Arterial hypertension 1, 2, 3 degrees

Arterial hypertension is a syndrome of persistent increase in pressure in the arteries, when the systolic pressure is above 139 mm Hg. st., and the diastolic is higher than 89 mm Hg. Art.

The normal arterial blood pressure of a healthy person is considered to be 120 and 80 mm Hg. (systolic / diastolic, respectively). There are two types of hypertension: primary (essential) hypertension and symptomatic arterial hypertension (it is secondary).

Probably, every person at least once in his life encountered increased pressure, experienced it himself or learned about it through complaints of relatives and friends. Not only is hypertension dangerous in itself, it is also a catalyst and the cause of several other, much more dangerous diseases, which do not so rarely end in a fatal outcome.

Researches of scientists have shown, that changes of indicators of a BP on 10 mm of a mercury column raise risk of occurrence of serious pathologies. The heart, vessels, brain and kidneys suffer the most. It is these organs that take the blow, so they are also called "target organs". Completely cure this disease is impossible, but blood pressure can be kept under control.

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Statistics

Here are some statistical facts:

Arterial hypertension was detected in 20-30% of the total adult population.
The prevalence of pathology grows commensurately with age: in the elderly, 60-65 years, incidence rates reach 50-65%.
At the age of 40 years, hypertension is more common among men, whereas after 40 years it is more often diagnosed in women. This is explained by the protective effect of estrogens, which cease to be actively developed during the menopause.
In 90% of patients with arterial hypertension, it is not possible to identify the cause of the pathology. This form of the disease is called essential, or primary.
3-4% of patients have high blood pressure due to kidney problems, 0.1-0.3% - endocrine pathologies. Active stress on the development of hypertension is exerted by stresses, hemodynamic, neurological factors and the use of medications.

Causes of development

What is it, and what are the risk factors? The causes of hypertension are very diverse. At the heart of the division of hypertension into primary and secondary is the etiology of this disease.

The primary episode arises independently against a background of certain risk factors. These include:

Heredity. Unfortunately, this is the most common cause of the disease. It is especially regrettable that no medications can modify this risk factor and reduce its impact on human health.
Floor. Most hypertensive disease affects women, which is explained by the corresponding hormonal background.
Age. 55 years for women and 60 years for men are already considered risk factors for the development of hypertension.
Obesity. Excess body weight affects the work of the heart and leads to a rapid depletion of energy reserves of the myocardium (cardiac muscle).
Diabetes.
Excessive exposure to stress;
Hypodinamy. The disease of the 21st century is a violation of the work of various organs and systems due to a sedentary lifestyle.

Risk factors increase blood pressure gradually, leading to the development of hypertensive disease.

Classification of blood pressure levels

According to this classification, adopted in 1999 by WHO, the following indicators are classified as the "norm" of AD:

Optimum - less than 120/80 mm Hg. Art.
Normal - less than 130/85 mm Hg.
Normal elevated - 130-139 / 85-89 mm Hg.

And the indices of arterial hypertension are classified in degrees:

1 degree (hypertension is mild) - 140-159 / 90-99 mmHg.
2 degree (moderate hypertension) - 160-179 / 100-109 mm Hg.
3 degree (hypertension severe) - 180 and above / 110 and above
Borderline hypertension is 140-149 / 90 and below. (This implies an episodic increase in blood pressure followed by spontaneous normalization).
Isolated systolic hypertension is 140 and above / 90 and below. (Systolic blood pressure is increased, and the diastolic blood pressure remains normal).

Classification of the disease

During the diagnostic examination it is very difficult to determine the location of the pathological factors causing the pressure increase. Pathogenesis also differs from taking into account the varieties of the disease. There is the following classification of hypertension:

Pulmonary essential hypertension is considered to be one of the types of arterial hypertension that rarely meets, but which pose a great danger to human life. It is very difficult to determine this ailment by symptoms, and it is even more difficult to treat. Pulmonary arterial hypertension is formed due to increased resistance of the lung vessels and, as a consequence, insufficient blood flow.
Malignant. Symptoms of such arterial hypertension are presented in the form of elevated blood pressure to 220/130. there is a radical change in the fundus and edema of the ocular nerve disc. If the diagnosis was done on time, then this type of hypertension is cured really.
Renovascular hypertension. The reasons for the formation of this type of disease are the presence of such pathologies as vasculitis, arteriosclerosis of the vessels, malignant formations in the kidneys. The pathogenesis of the disease is reduced to the formation of a characteristic pressure, which can be represented in normal systolic and overstated diastolic blood pressure.
Labile arterial hypertension. For this type of illness, the periodic normalization of pressure is characteristic. Patients suffering from this form of hypertension are not called patients, since this condition is not a pathology. In a number of cases, with the passage of a certain period of time, the blood pressure returns to normal.

