
• rejection of bad habits;
• adequate physical activity;
• avoidance of physical and mental stress;
• rationalization of the regime of work and rest.

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!