Arterial hypertension

The arterial hypertension is a systematic stable increase of arterial pressure (systolic pressure is over 139 mm hg and/or diastolic pressure is over 89 mm of a mercury column). The hypertension is the most widespread disease of cardiovascular system. Increase of arterial pressure in vessels results from narrowing of the arteries and their smaller branches called by arterioles.

It is known that the total quantity of blood in a human body makes, about, 6 - 8% of all body weight, thus, it is possible to calculate what volume of blood in an organism of each specific person. All blood moves on the circulatory system of vessels which is the trunk main main of the movement of blood. Heart is reduced and moves blood on vessels, blood presses on walls of vessels with a certain force. This force is also called arterial pressure. In other words, arterial pressure promotes the movement of blood on vessels.

As indicators of arterial pressure consider: the systolic arterial pressure (SAP) which is called still "upper" arterial pressure. Systolic pressure shows pressure size in arteries, created by reduction of a cardiac muscle at emission of a portion of blood in arteries; the diastolic arterial pressure (DAP), it is called still the "lower" pressure. It shows pressure size during relaxation of heart while there is its fullness before the following reduction. Both indicators are measured millimeters of mercury (mm of mercury.).

Some people, owing to the various reasons, have a narrowing of arterioles, at first because of a vasospasm. Then their gleam remains narrowed constantly, it is promoted by a thickening of walls of vessels. Overcoming of these narrowings which are an obstacle for a free blood flow requires more hard work of heart and bigger emission of blood in a vascular bed. The idiopathic hypertensia develops.

Approximately, at every tenth hypertensive person increase arterial pressure is caused by defeat of any body. In such cases, it is possible to speak about a symptomatic or secondary hypertension. About 90% of patients with an arterial hypertension have essential or primary hypertension.

Reference point with which it is possible to speak about the increased arterial pressure, as a rule, is, at least, triple, registered by the doctor, the level of 139/89 mm of a mercury column on condition of the fact that the patient does not accept any drugs for pressure decrease.

Insignificant, sometimes even permanent increase of arterial pressure, does not mean existence of an illness yet. If, at the same time, at you are absent any, risk factors also are not present signs of defeat of bodies, at this stage the hypertension is potentially removable. But, nevertheless, at increase of arterial pressure, it is necessary to see surely a doctor, only he can define degree of a disease and to appoint treatment of an arterial hypertension.

Hypertensive crisis

The sudden and substantial increase of arterial pressure accompanied with sharp deterioration in coronary, cerebral and renal circulation is called hypertensive crisis. It is dangerous that significantly increases risk of development of heavy cardiovascular complications, such as: myocardial infarction, stroke, subarachnoidal hemorrhage, fluid lungs, stratification of a wall of an aorta, acute renal failure.

There is hypertensive crisis, most often, after the termination of reception of medicines without approval of the attending physician, owing to influence of meteorological factors, adverse psychoemotional tension, systematic excess consumption of salt, inadequate treatment, alcoholic excesses.

Hypertensive crisis is characterized by excitement of the patient, concern, fear, tachycardia, feeling of shortage of air. At the patient cold sweat, a tremor of hands, face reddening, sometimes considerable, "goose-pimples", feeling of an internal shiver, numbness of lips and language, disturbance of the speech, weakness in extremities is observed.

Disturbance of blood supply of a brain is shown, first of all, by dizziness, nausea or even single vomiting. Often there are symptoms of heart failure: asthma, short wind, the unstable stenocardia expressed in retrosternal pains or other vascular complications.

Hypertensive crises can develop at any stage of a disease of an arterial hypertension. If crises repeat, it can demonstrate incorrectly carried out therapy.

Hypertensive crises there can be 3 types:

1. Neurovegetative crisis, is characterized by increase of pressure, mainly, systolic. The patient experiences excitement, looks scaredly, worries. Perhaps small fervescence, is observed tachycardia.