Arterial hypertension 1, 2, 3 degrees

To determine the degree of arterial hypertension, it is necessary to establish normal blood pressure values. In people older than 18 years, the normal pressure is not more than 130/85 mm Hg... Pressure 135-140 / 85-90 - borderline between the norm and pathology.

The following stages of arterial hypertension are distinguished by the level of increase in arterial pressure:

Light (140-160 / 90-100 mm Hg. ) - the pressure rises under the influence of stress and physical exertion, after which it slowly returns to normal values.
Moderate (160-180 / 100-110 mm Hg. st.) - BP fluctuates throughout the day; signs of damage to internal organs and the central nervous system are not noted. Hypertensive crises are rare and occur in mild form.
Heavy (180-210 / 110-120 mm Hg. st.). This stage is characterized by hypertensive crises. When conducting a medical examination, patients are exposed to transient ischemia of the brain, hypertrophy of the left ventricle, increased serum creatinine, microalbuminuria, narrowing of the arteries of the mesh shell of the eyes.
Extremely heavy (over 210/120 mm Hg. st.). Hypertensive crises occur frequently and occur severely. Serious tissue lesions develop leading to impaired functions of the organs (chronic renal failure, nephroangiosclerosis, exfoliating aneurysm blood vessels, edema and hemorrhages of the optic nerve, thrombosis of cerebral vessels, cardiac left-ventricular failure, hypertensive encephalopathy).

Adrift hypertension may be benign or malignant. Malignant form is characterized by rapid progression of symptoms, the addition of severe complications from the cardiovascular and nervous systems.

First signs

Let's talk about the common symptoms of hypertension. Many very often justify their ailment with fatigue, and the body already signals the whole, so that people finally pay attention to their health. Day by day methodically destroying the human body, hypertension leads to serious complications and severe consequences. Happened suddenly heart attack or unexpected stroke - alas, sad regularity. Undiagnosed hypertension is capable of "quietly killing" a person.

The figures below compel us to think. People with high blood pressure:

2 times more often the leg vessels are affected.
4 times more often develops ischemic heart disease.
In 7 times more often there are strokes.

That's why it's very important to visit a doctor if you are concerned:

Frequent headaches;
Dizziness;
Pulsating sensations in the head;
"Flies" in the eyes and noises in the ears;
Tachycardia (rapid heartbeat);
Pain in the heart;
Nausea and weakness;
Puffiness of the extremities and puffiness of the face in the morning;
Numbness of limbs;
An inexplicable sense of anxiety;
Irritability, stubbornness, throwing from one extreme to another.

By the way, as regards the last point, hypertension, in fact, leaves an imprint on the human psyche. There is even a special medical term "hypertonic character", so if a person suddenly becomes difficult to communicate, do not try to change it for the better. The reason lies in the illness that needs to be treated.

It should be remembered that hypertension, which is not given due attention, can make life much shorter.

Symptoms of hypertension

The clinical course of arterial hypertension is variable and is determined not only by the level increase of arterial pressure, but also in what target organs are involved in the pathological process.

The early stage of arterial hypertension is characterized by disorders from the nervous system:

transient headaches, most often localized in the occipital region;
dizziness;
sensation of pulsation of blood vessels in the head;
noise in ears;
sleep disorders;
nausea;
palpitation;
fast fatigue, lethargy, a sense of weakness.

With further progression of the disease, in addition to the above symptoms, shortness of breath is added, which occurs with physical activity (climbing stairs, running or brisk walking).

Increase in blood pressure more than 150-160 / 90-100 mm Hg. Art. is manifested by the following signs:

blunt pain in the heart;
numbness of fingers;
muscular tremor resembling a fever;
redness of the face;
increased sweating.

If arterial hypertension is accompanied by fluid retention in the body, then the listed symptoms are joined by the puffiness of the eyelids and the face, swelling of the fingers.

Against the background of arterial hypertension, patients undergo a spasm of retinal arteries, which is accompanied by a deterioration of vision, the appearance of spots in the form of lightning, flies before the eyes. With a significant increase in blood pressure, a retinal hemorrhage can occur, resulting in blindness.

When is it worth visiting a doctor?

