Arterial hypertension (hypertension) - symptoms and treatment

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:

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%.

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.

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.

Main differences

How is arterial hypertension different from essential hypertension (hypertension)?

• Hypertension is a disease. Hypertension is one of the symptoms of this disease, which may or may not be present in the body of a sick person. However, in 95% of cases this symptom is present, and only in 5% it is not.
• The main cause of hypertension is increased vascular tone (hypertonicity). There is no main cause of hypertension. It can appear in various pathological conditions.
• Hypertension is a general pathology of the body. It requires mandatory observation and treatment. Advanced hypertension causes serious complications and deaths. Hypertension is not always a pathology. It can appear in a sick and healthy body. For example, in a healthy person, hypertension can appear due to physical overexertion or emotional stress. Therefore, hypertension is not treated separately from the cause. It is necessary to determine the disease that caused the increase in pressure and treat it.

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.

Features of the course of the disease

Labile hypertension develops progressively; doctors describe 3 stages of the disease:

1. Initially, based on the symptoms that patients describe, it is quite difficult to establish an accurate diagnosis, since obvious abnormalities are not detected. The main symptom at this stage is associated not with a physiological, but with a mental state - patients often complain of nervous tension and sleep disorders.
2. At the second stage, there are also no clearly defined health complaints, but an increased level of pressure is recorded instrumentally, which can be described as moderate hypertension. Some patients are characterized by periodically occurring hypertensive crises and renal dysfunction. However, a routine urine test gives normal results.
3. Symptoms of the disease are pronounced, and patients often experience discomfort due to pressure surges. At this stage, the preconditions for myocardial infarction often develop, so it is quite dangerous to start the disease.

The rate of development of pathology is not the same; it largely depends on the individual characteristics of a person, his lifestyle and chronic diseases.

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.

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.

“At a young age, women are protected by hormones.” A cardiologist talks about how high blood pressure affects the body and what to do to get it under control

How does high blood pressure affect the body and what complications does it lead to? Is it possible to get rid of arterial hypertension if you completely change your lifestyle? And if it doesn’t work out, is it true that now you need to take pills for the rest of your life? We talk with cardiologist Svetlana Galitskaya about everything you need to know about arterial hypertension in order to live a healthy and quality life.

Svetlana Sergeevna Galitskaya. Cardiologist, Candidate of Medical Sciences. She has been working at the Republican Clinical Medical Center since 2010. Deputy Chief Physician for Medical Affairs, while continuing to conduct medical practice and consult patients.

What can be considered normal and for what age is hypertension most dangerous?

— 120 over 80 are considered reference values ​​for blood pressure.
Is this really the norm? — Values ​​from 110 to 130 are considered optimal for upper pressure and from 70 to 89 for lower pressure. A run of ten units in both directions is considered normal. But it’s easier, of course, to remember “120 to 80.”

Such blood pressure allows you to maintain the functioning of the body at a normal level, and this does not lead to the development of complications associated with the cardiovascular system.

— Can the norm differ for different people?

- Certainly. All people, as we know, are different by nature. They may have different vascular tone, their body and autonomic nervous system may function differently. Therefore, the norms are quite vague.

For example, there are people with low blood pressure, and for them 120 over 80 is practically a disaster.

In this case, there cannot be a “normal pressure” above 140 units. Previously, one could hear from patients: “My working pressure is 160.” No, there is no such thing and there should not be, because in the future such “working” pressure will lead to the development of complications. Except in rare cases - in elderly patients with severe vascular atherosclerosis or congenital defects - we always try to reduce blood pressure to normal values.

— Are there statistics on how many Belarusians have arterial hypertension?

— Such studies are carried out periodically. Overall, the worldwide prevalence of hypertension is 20-30 percent. For Belarus, there is data that this number is 40-45 percent.

These statistics are quite vague, because often patients do not consult doctors about high blood pressure. Or they simply don’t know about it.