2. Edematous hypertensive crisis arises, most often at women, usually after the use of salty food or the use of a large amount of liquid. Both systolic, and diastolic pressure increases. Patients are sleepy, slowed slightly down, visually noticeable face edemas and hands.

3. Convulsive hypertensive crisis — one of the heaviest, arises usually at a malignant hypertension. There is the heaviest damage of a brain, encephalopathy which wet brain, perhaps brain hemorrhage joins.

As a rule, hypertensive crisis is caused by disturbances of intensity and a rhythm of blood supply of a brain and its covers. Therefore, at hypertensive crisis, pressure increases not really strongly.

To avoid hypertensive crises, it is necessary to remember that treatment of an arterial hypertension demands a constant maintenance therapy and the termination of drug intake without the permission of the doctor is inadmissible and dangerous.

Malignant arterial hypertension

Артериальная гипертонияThe syndrome which is characterized by very high figures of arterial pressure, immunity or a weak susceptibility to the carried-out therapy, quickly progressing organic changes in bodies is called a malignant arterial hypertension.

There is a malignant arterial hypertension seldom, no more at 1% of patients and most often at males at the age of 40-50.

The forecast of a syndrome adverse, in lack of effective treatment to 80% of the patients suffering from this syndrome die within one year from chronic cordial and/or a renal failure, the stratified aortic aneurysm or a hemorrhagic stroke.

Timely begun treatment in modern conditions several times reduces a lethal outcome of the disease and more than a half of patients survive during 5 flyings or even more.

In Russia about about 40% of adult population suffer from the increased level of arterial pressure. It is dangerous that at the same time, many of them, do not even suspect about existence of this serious disease and therefore they, do not exercise control of the arterial pressure.

In different years there were several different classifications of an arterial hypertension, however, since 2003 on an annual International symposium of cardiologists uniform classification by degrees was accepted.

1. Easy degree of an arterial hypertension when arterial pressure is in limits of 140 — 159 mm hg systolic and 90 — 99 mm of mercury. distolichesky.

2. The second degree or moderate degree is characterized by pressure from 160/100 to 179/109 mm Hg.

3. Heavy degree of a hypertension – it increase of arterial pressure is higher than 180/110 mm of mercury.

Severity of an arterial hypertension cannot be defined without risk factors. Among cardiologists there is a concept of risk factors of development of an arterial hypertension. So they call those factors which at genetic predisposition to this illness, serve as the push starting the mechanism of development of an arterial hypertension. Rank as risk factors:

Excess weight — people with an excess weight risk to get sick an arterial hypertension more. The slow-moving way of life, a hypodynamia, a sedentary life and low physical activity reduce immunity, weaken a tone of muscles and vessels, lead to obesity that promotes development of a hypertension;

The psychological stress and psychological overstrain lead to activation of a sympathetic nervous system which carries out function of the activator of all systems of an organism, including affects also cardiovascular. Besides, are thrown out blood, the so-called, pressor hormones causing a spasm of arteries. It, by the way, as well as smoking, can result in rigidity of walls of arteries and development of an arterial hypertension.

Diet with the increased content of table salt, a high-salt diet always promote increase of pressure. Unbalanced food with the increased maintenance of atherogenous lipids, excess caloric content which leads to obesity and promotes progressing of diabetes of the II type. Atherogenous lipids in a large number contain in animal fats and meat, especially pork and mutton.

Smoking, one of terrible factors of development of an arterial hypertension. The nicotine and pitches which are contained in tobacco lead to a constant spasm of arteries that, in turn, leads to rigidity of arterial walls and attracts increase of pressure in vessels.

Alcohol abuse one of the most frequent reasons of cardiovascular diseases. Alcoholism promotes developing of an arterial hypertension;

Sleep disorders, the syndrome of a night apnoea or snore, causes increase of pressure in a thorax and an abdominal cavity that causes a vasospasm.

These factors, also lead to coronary heart disease and atherosclerosis. In the presence, at least several factors, it is regularly necessary to pass survey at the cardiologist and, whenever possible, to minimize them.