It is very important to make an appointment with a doctor if you are concerned about this symptomatology:

frequent headaches;
dizziness;
pulsating sensations in the head;
"Flies" in the eyes and noise in the ears;
tachycardia (heart palpitations);
pain in the heart;
nausea and weakness;
puffiness of the extremities and puffiness of the face in the morning;
numbness of limbs;
an inexplicable sense of anxiety;
irritability, stubbornness, throwing from one extreme to the other.

It should be remembered that hypertension, which is not given due attention, can make life much shorter.

Arterial hypertension 3 degrees risk 3 - what is it?

When formulating the diagnosis, in addition to the degree of hypertension, the degree of risk is also indicated. Under the risk in this situation, the probability of developing a cardiovascular disease in a given patient for 10 years is implied. In assessing the degree of risk, many factors are taken into account: the age and sex of the patient, heredity, lifestyle, the presence of concomitant diseases, the state of target organs.

Patients with hypertension are divided into four main groups of risk:

The chances of developing cardiovascular diseases are less than 15%.
The incidence of diseases for these patients is 15-20%.
The frequency of development reaches 20-30%.
The risk in this group of patients is above 30%.

Patients with a diagnosis of arterial hypertension of the 3rd degree belong to 3 or 4 risk groups, since this stage of the disease is characterized by the defeat of internal target organs. 4 group is also called a group of very high risk.

This dictates the need for establishing a diagnosis of hypertension grade 3 risk 4 to urgently carry out intensive treatment. This means that for patients at risk groups 1 and 2, it is permissible to monitor the patient and use non-drug treatment methods, then patients with 3 and 4 risk groups require the immediate appointment of antihypertensive therapy immediately after diagnosis.

Arterial hypertension 2 degrees risk 2 - what is it?

At the 2nd degree, risk factors may be absent or only one or two similar signs will be available. At risk 2, the probability of the onset of irreversible changes in organs after 10 years, fraught with heart attacks and strokes, is 20%.

Therefore, the diagnosis of "grade 2 arterial hypertension, risk 2" is set when this pressure lasts for a long time, there are no endocrine violations, but one or two internal target organs have already begun to undergo changes, atherosclerotic plaques have appeared.

Prevention

Preventive measures should be taken to reduce the risk of hypertension. Mainly:

Prevention of bad habits: use of alcohol, drugs, smoking, overeating.
Active lifestyle. Hardening. Dosed physical exercise (skating, skiing, swimming, running, biking, walking, rhythmic, dancing). For boys 5-18 years of age the norm of motor activity is 7-12 hours a week, for girls 4-9 hours.
Rational nutrition that prevents obesity. Restriction of salt intake.
Increased resistance to stress, a favorable psychological climate in the family.
Mandatory measurement of blood pressure in different periods of life.

Diagnosis of arterial hypertension

When collecting anamnesis, the duration of arterial hypertension and the highest figures of blood pressure that were previously registered are specified; any indication of the presence or manifestation of PVS, HF or other concomitant diseases (for example, stroke, kidney failure, peripheral arterial disease, dyslipidemia, diabetes, gout), as well as a family history of these diseases.

The history of life includes the level of physical activity, smoking, drinking alcohol and stimulants (prescribed by a doctor and taken independently). Features of nutrition are specified in terms of the amount of salt and stimulants consumed (for example, tea, coffee).

The main tasks of diagnosing this pathological process are to determine the stable and elevated degree AD, exclusion or detection of symptomatic arterial hypertension, assessment of overall risk.

It is necessary:

conduct biochemical analysis to determine the concentration of glucose, creatinine, potassium ions and cholesterol.
it is obligatory to pass an electrocardiogram, Echo KG.
pass the ultrasound of the kidneys.
check the renal arteries, peripheral vessels.
to investigate the fundus.

Also an important diagnostic method of examination is the monitoring of pressure throughout the day, providing the necessary information about the mechanisms cardiovascular regulation with diurnal variability of blood pressure, nighttime hypertension or hypotension, uniformity of antihypertensive action of drugs.

Treatment of arterial hypertension

hypertension 3 In the case of hypertension, treatment should begin with a change in one's lifestyle and non-drug therapy. (An exception is the syndrome of secondary hypertension. In such cases, the treatment of the disease is also prescribed, the symptom of which is AH).

The treatment regimen includes therapeutic nutrition (with limited intake of liquid and table salt, with obesity - with a restriction of daily calories); restriction of alcohol intake, smoking cessation, observance of the work and rest regime, physical therapy, physiotherapy (electrosleep, medicinal electrophoresis, warm - coniferous or fresh, radon, carbon dioxide, hydrogen sulphide baths, circular and fan shower, etc.).

