From the article you will learn about hypertension of the 2nd degree: symptoms and treatment of the disease, why it arises, for what reason goes from the first degree to the second. What is dangerous pathology, how to make a diagnosis.
The reasons for the development of
Hypertensive disease( abbreviated GB) is a disease with a chronic course that manifests itself as arterial hypertension( abbreviated AH), not associated with other pathologies.
By the level of increase in blood pressure, several degrees of AH are distinguished, if the indications of systolic and diastolic pressure appear in different intervals, then the degree is assigned according to the highest index.
| Degree | Systolic, or upper, in mm Hg. Art. | Diastolic, or inferior, in mm Hg. Art. |
|---|---|---|
| 1 | 140-159 | 90-99 |
| 2 | 160-179 | 100-109 |
| 3 | More than 180 | More than 110 |
The stage depends on the degree of pathological changes in the organs that are most affected by the increase in blood pressure( myocardium, central nervous system, glomerulus of the kidneys, ocular fundus):
| Stage | Pathological changes |
|---|---|
| 1 | No |
| 2 | In one or more organs of the |
| 3 | There are complications from the targets( stroke, degeneration of the renal tissue into the connective, infarction, optic nerve edema) |
According to this division, I can have any pressure ratio, it all depends on the individual risk factors and disease in a patient flow.
In pathology under the influence of risk factors( described below), there is a violation in the system of constriction-expansion of the vessels, which leads to the prevalence of constriction and, as a consequence, to increased pressure.
High AD numbers trigger a cascade of chemical changes, there is an increase in the production of a special angiotensin enzyme, which, subject to transition into an active form, causes vasoconstriction and maintains a high level of pressure.
Against the backdrop of narrowing of blood vessels and high blood pressure in hypertension of the 2nd stage, pathological changes occur in the organs most sensitive to lack of oxygen and nutrients:
- cardiac muscle;
- brain structures;
- of the retina of the eye;
- kidney;
- large and small arterial vessels.
Target organs for hypertension Processes of blood flow change in these organs as they progress lead to disability and cause premature death of the patient.
There is no complete cure for the disease, but the elimination of managed risk factors and constant drug therapy stabilize blood pressure, preventing the progression of pathological changes in the organs.
Treatment of the disease involved therapists and cardiologists. With the development of complications from other organs, the neurologist, oculist, nephrologist, endocrinologist and vascular surgeon need help.
Causes of development of
Hypertensive disease of the 2nd degree, or 2 stages - is the next phase after the first. The reason for the transition is:
- lack of treatment;
- continued risk factors.
On how to treat the disease, it is written in the relevant section of the article. This part deals with the factors that cause the disease and its progression over time.
| Factor group | Self causes |
|---|---|
| Controlled or modifiable | Smoking: even 1-4 cigarettes a day increase the risk of vascular and heart disease by a factor of 2 Abdominal type of obesity: waist in men> 102 cm, and in women>88 cm Increase in cholesterol more than 5 mmol / L, low density lipids - more than 3 mmol / l Excess triglyceride levels more than 1.7 mmol / l: each unit above the norm is accompanied by a 32% increase in risk for men and 76% forof women Blood glucose in the morning, fasting to 6.9 mmol / L, after loading test - up to 11 mmol / l Metabolic syndrome( weight gain with subsequent disruption of sugar metabolism and all types of nutrient metabolism) |
| Unmanaged or unchangeable | Age:us & gt;65 years, men & gt;55 years Genetics: the presence of heart and vascular disease in first-line relatives under 55 |
Abdominal type of obesity in a male Additional factors of hypertension not listed above have a less pronounced effect:
- Any form of tachyarrhythmia is an increase in the number of heart beats at restmore than 85 per minute.
- Psycho-emotional and social stresses - lead to increased consumption of food and cigarettes smoked per day, cause the release of hormones with a BP-boosting effect, etc.
- As a complete refusal to drink alcohol, and taking more than 168 grams of pure ethanol per week.
- Lack of sufficient physical exertion: sitting for more than 5 hours without a break and less than 10 hours of active rest during the week.
For the development of the disease requires the impact of several factors simultaneously, while for the progression of the stage of hypertension, one or two are sufficient.
