Occurs in impressionable, emotional people.

The mechanism of origin and development of hypertension is quite complicated.

The main reason for the appearance of deviations are disorders that have arisen in the departments of the nervous and endocrine systems responsible for control.

As a rule, such manifestations are caused by a permanent one in which most modern people live. Staying in negatively affects the inhibitory and activating signals of the brain.

As a result, there is an increase in the activity of the sympathetic nervous system, which provokes vasospasm and associated negative changes, discomfort.

If left untreated, hypertension can worsen, gradually flowing into a chronic disease. If you start therapy when initial symptoms are detected, it is possible.

Disease classification

Hypertension is characterized by different conditions, accompanied by more or less severe symptoms.

Since the symptoms have different intensities, experts have identified separate stages and degrees of hypertension.

This made it possible to identify treatment options that effectively eliminate symptoms of varying intensity and maintain the patient's health in a satisfactory condition.

Today, medicine uses the generally accepted classification of hypertension, which clearly defines blood pressure thresholds and symptoms that allow you to quickly diagnose the severity of the disease and choose the right set of therapeutic measures.

Data on the stages and degrees of the disease are publicly available. But, even despite the availability of open data on the Web, you should not engage in self-diagnosis and self-treatment, since in such situations the probability of making an incorrect diagnosis is quite high.

In the case of hypertension, incorrectly taken measures can only aggravate the symptoms, provoke a further and more intensive development of the disease and lead to.

Today, when diagnosing and choosing therapeutic procedures that can improve the patient's condition, two options for systematizing symptoms are used.

The main classification of GB is due to the division of indicators into stages and degrees. Also in medical practice, separation according to is often used.

Classification of GB by stages

The stages of hypertension, a table with which was derived on the basis of data obtained in the course of research by the World Health Organization (WHO), is one of the basic sources of information that doctors use in the diagnostic process.

The classification is based mainly on symptoms, accompanied by certain sensations for each individual stage:

• 1 stage. This is characterized by an unstable, often slight increase in blood pressure. At the same time, dangerous or irreversible changes do not occur in the tissues of internal organs;
• 2 stage. This stage is characterized by a steady increase in blood pressure. At the second stage, changes are already taking place in the internal organs, but their functionality has not yet been affected. Possible simultaneous violations in the tissues of one or more organs: kidneys, heart, retina, pancreas and;
• 3 stage. There is a significant increase in pressure, accompanied by numerous severe symptoms and serious violations of the internal organs.

Possible consequences of stage 3 hypertension may include:

• retinal depletion;
• violation of blood circulation in the tissues of the brain;
• violation of the normal functioning of the kidneys and adrenal glands;
• atherosclerosis.

These effects can occur in combination or separately from each other. In any case, the classification of pathology by stages allows you to accurately determine the extent of the disease and correctly choose ways to deal with existing disorders.

Classification of arterial hypertension by degrees

In addition, modern medicine also uses another classification of hypertension. These are degrees based on the level of blood pressure.

This system was introduced in 1999, and since then it has been successfully used alone or in combination with other classifications to determine the extent of the disease and the correct choice of treatment methods.

So, the following degrees of arterial hypertension are distinguished:

• . Doctors also call this degree of GB “mild”. At this stage, the pressure does not exceed 140-159 / 90-99 mm Hg;
• . Blood pressure in moderate hypertension reaches 160-179 / 100-109 mm Hg, but does not exceed the specified limits;
• . This is a severe form of the disease in which blood pressure reaches and may even exceed the specified limits.

In the second and third degree of GB, 1,2,3 and 4 risk groups are distinguished.

As a rule, the disease begins with the slightest organ damage and over time, the risk group grows due to an increase in the number of pathological changes in the tissues of the organs.

In this classification, there are also such concepts as normal and high. In the first case, the blood pressure indicator is 120/80 mm Hg, and in the second case it is in the range of 130-139/82-89 mm Hg.

High normal pressure is not dangerous to health and life, therefore, in 50% of cases, correction of the patient's condition is not required.

Risks and Complications

In itself, an increase in pressure for the body does not pose any danger. Harm to health is caused by risks, which, depending on the severity, can lead to a variety of consequences. In total, doctors distinguish 4 risk groups.

To clarify, doctors make a conclusion as follows: hypertension grade 2, risk 3. In order to determine the risk group during the examination, doctors take into account many factors.

So, the following groups of risks are distinguished:

• 1 group (small). The degree of risk of negative effects on the heart and blood vessels is extremely small;
• group 2 (medium). The risk of complications is 15-20%. At the same time, health problems due to GB occur after about 10-15 years;
• 3 group (high). The chance of complications with such symptoms is 20-30%;
• 4 group (very high). This is the most dangerous group, the risk of complications in which is at least 30%.

The high-risk group includes patients over 55 years of age and those with a hereditary predisposition to hypertension.

As a rule, hypertension of groups 3 and 4 most often occurs in those who have bad habits and increased.

Symptoms

Symptoms of hypertension can be very different. But often at the initial stage, patients do not take into account the alarming “bells” that the body gives them.

Most often, such general manifestations as excessive sweating, weakness, distracted attention, and shortness of breath are perceived by the patient as beriberi or overwork, so there is no question of measuring blood pressure. In fact, these signs are evidence of the initial stage of hypertension.

If we consider the symptoms in more detail, all the signs can be divided into groups, according to the stages of development of the disease:

• 1 stage. At this stage, the patient has not yet experienced changes in tissues and organs. The first stage of hypertension is easily eliminated. The main thing is a timely appeal to the doctor and constant. These measures will slow down the development of the disease;
• 2 stage. In the second stage, the main load falls on one of. It may increase in size. Accordingly, the patient feels. At the same time, other organs do not bother him;
• 3 stage. This degree significantly expands the range of affected organs. For this reason, the occurrence of heart attacks, strokes, heart failure is possible. Also, in most cases, the development of renal failure and hemorrhage in the vessels of the eyeballs occurs.

Related videos

About how hypertension is classified in the video:

To minimize the consequences of hypertension and prevent irreversible consequences, it is recommended to seek medical help as soon as alarming symptoms are detected. Regular examinations and visits to specialists for preventive purposes are also possible.

The word "hypertension" means that the human body had to increase blood pressure for some reason. Depending on which can cause this condition, types of hypertension are distinguished, and each of them is treated in its own way.