Recommendations include regular physical activity in the fresh air, at least 30 minutes a day 3-5 times a week; weight loss before reaching a BMI of 18.5 to 24.9; a diet under increased pressure, rich in fruits, vegetables, low-fat foods with a reduced amount of saturated and total fat; the use of sodium.

Medication

According to the recommendations of the Moscow Association of Cardiologists, it is necessary to treat arterial hypertension with medication in the following cases:

With an increase in blood pressure to 160/100 mm Hg. Art. and higher;
With blood pressure less than 160/100 mm Hg. Art. in case of ineffectiveness of non-drug treatment;
When target organs are involved (hypertrophy of the left ventricle of the heart, changes in the fundus, changes in urinary sediment and / or increase in the level of the creatinine of the blood);
In the presence of two or more factors of development of the risk of coronary heart disease (dyslipidemia, smoking, etc.).

For treatment, these groups of drugs can be used:

Diuretics (diuretics);
Alpha-blockers;
Beta-blockers;
Angiotensin-converting enzyme (ACE) inhibitors;
Angiotensin II antagonists;
Calcium antagonists;

The choice of a specific agent for the treatment of hypertension depends on the degree of increase in blood pressure and the risk of developing coronary artery disease, as well as age, sex, concomitant diseases and individual characteristics of the patient's body.

Diuretics (diuretics)

Diuretics recommended for hypertension include:

Hypothiazide;
Indapamide;
Indapamide retard;
Xipamid;
Triamterene.

These medicines have proved to be highly effective drugs that positively affect the cardiovascular system and are easily tolerated by patients. Most often, it is with them that hypertension is started, provided that there are no contraindications in the form of diabetes and gout.

They increase the amount of urine secreted by the body, from which excess water and sodium are excreted. Diuretics are often prescribed in conjunction with other drugs that lower blood pressure.

Calcium channel blockers

By blocking the influx of calcium into the sarcoplasm of smooth blood vessel myocytes, vasospasm is prevented, due to which the hypotensive effect is achieved. Influences also on the vessels of the brain, in connection with which they are used to prevent violations of the cerebral circulation. They are also the drugs of choice for bronchial asthma, combined with arterial hypertension. The most common side effects are headache and leg swelling.

Dihydropyridine preparations:

Nifedipine;
Amlodipine, s-amlodipine;
Felodipine;
Nimodipine;
Lercanidipine;
Lacidipine;
Riodipine.

Non-dihydropyridine preparations:

Diltiazem;
Verapamil - reduces the heart rate, which is why sharing with beta-blockers is not recommended.

Angiotensin converting enzyme (ACE) inhibitors

Captopril;
Perindopril;
Ramipril;
Trandolapril;
Fosinopril;
Enalapril.

These drugs are highly effective. They are well tolerated by patients. ACE inhibitors prevent the formation of angiotensin II, a hormone that causes vasoconstriction. Due to this, the peripheral vessels expand, the heart becomes lighter and blood pressure decreases. When these drugs are taken, the risk of developing nephropathy against diabetes mellitus, morphofunctional changes, and death in people with heart failure is reduced.

Angiotensin II antagonists

Walsartan;
Irbesartan;
Candesartan;
Losartan.

This group of drugs is aimed at blocking the already mentioned above angiotensin II. They are prescribed in cases where it is impossible to treat angiotensin-converting enzyme inhibitors because the drugs have similar characteristics. They also neutralize the effect of angiotensin II on blood vessels, promote their expansion and lower blood pressure. It is worth noting that these drugs in some cases are superior in efficiency to ACE inhibitors.

Calcium antagonists

Verapamil;
Diltiazem;
Nifedipine;
Norvasc;
Plandil.

All drugs of this group expand the vessels, increasing their diameter, prevent the development of a stroke. They are very effective and easily tolerated by patients. They have a fairly broad positive range of properties with a small list of contraindications, which makes it possible actively use them in the treatment of hypertension in patients of different clinical categories and age groups. In the treatment of AH, calcium antagonists are most in demand with combined therapy.

