Hypertension and symptomatic hypertension

In the 21st century, arterial hypertension remains an important medical and social problem, as it is fraught with complications that lead to disability, disrupt the quality of life and can be fatal.

The disease is being successfully treated by doctors at the Yusupov Hospital. If you have high blood pressure, you should consult a doctor immediately. Only timely and competent treatment promotes recovery.

For each patient, the Yusupov Hospital selects an individual treatment regimen depending on the primary disease, individual characteristics, the presence of contraindications and concomitant pathology.

Classification of arterial hypertension

It is customary to distinguish 4 risk groups for arterial hypertension, depending on the likelihood of damage to the heart, blood vessels and other target organs, as well as the presence of aggravating factors:

• 1 – risk less than 15%, no aggravating factors;
• 2 – the risk is within 10-20%, no more than 3 aggravating factors;
• 3 – risk from 20 to 30%, more than 3 aggravating factors;
• 4 – the risk is higher than 30%, more than three aggravating factors, target organs are affected.

In arterial hypertension, the following target organs are affected:

• brain (transient cerebrovascular accidents, stroke);
• organ of vision (degenerative changes and retinal detachment, hemorrhage, blindness);
• blood (increased glucose levels leading to damage to the central nervous system);
• heart (left ventricular hypertrophy, myocardial infarction);
• kidneys (proteinuria, renal failure).

Depending on the severity of cardiovascular risk, several levels of blood pressure are distinguished, presented in Table No. 1.

Table No. 1. Blood pressure levels:

Categories	Systolic A/D (mmHg)	Diastolic A/D (mmHg)
Optimal	Below 120	Below 80
Normal	120-129	80-84
High normal	130-139	85-89
Arterial hypertension 1st degree	140-159	90-99
Arterial hypertension 2 degrees	160-179	100-109
Arterial hypertension 3 degrees	≥180	≥110
Isolated systolic hypertension	≥140	≤90

Doctors make the diagnosis of “arterial hypertension stage 2, risk 2” when high blood pressure remains for a long time at 160 (180) / 90 (110) mm Hg. Art., there are no endocrine disorders, but 1 or 2 internal target organs have already begun to undergo changes, atherosclerotic plaques have appeared in the arteries. A diagnosis of “hypertension 2 risk 3” can be made if the same blood pressure figures are present, but there are more than 3 aggravating factors. If grade 3 hypertension, risk 3, is diagnosed, doctors detect an increase in blood pressure above 180/120 mmHg. rt. Art., the presence of 4 or more aggravating factors. The probability of complications from the cardiovascular system exceeds 20%. If grade 3 hypertension is detected, risk 4, then the pressure numbers are the same, but, in addition to the fact that there are more than three aggravating factors, target organs are affected, and the probability of complications is more than 30%.

Risks 1-4 with end-stage hypertension

Depending on the likelihood of developing complications that threaten the health and life of the patient, in cardiological practice there are 4 risk factors, each of which has its own characteristics and course.

Risk 1 (low)

It develops extremely rarely in stage 3 arterial hypertension. It is often diagnosed in patients who have just encountered pathology. Timely treatment and lifestyle adjustments help control the condition and prevent more serious complications. With hypertension occurring at the last stage, such a condition is in principle impossible, because the disease makes itself felt all the time and is almost always unpredictable.

Risk 2 (medium)

The average risk is also uncharacteristic of hypertension, which occurs at stage 3. In this case, the risk of developing complications from the cardiovascular system, as well as damage to target organs, does not exceed 10–12%. Medium risk is more common in stage 1–2 arterial hypertension, subject to the presence of several factors, under the influence of which the outcome of the disease may worsen.

Risk 3 (high)

The high risk of hypertension indicates that the risk of developing cardiovascular complications and target organ damage increases significantly. The probability of death in this case is 15–25%.

To maintain the life and health of the patient, regular drug therapy and lifestyle changes are necessary. A grade 3 risk is still not a death sentence, but it is no longer an indication of a favorable outcome of the disease.

Risk 4 (extremely high)

Risk 4 for stage 3 hypertension is the most likely picture of the course of the pathology at this stage of progression. The probability of severe complications and death is in the range of 30–50% or higher. Complex drug therapy and regular blood pressure monitoring will help reduce the rate to 25–30%, but doctors will not be able to guarantee one hundred percent survival.

At extremely high risks, severe complications develop, accompanied by damage to target organs. The therapy regimen is changed regularly, on average 2–4 times a year. During the treatment period, the patient is indicated for hospitalization. In a hospital setting, the doctor will be able to monitor the dynamics of treatment and, if necessary, make adjustments.

Causes of hypertension

The main risk factors for primary arterial hypertension include:

• Gender and age. Men aged 35 to 50 years are most predisposed to developing the disease. In women, the risk of arterial hypertension increases significantly after menopause;
• Hereditary predisposition. The risk of the disease is very high in people whose first-degree relatives suffered from this disease. If two or more relatives had hypertension, the risk increases;
• Increased psycho-emotional stress and stress. During psycho-emotional stress, a large amount of adrenaline is released, under the influence of which the heart rate and the volume of pumped blood increase. If a person is in a state of chronic stress, then the increased load leads to wear and tear of the arteries and the risk of complications from the heart and blood vessels increases;
• Drinking alcoholic beverages. With daily consumption of strong alcohol, blood pressure increases by 5 mm Hg annually. Art.;
• Smoking. Tobacco smoke causes spasm of peripheral and coronary vessels. The artery wall is damaged by nicotine and other components, and atherosclerotic plaques form at the sites of damage;
• Atherosclerosis develops due to excessive consumption of foods containing cholesterol and smoking. Atherosclerotic plaques narrow the lumens of blood vessels and interfere with free blood circulation. This leads to arterial hypertension, which stimulates the progression of atherosclerosis;
• Increased consumption of table salt provokes spasm of the arteries, retains fluid in the body, which together leads to the development of hypertension;
• Excess body weight leads to decreased physical activity. Clinical trials have shown that for every extra kilogram there is 2 mm. rt. Art. blood pressure;
• Physical inactivity increases the risk of developing hypertension by 20-50%.