Reasons of an arterial hypertension

The reasons of an arterial hypertension are for certain unknown. There is an assumption that in the most part, the illness is caused by the hereditary reasons, i.e. genetic predisposition, especially, on the maternal line.

Very dangerously the fact that if the arterial hypertension develops at young age, most often, it remains unnoticed long time, so, is not present treatment, and precious time is wasted. Patients write off feeling sick and increase of pressure upon a weather factor, fatigue, vegeto-vascular dystonia. If the person sees a doctor, then treatment of vegeto-vascular dystonia, almost, matches initial treatment of essential or primary hypertension. It both a physical activity, and the balanced food with salt consumption reduction and tempering procedures.

At first it can help, but, nevertheless, it is impossible to cure even primary hypertension by such methods, drug treatment of an arterial hypertension under supervision of the doctor is necessary.

Therefore, patients with vegeto-vascular dystonia, have to be inspected very carefully regarding confirmation of the diagnosis and an exception of an arterial hypertension, especially, if in a family there are patients or having an arterial hypertension.

The hereditary or acquired renal failure developing at systematic hit in an organism of excess amount of table salt can sometimes be the cause of a hypertension. It is necessary to know that the first reaction of an organism to it – increase of arterial pressure. If such situation arises often, the arterial hypertension develops and progresses. Also, the renal failure can develop in the course of aging of an organism at people 50-60 years are more senior.

The origin of only 5-10% of cases of symptoms of an arterial hypertension is known, these are cases of a secondary, symptomatic hypertension. It arises for the following reasons:

  • primary damage of kidneys (glomerulonephritis) – the most frequent reason of a symptomatic arterial hypertension,
  • inborn aortostenosis — coarctation,
  • developing of the tumor of adrenal glands developing adrenaline and noradrenaline (pheochromocytoma)
  • unilateral or bilateral narrowing of renal arteries (stenosis),
  • the tumor of adrenal glands developing Aldosteronum (hyper aldosteronism)
  • the ethanol use (wine alcohol) of more than 60 ml a day,
  • increase of function of a thyroid gland, thyrotoxicosis,
  • uncontrolled use of some medicines: antidepressants, cocaine and its derivatives, hormonal drugs, etc.

Symptoms of an arterial hypertension

Big danger of an arterial hypertension is that it can proceed long time asymptomatically and the person does not even guess the begun and developing disease. The dizziness arising sometimes, weakness, faintness, "front sights in eyes" write off for overfatigue or meteorological factors instead of measuring pressure. Though these symptoms speak about disturbance of cerebral circulation and press for consultations at the cardiologist.

If not to begin treatment, further symptoms of an arterial hypertension develop: such as numbness of extremities, sometimes difficulty of the speech. At inspection the hypertrophy, increase in a left ventricle of heart and the growth of its weight happening owing to a thickening of cells of heart, cardiomyocytes can be observed. In the beginning there is an increase in thickness of walls of a left ventricle, further, the heart camera extends.

The progressing dysfunction of a left ventricle of heart causes emergence of an asthma at loading, cardiac asthma (a paroxysmal night asthma), to a fluid lungs, chronic heart failure. There can be a fibrillation of ventricles.

Symptoms of an arterial hypertension which cannot be disregarded:

  • continuous or frequent increase of arterial pressure, is one of the most important symptoms which has to guard;
  • often arising headache, one of the main displays of an arterial hypertension. It can not have accurate communication with time of day and arises at any time, but, as a rule, at the nights or early in the morning, after awakening. Weight or "raspiraniye" in occipital part of the head is felt. Patients complain of pain which amplifies at inclinations, cough, tension. There can be a small face edema. Acceptance by the patient of vertical position (venous outflow), reduces pain a little.
  • the frequent pains in heart which are localized to the left of a breast or in the field of a heart top. Can arise both at rest, and at an emotional pressure. Pains are not stopped by nitroglycerine and, usually, last long.
  • the asthma arising in the beginning only at an exercise stress, but, then and at rest. Points to already happened considerable defeat of a cardiac muscle and development of heart failure.
  • there are various vision disorders, emergence, as if a veil or fog in eyes, flashing of "front sights" This symptom is connected with functional disturbance of blood circulation in a retina of eyes, its rough change (amotio of a retina, fibrinferments of vessels, hemorrhages). Changes of a retina can bring to doubling in eyes, to considerable decrease in sight and, even, full loss of sight.
  • hypostases of legs which indicate heart failure.

