High Blood Pressure: Causes, Treatment, Prognosis, Stages, and Risks

Hypertension (HTN) is one of the most common diseases of the cardiovascular system, affecting one third of the world's inhabitants, based only on approximate data. By the age of 60-65, more than half of the population has been diagnosed with hypertension. This disease is known as the "silent killer" because its symptoms may not appear for a long time, and the blood vessel walls begin to change during the asymptomatic stage, greatly increasing the risk of vascular accidents.In Western literature, this disease is known as arterial hypertension (AH). Although "hypertension" and "hypertension" are still commonly used, others have adopted this expression.

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 disease in the brain, heart, and kidneys. Prevention is the primary goal of treatment to maintain normotensive blood pressure (BP).

It is important to identify all possible risk factors,and elucidating their role in disease progression. The relationship between the degree of hypertension and existing risk factors is shown at the time of diagnosis, simplifying the assessment of the patient's condition and prognosis.For most patients, the numbers after "AH" in the diagnosis have no meaning, although it is clear that the higher the degree and risk indicators, the worse the prognosis and the more severe the pathology. In this article we will try to understand how and why one or another degree of hypertension is diagnosed and on what basis the risk of complications is determined.

Causes and risk factors of high blood pressure

There are many causes of arterial hypertension. governmentWhen it comes to primary or essential hypertension, we talk aboutWe refer to this in the absence of specific preexisting disease or internal organ pathology. In other words, this type of hypertension is autogenic and involves pathological processes in other organs. Essential hypertension accounts for more than 90% of chronic hypertension cases.The main cause of essential hypertension is considered to be stress and psycho-emotional overload, which leads to the destruction of the central mechanism of pressure regulation in the brain, which in turn leads to damage to the humoral mechanism and affects target organs (kidneys, heart, retina).secondary hypertension– A manifestation of another pathology, so its cause is always known. It accompanies and is secondary to diseases of the kidneys, heart, brain, and endocrine disorders. High blood pressure disappears when the underlying disease is cured, so there is no point in determining risk and extent in this setting. Symptomatic hypertension accounts for only 10% of cases.The risk factors for hypertension are also well known. Clinics are setting up hypertension schools, whose experts convey information to people about adverse conditions that lead to high blood pressure. Any therapist or cardiologist will tell a patient about the risks at the first documented case of high blood pressure.Among the diseases that cause hypertension, the most important are:

1. smokes;
2. Too much salt in food and too much fluid intake;
3. insufficient physical activity;
4. Abuse of alcohol;
5. Overweight and fat metabolism disorders;
6. Chronic psycho-emotional and physical overload.

If we can eliminate the factors listed, or at least try to reduce their impact on health, characteristics such as gender, age, genetics, etc. cannot be changed, so we will have to live with them, but not forgetting the increased risks.

Classification of arterial hypertension and determination of risk levels

Classification of hypertension involves determining the stage, extent of the disease, and level of risk for vascular accidents.

disease stageDepends on clinical presentation. emphasize:

• In the preclinical phase, there are no signs of hypertension and the patient is unaware of the elevated blood pressure;
• In the first stage of hypertension, when pressure rises, a crisis may occur without evidence of target organ damage;
• The second stage is accompanied by damage to target organs - myocardial hypertrophy, significant changes in the retina of the eyes, and kidney damage;
• In the third stage, stroke, myocardial ischemia, visual pathology, macrovascular changes (aortic aneurysm, atherosclerosis) may occur.

High blood pressure

Determining the degree of hypertension is important for assessing risk and prognosis and is based on pressure data. It must be said that normal blood pressure values also have different clinical meanings. Therefore, the indicator is as high as 120/80 mm Hg. Art. countThe best,normalThe pressure will be between 120-129 mmHg. Art. Systolic blood pressure and 80-84 mm Hg. Art. diastole. Pressure value 130-139/85-89 mmHg. Art. Still within the normal range, but approaching the border of pathology, which is why they are calledVery normal", and the patient may be told that he has normal hypertension. These indicators can be considered pathological precursors, since the pressure is only "a few millimeters" away from being elevated.From that moment the blood pressure reached 140/90 mm Hg. Art. We can already talk about the existence of this disease. This indicator is used to determine the degree of hypertension itself:

• Stage 1 hypertension (stage 1 of HTN or AH in diagnosis) is an elevated pressure in the range of 140-159/90-99 mmHg. Art.
• Stage 2 headache is associated with numbers 160-179/100-109 mm Hg. Art.
• Stage 3 hypertension is 180/100 mmHg. Art. and higher.

Systolic blood pressure numbers will rise to 140 mm Hg. Art. and higher, while diastolic blood pressure values were within the normal range. In this case they talk aboutisolated contracted formhypertension. In other cases, the indicators of systolic and diastolic blood pressure correspond to different degrees of disease, so the diagnosis made by the doctor tends to be of greater degree, and it is not important to draw conclusions based on systolic or diastolic blood pressure.

The most accurate diagnosis of the degree of hypertension is possible when the disease is first diagnosed, treatment has not yet begun, and the patient is not taking any antihypertensive medications. During treatment, these numbers decrease, and when treatment is stopped, on the contrary, they increase sharply, so it is no longer possible to fully assess their extent.