It is believed that arterial hypertension develops due to a combination of genetic influences. This is manifested by the inability of the terminal arteries and arterioles to dilate in response to increased cardiac output. Neurogenic, environmental and humoral influences increase the reactivity of blood vessels to pressor influences.

Proponents of one of the modern theories believe that the cause of hypertension is a generalized defect in cell membranes. The disease can develop in the presence of genetically determined insufficiency of the renal tissue in relation to the excretion of water and sodium chloride.

Reasons for the development of arterial hypertension

The exact cause of the development of hypertension has not yet been established, however, a clear relationship has been identified between hypertension and the following factors:

• Exposure to stress;
• hereditary predisposition;
• age;
• gender (AH is more common in men);
• abuse of table salt;
• smoking and alcohol;
• endocrine disorders;
• excess body weight;
• physical inactivity;
• kidney diseases;
• increased adrenaline levels;

Symptoms of arterial hypertension

The danger of high blood pressure is that it is not accompanied by any characteristic symptoms, but slowly and quietly “kills”. The disease in most cases does not show any signs, progresses and leads to fatal complications such as myocardial infarction or stroke. When asymptomatic, arterial hypertension can remain undetected for decades.

The most common complaints patients have are:

• headache;
• flickering of flies before the eyes;
• blurred vision;
• dizziness;
• dyspnea;
• fast fatiguability;
• chest pain;
• visual impairment;
• nosebleeds;
• swelling of the lower extremities.

However, the most important sign of hypertension is elevated blood pressure. Headaches can be manifested by a feeling of squeezing the head with a “hoop”, accompanied by dizziness and nausea. They occur against a background of physical or nervous stress. If the pain persists for a long time, short temper, irritability, and sensitivity to noise appear.

Chest pain can be localized to the left of the sternum or at the apex of the heart. They occur at rest or during emotional stress. Physical activity with hypertension does not provoke heart pain. The pain continues for a long time and is not relieved by nitroglycerin.

In the initial stage of the disease, sometimes shortness of breath appears after physical activity, and subsequently it is determined at rest. This may indicate damage to the heart muscle and progression of heart failure. Slight swelling of the legs occurs when kidney function is impaired, and persistent swelling is characteristic of severe heart failure.

Often, an increase in pressure is accompanied by a disturbance in the quality of vision: flickering “spots” before the eyes, the appearance of fog or a veil. These signs are a manifestation of functional circulatory disorders in the retina.

With the development of cardiovascular failure, an enlargement (hypertension) of the liver occurs. It is manifested by organ enlargement, jaundice, and subsequently the development of cirrhosis and ascites.

Characteristic symptoms

Symptoms develop in isolation only in the case of the primary origin of the pathology. If hypertension is a complication of other diseases, the symptoms develop nonspecific.

General symptoms of stage 3 arterial hypertension:

• A sharp, unbearable headache localized in the occipital, temporal and parietal areas.
• Disorientation in space. An increase in blood pressure leads to dysfunction of the vestibular apparatus, as a result of which it is difficult for the patient to navigate in space.
• Ringing, noise in the ears.
• Weakness, drowsiness or, conversely, hyperactivity. In the latter case, the patient is very overexcited, it is difficult for him to relax and fall asleep even if he is very tired and feels unwell.
• Memory loss, slow thinking. The patient cannot always follow the meaning of the conversation and often forgets recent events.
• Arrhythmia. It manifests itself as a rapid or, conversely, pathologically rare heartbeat.

In the chronic course of hypertension, the symptoms are blurred. The pain in the head almost disappears and makes itself felt only periodically. Other suspicious symptoms may be completely absent.

Secondary hypertension

The most common type is primary hypertension, sometimes called hypertensive hypertension. In addition to the primary, or idiopathic form of the disease, which is often called hypertension, secondary hypertension is also known. This is a disease in which an increase in blood pressure is recorded, caused by another pathology, and of a secondary nature. It is registered in 5-10% of patients who have elevated blood pressure numbers. In 25% of cases it is diagnosed in persons under 35 years of age.

Depending on the cause, the following types of disease are distinguished:

• renal hypertension occurs due to damage to the renal arteries. This form of the disease is called renovascular hypertension. When the blood supply to an organ is disrupted, substances enter the blood that increase blood pressure in order to ensure renal blood flow. Insufficient blood supply to the kidneys develops as a result of congenital pathology of the renal arteries, atherosclerosis, thrombosis, compression from the outside by a space-occupying formation. Renal hypertension, symptoms of the disease occur in the presence of polycystic kidney disease, inflammatory processes in the organ (chronic pyelonephritis or glomerulonephritis);
• An increase in systolic blood pressure occurs with Itsenko-Cushing syndrome. In this case, the adrenal medulla is affected;
• Pheochromocytoma is a disease that affects the adrenal medulla. It is the cause of a malignant form of arterial hypertension. The tumor compresses the outer layer of the adrenal glands, as a result of which adrenaline and norepinephrine are released into the blood, which causes a constant or crisis increase in pressure;
• Hyperaldosteronism, or Cohn's syndrome, is a tumor of the adrenal gland that causes an increase in aldosterone levels. As a result, the level of potassium in the blood decreases and blood pressure increases;
• thyroid diseases such as hyperparathyroidism, hyper- and hypothyroidism are the cause of secondary arterial hypertension;
• hemodynamic or cardiovascular arterial hypertension occurs as a result of involvement of the great vessels in the pathological process. It occurs with coarthration, or narrowing, of the aorta and aortic valve insufficiency;
• arterial hypertension in adults of central origin develops in diseases of the brain with a secondary disturbance of central regulation (stroke, encephalitis, head injuries);
• drug-induced hypertension can occur when taking oral contraceptives, nonsteroidal anti-inflammatory drugs, and glucocorticosteroids.