Symptoms change at different stages of an illness.

On the first, easiest degree of a hypertension pressure fluctuates in limits, norms are slightly higher: 140 — 159 / 90 — 99 mm of mercury. At this stage the arterial hypertension can be confused with the beginning cold or overfatigue easily. Sometimes frequent bleedings from a nose and dizziness disturb. If to begin treatment at this stage, very often if to implement all recommendations of the doctor and to set the correct mode of life and food, it is possible to achieve an absolute recovery and disappearance of symptoms.

At the second, moderate stage, higher also reaches arterial pressure 160 — 179/100 — 109 mm of a mercury column. At this stage the patient has severe and painful headaches, frequent dizzinesses, pains in heart, pathological changes in some bodies, first of all, in eyeground vessels are already possible. Considerably work of a cardiovascular and nervous system, kidneys worsens. There is a possibility of a stroke. Normalization of pressure on this, requires use of medicines according to doctor's instructions, independently it will not be possible to reduce the level of arterial pressure any more.

The third and heavy degree of a hypertension at which arterial pressure exceeds a mark of 180/110 mm hg. At this stage of a disease there is already a threat of life of the patient. Due to big load of vessels, there are irreversible disturbances and changes in cordial activity. This degree often has complications of an arterial hypertension in the form of dangerous diseases of cardiovascular system as a myocardial infarction and stenocardia. Emergence of acute heart failure, arrhythmia, stroke or encephalopathy is possible, eye retina vessels are surprised, sight sharply worsens, the chronic renal failure develops. Medical intervention at this stage is vital.

If the illness comes far, development of brain hemorrhage or heart attack heart myocardiums is possible.

Diagnosis of an arterial hypertension

Артериальная гипертонияFor diagnosis of an arterial hypertension obligatory laboratory researches are conducted: general analysis of urine and blood. Creatinine level in blood for the purpose of an exception of damage of kidneys, potassium level in blood for the purpose of detection of tumors of adrenal glands and a renal artery stenosis is defined. Without fail carry out blood test on the content of glucose.

The electrocardiogram is carried out for the objective analysis of a course of an arterial hypertension. Also the level of the general cholesterol in blood serum, cholesterol of lipoproteins of low and high density, the content of uric acid, triglycerides is defined. The echocardiography, is carried out for definition of degree of a hypertrophy, a myocardium of a left ventricle of heart and a condition of its sokratitelny ability.

Research of an eyeground by the oculist is appointed. Identification of changes in vessels and small hemorrhages can confirm existence of a hypertension.

Except the main laboratory researches additional diagnosis is appointed it is ultrasonography of kidneys and adrenal glands, a X-ray analysis of a thorax, ultrasonography of renal and brakhiotsefalny arteries.

The patients having a diabetes mellitus make tests on definition of micro albumine in urine.

At confirmation of the diagnosis further profound examination for an assessment of disease severity and purpose of adequate treatment is conducted. Such diagnosis is necessary for an assessment of a functional condition of a brain blood-groove, a myocardium, kidneys, detection of concentration in blood of corticosteroids, Aldosteronums, activity of a renin; The magnetic and resonant tomography or a computer tomography of a brain and adrenal glands, and also a belly aortografiya Is appointed.

Diagnosis of an arterial hypertension is considerably facilitated if the patient has information on cases of such disease in a family at close relatives. It can speak about genetic predisposition to a disease and will demand close attention to a condition of the health even if the diagnosis will not be confirmed.