Today, young patients are increasingly turning to us. For example, a 30-35 year old man comes and already has high blood pressure. When you start asking: “How did you notice and identify it?”, you may hear the answer: “I went to visit my grandmother. She measured her blood pressure - and I was along for the ride. That’s how I found out.” And he simply did not pay attention to the fact that his head ached from time to time.

— Is arterial hypertension a problem at a certain age? Or is “all ages submissive” to her?

- Yes, this is a problem of different ages. Although the prevalence of hypertension does increase over the years.

People over 60-65 years old encounter it quite often. For those between 30 and 40 years old, this is less of a problem. But for them it is more dangerous. Because with a long course and in the absence of control, arterial hypertension leads to complications earlier. As a result, the quality of life decreases and severe consequences develop.

Therefore, the earlier arterial hypertension occurs, the more attention the patient needs in order to ensure the healthiest possible life in the future.

— Why is arterial hypertension becoming more common among people over 60 years of age?

- Firstly, because by this time the vessels become less elastic and more rigid. Secondly, with age, unfortunately, we do not lose diseases, but acquire them; diseases that accompany arterial hypertension develop. For example, diabetes mellitus, metabolic disorders. When they meet with arterial hypertension, they, in fact, aggravate and reinforce each other. This phenomenon in medicine is called comorbidity.

— Let’s say that at the age of 40 a person was diagnosed with arterial hypertension. If the disease is not controlled, what complications can it lead to?

— If you start treating the disease at the first stage, then at this stage you can control the disease by simply adjusting your lifestyle. The drugs may not even be needed.

If you miss this important point, then in the future - if the course is unfavorable - arterial hypertension will lead to damage to target organs, and this is the cardiovascular system, blood vessels of the eyes and kidneys. That is, complications develop on the part of the visual and excretory system, changes in the heart muscle itself begin, and its hypertrophy—thickening—occurs. As a result, the load on the heart increases. In addition, increased pressure damages the walls of blood vessels, which can lead to a stroke.

Arterial hypertension: who is at risk of getting it?

— If the disease already exists, how can you change your lifestyle to prevent its development?
— Here we should talk about risk factors for arterial hypertension. They are divided into two groups: those that cannot be changed (this is what nature has endowed us with), and those that can be influenced (they are called modifiable).

The first group, for example, includes heredity. Another unchangeable factor is age. As we know, it is impossible to rewind it in the opposite direction.

At the same time, I note that at a young age, arterial hypertension most often develops in men, and women at this time are protected by sex hormones. But over time, when women begin menopause, doctors observe a peak in their arterial hypertension.

However, there are a number of factors that play an even greater role in the development of the disease. And it is possible to change them.

In first place is smoking. It can be called the most harmful factor.

The second group includes overweight and obesity, low levels of physical activity, high cholesterol and alcohol consumption.

If a person begins to move actively, play sports, lose weight and quit smoking, then we see that high blood pressure goes away.

I always tell my patients: losing 10-15 kilograms while overweight reduces blood pressure by 10-15 units. This is really how it works.

Moreover, if my patients begin to gain weight, then they see that the usual doses of drugs are not enough - and I, the doctor, have to increase them.

And there are patients who reserve enormous willpower because they want not to get sick, but to live long and well, and get rid of all modifiable risk factors. In fact, we meet with them only to find out from each other how we are doing and have a cup of tea.

— So it’s not a myth that losing weight by 10 kilograms causes your blood pressure to drop by 10 units?

- Yes, my own practice shows that this is exactly what happens.

Of course, there will not be a clear relationship here: “10 kilograms lost is equivalent to 10 millimeters of mercury,” but losing weight does lead to lower blood pressure.

After all, adipose tissue is not just a cosmetic defect. It is hormonally active, produces a large number of different hormones, biologically active substances, which, among other things, trigger the processes of increasing blood pressure and carbohydrate metabolism disorders.

By the way, in men, potency may decrease due to excess body weight. Adipose tissue produces large amounts of estrogens - female sex hormones. Accordingly, testosterone levels decrease, which entails a decrease in libido and potency. We can say that men have an additional incentive to lose weight, because then everything becomes good for them in this important matter.