The symptoms of primary and secondary arterial hypertension are similar. Unlike the primary form of the disease, secondary hypertension also manifests itself with signs of the underlying disease. Sometimes patients make the following complaints:

• headache;
• dizziness;
• flickering of flies before the eyes;
• feeling of tightness in the temples;
• noise in ears;
• general weakness;
• facial redness;
• nausea.

Diagnosis of secondary hypertension is difficult, but there are several signs to suspect it:

• increased blood pressure in young people;
• acute sudden onset of the disease immediately with high blood pressure numbers;
• unresponsiveness to ongoing antihypertensive therapy;
• sympathoadrenal crises.

Secondary, or symptomatic hypertension, has several forms, which depend on the persistence and magnitude of pressure, the degree of left ventricular hypertrophy and the stage of changes in the fundus vessels:

• transient hypertension is characterized by the absence of a persistent increase in pressure, enlargement of the left ventricle and changes in the fundus;
• Labile hypertension is characterized by a moderate increase in pressure, which does not decrease on its own, slight hypertrophy of the left ventricle, and mild constriction of the fundus vessels;
• with stable hypertension, there is a steady increase in pressure, an increase in the myocardium of the left ventricle, and a pronounced change in the ocular vessels;
• Malignant hypertension is characterized by sudden and rapid development, consistently high blood pressure numbers, and a high risk of complications from the blood vessels, fundus, heart, and brain.

When making a diagnosis, research methods play an important role, which largely depend on the underlying disease. In addition to standard examinations, the patient is prescribed intravenous urography, magnetic resonance angiography, computed tomography with contrast of vessels, and the level of thyroid hormones and catecholamines in the urine and blood is determined. Doctors at the Yusupov Hospital will conduct an ultrasound and MRI of the adrenal glands and thyroid gland.

One or another genesis of the disease can be suspected by the degree of change in systolic and diastolic blood pressure. Thus, with kidney disease, diastolic pressure most often increases, and for hemodynamic hypertension, an isolated increase in systolic pressure is more typical. Endocrine diseases are characterized by systolo-diastolic arterial hypertension.

Treatment of secondary hypertension requires an individual approach. Standard antihypertensive therapy for this form of the disease is ineffective. If there is a mass formation in the kidneys or adrenal glands, surgical intervention is recommended. If there is renal hypertension, treatment is carried out jointly with an endocrinologist and nephrologist. In the case of inflammatory kidney diseases, antibacterial and anti-inflammatory therapy is prescribed. In the presence of thyroid diseases, hormonal correction is carried out with medication.

The hemodynamic form of the disease requires cardiac surgery and drug correction of heart failure. If the cause of high blood pressure is taking medications, the patient should stop taking them. In case of hypertension of central origin, the primary disease should be compensated for, conservative (for stroke) or surgical treatment (for brain tumors) should be performed. Abnormalities in the vessels of the kidneys are corrected surgically.

In parallel with the treatment of the primary disease, patients are prescribed antihypertensive therapy, that is, drug lowering of blood pressure:

• ACE inhibitors;
• calcium channel antagonists;
• β-blockers;
• diuretics;
• centrally acting antihypertensive drugs.

Treatment methods

To stabilize blood pressure, the following groups of drugs are prescribed:

• calcium channel blockers;
• α and β-blockers;
• ACE inhibitors;
• diuretics;
• sedatives;
• medications that have a blood-thinning effect;
• vitamin and mineral complexes that strengthen the immune system.

In advanced cases, surgical intervention is performed. Indications for surgery for stage 3 hypertension:

• acute vascular stenosis;
• advanced atherosclerosis;
• renal pathologies;
• heart disease;
• aortic aneurysm.

Diastolic hypertension

The diagnosis of “isolated diastolic hypertension” is valid when the systolic value is 90 mm Hg. Increase in diastolic pressure to 90 mm Hg. does not pose a threat to a person who does not have a somatic pathology. But, if he suffers from diabetes, kidney disease, obesity, atherosclerosis, thyroid adenoma, or has previously suffered a heart attack, increased diastolic pressure is a sign of impending heart problems. Complications can only be avoided with adequate treatment of the underlying pathology.

People who have elevated diastolic pressure numbers and do not have concomitant pathologies are recommended to control their blood pressure and change their lifestyle:

• regulate sleep quality;
• do not drink red wine;
• limit the number of cigarettes smoked per day;
• avoid stress;
• eliminate salt from the diet;
• Healthy food;
• maintain normal weight;
• do physical exercise or yoga.

In the presence of diastolic hypertension, the following complications are possible:

• subarachnoid hemorrhage;
• congestive heart failure;
• abdominal aortic aneurysm;
• chronic renal failure;
• dementia;
• Eitzheimer's disease.

When diastolic hypertension occurs, hospital treatment is necessary if persistently high diastolic pressure is present. The underlying disease is treated, for example, surgical correction of aortic valve disease. Doctors individually prescribe medications for hypertension. The following tablets for hypertension are used:

• diuretics (lasix, furosemide);
• beta-blockers (anaprilin, nebilet);
• calcium channel blockers (cinnarizine);
• ACE inhibitors (captopril);
• angiotensin II receptor blockers (yuloctran).