Classification of arterial hypertension, taking into account only the cause of the disease:

1. Its cause cannot be identified by examining those organs whose disease requires the body to increase blood pressure. It is because of an unexplained reason that all over the world she is called essential or idiopathic(both terms are translated as "unclear reason"). Domestic medicine calls this type of chronic increase in blood pressure hypertension. Due to the fact that this disease will have to be reckoned with all life (even after the pressure returns to normal, certain rules will need to be followed so that it does not rise again), in popular circles it is called chronic hypertension, and it is she who is divided into degrees, stages and risks discussed below.
2. - one whose cause can be identified. She has her own classification - according to the factor that "activated" the mechanism of increasing blood pressure. We will talk about this a little lower.

Both primary and secondary hypertension are divided according to the type of increase in blood pressure. So, hypertension can be:

There is a classification according to the nature of the course of the disease. It divides both primary and secondary hypertension into:

According to another definition, malignant hypertension is an increase in pressure up to 220/130 mm Hg. Art. and more, when, at the same time, an ophthalmologist detects retinopathy of 3-4 degrees in the fundus (hemorrhages, retinal edema or optic nerve edema and vasoconstriction, and fibrinoid arteriolonecrosis is diagnosed by kidney biopsy.

Symptoms of malignant hypertension are headaches, "flies" before the eyes, pain in the heart, dizziness.

Before that, we wrote “upper”, “lower”, “systolic”, “diastolic” pressure, what does this mean?

Systolic (or “upper”) pressure is the force with which blood presses on the walls of large arterial vessels (that is where it is thrown out) during heart compression (systole). In fact, these arteries, 10-20 mm in diameter and 300 mm or more long, must “compress” the blood that is ejected into them.

Only systolic pressure rises in two cases:

• when the heart ejects a large amount of blood, which is typical for hyperthyroidism - a condition in which the thyroid gland produces an increased amount of hormones that cause the heart to contract strongly and frequently;
• when the elasticity of the aorta is reduced, which is observed in the elderly.

Diastolic (“lower”) is the pressure of the fluid on the walls of large arterial vessels, which occurs during the relaxation of the heart - diastole. In this phase of the cardiac cycle, the following happens: large arteries must transfer the blood that has entered them during systole into the arteries and arterioles of a smaller diameter. After that, the aorta and large arteries need to prevent overloading the heart: while the heart relaxes, taking blood from the veins, the large vessels must have time to relax in anticipation of its contraction.

The level of arterial diastolic pressure depends on:

1. The tone of such arterial vessels (according to Tkachenko B.I. " normal human physiology."- M, 2005), which are called vessels of resistance:
   • mainly those that have a diameter of less than 100 micrometers, arterioles - the last vessels before the capillaries (these are the smallest vessels from where substances penetrate directly into the tissues). They have a muscle layer of circular muscles, which are located between the various capillaries and are a kind of "tap". It depends on the switching of these “faucets” which part of the organ will now receive more blood (that is, nutrition), and which one will receive less;
   • to a small extent, the tone of medium and small arteries (“distribution vessels”), which carry blood to organs and are inside tissues, plays a role;
2. Heart rates: if the heart contracts too often, the vessels do not yet have time to deliver one portion of blood, as they receive the next one;
3. The amount of blood that is included in the circulation;
4. Blood viscosity.

Isolated diastolic hypertension is very rare, mainly in resistance vascular disease.

Most often, both systolic and diastolic pressure increase. It happens like this:

When the heart begins to work against increased pressure, pushing blood into vessels with a thickened muscle wall, its muscle layer also increases (this is a common property for all muscles). This is called hypertrophy, and it mostly affects the left ventricle of the heart because it communicates with the aorta. There is no concept of "left ventricular hypertension" in medicine.

Primary arterial hypertension

The official widespread version says that the causes of primary hypertension cannot be found out. But the physicist Fedorov V.A. and a group of doctors explained the increase in pressure by such factors:

Scrupulously studying the mechanisms of the body, Fedorov V.A. with doctors they saw that the vessels cannot feed every cell of the body - after all, not all cells are close to the capillaries. They realized that cell nutrition is possible thanks to microvibration - a wave-like contraction of muscle cells, which make up more than 60% of body weight. Such, described by academician Arinchin N.I., ensure the movement of substances and the cells themselves in the aqueous medium of the intercellular fluid, making it possible to provide nutrition, remove substances used in the process of vital activity, and carry out immune reactions. When microvibration in one or more areas becomes insufficient, a disease occurs.

In their work, the muscle cells that create microvibration use the electrolytes available in the body (substances that can conduct electrical impulses: sodium, calcium, potassium, some proteins and organic substances). The balance of these electrolytes is maintained by the kidneys, and when the kidneys become ill or the volume of working tissue in them decreases with age, microvibrations begin to be lacking. The body does its best to eliminate this problem by increasing blood pressure so that more blood flows to the kidneys, but the whole body suffers because of this.

Deficiency of microvibration can lead to the accumulation of damaged cells and decay products in the kidneys. If they are not removed from there for a long time, then they are transferred to the connective tissue, that is, the number of working cells decreases. Accordingly, the performance of the kidneys decreases, although their structure does not suffer.

The kidneys themselves do not have their own muscle fibers and receive microvibration from neighboring working muscles of the back and abdomen. Therefore, physical activity is necessary primarily to maintain the tone of the muscles of the back and abdomen, which is why correct posture is necessary even in a sitting position. According to Fedorov V.A., “constant tension of the back muscles with correct posture significantly increases the saturation of internal organs with microvibration: kidneys, liver, spleen, improving their work and increasing the resources of the body. This is a very important circumstance that increases the importance of posture. ("" - Vasiliev A.E., Kovelenov A.Yu., Kovlen D.V., Ryabchuk F.N., Fedorov V.A., 2004)

The way out of the situation can be the message of additional microvibration (optimally - in combination with thermal exposure) to the kidneys: their nutrition is normalized, and they return the electrolyte balance of the blood to the "initial settings". Hypertension is thus resolved. At its initial stage, such treatment is enough to naturally lower blood pressure, without taking additional medications. If a person’s disease has “gone far” (for example, it has a 2-3 degree and a risk of 3-4), then a person may not do without taking medications prescribed by a doctor. At the same time, the message of additional microvibration will help to reduce the doses of medications taken, and therefore, reduce their side effects.

• in 1998 - at the Military Medical Academy. S.M. Kirov, St. Petersburg (“ . »)
• in 1999 - on the basis of the Vladimir Regional Clinical Hospital (" " and " »);
• in 2003 - at the Military Medical Academy. CM. Kirov, St. Petersburg (" . »);
• in 2003 - on the basis of the State Medical Academy. I.I. Mechnikova, St. Petersburg (“ . »)
• in 2009 - in the boarding house for labor veterans No. 29 of the Department of Social Protection of the Population of Moscow, the Clinical Hospital of Moscow No. 83, the clinic of the Federal State Institution FBMC named after. Burnazyan FMBA of Russia ("" Dissertation of the candidate of medical sciences Svizhenko A. A., Moscow, 2009).