Combined preparations

Combinations of two antihypertensive drugs are divided into rational (proven), possible and irrational. Rational combinations: ACEI + diuretic, ARB + diuretic, ACC + diuretic, ARB + ACC, ACE + ACC, β-AB + diuretic. There are fixed combinations (in one tablet) in the form of ready-made dosage forms, which have considerable convenience in use and increase adherence of patients to treatment:

ACE inhibitor + diuretic (Noliprel A, Co-renitek, Enap N, Fosicard N, Berlipril plus, Rami-Hexal compositum, Liprazide, Enaloside, Co-Diroton)
ACE inhibitor + Calcium antagonist (Equator, Gipril A, Prestans, Rami-Azomeks)
BRA + diuretic (Gisaar, Lozarel Plus, Ko-Diovan, Lozap +, Valz (Vasar) N, Dyokor, Mikardis plus)
BRA + Calcium antagonist (Amsaar, Exforge, Lo-Azomex)
A calcium antagonist (dihydropyridine) + beta-AB (Beta-Azomex)
Calcium antagonist (non-dihydropyridine) + ACE inhibitor (Tarka)
A calcium antagonist (dihydropyridine) + diuretic (Azomex H)
β-AB + diuretic (Lodose)

One of the most used is the combination of ACE inhibitors and diuretics. Indications for the use of this combination: diabetic and nondiabetic nephropathy, microalbuminuria, hypertrophy left ventricle, diabetes mellitus, metabolic syndrome, advanced age, isolated systolic hypertension.

Invasive methods

Also, studies are carried out using a partial renal sympathetic denervation minimally invasive treatment resistant to conventional non-drug and drug therapy with at least three antihypertensive drugs, one of which is a diuretic, with systolic arterial pressure under conditions of therapy of at least 160 mm Hg, including malignant, arterial hypertension [36]. Such an intervention will be sufficient only once, and the patient will no longer need ineffective in these patients strict schedule of daily intake of drugs, switching to course treatment by them.

It is possible that interruptions in taking drugs in the future will allow conceiving and bearing a child without affecting the fetus of antihypertensive therapy. In the human body there are no alien objects left. All manipulation is performed by the endovascular method with the help of a special catheter inserted into the renal arteries. A group of 530 people was selected to study the long-term effects of such denervation in US conditions. According to 2000 such operations outside the United States, in two years, 84% of patients managed to achieve a reduction in systolic pressure not less than 30 mm Hg, and diastolic pressure - not less than 12 mm Hg.

At one time, a similar treatment of arterial hypertension and most other diseases of visceral organs was suggested by F. AND. Inozemtsev, but in his time there were no necessary medications and minimally invasive procedures. The effectiveness of treatment with this method of resistant arterial hypertension in patients with severe and moderate chronic renal failure is shown [37]. In the absence of long-term dangerous effects in patients with resistant hypertension, it is planned to widely use this method for the treatment of many other diseases and resistant, especially malignant, arterial hypertension, it is unlikely to be widely used for therapy of conventional non-resistant to medical treatment of hypertension.

Invasive treatment and before this study was widely used for indications for the treatment of diseases, manifested by secondary hypertension, and symptomatic components of hypertensive disease. For example, it is used to treat pathological tortuosity of arteries (kicking and coiling), which can be congenital, occur when combination of atherosclerosis and arterial hypertension, be a consequence of arterial hypertension and contribute to its strengthening and progression. It is most often localized in the internal carotid artery, usually before entering the skull.

In addition, vertebral, subclavian arteries and brachiocephalic trunk may be affected. In the arteries of the lower extremities, this type of circulatory disturbance is much less common and has less clinical significance than in brachiocephalic vessels. Invasive treatment for pathological tortuosity, which can occur in almost a third of people and is not always cause AH, is the resection of the affected segment with the subsequent direct anastomosis end to end.

Effects

Hypertensive disease is dangerous in terms of the likelihood of developing severe complications. Many do not realize that with hypertension symptoms may be absent for a long time, and signs of abnormalities appear only when the disease has affected vital organs.

Vascular disorders:

increased heart size;
attacks of angina pectoris;
progressive heart disorders;
heart attack;
intermittent claudication;
exfoliating aortic aneurysm.

Pathological changes in the kidney:

signs of impaired renal function;
nephrosclerosis.

Disorders from the brain:

decreased visual function;
neurological disorders;
stroke;
transient ischemic attack;
encephalopathy.

The described changes are often irreversible, and further treatment is aimed at supporting the life of the patient. Without adequate therapy, high blood pressure can have fatal consequences.

Forecast

The prognosis for arterial hypertension is determined by the nature of the course (malignant or benign) and the stage of the disease. The factors that worsen the forecast are:

rapid progression of signs of damage to target organs;
III and IV stage of arterial hypertension;
severe damage to blood vessels.

The extremely unfavorable course of arterial hypertension is noted in people of young age. They have a high risk of developing a stroke, myocardial infarction, heart failure, sudden death.

At the early start of the treatment of hypertension and subject to careful compliance by the patient with all the recommendations of the attending physician, it is possible to slow the progression of the disease, improve the quality of life of patients, and sometimes to achieve a long-term remission.