Doctors at the Yusupov Hospital do not recommend using medications without a prescription from a cardiologist, as this is extremely dangerous. Treatment of isolated diastolic hypertension should be adequate and continuous. Hypertensive crises and sudden changes in blood pressure should be avoided.

Causes of hypertension

True hypertension, or, as it is also called, essential hypertension, occurs as a result of overstrain of the nervous system. The result of this process is a disruption of the processes of regulation and maintenance of optimal blood pressure.

Scientists have identified many factors that contribute to the occurrence of hypertension:

• excessive emotional stress;
• irregular working hours;
• lack of sleep;
• obesity;
• physical inactivity;
• diabetes;
• alcohol and tobacco abuse.

The hereditary dependence of the formation of hypertension has been proven - more than 20 genes have been identified that are responsible for the development of the pathology.

Hypertensive crises

Hypertensive crisis is a state of individual significant increase in blood pressure in patients suffering from primary or secondary arterial hypertension, accompanied by the appearance or worsening of clinical symptoms and requiring rapidly controlled pressure to limit or prevent damage to target organs. It can be an exacerbation or complication of arterial hypertension, an indicator of inadequate therapy, a manifestation of drug withdrawal syndrome, the debut or the only manifestation of the disease.

Type 1 crisis (adrenal, neurovegetative) is manifested by an increase in systolic blood pressure, an increase in pulse pressure, tachycardia, extrasystole, and agitation. Type 2 crisis (water-salt, norepinephrine) has the following symptoms:

• a predominant increase in diastolic pressure with a decrease in pulse pressure;
• swelling of the face, legs, arms;
• a noticeable decrease in diuresis on the eve of a crisis.

To treat an uncomplicated crisis, doctors use the following drugs:

• nifedipine;
• captopril;
• carvedilol or other beta blockers;
• metoprolol;
• propranolol;
• furosemide;
• clonidine.

In case of a complicated crisis, the respiratory tract is sanitized, the patient is provided with oxygen, and venous access is made. The choice of antihypertensive drug is approached in a differentiated manner; it is administered intravenously. They quickly reduce the pressure, and then within 2-6 hours switch to oral medications, which reduce it to 160/100 mmHg. The patient is hospitalized in a specialized hospital.

Hypertensive cerebral crisis is a sudden increase in blood pressure to critical levels, which leads to impaired cerebral circulation. It is manifested by headache and other symptoms characteristic of liquor hypertension syndrome. It develops against the background of hypertension, atherosclerosis, pyelonephritis, glomerulonephritis, diabetic nephropathy, etc. In 50% of cases, hypertensive cerebral crisis occurs after stressful situations. It can be triggered by a sudden change in weather, overeating, hypothermia, or excessive physical activity.

Angiohypotonic hypertensive cerebral crisis develops against the background of a headache that is familiar and typical for hypertensive patients, which occurs in the form of a feeling of heaviness in the head or is localized in the occipital region. It intensifies with a body position that impedes venous outflow from the cranial cavity (bending, straining, coughing, lying down). Often the pain goes away when drinking coffee, strong tea or standing upright.

Hypertensive cerebral crisis begins with the spread of headache to the orbital area. In this case, patients complain of the appearance of pressure behind the eyeballs and on the eyes. A distinctive feature of angiohypotonic hypertensive cerebral crisis is its occurrence with a moderate increase in blood pressure (170/100 mm Hg). Then the pain rapidly intensifies within an hour and spreads throughout the head. Nausea and repeated vomiting appear, which brings some temporary relief.

Angiohypotonic hypertensive cerebral crisis is accompanied by autonomic reactions: tachycardia, increased sweating, wave-like breathing, and sometimes facial cyanosis. Then comes the late phase, which is characterized by the following symptoms: increasing lethargy, nystagmus, dissociation of tendon reflexes. During this period, blood pressure can be at the level of 220/120 mmHg. Art. or more, but sometimes it does not rise above 200/100 mm Hg.

Ischemic hypertensive cerebral crisis is observed much less frequently than angiohypotonic crisis. It is typical for hypertensive patients who tolerate increased blood pressure well and do not suffer from headaches. Often, ischemic hypertensive cerebral crisis develops against the background of very high blood pressure numbers, which may go beyond the tonometer scale.

Patients become overly energetic, overly emotional and outwardly too businesslike. Then they develop irritability, which is replaced by tearfulness and depression. They may start to behave aggressively. Due to the lack of criticism, patients themselves are not able to adequately assess their condition.

Subsequently, focal neurological symptoms appear:

• blurred vision (double vision or flickering “spots” in the eyes);
• sensitivity disorders (tingling, numbness);
• speech disorder;
• unsteady gait;
• vestibular ataxia;
• asymmetry of tendon reflexes.

A complex cerebral hypertensive crisis begins with clinical manifestations characteristic of the angiohypotonic variant of the course of cerebral crisis, but quite often occurs against the background of significantly increased pressure. As the crisis develops, focal symptoms appear, characteristic of the ischemic variant of the course of cerebral crisis.

Ischemic and mixed hypertensive cerebral crisis is an indication for hospitalization of the patient. Comprehensive treatment should include tranquilizing antihypertensive therapy, vasoactive drugs and symptomatic treatment.

The main way to prevent hypertensive cerebral crisis is adequate antihypertensive therapy for patients with arterial hypertension. If blood pressure is moderately elevated, work that requires heavy lifting, a fixed body position, or an inclined position should be avoided. There is no need to overcool your head or overexert yourself emotionally. For constipation, you need to follow a diet and take laxatives. If morning headaches occur regularly, it is better for the patient to sleep on a high pillow and take a long walk before bed.