Types of secondary arterial hypertension

Secondary arterial hypertension is:

1. (caused by a disease of the nervous system). It is divided into:
   • centrogenous - it occurs due to violations of the work or structure of the brain;
   • reflexogenic (reflex): in a certain situation or with constant irritation of the organs of the peripheral nervous system.
2. (endocrine).
3. - occurring when organs such as the spinal cord or brain suffer from a lack of oxygen.
4. , it also has its division into:
   • renovascular, when the arteries that bring blood to the kidneys narrow;
   • renoparenchymal, associated with damage to the kidney tissue, because of which the body needs to increase pressure.
5. (due to diseases of the blood).
6. (due to a change in the "route" of blood movement).
7. (when it was caused by several reasons).

Let's talk a little more.

The main command to the large vessels, causing them to contract, increasing blood pressure, or relax, reducing it, comes from the vasomotor center, which is located in the brain. If its work is disturbed, centrogenous hypertension develops. This can happen due to:

1. Neuroses, that is, diseases when the structure of the brain does not suffer, but under the influence of stress, a focus of excitation is formed in the brain. It also activates the main structures that “turn on” the increase in pressure;
2. Brain damage: injuries (concussions, bruises), brain tumors, stroke, inflammation of a part of the brain (encephalitis). To increase blood pressure should be:

• or structures that directly affect blood pressure are damaged (the vasomotor center in the medulla oblongata or the nuclei of the hypothalamus associated with it or the reticular formation);
• or extensive brain damage occurs with an increase in intracranial pressure, when in order to ensure the blood supply to this vital organ, the body will need to increase blood pressure.

Reflex hypertension also belongs to neurogenic ones. They can be:

• conditioned reflex, when at first there is a combination of some event with taking a medicine or a drink that increases blood pressure (for example, if a person drinks strong coffee before an important meeting). After many repetitions, the pressure begins to rise only at the very thought of a meeting, without drinking coffee;
• unconditional reflex, when the pressure rises after the cessation of constant impulses from inflamed or strangulated nerves that go to the brain for a long time (for example, if a tumor that pressed on the sciatic or any other nerve was removed).

Endocrine (hormonal) hypertension

These are such secondary hypertension, the causes of which are diseases of the endocrine system. They are divided into several types.

Adrenal hypertension

In these glands, lying above the kidneys, a large number of hormones are produced that can affect vascular tone, strength or frequency of heart contractions. An increase in pressure can be caused by:

1. Excessive production of adrenaline and norepinephrine, which is typical for a tumor such as pheochromocytoma. Both of these hormones simultaneously increase the strength and frequency of heart contractions, increase vascular tone;
2. A large amount of the hormone aldosterone, which does not release sodium from the body. This element, appearing in the blood in large quantities, "attracts" water from the tissues to itself. Accordingly, the amount of blood increases. This happens with a tumor that produces it - malignant or benign, with non-tumor growth of the tissue that produces aldosterone, as well as with stimulation of the adrenal glands in severe diseases of the heart, kidneys, liver.
3. Increased production of glucocorticoids (cortisone, cortisol, corticosterone), which increase the number of receptors (that is, special molecules on the cell that act as a “lock” that can be opened with a “key”) to adrenaline and norepinephrine (they will be the necessary “key” for “ castle") in the heart and blood vessels. They also stimulate the liver to produce the hormone angiotensinogen, which plays a key role in the development of hypertension. An increase in the amount of glucocorticoids is called Itsenko-Cushing's syndrome and disease (a disease when the pituitary gland commands the adrenal glands to produce a large amount of hormones, a syndrome when the adrenal glands are affected).

Hyperthyroid hypertension

It is associated with excessive production by the thyroid gland of its hormones - thyroxine and triiodothyronine. This leads to an increase in the heart rate and the amount of blood ejected by the heart in one contraction.

The production of thyroid hormones can increase with such autoimmune diseases as Graves' disease and Hashimoto's thyroiditis, with inflammation of the gland (subacute thyroiditis), and some of its tumors.

Excessive secretion of antidiuretic hormone by the hypothalamus

This hormone is produced in the hypothalamus. Its second name is vasopressin (translated from Latin means “compressing the vessels”), and it acts in this way: by binding to receptors on the vessels inside the kidney, it causes their narrowing, as a result of which less urine is produced. Accordingly, the volume of fluid in the vessels increases. More blood flows to the heart - it stretches more. This leads to an increase in blood pressure.

Hypertension can also be caused by an increase in the production in the body of active substances that increase vascular tone (these are angiotensins, serotonin, endothelin, cyclic adenosine monophosphate) or a decrease in the amount of active substances that should dilate blood vessels (adenosine, gamma-aminobutyric acid, nitric oxide, some prostaglandins).

The extinction of the function of the gonads is often accompanied by a constant increase in blood pressure. The age of entry into menopause for each woman is different (it depends on genetic characteristics, living conditions and body condition), but German doctors have proven that age over 38 years is dangerous for the development of arterial hypertension. It is after 38 years that the number of follicles (from which eggs are formed) begins to decrease not by 1-2 every month, but by dozens. A decrease in the number of follicles leads to a decrease in the production of hormones by the ovaries, as a result, vegetative (sweating, paroxysmal sensation of heat in the upper body) and vascular (reddening of the upper half of the body during an attack of heat, increased blood pressure) disorders develop.

Hypoxic hypertension

They develop when there is a violation of blood delivery to the medulla oblongata, where the vasomotor center is located. This is possible with atherosclerosis or thrombosis of the vessels that carry blood to it, as well as with squeezing of the vessels due to edema and hernias.

Renal hypertension

As already mentioned, there are 2 types:

Vasorenal (or renovascular) hypertension

It is caused by a deterioration in the blood supply to the kidneys due to the narrowing of the arteries supplying the kidneys. They suffer from the formation of atherosclerotic plaques in them, an increase in the muscle layer in them due to a hereditary disease - fibromuscular dysplasia, aneurysm or thrombosis of these arteries, aneurysm of the renal veins.

The basis of the disease is the activation of the hormonal system, due to which the vessels spasm (shrink), sodium is retained and fluid in the blood increases, and the sympathetic nervous system is stimulated. The sympathetic nervous system, through its special cells located on the vessels, activates their even greater compression, which leads to an increase in blood pressure.

Renoparenchymal hypertension

It accounts for only 2-5% of cases of hypertension. It occurs due to diseases such as:

• glomerulonephritis;
• kidney damage in diabetes;
• one or more cysts in the kidneys;
• kidney injury;
• kidney tuberculosis;
• kidney tumor.