Diagnostic risk concept

High blood pressure is dangerous because of its complications. It is known that the death or disability of the vast majority of patients is not due to hypertension itself, but to acute diseases caused by hypertension.Cerebral hemorrhage or ischemic necrosis, myocardial infarction, and renal failure are the most dangerous conditions caused by hypertension. In this regard, after a thorough examination of each patientIdentify the risk, represented by the numbers 1, 2, 3, 4 in the diagnosis. Therefore, the diagnosis is based on the degree of hypertension and the risk of vascular complications (eg, hypertension/hypertension stage 2, risk 4).risk stratification criteriaIn patients with hypertension, external conditions, the presence of other diseases and metabolic disorders, target organ involvement, and concomitant changes in organs and systems need to be considered.Major risk factors affecting prognosis include:

1. The patient's age is over 55 years old for men and over 65 years old for women;
2. smokes;
3. Lipid metabolism disorder (excessive cholesterol, low-density lipoprotein, and reduced high-density lipoprotein);
4. Presence of cardiovascular pathology in blood relatives in the family with females and males younger than 65 and 55 years respectively;
5. Overweight, with abdominal circumference exceeding 102 cm for men and 88 cm for women.

The factors listed are considered major, but many patients with hypertension have diabetes mellitus, impaired glucose tolerance, a sedentary life, and coagulation abnormalities in the form of elevated fibrinogen concentrations. Consider these factorsadditional, also increases the likelihood of complications.From the second stage onwards, target organ damage is characteristic of hypertension and serves as an important criterion in determining risk, so the patient's examination includes electrocardiography, cardiac ultrasound to determine the degree of hypertrophy of the patient's muscles, blood and blood vessels. Urine tests for kidney function indicators (creatinine, protein).First, when the heart has high blood pressure, it pushes blood into the blood vessels with greater force. As arteries and arterioles change, the load on the heart gradually increases as their walls lose elasticity and the lumens become spasmodic. Characteristics considered when considering stratified riskcardiac hypertrophy, can be suspected by electrocardiogram and confirmed by ultrasound.The increase in creatinine in the blood and urine and the appearance of albumin in the urine indicate the involvement of the kidney as a target organ. Against the background of hypertension, the walls of large arteries thicken and atherosclerotic plaques appear, which can be detected by ultrasound (carotid, brachiocephalic) arteries.The third stage of hypertension occurs with associated pathology, that is, with hypertension.Among related diseases, the most important for prognosis are stroke, transient ischemic attack, myocardial infarction and angina, nephropathy due to diabetes, kidney failure, retinopathy (damage to the retina) due to hypertension.

Therefore, the reader may understand how to independently determine the extent of a headache. It's not difficult, you just need to measure the pressure. Next, you can consider whether certain risk factors are present, taking into account age, gender, laboratory parameters, ECG data, ultrasound, etc. Generally speaking, everything listed above.

For example, a patient has blood pressure equivalent to stage 1 hypertension but also has a stroke, which means the risk is at most 4, even if the stroke is the only problem besides high blood pressure. If the stress corresponds to level one or two, and the only risk factors that can be noticed in good health are smoking and age, then the risk will be moderate - 1 tablespoon. (2 tablespoons), Risk 2.To make it clearer what the risk indicators mean in a diagnosis, you can summarize everything in a small table. By determining your degree and "calculating" the factors listed above, you can determine a specific patient's risk for vascular accidents and complications of hypertension. The number 1 represents low risk, 2 represents moderate risk, 3 represents high risk, and 4 represents very high risk of complications.<头>

risk factors	BP 130-139/85-89, risk	National Standard (AH) 1. Risk	National Standard 2. Risk	National Standard 3. Risk
not any	1	2	3
1-2	1	2	2	4
More than three factors/target impairment/diabetes	3	3	3	4
Related pathology	4	4	4	4

Low risk means the chance of a vascular accident is no more than 15 percent, moderate risk is up to 20 percent, high risk means one-third of patients in the group develop complications, and very high risk means more than 30 percent develop complications. Complications are prone to occur.

Headache manifestations and complications

The manifestations of hypertension depend on the stage of the disease. In the preclinical phase, the patient feels fine and only tonometer readings indicate that the disease is progressing.Along with changes in the blood vessels and heart, visual symptoms such as headaches, weakness, decreased performance, periodic dizziness, weakened vision, and "spots" appearing in front of the eyes appear. All these signs are not manifest during the stable course of the pathology, but become clinically brighter when a hypertensive crisis develops:

• Severe headache;
• Noise, ringing in the head or ears;
• Darkening of eyes;
• Pain in the heart area;
• Difficulty breathing;
• facial congestion;
• Feelings of excitement and fear.

Hypertensive crises are caused by traumatic situations, overexertion, stress, consumption of coffee and alcoholic beverages, so diagnosed patients should avoid such effects. In the context of hypertensive crisis, the likelihood of complications, including life-threatening complications, increases dramatically:

1. Bleeding or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly accompanied by cerebral edema;
3. Pulmonary Edema;
4. acute renal failure;
5. heart attack.