In order to avoid a cerebral crisis when the headache intensifies, you need to warm your head with a hairdryer or a warm shower, massage the cervical-collar area, and drink strong tea. If you have an intense headache, it is recommended to take caffeine tablets or seduxen.

Causes of increased blood pressure

Let's look at the main reasons why blood pressure begins to rise. Knowledge of these risk factors will help a person take preventive measures in the future and prevent increased blood pressure.

• Disturbances in the functioning of the endocrine system.
• Diabetic syndrome, when blood sugar levels begin to rise sharply.
• High levels of cholesterol in the blood, which impairs vascular patency.
• Excessive salt consumption, disruption of salt metabolism in the body. Health is negatively affected by the retention and significant accumulation of fluid in the body caused by an excess of salt.
• Physical inactivity (sedentary lifestyle). When a person moves little, his metabolism in the body worsens, all metabolic processes slow down, and toxins accumulate. As a result, the pressure also increases.
• Excess body weight often causes various disturbances in the functioning of the vascular and cardiac systems. With any negative phenomena in the area of ​​blood circulation, an increase in blood pressure is also observed.
• The disease can also be triggered by certain medications, the use of which is associated with an increase in blood sugar levels, for example. If such drugs are prescribed, they should be taken under specialist supervision.
• In many cases, the predisposition to hypertension is determined at the genetic level. In other words, the disease is inherited. If parents already suffer from high blood pressure, there is a high probability that their children will also develop hypertension.
• All kinds of sexual dysfunctions and hormonal imbalances also cause an increase in blood pressure. Women who are experiencing menopause and taking contraceptive medications are immediately at risk. During menopause, hot flashes are characteristic, accompanied by an increase in pressure. In addition, the body stops producing the beneficial female sex hormone estrogen. This fact in itself provokes disruptions in the activity of the heart and blood vessels. Anti-pregnancy medications can also cause high blood pressure.
• Any diseases or problems in the central nervous system are also associated with hypertension. The risk of blood clots, their rupture and penetration into target organs, the development of myocardial infarction and strokes increases significantly.
• Stress and unstable emotional background also become causes of hypertension. It is because of nerves that a stroke or micro-stroke can develop.
• Physical overload also provokes an increase in pressure in the blood vessels.

Having considered the key signs, we can conclude how arterial hypertension differs from hypertension. The fact is that hypertension is a sign, that is, a result reflected on a tonometer, signaling the presence of an underlying disease - hypertension.

Arterial hypertension can be detected not only by hypertension. This symptom is also characteristic of other diseases and disorders in the functioning of various body systems. For example, failures in the functioning of the kidneys provoke an increase in blood pressure. At the same time, hypertension is a chronic disease, accompanied by high blood pressure and an increase in overall muscle tone. Thus, hypertension is a consequence of hypertension.

Diagnosis of arterial hypertension

It is very important to know how to measure blood pressure; only then can hypertension be diagnosed. The exercise begins with an explanation of the person’s behavior during the procedure, then they show how to correctly apply the cuff and record the indicators. It depends on which device measures pressure: mechanical or electronic.

It is necessary to carry out such laboratory tests as:

• general blood and urine analysis;
• blood glucose levels;
• creatinine, uric acid and potassium levels;
• lipid profile;
• content of C-reactive protein in blood serum;
• bacterial culture of urine.

Patients are prescribed the following instrumental research methods:

• electrocardiogram;
• echocardiogram;
• chest x-ray;
• ultrasound examination of the kidneys and adrenal glands;
• Ultrasound of the renal and brachycephalic arteries.

The ophthalmologist will examine the fundus of the eye and assess the presence and degree of microproteinuria. All patients at the Yusupov Hospital undergo daily blood pressure monitoring.

How to diagnose the disease?

When the first symptoms of hypertension appear, consult a cardiologist. He will conduct an examination and refer you for tests:

• general blood and urine analysis;
• blood test for hemoglobin;
• urine test for protein and glucose;
• electrocardiography;
• echocardiography;
• chest x-ray;
• biochemical blood test to detect cholesterol, urea, glucose and calcium levels;
• phosphates and uric acid;
• CT scan;
• ultrasonography.

Based on the results of the tests, the attending physician will determine whether hypertension is present, the stability of the increase in pressure, the degree of development of pathological changes in the internal organs, and the cause of the increased pressure.

Treatment of arterial hypertension

The goal of treatment for any patient with hypertension is to reduce the risk of developing cardiovascular complications and death from them. The selection of drugs for the treatment of hypertension is determined by the following strategy: achieving the target blood pressure, that is, 140/80 mmHg. and addressing risk factors. In patients suffering from kidney disease and diabetes, the pressure must be reduced to 130/80 mmHg. This will improve the quality of life and eliminate the symptoms of the disease.

European and national recommendations state that the indication for starting drug treatment is the severity of the risk of cardiovascular complications and the level of high blood pressure. Doctors at the Yusupov Hospital use 2 approaches: they are looking for the optimal drug for monotherapy or a low-dose combination of two drugs.

Most doctors and patients prefer monotherapy because it minimizes the risk of side effects. With this approach, one should not expect an immediate effect, and the patient must understand this. It takes time to select a drug, change medications, manipulate doses, and carefully monitor blood pressure. When using antihypertensive drugs, the effect occurs much faster, but this is the first step towards polypharmacotherapy.

Currently, doctors use 7 classes of pharmacological drugs to treat hypertension:

• basic (diuretics, slow calcium channel blockers, beta blockers, angiotensin-converting enzyme inhibitors and angiotensin 1 receptor blockers);
• additional (central sympatholytics and imidozoline receptor agonists).

The drug is selected according to the following scheme:

• drug class;
• drug within a class;
• dosage form;
• specific medicine taking into account the manufacturer.