With any of these diseases, the number of nephrons (the main working units of the kidneys through which blood is filtered) decreases. The body tries to correct the situation by increasing the pressure in the arteries that carry blood to the kidneys (the kidneys are an organ for which blood pressure is very important, at low pressure they stop working).

Medicinal hypertension

The following drugs can cause an increase in pressure:

• vasoconstrictor drops used for the common cold;
• tableted contraceptives;
• antidepressants;
• painkillers;
• preparations based on glucocorticoid hormones.

Hemic hypertension

Due to an increase in blood viscosity (for example, with Wakez disease, when the number of all its cells in the blood increases) or an increase in blood volume, blood pressure may increase.

Hemodynamic hypertension

This is the name of hypertension, which is based on a change in hemodynamics - that is, the movement of blood through the vessels, usually as a result of diseases of large vessels.

The main disease causing hemodynamic hypertension is coarctation of the aorta. This is a congenital narrowing of the aorta in its thoracic (located in the chest cavity) section. As a result, in order to ensure normal blood supply to the vital organs of the chest cavity and the cranial cavity, blood must reach them through rather narrow vessels that are not designed for such a load. If the blood flow is large, and the diameter of the vessels is small, the pressure in them will increase, which happens with coarctation of the aorta in the upper half of the body.

The body needs the lower limbs less than the organs of these cavities, so the blood already reaches them “not under pressure”. Therefore, the legs of such a person are pale, cold, thin (muscles are poorly developed due to insufficient nutrition), and the upper half of the body has an "athletic" appearance.

Alcoholic hypertension

How ethyl alcohol-based drinks cause an increase in blood pressure is still unclear to scientists, but 5-25% of people who drink alcohol constantly increase blood pressure. There are theories suggesting that ethanol may affect:

• through increased activity of the sympathetic nervous system, which is responsible for vasoconstriction, increased heart rate;
• by increasing the production of glucocorticoid hormones;
• due to the fact that muscle cells more actively capture calcium from the blood, and therefore are in a state of constant tension.

Mixed hypertension

When any provoking factors are combined (for example, kidney disease and taking painkillers), they are added (summation).

Certain types of hypertension that are not included in the classification

There is no official concept of "juvenile hypertension". The increase in blood pressure in children and adolescents is mainly secondary. The most common causes of this condition are:

• Congenital malformations of the kidneys.
• Congenital narrowing of the renal arteries.
• Pyelonephritis.
• Glomerulonephritis.
• Cyst or polycystic kidney disease.
• Tuberculosis of the kidneys.
• Kidney injury.
• Coarctation of the aorta.
• Essential hypertension.
• Wilms tumor (nephroblastoma) is an extremely malignant tumor that develops from the tissues of the kidneys.
• Damage to either the pituitary gland or the adrenal glands, resulting in a lot of glucocorticoid hormones in the body (syndrome and Itsenko-Cushing's disease).
• Thrombosis of the arteries or veins of the kidneys
• Narrowing of the diameter (stenosis) of the renal arteries due to a congenital increase in the thickness of the muscular layer of the vessels.
• Congenital disorder of the adrenal cortex, hypertensive form of this disease.
• Bronchopulmonary dysplasia - damage to the bronchi and lungs by air blown in by a ventilator, which was connected in order to resuscitate a newborn.
• Pheochromocytoma.
• Takayasu's disease is a lesion of the aorta and large branches extending from it due to an attack on the walls of these vessels by its own immunity.
• Periarteritis nodosa - inflammation of the walls of small and medium-sized arteries, resulting in the formation of saccular protrusions - aneurysms.

Pulmonary hypertension is not a type of arterial hypertension. This is a life-threatening condition in which pressure in the pulmonary artery rises. This is the name of 2 vessels into which the pulmonary trunk is divided (a vessel emanating from the right ventricle of the heart). The right pulmonary artery carries oxygen-depleted blood to the right lung, the left to the left.

Pulmonary hypertension develops most often in women aged 30-40 years and, gradually progressing, is a life-threatening condition, leading to disruption of the right ventricle and premature death. It occurs due to hereditary causes, and due to diseases of the connective tissue, and heart defects. In some cases, its cause cannot be found. Manifested by shortness of breath, fainting, fatigue, dry cough. In severe stages, the heart rhythm is disturbed, hemoptysis appears.

Stages, grades and risk factors

In order to find treatment for people suffering from hypertension, doctors have come up with a classification of hypertension by stages and degrees. We will present it in the form of tables.

Stages of hypertension

The stages of hypertension indicate how much the internal organs have suffered from constantly elevated pressure:

	Damage to target organs, which include the heart, blood vessels, kidneys, brain, retina
	The heart, blood vessels, kidneys, eyes, brain still do not suffer
	According to the ultrasound of the heart, either the relaxation of the heart is disturbed, or the left atrium is enlarged, or the left ventricle is narrower; the kidneys work worse, which is noticeable so far only by urinalysis and blood creatinine (an analysis for kidney slags is called "blood creatinine"); vision has not yet become worse, but when examining the fundus, the oculist already sees a narrowing of the arterial vessels and an expansion of the venous vessels.
	One of the complications of hypertension has developed: heart failure, manifested by either shortness of breath, or edema (in the legs or all over the body), or both of these symptoms; coronary heart disease: or angina pectoris, or myocardial infarction; severe damage to the vessels of the retina, due to which vision suffers.

Blood pressure numbers at any stage are above 140/90 mm Hg. Art.

Treatment of the initial stage of hypertension is mainly aimed at changing lifestyle:, inclusion in the daily regimen of mandatory,. Whereas stage 2 and 3 hypertension should already be treated with the use of. Their dose and, accordingly, side effects can be reduced if you help the body restore blood pressure in a natural way, for example, by giving it additional help.

Degrees of hypertension

The degrees of development of hypertension indicate how high blood pressure is:

The degree is established without taking pressure-reducing drugs. To do this, in a person who is forced to take drugs that reduce pressure, it is necessary to reduce their dose or completely cancel them.

The degree of hypertension is judged by the figure of that pressure ("upper" or "lower"), which is greater.

Sometimes 4 degrees of hypertension are isolated. It is treated as isolated systolic hypertension. In any case, this refers to the state when only the upper pressure is increased (above 140 mm Hg), while the lower one is within the normal range - up to 90 mm Hg. This condition is most often recorded in the elderly (associated with a decrease in the elasticity of the aorta). Occurring in young people, isolated systolic hypertension indicates that it is necessary to examine the thyroid gland: this is how hyperthyroidism “behaves” (an increase in the amount of thyroid hormones produced).