How to measure blood pressure correctly?

If there is reason to suspect hypertension, the first thing a specialist will do is measure your blood pressure. Until recently, it was thought that blood pressure readings would typically vary from hand to hand, but practice has shown that differences of even 10 mm Hg are possible. Art. It may be due to peripheral vascular disease, so differential pressure on the left and right hands should be treated with caution.For the most reliable data, it is recommended to measure pressure 3 times on each arm at short intervals, record each result obtained. For most patients, the minimum value obtained is the most correct, but in some cases the pressure increases continuously during the measurement, which is not always beneficial for hypertension.The wide variety and availability of devices for measuring blood pressure make it possible to monitor blood pressure at home in a wide range of people. Often, people with high blood pressure have a tonometer at home so they can measure their blood pressure immediately if their health deteriorates. But it is worth noting that in absolutely healthy individuals without hypertension, blood pressure may also fluctuate, so exceeding the normal value once should not be considered a disease, but to diagnose hypertension, the pressure must be measured at different times, under different conditionsRepeatedly.Blood pressure data, electrocardiogram data, and cardiac auscultation results are considered fundamental when diagnosing hypertension. While listening, noise, increased pitch, and arrhythmias can be detected. Starting in the second stage, the EKG will show signs of pressure on the left side of the heart.

Treatment of high blood pressure

To correct hypertension, treatment regimens including drugs from different groups and with different mechanisms of action have been developed. TheirCombination and dosage are chosen individually by the doctorConsider the stage of hypertension, concomitant pathology, and response to specific medications. After a diagnosis of high blood pressure, and before starting drug treatment, your doctor will recommend non-pharmacological measures to significantly increase the effectiveness of the medications, sometimes allowing you to reduce the dosage of your medications or at least give up some of them.

First of all, it is recommended to regulate your work and rest, eliminate stress, and ensure physical activity. The aim of this diet is to reduce salt and fluid intake and to abstain from alcohol, coffee and drinks, as well as substances that stimulate the nervous system. If you are overweight, you should limit calories and avoid fats, flours, fried and spicy foods.Non-drug treatments for early stages of hypertension are so effective that prescription medications are no longer needed. If these measures don't work, your doctor will prescribe appropriate medications.The goal of treating hypertension is not only to lower it but, if possible, to eliminate its cause.The following classes of antihypertensive drugs are traditionally used to treat high blood pressure:

• diuretics;
• Angiotensin II receptor antagonist;
• angiotensin-converting enzyme inhibitors;
• Adrenergic blocking agents;
• Calcium channel blockers.

Every year, the number of blood pressure-lowering drugs increases while becoming more effective and safer, with fewer side effects. When starting treatment, the minimum dose of a drug is prescribed; if it is ineffective, the dose can be increased. If the disease progresses and the pressure does not remain at acceptable values, another drug from a different group is added to the first drug. Clinical observations show that combined use of drugs is more effective than the maximum dose of a single drug.Reducing the risk of vascular complications is important in selecting treatment options.As a result, it was noted that some combinations had a more pronounced "protective" effect on the organs, while others provided better control of stress. In this case, experts prefer a combination of medications to reduce the likelihood of complications, even though blood pressure will fluctuate somewhat from day to day.In some cases, it is necessary to adjust the headache treatment regimen by taking into account concomitant pathologies. For example, men with prostate adenomas take alpha-blockers, but other patients are not recommended to continue using the drug to lower blood pressure.The most widely used ACE inhibitors, calcium channel blockers,These drugs are indicated for use in both young and elderly patients, with or without concomitant medical conditions, diuretics, and sartans. Medications from these groups are suitable for initial treatment and can then be supplemented with a third medication of different composition.ACE inhibitors can lower blood pressure and have protective effects on the kidneys and myocardium. They are more suitable for younger patients, women taking hormonal contraceptives, patients with diabetes, and older patients.diureticsThe popularity continues unabated. To reduce adverse effects, they are combined with angiotensin-converting enzyme inhibitors, sometimes "in one tablet. "beta blockersIt is not a priority group for treatment of hypertension, but it is effective for accompanying heart diseases - heart failure, tachycardia, coronary heart disease.calcium channel blockersThey are often used in combination with angiotensin-converting enzyme inhibitors and are particularly suitable for the treatment of bronchial asthma associated with hypertension because they do not cause bronchospasm.angiotensin receptor antagonist– The most commonly used group of medications for high blood pressure. They are effective in lowering blood pressure and do not cause coughing like many ACE inhibitors. But in the United States, it's particularly common due to a 40 percent reduction in Alzheimer's disease risk.

When treating high blood pressure, you must not only choose an effective treatment plan, but also take medications for a long time, or even for life. Many patients believe that treatment can be stopped when stress reaches normal levels, but they do not start taking medications until a crisis occurs. It is known that unsystematic use of antihypertensive drugs is even more harmful to health than no treatment at all. Therefore, informing patients about the duration of treatment is one of the important tasks of doctors.