— You mentioned that arterial hypertension has a genetic basis. How much can heredity influence whether a person will have arterial hypertension or not if one of his parents had it?

— Yes, there is a risk of developing the disease. People who have relatives with arterial hypertension should be more careful. You need to periodically measure and monitor your blood pressure and follow the principles of a healthy life. When the first signs appear, contact a specialist.

But let’s still remember the health formula. In it, heredity takes up only 15 percent, but lifestyle makes up more than 50 percent.

Lifestyle refers not only to nutrition or physical activity, but also to stress. We observe that people whose work is associated with stress and emotional stress develop arterial hypertension more often.

Yes, in modern life it is absolutely impossible to get rid of stress. They accompany us everywhere: at work, sometimes, unfortunately, at home. In such cases, it is important to be able to deal with them. Someone may take up meditation or yoga, for others the fight against stress will be in the gym or swimming pool, for others, it may be that they need the help of psychologists or psychotherapists.

In addition, a person must have an adequate rest regime. If there is not enough sleep in his life, then, naturally, the body will not function normally the next day; the level of stress hormone will always be elevated, which will lead to the body working at the limit of adaptation. And if adaptation fails, then the development of a variety of diseases begins.

How to choose the right medications that will reduce blood pressure and keep it normal

— If a person’s blood pressure does not rise systematically, but from time to time, is this already a reason to worry?
- In any case, you need to contact a doctor who will prescribe additional examination methods. Because it may not be true arterial hypertension, but secondary, which developed against the background of another pathology. For example, in case of endocrine diseases, when there is excessive function of the thyroid gland, adrenal glands or pituitary gland. Sometimes this is how kidney disease manifests itself.

This is why you need to see a doctor. He will conduct an examination to rule out secondary hypertension. If the doctor is convinced that this is indeed the beginning of primary hypertension, at the initial stage he will select recommendations for correcting risk factors and lifestyle, teach you how to deal with high blood pressure and explain what medications to take.

— What examinations should a person undergo to understand what’s wrong with him?

— Talking about examinations and saying that you need to take such and such a hormonal panel and do such an ultrasound is not entirely correct. Recently, we have observed that people often engage in self-diagnosis and self-medication. Although first of all they should go to the doctor. Otherwise, this is a road to nowhere.

This is why doctors study at a medical university in order to draw certain conclusions during a conversation with a patient, during anamnesis collection and examination. If we undress a patient and see stretch marks on his body, certain changes and a certain type of fat deposition, this is already a reason to think: perhaps he has hormonal disorders, problems with the adrenal glands or pituitary gland. Only a doctor can prescribe the necessary examinations.

— When a person is diagnosed with arterial hypertension, what ways does he have to control it?

— In addition to general recommendations, the doctor selects individual drug therapy. It should reduce blood pressure to target normal values. Sometimes it is difficult for patients to understand that there is no unique pill that suits everyone.

Selecting a drug can sometimes take several months, so you may need a second visit to the doctor to understand whether the target blood pressure is maintained and whether there are any side effects. Sometimes the doctor changes the dosage, even the drug itself, and creates combinations. This is absolutely normal.

After all, the main goal is to select an individual scheme that will allow you to control blood pressure and protect target organs. The drugs that are used now have additional effects - to protect blood vessels and slow down their aging, to protect heart or brain cells.

The sooner a person applies, the fewer medications he will have to take. If the patient arrives in a “neglected” state, then it will no longer be possible to manage with one tablet.

— How does a doctor understand that the drug has been chosen correctly?

— When the pressure values ​​return to normal. And if the patient does not experience new unpleasant sensations from taking the drug.

There are indicators that we evaluate when we observe a patient for a long time. For example, in arterial hypertension, the heart is one of the target organs. If left uncontrolled (or improperly controlled), left ventricular hypertrophy occurs.

If the drug is chosen correctly, then this hypertrophy does not worsen, and further thickening of the heart wall does not occur, which is what we see during an ultrasound. In some cases, even a slight reverse process is observed. That is, the functioning of the heart improves. This has been proven, and we observe this in our practice.