Definition of risk

There is also a classification by risk groups. The higher the number after the word “risk”, the higher the likelihood that a dangerous disease will develop in the coming years.

There are 4 levels of risk:

1. At risk 1 (low), the probability of developing a stroke or heart attack in the next 10 years is less than 15%;
2. At risk 2 (medium), this probability in the next 10 years is 15-20%;
3. At risk 3 (high) - 20-30%;
4. At risk 4 (very high) - more than 30%.

risk factor	Criterion
Arterial hypertension	Systolic pressure >140 mm Hg. and/or diastolic pressure > 90 mm Hg. Art.
	More than 1 cigarette per week
Violation of fat metabolism (according to the analysis of "Lipidogram")	total cholesterol ≥ 5.2 mmol/l or 200 mg/dl; low-density lipoprotein cholesterol (LDL cholesterol) ≥ 3.36 mmol / l or 130 mg / dl; high density lipoprotein cholesterol (HDL cholesterol) less than 1.03 mmol/l or 40 mg/dl; triglycerides (TG) > 1.7 mmol/L or 150 mg/dL
Increased fasting glucose (blood sugar test)	Fasting plasma glucose 5.6-6.9 mmol/L or 100-125 mg/dL Glucose 2 hours after ingestion of 75 grams of glucose - less than 7.8 mmol/L or less than 140 mg/dL
Low tolerance (digestibility) of glucose	Fasting plasma glucose less than 7 mmol/L or 126 mg/dL 2 hours after ingestion of 75 grams of glucose more than 7.8 but less than 11.1 mmol / l (≥140 and<200 мг/дл)
Cardiovascular disease in next of kin	They are taken into account in men under 55 years of age and women under 65 years of age.
Obesity (it is estimated by the Quetelet index, I I=body weight/height in meters* height in meters. Norm I = 18.5-24.99; Preobesity I = 25-30)	Obesity of the I degree, where the Quetelet index is 30-35; II degree 35-40; III degree 40 or more.

To assess risk, target organ damage is also assessed, which is either present or absent. Target organ damage is assessed by:

• hypertrophy (enlargement) of the left ventricle. It is assessed by electrocardiogram (ECG) and ultrasound of the heart;
• kidney damage: for this, the presence of protein in the general urine test (normally it should not be), as well as blood creatinine (normally it should be less than 110 µmol / l) is assessed.

The third criterion that is evaluated to determine the risk factor is comorbidities:

1. Diabetes mellitus: it is established if fasting plasma glucose is more than 7 mmol / l (126 mg / dl), and 2 hours after ingestion of 75 g of glucose - more than 11.1 mmol / l (200 mg / dl);
2. metabolic syndrome. This diagnosis is established if there are at least 3 of the following criteria, and body weight is necessarily considered one of them:

• HDL cholesterol less than 1.03 mmol/l (or less than 40 mg/dl);
• systolic blood pressure more than 130 mm Hg. Art. and/or diastolic pressure greater than or equal to 85 mm Hg. Art.;
• glucose over 5.6 mmol/l (100 mg/dl);
• waist circumference for men is more than or equal to 94 cm, for women - more than or equal to 80 cm.

Setting the degree of risk:

Degree of risk	Criteria for making a diagnosis
	These are men and women under 55 years of age who, apart from high blood pressure, have no other risk factors, no target organ damage, or concomitant diseases.
	Men over 55, women over 65. There are 1-2 risk factors (including arterial hypertension). No target organ damage
	3 or more risk factors, target organ damage (left ventricular hypertrophy, kidney or retinal damage), or diabetes mellitus, or ultrasonography found atherosclerotic plaques in any arteries
	Have diabetes mellitus, angina, or metabolic syndrome. It was one of the following: angina; had a myocardial infarction; suffered a stroke or microstroke (when a blood clot blocked the artery of the brain temporarily, and then dissolved or was excreted by the body); heart failure; chronic renal failure; peripheral vascular disease; the retina is damaged; an operation was performed that allowed the circulation of the heart to be restored

There is no direct relationship between the degree of pressure increase and the risk group, but at a high stage, the risk will also be high. For example, it could be hypertension 1st stage 2nd degree risk 3(that is, there is no damage to target organs, pressure is 160-179 / 100-109 mm Hg, but the probability of heart attack / stroke is 20-30%), and this risk can be both 1 and 2. But if stage 2 or 3, then the risk cannot be lower than 2.

Examples and interpretation of diagnoses - what do they mean?

What it is - hypertension stage 2 stage 2 risk 3?:

• blood pressure 160-179 / 100-109 mm Hg. Art.
• there are problems with the heart, determined by ultrasound of the heart, or there is a violation of the kidneys (according to analyzes), or there is a violation in the fundus, but there is no visual impairment;
• there may be either diabetes mellitus, or atherosclerotic plaques are found in some vessel;
• in 20-30% of cases, either a stroke or a heart attack will develop in the next 10 years.

3 stages 2 degree risk 3? Here, in addition to the parameters indicated above, there are also complications of hypertension: angina pectoris, myocardial infarction, chronic heart or kidney failure, retinal vascular damage.

Hypertonic disease 3 degrees 3 stages risk 3- everything is the same as for the previous case, only the blood pressure numbers are more than 180/110 mm Hg. Art.

What is hypertension 2 stages 2 degree risk 4? Blood pressure 160-179/100-109 mm Hg. Art., target organs are affected, there is diabetes mellitus or metabolic syndrome.

It even happens when 1st degree hypertension, when the pressure is 140-159 / 85-99 mm Hg. Art., already available 3 stage, that is, life-threatening complications (angina pectoris, myocardial infarction, heart or kidney failure) developed, which, together with diabetes mellitus or metabolic syndrome, caused risk 4.

It does not depend on how much the pressure rises (the degree of hypertension), but on what complications the constantly elevated pressure caused:

Stage 1 hypertension

In this case, there are no lesions of target organs, therefore, disability is not given. But the cardiologist gives recommendations to the person, which he must take to the workplace, where it is written that he has certain limitations:

• heavy physical and emotional stress is contraindicated;
• cannot work on the night shift;
• work in conditions of intense noise, vibration is prohibited;
• it is impossible to work at height, especially when a person serves electrical networks or electrical units;
• it is impossible to perform those types of work in which a sudden loss of consciousness can create an emergency (for example, public transport drivers, crane operators);
• prohibited those types of work in which there is a change in temperature regimes (bath attendants, physiotherapists).