Initially, a first-line drug is chosen, but in 50% of patients it is possible to achieve target blood pressure with two drugs, and in 30% with three. The decision is made after receiving answers to the following questions:

• whether patients are at risk of developing cardiovascular complications and which ones;
• whether target organs are affected;
• what are the manifestations of cardiovascular failure;
• whether there are kidney diseases and diabetes;
• how much the risk of complications will decrease after taking a drug from this group.

Next, they move on to choosing a specific drug within the class, paying attention to the following points:

• variability in patient response to the drug;
• economic and social factor;
• presence of contraindications;
• interaction with other drugs that the patient is already taking.

When choosing the form of the drug, it should be taken into account that patients prefer tablets for hypertension. They prefer to take them once a day. Long-acting drugs do not cause fluctuations in blood pressure. For emergency assistance in case of a life-threatening condition, a short-acting antihypertensive drug should be taken.

Of the three groups of diuretics, cardiologists at the Yusupov Hospital give preference to thiazide and thiazide-like drugs. They act less intensely, but last longer. New generation thiazide diuretics do not affect metabolism, they are inexpensive and can be widely used as monotherapy drugs. Before starting therapy, patients must determine the level of potassium in the blood, creatinine and uric acid, parameters of carbohydrate metabolism and lipid profile. Treatment begins with small doses of drugs, gradually increasing them. It is not recommended to resort to high doses of diuretics.

B-blockers have several effects:

• due to a decrease in sympathetic tone, they reduce cardiac output;
• reduce the frequency and strength of heart contractions;
• block the release of renin and the formation of angiotensin II;
• inhibit the release of norepinephrine.

Cardiologists at the Yusupov Hospital prescribe beta blockers to control blood pressure after myocardial infarction in the presence of concomitant heart failure, coronary heart disease and tachycardia. They reduce mortality and reduce the risk of life-threatening arrhythmias. Cardiologists prefer to prescribe cardioselective β blockers.

ACE inhibitors are used for monotherapy and combination treatment of patients with arterial hypertension. They block the enzyme that converts the inactive form of angiotensin into active angiotensin II. This leads to decreased activation of the angiotensin-renin system, vasoconstriction, and aldosterone production. Reverse development of the walls of blood vessels and the left ventricle occurs. In Russia, doctors use 10 drugs from this group.

Angiotensin receptor blockers used in clinical practice selectively block type 1 receptors. They have high antihypertensive effectiveness, are well tolerated by patients, and with a single dose they normalize blood pressure within 24 hours. With long-term use of drugs, the enlarged left ventricle develops reversely. They are prescribed for diastolic hypertension and diabetes mellitus. These drugs are also used to treat renal hypertension. Medicines should be prescribed by a cardiologist together with a nephrologist.

There are 3 groups of calcium channel blockers. Some of them reduce myocardial contractility, reduce heart rate and slow down atrioventricular conduction. Others act on peripheral blood vessels, reducing systemic resistance and reducing the volume of blood that returns to the heart. They have the side effect of causing tachycardia. Short-acting drugs are used to relieve hypertensive crisis.

If necessary, cardiologists prescribe centrally acting antihypertensive drugs to patients. These include β 2 adrenergic receptor antagonists and I1 imidazoline receptor agonists. They reduce blood pressure, the level of adrenaline in the blood plasma, and slow down the heart rate. The positive point is that the drugs reduce peripheral resistance and cardiac output, despite the decrease in blood pressure, maintain renal blood flow, and promote the reverse development of the hypertrophied left ventricle.

Treatment of hypertension at the clinic “Mom, Dad, Me”

At the first signs of increased blood pressure, we recommend that you contact a cardiologist at one of the branches of the “Mom, Dad, Me” family clinic network, located in Moscow. Our advantages:

• reception of adults;
• performing the most important diagnostic studies - ECG, EchoCG, HM ECG;
• if myocardial infarction is suspected, urgent determination of troponins in the blood;
• in-depth laboratory diagnosis of metabolic disorders aggravating the course of hypertension;
• development of an individual treatment and observation plan;
• affordable prices for services in our clinic.

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Today I was treated at the clinic, I was satisfied with the staff, as well as the gynecologist. Everyone treats patients with respect and attention. Many thanks to them and continued prosperity.

Anonymous user

The Mama Papa Ya clinic in Lyubertsy is very good. The team is friendly and responsive. I recommend this clinic to all my friends. Thanks to all doctors and administrators. I wish the clinic prosperity and many adequate clients.

Iratyev V.V.

We visited the “Mama Papa Ya” Clinic with our child. A consultation with a pediatric cardiologist was needed. I liked the clinic. Good service, doctors. There was no queue, everything was the same price.

Evgeniya

I liked the first visit. They examined me carefully, prescribed additional examinations, and gave me good recommendations. I will continue treatment further; I liked the conditions at the clinic.

Christina

The doctor carefully examined my husband, prescribed an ECG and made a preliminary diagnosis. She gave recommendations on our situation and ordered additional examination. No comments so far. Financial agreements have been met.

Marina Petrovna

I really liked the clinic. Helpful staff. I had an appointment with gynecologist E.A. Mikhailova. I was satisfied, there are more such doctors. Thank you!!!

Olga

Pulmonary hypertension

Pulmonary hypertension - what is it? Pulmonary hypertension is defined as a group of diseases that are characterized by a progressive increase in blood pressure in the pulmonary artery, which leads to right ventricular failure and is a cause of premature death. The disease cannot be diagnosed until the target organ (right ventricle) is affected. In clinical practice, it is actually possible to detect pulmonary hypertension at the stage of latent dysfunction of the right ventricle, manifested by dilatation of its cavity or hypertrophy of the walls, and, in the worst case, at the stage of right ventricular heart failure.