What can happen if you don’t take prescribed medications and ignore your doctor’s recommendations?

— A person who considered an upper pressure of 160 to be “working” might feel uncomfortable the first time after starting to take medications?
— Yes, patients who have lived with high blood pressure for a long time, when prescribed medications and normalization, feel weak, sometimes a little dizzy. The body needs time to adapt to normal pressure. After about a week, these unpleasant sensations go away.

— If a patient is diagnosed with arterial hypertension, does this mean that he will now take medications for the rest of his life?

- Again, it all depends on the stage at which we “caught” the patient.

- But what if she’s not the first?

“Patients who have lost weight, modified their risk factors, and now do without medications and simply periodically monitor their blood pressure are rather exceptions to the rule.”

Most often, patients take medications for a long time. When they ask the question: “How long should I take the pills?”, it can be very difficult to explain that now they need to be taken for life.

In such cases, I argue that the person probably wants to live long and comfortably, and not suffer a stroke after some time. I think this is more than convincing. And most often it works.

— If medications are not taken, what can such a patient expect?

- Development of complications. Vision gradually deteriorates and chronic kidney disease may occur. As well as acute severe diseases such as stroke.

— What is the connection between arterial hypertension and stroke?

- The most direct one. Often the course of a hypertensive crisis is complicated by the development of either a transient temporary disorder of cerebral circulation, or a persistent disorder of cerebral circulation, in other words, a stroke.

— Can a hypertensive crisis lead to a heart attack?

“The connection here is a little different.

A heart attack develops against the background of vascular atherosclerosis. But sometimes, even against the background of a hypertensive crisis, when the patient’s blood pressure rises greatly, vasospasm occurs - and the heart begins to lack nutrition.

How to measure blood pressure correctly

— There is a strong belief that people with arterial hypertension should not drink coffee because it increases blood pressure.
Is this really true? Are there any products that can increase it? - Yes, there are some. Among them are caffeine, licorice, and certain herbs. But it all depends on the quantity. I do not forbid any of my patients with arterial hypertension from drinking coffee. Two cups a day has never caused a hypertensive crisis in anyone without the presence of much more serious factors.

And if coffee is a moment of relaxation and pleasure, then on the contrary it will be useful for a patient with arterial hypertension. Just let it be a weaker drink.

— Does a patient who follows all doctor’s prescriptions need to monitor his blood pressure every day?

— There are patients who feel the increase in pressure well. If they take medications and feel well, then measuring blood pressure every day is not necessary. But periodically, several times a week, it’s worth it.

For those patients who do not feel the increase in blood pressure well and may still have incomplete blood pressure correction, we recommend measuring it every day.

— Which tonometer is better to measure blood pressure: mechanical or automatic? Is there a difference?

— Measuring your own blood pressure with conventional mechanical tonometers is quite difficult. I am a doctor myself, and doing this to myself can be extremely inconvenient.

I assume that if the patient does this, then there may be errors and errors in the process. We would recommend that patients measure their blood pressure with an automatic device.

How to measure blood pressure correctly?

• In a sitting position, at least after a 5-minute rest, in a calm state. If before this you experienced some kind of emotional situation or worked physically, it is better to maintain a longer interval - 25-30 minutes.
• You need to sit up straight and not cross your legs. The arm should be extended. The cuff is placed at the level of the heart and two centimeters above the cubital fossa.
• You need to take at least two measurements with an interval of one to two minutes and display the average value.
• The measurement is carried out on the arm on which the pressure is higher.

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.

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.

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.

Table of differences between hypertension and 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.

Complications of arterial hypertension

Under conditions of constantly elevated blood pressure, the walls of blood vessels thicken and lose their ability to relax, which prevents normal blood supply and saturation of tissues and organs with oxygen and nutrients. Various serious complications arise, including the following:

• Hypertensive crisis;
• myocardial infarction;
• stroke;
• angina pectoris;
• heart failure;
• cardiac ischemia;
• chronic renal failure;
• retinopathy;
• atherosclerosis, etc.