Stage 2 hypertension

In this case, target organ damage is implied, which worsens the quality of life. Therefore, at the VTEK (MSEC) - a medical labor or medical and sanitary expert commission - he is given a III group of disability. At the same time, those restrictions that are indicated for stage 1 of hypertension remain. The working day for such a person can be no more than 7 hours.

To qualify for a disability, you must:

• submit an application addressed to the chief physician of the medical institution where MSEC is carried out;
• get a referral to a commission at a polyclinic at the place of residence;
• validate the group annually.

Stage 3 hypertension

Diagnosis of hypertension 3 stages no matter how high the pressure is 2 degrees or more, implies damage to the brain, heart, eyes, kidneys (especially if there is a combination with diabetes mellitus or metabolic syndrome, which makes it risk 4), which significantly limits the ability to work. Because of this, a person can receive II or even I group of disability.

Consider the "relationship" of hypertension and the army, regulated by Decree of the Government of the Russian Federation of 07/04/2013 N 565 "On approval of the Regulations on military medical expertise", Article 43:

Do they take to the army with hypertension if the increase in pressure is associated with disorders of the autonomic (which controls the internal organs) nervous system: sweating of the hands, variability in pulse and pressure when changing body position)? In this case, a medical examination is carried out under article 47, on the basis of which either category “C” or “B” is set (“B” - fit with minor restrictions).

If, in addition to hypertension, the conscript has other diseases, they will be examined separately.

Can hypertension be completely cured? This is possible if eliminated - those that are detailed above. To do this, you need to carefully examine, if one doctor did not help to find the cause - consult with him, which narrow specialist should still go to. Indeed, in some cases, it is possible to remove the tumor or expand the diameter of the vessels with a stent - and get rid of painful attacks forever, and reduce the risk of life-threatening diseases (heart attack, stroke).

Do not forget: a number of causes of hypertension can be eliminated by giving the body an additional message. This is called, and helps to speed up the removal of damaged and used cells. In addition, it resumes immune responses and helps to carry out reactions at the tissue level (it will act like a massage at the cellular level, improving the connection between the necessary substances). As a result, the body will not need to increase the pressure.

The phonation procedure with the help can be performed while sitting comfortably on the bed. The devices do not take up much space, are easy to use, and their cost is quite affordable for the general population. Its use is cost-effective: in this way you make a one-time purchase, instead of a permanent purchase of medicines, and, in addition, the device can treat not only hypertension, but also other diseases, and can be used by all family members). Phonation is also useful after the elimination of hypertension: the procedure will increase the tone and resources of the body. With the help you can carry out a general recovery.

The effectiveness of the use of devices is confirmed.

For the treatment of stage 1 hypertension, such exposure may be quite enough, but when a complication has already developed, or hypertension is accompanied by diabetes mellitus or metabolic syndrome, therapy should be agreed with a cardiologist.

Bibliography

1. Guide to cardiology: Textbook in 3 volumes / Ed. G.I. Storozhakova, A.A. Gorbachenkov. - 2008 - Vol. 1. - 672 p.
2. Internal diseases in 2 volumes: textbook / Ed. ON THE. Mukhina, V.S. Moiseeva, A.I. Martynov - 2010 - 1264 p.
3. Aleksandrov A.A., Kislyak O.A., Leontieva I.V. Diagnosis, treatment and prevention of arterial hypertension in children and adolescents. - K., 2008 - 37 p.
4. Tkachenko B.I. normal human physiology. - M, 2005
5. . Military Medical Academy. CM. Kirov, St. Petersburg. 1998
6. P. A. Novoselsky, V. V. Chepenko (Vladimir Regional Hospital).
7. P. A. Novoselsky (Vladimir Regional Hospital).
8. . Military Medical Academy. CM. Kirov, St. Petersburg, 2003
9. . State Medical Academy. I.I. Mechnikov, St. Petersburg. 2003
10. Dissertation of the candidate of medical sciences Svizhenko A.A., Moscow, 2009
11. Order of the Ministry of Labor and Social Protection of the Russian Federation of December 17, 2015 No. 1024n.
12. Decree of the Government of the Russian Federation of 04.07.2013 No. 565 “On Approval of the Regulations on Military Medical Expertise”.
13. Wikipedia.

You can ask questions (below) on the topic of the article and we will try to answer them competently!

Hypertension is a pathology of the cardiovascular system, in which persistent high blood pressure is noted, which leads to dysfunctions of the corresponding target organs: heart, lungs, brain, nervous system, kidneys.

Hypertensive disease (AH) or arterial hypertension develops as a result of a malfunction in the work of higher centers that regulate the functions of the vascular system, neurohumoral and renal mechanisms.

The main clinical signs of GB:

• Dizziness, ringing and noise in the ears;
• Headache;
• Shortness of breath, a state of suffocation;
• Darkening and "stars" before the eyes;
• Pain in the chest, in the region of the heart.

There are different stages of hypertension. Determination of the degree of hypertension is carried out using the following methods and studies:

1. Biochemical blood test and urinalysis.
2. Ultrasound of the arteries of the kidneys and neck.
3. Electrocardiogram of the heart.
4. EchoCG.
5. Blood pressure monitoring.

Taking into account the risk factors and the degree of damage to target organs, a diagnosis is made and treatment is prescribed using medications and other methods.

Hypertension - definition and description

The main clinical signs of hypertension are sharp and persistent jumps in blood pressure, while blood pressure is consistently high, even if there is no physical activity and the patient's emotional state is normal. The pressure decreases only after the patient takes antihypertensive drugs.

• Systolic (upper) pressure - not higher than 140 mm. rt. Art.;
• Diastolic (lower) pressure - no higher than 90 mm. rt. Art.

If, during two medical examinations on different days, the pressure was higher than the established norm, arterial hypertension is diagnosed and adequate treatment is selected. GB develops in both men and women with approximately the same frequency, mainly after the age of 40 years. But there are clinical signs of GB in young people.

Arterial hypertension is often accompanied by atherosclerosis. One pathology complicates the course of another. Diseases that occur against the background of hypertension are called associated or concomitant. It is the combination of atherosclerosis and hypertension that causes death among the young, able-bodied population.

According to the mechanism of development, according to WHO, I distinguish primary or essential hypertension, and secondary or symptomatic. The secondary form occurs only in 10% of cases of diseases. The diagnosis of essential arterial hypertension is much more common. As a rule, secondary hypertension is a consequence of such diseases:

1. Various kidney pathologies, renal artery stenosis, pyelonephritis, hydronephrosis tuberculosis.
2. Thyroid dysfunction - thyrotoxicosis.
3. Disorders of the adrenal glands - Itsenko-Cushing's syndrome, pheochromocytoma.
4. Atherosclerosis of the aorta and coarctation.