Cardiologists use a clinical classification of pulmonary hypertension. It can be idiopathic and hereditary. The latter form develops due to a mutation in the bone-derived protein receptor type 2 gene or a mutation in the activin-like kinase-1c gene and non-hereditary hemorrhagic telangiectasia. It may be caused by unknown mutations.

The disease also develops when taking certain medications. Pulmonary hypertension can be associated with connective tissue diseases, systemic diseases, HIV infection, dysmetabolic syndrome, etc.

The first symptom of pulmonary hypertension is shortness of breath, which increases with physical activity or paroxysmal nocturnal shortness of breath. Then a nonproductive cough, palpitations, chest pain, fainting or presyncope, increased fatigue or weakness, peripheral edema and heaviness in the right hypochondrium appear.

Diagnostic methods used include ECG, chest x-ray, functional study of the lungs and blood gas composition, D-Echo-CG, ventilation-perfusion scintigraphy, CT and MRI.

For idiopathic and associated forms of pulmonary hypertension, treatment is aimed at reducing the risk of worsening the disease. It includes:

• contraception for women of reproductive age;
• prevention of pulmonary infectious complications (vaccination against influenza and pneumococcal infection);
• supervised rehabilitation;
• psychosocial support.

Patients are advised to undergo dosed physical activity. For planned surgical interventions, it is recommended to give preference to epidural anesthesia. Drug treatment should be aimed at three main pathogenetic mechanisms: thrombosis, vasoconstriction and proliferation. Depending on the stage of the disease, doctors prescribe indirect anticoagulants and factor Xa inhibitors. Non-steroidal anti-inflammatory drugs should be avoided.

If there is a significant increase in pressure in the right atrium and the appearance of symptoms of right ventricular heart failure in the right ventricular heart failure, diuretics are prescribed. For hypoxemia at rest, oxygen therapy is indicated.

The most effective group of drugs for the treatment of arterial pulmonary hypertension are vasodilators, which include calcium antagonists and prostacyclin analogues.

Prevention of hypertension

Every adult should monitor their blood pressure. In case of high blood pressure, you should consult a doctor.

People with high blood pressure who also have high blood sugar, high blood cholesterol or kidney problems are at increased risk of heart attack and stroke. Therefore, it is important to regularly check your blood sugar levels, blood cholesterol levels and urine protein levels.

There are a number of specific steps everyone can take to minimize the risk of developing high blood pressure and its adverse effects:

Mental balance

Mental well-being and a positive emotional state are essential conditions for maintaining health. What is especially important for patients with hypertension or predisposed to its development, because the disease is directly related to an inadequate response to stress.

It is necessary to learn how to manage stress in healthy ways such as meditation, various types of psychotherapy and positive social contacts.

Specialists of the Peredelkino Cardiological Sanatorium Center: neurologists, psychotherapists, cardiologists will give you comprehensive recommendations and teach you how to resist stress.

Walking in the fairytale forest surrounding the sanatorium and active recreation in nature will give you a good boost of energy. Getting to know the local attractions will give you peace of mind.

Physical activity

The second component of the prevention of hypertension is sufficient physical activity, without which we all suffer to varying degrees from manifestations of physical inactivity.

For a city dweller, it would be optimal to walk for at least 1 hour every day in a forested area.

At the Peredelkino Cardiological Sanatorium Center, as part of the Cardioprevention program, dosed walking classes are held in Meshchersky Park, mechanical therapy in the gym, group water aerobics in the pool, and city sports competitions are held.

Patients with an already manifested disease should engage in physical therapy.

It is necessary to adhere to a regime of rational alternation of work and rest. Overwork of any type, both mental and physical, should not be allowed. Healthy physiological sleep is of great importance, during which the body rests from all stress. Patients at the initial stage of hypertension should sleep at least 8-9 hours a day.

Healthy eating

In the prevention of hypertension, proper nutrition or diet in clinically pronounced forms of the disease is of great importance.

Carbohydrates

Here you should give preference to vegetables and fruits, as this will allow you to get a sufficient amount of fiber, vitamins and minerals.

Squirrels

When choosing proteins, you should avoid or limit meat products in favor of dairy and plant-based ones.

Fats

Total fat intake should be reduced. Try to replace animal fats with vegetable fats, and among animal fats there should be more fish fats.

A diet with limited salt can be a cure for patients with hypertension. No more than 5 g (slightly less than one teaspoon) is allowed per day, which makes control over blood pressure levels much easier.

Maintain a normal weight

Reducing excess weight or treating obesity is the main factor that can lead to satisfactory control of blood pressure and even, in some cases, abandon drug correction of the latter.

An effective means for normalizing weight is diet therapy and various types of physical activity.

Rejection of bad habits

If a person is prone to drinking alcohol in large doses or smoking, then the risk of hypertension increases many times over.

Alcohol intake promotes spasm of peripheral vessels and increased blood pressure due to increased vascular resistance.

After smoking, cholesterol levels increase, which is due to the release of large amounts of adrenaline and norepinephrine from the adrenal glands. There is even such a medical term - nicotine hypertension.

Prevention of arterial hypertension

To prevent the development of arterial hypertension it is necessary:

• organize proper nutrition;
• avoid emotional stress and stress;
• use rational physical activity;
• normalize sleep patterns;
• monitor your weight;
• active rest;
• stop smoking and drinking alcohol;
• Visit your doctor regularly and get tested.

Arterial hypertension leads to disability and death. The disease is being successfully treated by doctors at the Yusupov Hospital. Treatment for this disease involves continuous use of medications to control blood pressure. Hypertensive crises and sudden changes in pressure should be avoided.

If you encounter this problem, call and the coordinating doctor will make an appointment with a cardiologist and answer all your questions.