Manifestations of
The main clinical symptom of stage 2 GB is pressure increase. More often mark AH 2 or 3 degrees, much less often - the first.
In the second stage of the disease there is no asymptomatic course, there are always signs of pathological disorders in the organs. Depending on which of them are affected, patients may feel relatively satisfactory or experience difficulties in their daily routine and at work.
Symptoms associated with changes in heart
- Increased fatigue.
- Discomfort and / or undefined pain in the chest.
- Disturbance of breathing during exercise.
- Enhanced heart rate.
- Sense of uneven heart muscle work.
Symptoms associated with changes in the brain
- Headaches of varying localization and intensity.
- Drowsiness.
- Dizziness.
- Decreased ability to remember information and learn new skills.
- Sensation of noise in the head.
- Forgetfulness.
- Decreased performance.
- Instability of the emotional background.
- Changes in sleep.
- Nausea.
- Vomiting is rare.
Symptoms associated with retinal lesions
- Progressive decrease in vision over time. Episodes of darkening in the eyes.
- "Shroud" before the eyes.
Symptoms associated with kidney damage
- Appearance or increased frequency of nocturnal urination.
- Muddy urine.
- A mild pinkish staining of urine may appear.
- Swelling of the feet after a night's sleep.
Symptoms associated with small and large vessels
- Chilliness.
- Sensitivity disorders in the limbs.
- Changes in the skin on the hands, feet( dryness, fragility).
Diagnostics
The main questions of diagnostic search for hypertension of the second stage:
- reveal the degree of pressure increase;
- determine its stability during the day;
- to exclude the possibility of secondary BP elevation on the background of other diseases;
- identify factors contributing to or causing hypertension;
- to diagnose pathological changes in organs;
- assess the risk of complications of the disease;
Measurement features AD
- Measurement is carried out at home and at reception to exclude fear of a medical institution.
- Be sure to determine on both hands, and if possible - and on the legs.
- Multiplicity of measurement - from 2 times per day for 1 week( keeping a "pressure diary" at home).
- A 24-hour blood pressure monitoring( BPM) is performed to accurately determine the degree and type of hypertension.
Example of a diary of blood pressure Other diagnostic procedures of
| Type of examination | What violations can be |
|---|---|
| Inspection | Displacement of cardiac boundary to the left Expansion of the zone and strengthening of the apical strike Pathological 3 and 4 tone when listening to the heart Systolic noise with a relative violation of the function of the mitral valve Changes in the pulse( frequency, strength, symmetry in some points on different extremities) Edema on the feet and legs Changes in the tissues and(dryness, traumatism) Low temperature of hands and feet Systolic hearing while listening to carotid arteries Instability in the study of neurological status Decreased activity of tendon reflexes Pathological movement of eyeballs with samples( nystagmus) |
| Laboratory tests | Increased cholesterol,low-density lipids, triglycerides Decreased amount of high-density lipids High fasting sugar or after glucose loadth Change in potassium content to either side Increase in uric acid and creatinine Decreased rate of filtration in the kidneys High creatinine clearance Presence of protein and blood in the urinary sediment |
| Cardiogram( ECG) | Signs of thickening of the left ventricle Tachyarrhythmias of any type |
| Ultrasound examination of the muscleof the heart | Increased thickness of the wall of the left ventricle( hypertrophy) Initial manifestations of the expansion of the left atrial cavity Incomplete closure of the valves Thickening of the walls of the heart vessels and the aorta |
| Ultrasonographic examination of the vessels of the neck and head | Narrowing or spasming the arteries Reducing the elasticity( mobility of the heart) of their walls Atherosclerotic changes |
| Survey of the oculist | Narrowing of the arterial vessels of the fundus Arteries and arterioles convoluted,the walls are thickened The veins are expanded There are sites of compression of the vein wall by arteries Minor hemorrhages on the retina |
| Ultrasabdominal diaphragm | Changes in the structure and size of the kidneys |
| Magnetic and computer tomography of the vessels of the neck and brain, abdomen and chest | Conducted for suspected secondary hypertension Or to exclude complications of GB in the presence of clinical manifestations( blood flow in the heart, brain,) |
Treatment of
Without exception, risk factors with a moderate increase in blood pressure and plus a constant drug correction with a high level of pressure compensation can not be achieved. Normalization and reduction of the possibility of complications of the disease occurs only with the constant observance of these conditions, since GB is a chronic process.
| choice of tactics of patients depends | Hypertension 2 degrees requires |
|---|---|
| on the degree of hypertension | change habitual way of life with the exception of all the controllable factors |
| From the number of risk factors | In parallel with this, the medication BP |
| correction The degree of internal organ involvement |
Treatment is adjusted soto reach the target level ≤ 130/80 mm Hg. Art.