Primary hypertension develops as an independent disease associated with impaired regulation of blood circulation in the body.

In addition, hypertension can be benign - that is, flowing slowly, with a slight deterioration in the patient's condition over a long period of time, the pressure can remain normal and increase only occasionally. It will be important to maintain pressure and maintain proper nutrition for hypertension.

Or malignant, when the pathology develops rapidly, the pressure rises sharply and remains at the same level, it is possible to improve the patient's condition only with the help of medications.

The pathogenesis of hypertension

An increase in pressure, which is the main cause and sign of hypertension, occurs due to an increase in cardiac output of blood into the vascular bed and an increase in peripheral vascular resistance. Why is this happening?

There are certain stress factors that affect the higher centers of the brain - the hypothalamus and the medulla oblongata. As a result, there are violations of the tone of peripheral vessels, there is a spasm of arterioles in the periphery - including the kidney ones.

Dyskinetic and dyscirculatory syndrome develops, the production of Aldosterone increases - this is a neurohormone that participates in water-mineral metabolism and retains water and sodium in the vascular bed. Thus, the volume of blood circulating in the vessels increases even more, which contributes to an additional increase in pressure and swelling of the internal organs.

All these factors also affect blood viscosity. It becomes thicker, the nutrition of tissues and organs is disturbed. At the same time, the walls of the vessels become denser, the lumen becomes narrower - the risk of developing irreversible hypertension increases significantly, despite treatment. Over time, this leads to ellastofibrosis and arteriolosclerosis, which in turn provokes secondary changes in target organs.

The patient develops myocardial sclerosis, hypertensive encephalopathy, primary nephroangiosclerosis.

Classification of hypertension by stage

There are three stages of hypertension. It is this classification, according to WHO, that is considered traditional and was used until 1999. It is based on the degree of damage to target organs, which, as a rule, if treatment is not carried out and the doctor's recommendations are not followed, becomes more and more.

At stage I of hypertension, signs and manifestations are practically absent, therefore such a diagnosis is made very rarely. No target organ damage was noted.

At this stage of hypertension, the patient very rarely goes to the doctor, since there is no sharp deterioration in the condition, only occasionally the blood pressure "rolls over". However, if you do not consult a doctor and start treatment at this stage of hypertension, there is a risk of rapid progression of the disease.

II stage of hypertension is characterized by a steady increase in pressure. There are violations of the heart and other target organs: the left ventricle becomes larger and thicker, sometimes there are lesions of the retina. Treatment at this stage is almost always successful with the cooperation of the patient and the physician.

In stage III hypertension, all target organs are affected. The pressure is consistently high, the risk of myocardial infarction, stroke, coronary heart disease is very high. If such a diagnosis is made, then, as a rule, angina pectoris, renal failure, aneurysm, hemorrhages in the fundus are already noted in the anamnesis.

The risk of a sudden deterioration in the patient's condition is increased if the treatment is not carried out properly, the patient has stopped taking medication, abuses alcohol and cigarettes, or experiences psycho-emotional stress. In this case, a hypertensive crisis may develop.

Classification of arterial hypertension by degree

Such a classification is currently considered more relevant and appropriate than by stage. The main indicator is the patient's pressure, its level and stability.

1. Optimal - 120/80 mm. rt. Art. or below.
2. Normal - it is permissible to add no more than 10 units to the upper indicator, and no more than 5 units to the lower one.
3. Close to normal - indicators range from 130 to 140 mm. rt. Art. and from 85 to 90 mm. rt. Art.
4. Hypertension I degree - 140-159 / 90-99 mm. rt. Art.
5. Hypertension II degree - 160-179 / 100-109 mm. rt. Art.
6. Hypertension III degree - 180/110 mm. rt. Art. and higher.

Hypertension of the III degree, as a rule, is accompanied by lesions of other organs, such indicators are characteristic of a hypertensive crisis and require hospitalization of the patient in order to carry out emergency treatment.

Risk stratification in arterial hypertension

There are risk factors that can lead to an increase in blood pressure and the development of pathology. The main ones are:

1. Age indicators: for men it is over 55 years old, for women - 65 years old.
2. Dyslipidemia is a condition in which the lipid spectrum of the blood is disturbed.
3. Diabetes.
4. Obesity.
5. Bad habits.
6. hereditary predisposition.

Risk factors are always taken into account by the doctor when examining a patient in order to make a correct diagnosis. It is noted that most often the cause of blood pressure surges is nervous overexertion, increased intellectual work, especially at night, and chronic overwork. This is the main negative factor according to WHO.

The second place is occupied by the abuse of salt. WHO notes - if you consume more than 5 grams daily. salt, the risk of developing arterial hypertension increases several times. The degree of risk increases if there are relatives in the family who suffer from high blood pressure.

If more than two close relatives are treated for hypertension, the risk becomes even higher, which means that the potential patient must strictly follow all the doctor's recommendations, avoid worries, give up bad habits and follow the diet.

Other risk factors, according to WHO, are:

• Chronic diseases of the thyroid gland;
• Atherosclerosis;
• Infectious diseases of a chronic course - for example, tonsillitis;
• menopause in women;
• Pathology of the kidneys and adrenal glands.

Comparing the factors listed above, the patient's pressure indicators and their stability, the risk of developing such a pathology as arterial hypertension is stratified. If 1-2 adverse factors are identified in first-degree hypertension, then the risk is 1, according to the WHO recommendation.

If the adverse factors are the same, but hypertension is already of the second degree, then the risk becomes moderate from low and is designated as risk 2. Further, according to the WHO recommendation, if third-degree hypertension is diagnosed and 2-3 adverse factors are noted, risk 3 is established. Risk 4 implies a diagnosis of third-degree hypertension and the presence of more than three adverse factors.

Complications and risks of hypertension

The main danger of the disease is in the serious complications on the heart that it gives. For hypertension, combined with severe lesions of the heart muscle and left ventricle, there is a WHO definition - decapitated hypertension. The treatment is complex and lengthy, decapitated hypertension is always difficult, with frequent attacks, with this form of the disease, irreversible changes in blood vessels have already occurred.

By ignoring pressure surges, patients put themselves at risk of developing such pathologies:

• angina;
• myocardial infarction;
• Ischemic stroke;
• hemorrhagic stroke;
• Pulmonary edema;
• Dissecting aortic aneurysm;
• Detachment of the retina;
• Uremia.

If a hypertensive crisis occurs, the patient needs urgent help, otherwise he may die - according to WHO, it is this condition in hypertension that in most cases leads to death. The degree of risk is especially high for those people who live alone, and in the event of an attack, there is no one next to them.