Concepts

First, let's define what it is - hypertension and hypertension.

Let's look at the main reasons that cause diseases. Arterial hypertension and essential hypertension are most often observed in older people suffering from diseases of the heart and vascular system.

The key symptom is an increase in blood pressure. Experts note that the critical level becomes 120/80. If you see exactly this kind of data in the tonometer window, we are probably talking about hypertension here. To make sure that this is not a random result, not an episodic phenomenon, observation must be continued.

10-15 minutes have passed, but the pressure has not decreased? Is this not the first time you have noticed such a high indicator? Then it’s definitely time to talk about hypertension, identifying hypertension and cardiovascular disease with all the accompanying signs and side effects.

It is very important to start therapy on time to prevent the development of numerous complications characteristic of hypertensive heart and vascular disease.

Physical methods for preventing the development and exacerbations of hypertension

Hydrotherapy

Hydrotherapy (hydrotherapy) is a powerful means of recovery, prevention and treatment of hypertension. Water can affect the body as a temperature, mechanical or chemical irritant, and the choice depends on the need for one or another factor of influence.

The temperature factor is the most important in choosing a hydrotherapy technique. Skin capillaries expand and contract in response to exposure to water of varying temperatures. In this case, either an increase in blood flow or a decrease in it occurs. Cold water also slows and increases heart rate and increases blood pressure. Hot water lowers blood pressure, speeds up the heart rate and weakens heart contractions

Most often, to prevent exacerbations of hypertension, water at an indifferent temperature is used, which is indicated for excessive nervous excitability, irritability, cardiac dysfunction, and insomnia.

Hydrotherapy procedures are contraindicated for stage III hypertension.

Before using water procedures as a treatment, you should consult your doctor.

For hypertension stages I-II, rain, dust and circular showers are used using indifferent or warm water with moderate pressure from water jets.

Baths can be general and local; in case of hypertension they are used for therapeutic and preventive purposes. Medicinal baths for hypertension are limited to the use of pine extract.

You can see about the types of hydrotherapy at the Peredelkino Cultural Center here

Drug electrophoresis

This is the use of galvanic current for the purpose of interstitial non-invasive administration of various drugs. Under the influence of galvanic current, drug ions enter the skin and are retained under the anode area, which creates a kind of drug depot. The drug enters the bloodstream rather slowly, which increases the duration of its effect on the body. The body is also affected by the positive effects of galvanic current.

Electrophoresis is indicated in the initial stages of hypertension. At stage III, it is contraindicated. In addition, contraindications are neoplasms, acute inflammatory processes of any location, disorders of blood clotting processes, pronounced atherosclerosis, decompensated diseases of the cardiovascular system, kidneys, pregnancy, individual intolerance to galvanic current.

At the Peredelkino Cultural Center, various types of physiotherapy are used. More details can be found here

Therapeutic exercise (physical therapy)

Therapeutic exercise is used at all stages of hypertension to prevent hypertensive crises and complications of the disease. It includes any available types of physical exercise - dosed walking, morning exercises, health path, swimming.

The best way of prevention is morning exercises or exercises, which allows you to prepare the body for a working day, stimulates the processes of nervous regulation of blood circulation and the reactivity of the vascular system as a whole.

If the disease has already developed, then you should add a daily complex of therapeutic exercises to the morning exercises.

At the Peredelkino Sports and Fitness Center, individual and group physical therapy classes are conducted under the guidance of professional exercise therapy instructors.

Drug therapy

The selection of medications for the treatment and prevention of exacerbations of hypertension should be carried out only by a doctor.

Drug therapy becomes necessary already at the second stage of the disease, when blood pressure reaches significant levels with regular measurements.

The main principle is the individual selection of antihypertensive drugs for each patient.

Dear readers, the articles are for informational purposes only. Before using the recommendations, you should consult your doctor.

Treatment of the disease

Treatment of hypertension is complex and depends on the stage, severity, causes, gender and age of the person and other factors. The disease cannot be completely cured, but the patient’s condition can be significantly improved and the onset of life-threatening complications can be delayed for a long time. Treatment can be non-drug and medicinal.

Non-drug therapy. It involves adjusting the patient’s lifestyle. Most patients do not attach much importance to it, considering it frivolous, but such treatment is the key to success.

First of all, it is necessary to review the diet of the sick person, reduce the intake of carbohydrates and fats, and increase the intake of proteins and vitamins. You should reduce your caloric intake, which will subsequently lead to a reduction in cholesterol and body weight. It is also necessary to normalize the drinking regime, reduce salt consumption to 5 g per day.

When treating hypertension in older people, spa therapy and climatotherapy are especially recommended. The doctor prescribes therapeutic exercises and physical education. Reducing anxiety levels and using psychotherapy methods are helpful.

Pharmacological treatment. Quite often, in the treatment of hypertension, the principle of “steps” is used when prescribing medications. Groups of drugs are prescribed in the required sequence, since drugs have different degrees of impact in the mechanism of increasing blood pressure. When a person achieves a stable decrease in blood pressure, the doctor transfers the patient to maintenance therapy.

• When treating grade 1 high blood pressure, one antihypertensive drug is usually prescribed, which is taken on an outpatient basis under the supervision of a specialist. Medicines are prescribed in courses lasting several weeks.
• When treating stage 2 hypertension or when monotherapy is ineffective, the doctor usually prescribes 2 drugs. Therapy is carried out in a hospital. If an elderly person experiences a stable decrease in blood pressure, the patient continues treatment at home.
• Treatment of stage 3 hypertension requires an individual approach. It is carried out in a hospital until the condition stabilizes. The doctor evaluates the results of the examinations and prescribes a special course of treatment for stage 3 hypertension.