In the second stage of GB, the scheme includes more than one drug, it is advisable to use combination extended-release medicines to enhance the patient's comfort.
The choice of the optimal drug or a combination thereof is carried out by an experimental method: the effect of these or other agents individually.
Traditionally, five main groups of medicines and their combined forms are used. In the new, sixth, the group so far only one drug has been developed.
1. Angiotensin converting enzyme
| monopreparations | Its combination with a diuretic | Its combination with calcium antagonists( amlodipine) | Its combination with a diuretic and a calcium antagonist |
|---|---|---|---|
| Prestarium | Prestarium arginine combi( + Indapamide) | Bi-Prestarium | triplex |
| Lisinopril Lisinopril | NL( + Hydrochlorothiazide) | Amlipin | |
| Hartil | Hartyl-H( + Hydrochlorothiazide) | Hartil-AM |
2. Beta-blockers
| Selective mono-preparation | Its combination with a diuretic | Its combination with a calcium channel blocker( amlodipine) | Its combination with a diuretic and a calcium channel blocker |
|---|---|---|---|
| Atenolol | Tenorik( + chlorthalidone) | Tenochek | Tonorma |
| bisoprolol | Bisoprol Sandoz( + Hydrochlorothiazide) | Alotendin |
3.Angiotensin 2 antagonists
| Monopreparation | Its combination with a diuretic( hydrochlorothiazide) | Its combination with a diuretic and calcium blocker |
|---|---|---|
| Vasar | Vasar-H | Eksofrigzh H |
| Lorista | Lorista-H | |
| Mikardis | Mikardis plus |
4. Calcium channel blockers or calcium antagonists, dihydropyridines
| Electoral cardiac action | Benzodiazepines | blocker in combination with a diuretic( hydrochlorothiazide) | |
|---|---|---|---|
| verapamil | Amlodipine Diltiazem Nifedipine | Azomeks | |
| Lercanidipine |
5. Diuretics or diuretics
Thiazide| Netiazidnye | Sulphonamides | preserving potassium | Combined together | |
|---|---|---|---|---|
| Hypothiazid | xipamide | Furosemide | Veroshpiron | Triampur |
| Indapamide | Torasemide | Eplerenone | Diuretidin |
6. renin antagonists
drug Rasilez.
Other medications
Depending on the clinical manifestations, other drugs are added to correct disorders in organs and / or laboratory tests to therapy:
| Improvement of the function of the brain | Lowering of the level of cholesterol and its derivatives | Improvement of blood flow |
|---|---|---|
| Actovegin Piracetam Cerebrolysin Vinpocetine | Simvastatin Pravastatin Lovastatin | Aspirin Clopidogrel Warfarin Xarelto |
Forecast
Forecast atOra stage disease depends upon a combination of risk factors, hypertension and somatic level of the patient.
For each patient, the risk of complications of the disease is calculated. Symptom
| degree AH | |||
|---|---|---|---|
| First Second Third | |||
| No risk factors | Small Large Moderate | ||
| There factor 1-2 | Moderate Moderate Very large | ||
| than three factors Metabolic syndrome Diabetes
| Large Very large Large |
- A small risk - the likelihood of complications from vascular and cardiac muscle, including fatal outcome, is less than 15% for ten years.
- For moderate risk this figure is 15-20%.
- For large - 20-30%, and for very large - more than 30%.
Second-stage GB is a disease that can not be completely cured, but can be controlled. It is necessary to exclude all possible factors that cause the disease, and constantly take the recommended therapy. This will significantly improve the prognosis and prolong life.