Regular measurement of arterial pressure at the patient is important for the correct diagnosis. For objective diagnosis and control of disease it is very important to take measurement of pressure regularly independently. Self-checking, except other, gives a positive effect from carrying out treatment since disciplines the patient.

Physicians do not recommend to use the devices measuring pressure in a finger or on a wrist for measurement of arterial pressure. At measurement of arterial pressure automatic electronic devices it is important to adhere to the corresponding instructions strictly.

Rather simple procedure if it is correct to carry out it and to observe measurement of arterial pressure by means of a tonometer necessary a condition even if they to you seem petty.

It is necessary to measure pressure level in 1-2 hours after food, in 1 hour after the use of coffee or smoking. The clothes should not pull together hands and forearms. The hand on which measurement is taken has to be exempted from clothes.

It is very important to take measurement in a quiet and convenient situation with a comfortable temperature. The chair has to be with a direct back, put it near a table. Be located on a chair so that the middle of a cuff on a forearm was at the level of heart. To spin lean against a chair back, do not talk and do not cross a leg. If you before it moved or worked, have a rest not less than 5 min.

Impose a cuff so that its edge was on 2,5 - 3 see above elbow hollows. Impose a cuff densely, but not hardly that between a cuff and a hand could pass a finger freely. It is necessary to force correctly air in a cuff. It is necessary to force quickly, before emergence of the minimum discomfort. It is necessary to blow off air with a speed of 2 mm of mercury. in a second.

Level of pressure at which there was a pulse, and then the level at which the sound was gone is registered. The membrane of a stethoscope is located on a point of the maximum pulsation of a humeral artery, is usually slightly higher than an elbow pole on an internal surface of a forearm. The head of a stethoscope should not concern tubes and a cuff. Follows it is, also, dense to beget a membrane to skin, but not to press. Emergence of a sound of pulse, in the form of bumps shows the level of systolic arterial pressure, disappearance of sounds of pulse – the level of diastolic pressure. For reliability and in order to avoid mistakes, it is necessary to repeat research, at least, 1 time in 3-4 minutes, alternately, on both hands.

Treatment of an arterial hypertension

Артериальная гипертонияTreatment of a hypertension directly depends on an illness stage. The main objective of the carried-out treatment – as much as possible to reduce risk of development of cardiovascular complications and to prevent threat of a lethal outcome.

If 1 degree of a hypertension is not burdened by any risk factor, then a possibility of development of dangerous complications of cardiovascular system, such as stroke or myocardial infarction for the next 10 years very low also makes no more than 15%.

Tactics of treatment of a hypertension of low risk of 1 degree consists in change of way of life and non-drug therapy lasting up to 12 months in which the cardiologist observes and controls dynamics of a disease. If level of arterial pressure vyshe140/90 mm of mercury. also does not tend to decrease, the cardiologist surely selects medicamentous therapy.

Average degree means that the possibility of development of cardiovascular complications of an essential hypertension for the next 10 years makes 15 — 20%. Tactics of treatment of an illness at this stage is similar to that which is applied by the cardiologist to a hypertension of 1 degree, but the period of non-drug therapy is reduced to 6 months. If the course of disease unsatisfactory and high arterial pressure remains, it is reasonable to transfer the patient to drug treatment.

Heavy degree of an arterial hypertension means that, in the next 10 years, complications of an arterial hypertension and other diseases of cardiovascular system, can arise at 20 — 30% of cases. Tactics of treatment of a hypertension of this degree consists in inspection of the patient and the subsequent obligatory drug treatment in total with non-drug methods.

If the risk is very high it means that the forecast of an illness and treatment is adverse and the possibility of development of heavy complications makes 30% and above. The patient needs urgent clinical inspection and immediate drug treatment.

Drug treatment of an arterial hypertension is directed to lowering of arterial pressure to normal indicators, elimination of threat of defeat of target organs: hearts, kidneys, brain, their greatest possible treatment. For treatment the anti-hypertensive drugs reducing arterial pressure which choice depends on the decision of the attending physician who proceeds from criteria of age of the patient, existence of these or those complications from cardiovascular system and other bodies are used.

Begin treatment with the minimum doses of hypotensive drugs and, watching a condition of the patient, gradually increase her before achievement of noticeable therapeutic effect. The appointed drug shall be transferred by the patient well.

Most often, at treatment of essential or primary hypertension, the combined medicamentous therapy including several drugs is applied. Advantages of such treatment consists in a possibility of simultaneous impact on several various mechanisms of a course of a disease and prescription of medicine in the lowered dosages at once that significantly reduces risk of side effects. This risk, besides, explains the most strict prohibition of independent use of the drugs reducing the arterial pressure or any change of a dosage without consultation of the doctor. All anti-hypertensive means possess so powerful action that their uncontrolled use can lead to unpredictable results.

The dosage of medicine decreases or increases as required only the cardiologist and after careful clinical inspection of a condition of the patient.

Non-drug treatment of an arterial hypertension is directed to decrease and elimination of risk factors and includes:

  • refusal of alcohol intake and smoking;
  • weight reduction to acceptable level;
  • observance of an electrolyte-deficient diet and balanced food;
  • transition to active lifestyle, occupations by morning exercises, walking, etc., refusal of a hypodynamia.

Complications of an arterial hypertension

Артериальная гипертонияIt is necessary to understand accurately that the neglect treatment of an arterial hypertension leads to heavy and dangerous complications. When progressing a hypertension various bodies seriously are surprised.

  • Heart. Acute or chronic heart failure develops, the hypertrophy of a myocardium of a left ventricle and a myocardial infarction is observed.
  • Kidneys. The renal failure, a nephrosclerosis develops.
  • Brain. Often there is distsirkulyatorny encephalopathy, tranzitorny ischemic attack, ischemic and hemorrhagic strokes.
  • Vessels. There is an aortic aneurysm, etc.
  • Hypertensive crises.

To avoid dangerous complications, follows, at increase of arterial pressure, to ask immediately in medical institution for the help and treatment.

Prevention of an arterial hypertension

For people with genetic predisposition to an arterial hypertension and burdened by risk factors, prevention of an illness is of great importance. First of all, this regular inspection at the cardiologist and observance of norms of the correct way of life which will help to delay and is frequent and to exclude a disease of an arterial hypertension. If you in the anamnesis have relatives who had a hypertension it is necessary to reconsider the way of life and to cardinally change many habits and way which are risk factors.

It is necessary to lead active lifestyle, to move more, depending on age, run, swimming, walking, driving the bicycle and skis is ideally suited for it. Exercise stresses should be entered gradually, without overloading an organism. Exercises in the fresh air are especially useful. Physical exercises strengthen a cardiac muscle and a nervous system and promote prevention of stresses.

It is necessary to reconsider the principles of food, to stop the use of salty and greasy food, to pass to the low-calorie diet including fish, seafood, fruit and vegetables in a large number.

Be not fond of alcoholic beverages and, especially, beer. They promote obesity, the uncontrolled use of table salt, harmful influence heart, vessels, a liver and kidneys.

Refuse smoking, the substances which are contained in nicotine provoke change in walls of arteries, increase them rigidity, therefore, can be responsible for increase of pressure. Besides, nicotine is very dangerous to heart and lungs.

Try that you were surrounded by the favorable psychoemotional environment. Whenever possible, avoid the conflicts, you remember, the loosened nervous system very often starts the mechanism of development of an arterial hypertension.

Thus, it is possible to tell shortly that prevention of an arterial hypertension includes regular surveys at the cardiologist, the correct way of life and a favorable emotional background of your environment.

At emergence of signs of regular increase of arterial pressure, it is necessary to address to medical institution urgently. Remember that it you can keep to yourself health and life!

Section: Cardiology