It should be noted that it is impossible to completely cure arterial hypertension. If, with hypertension of the first degree, at the very initial stage, you begin to strictly control pressure and adjust your lifestyle, you can prevent the development of the disease and stop it.

But in other cases, especially if associated pathologies have joined hypertension, full recovery is no longer possible. This does not mean that the patient should give up on himself and abandon the treatment. The main measures are aimed at preventing sharp jumps in blood pressure and the development of a hypertensive crisis.

For citation: Preobrazhensky D.V. NEW APPROACHES TO THE TREATMENT OF ARTERIAL HYPERTENSION // BC. 1999. No. 9. S. 2

Since 1959, experts from the World Health Organization (WHO) have been publishing recommendations for the diagnosis, classification and treatment of arterial hypertension, based on the results of epidemiological and clinical studies. Since 1993, such recommendations have been prepared by WHO experts in collaboration with the International Society of Hypertension. In the Japanese city of Fukuoka, from September 29 to October 1, 1998, the 7th meeting of experts from WHO and the International Society on Hypertension (ISH) was held, at which new recommendations for the treatment of arterial hypertension were approved. These guidelines were published in February 1999 (1999 WHO-ISH guidelines for the management of hypertension). Below we provide a summary of their main provisions.

FROM 1959 World Health Organization (WHO) experts publish recommendations for the diagnosis, classification and treatment of arterial hypertension based on the results of epidemiological and clinical studies. Since 1993, such recommendations have been prepared by WHO experts in collaboration with the International Society for Hypertension (Intern a National Society of Hypertension). In the Japanese city of Fukuoka, from September 29 to October 1, 1998, the 7th meeting of experts from WHO and the International Society on Hypertension (ISH) was held, at which new recommendations for the treatment of arterial hypertension were approved. These guidelines were published in February 1999 (1999 WHO-ISH guidelines for the management of hypertension). Below we provide a summary of their main provisions.

Definition and classification of arterial hypertension

In the 1999 WHO-IOH recommendations, arterial hypertension refers to a systolic blood pressure (BP) level of 140 mm Hg. Art. or more, and (or) the level of diastolic blood pressure equal to 90 mm Hg. Art. or more in people who are not receiving antihypertensive drugs. Given the significant spontaneous fluctuations in blood pressure, the diagnosis of hypertension should be based on the results of multiple blood pressure measurements during several visits to the doctor.
Table 1. Classification of blood pressure

BP class*	BP, mmHg Art.
	systolic	diastolic
Optimal blood pressure	< 120	< 80
Normal BP	< 130	< 85
Elevated normal BP	130-139	85-89
Arterial hypertension
1st degree ("soft")	140-159	90-99
Subgroup: borderline	140-149	90-94
2nd degree ("moderate")	160-179	100-109
3rd degree ("severe")	i 180	i 110
isolated c stolic hypertension	i 140	< 90
Subgroup: borderline	140-149	< 90
* If the systolic and diastolic blood pressure values ​​are in different classes, the patient's blood pressure level is assigned to a higher class.

Depending on the level of systolic and diastolic blood pressure, there are three degrees of arterial hypertension ( ). In the 1999 WHO-ISH classification, grades 1, 2, and 3 of arterial hypertension correspond to the terms "mild", "moderate" and "severe" hypertension, which were used, for example, in the 1993 WHO-ISH guidelines.
In contrast to the 1993 recommendations, the new guidelines state that the management of hypertension in the elderly and isolated systolic hypertension should be the same as the management of classical hypertension in middle-aged people.

Evaluation of the distant forecast

In 1962, in the recommendations of WHO experts, for the first time, it was proposed to distinguish three stages of arterial hypertension, depending on the presence and severity of target organ damage. For many years, it was believed that in patients with target organ damage, antihypertensive therapy should be more intensive than in patients without target organ damage.
The new classification of arterial hypertension by WHO-ISO experts does not provide for the allocation of stages in the course of hypertension. The authors of the new recommendations draw attention to the results of the Framingham study, which showed that in patients with arterial hypertension, the risk of developing cardiovascular complications over a 10-year follow-up period depended not only on the degree of increase in blood pressure and the severity of target organ damage, but also on other factors. risk and comorbidities. After all, it is known that such clinical conditions as diabetes mellitus, angina pectoris or congestive heart failure have a more adverse effect on the prognosis in patients with arterial hypertension than the degree of increase in blood pressure or left ventricular hypertrophy.
When choosing therapy in patients with arterial hypertension, it is recommended to take into account all factors that may affect the prognosis ().
Prior to initiation of therapy, each patient with arterial hypertension should be assessed for the absolute risk of cardiovascular complications and assigned to one of four risk categories, depending on the presence or absence of risk factors for cardiovascular disease, target organ damage, and comorbidities ( ).

Goal of antihypertensive therapy

The goal of treating a patient with arterial hypertension is to reduce the risk of cardiovascular complications as much as possible. This means that it is necessary not only to reduce high blood pressure, but also to act on all other reversible risk factors (smoking, hypercholesterolemia, diabetes mellitus), as well as to treat comorbidities. In young and middle-aged patients, as well as in patients with diabetes mellitus, if possible, blood pressure should be maintained at an "optimal" or "normal" level (up to 130/85 mm Hg. Art.). In elderly patients, blood pressure should be reduced to at least an "increased normal" level (up to 140/90 mm Hg; see).
Table 2. Prognostic factors of arterial hypertension

A. Risk factors for cardiovascular disease I. Used for risk assessment . Levels of systolic and diastolic blood pressure (arterial hypertension of the 1st - 3rd degree) . Men over 55 . Women over 65 . Smoking . Serum total cholesterol level more than 6.5 mmol/l(250 mg/dl) . Diabetes . Family history of early development of cardiovascular disease II. Other factors that have an adverse effect for the forecast . Decreased levels of high lipoprotein cholesterol density . Elevated levels of lipoprotein cholesterol low density . Microalbuminuria (30 - 300 mg/day) in diabetes mellitus . Impaired glucose tolerance . Obesity . Passive lifestyle . Elevated fibrinogen levels . Socioeconomic group at high risk . Ethnic group at high risk . High risk geographic region B. Target organ damage . Left ventricular hypertrophy (according to electrocardiography, echocardiography, or chest x-ray) . Proteinuria (>300 mg/day) and/or slight increase in plasma creatinine (1.2-2.0 mg/dL) . Ultrasound or X-ray angiographic signs of atherosclerotic lesions of the carotid, iliac and femoral arteries, aorta . Generalized or focal narrowing of the retinal arteries C. Associated clinical conditions Vascular disease of the brain . Ischemic stroke . Hemorrhagic stroke . Transient cerebrovascular accident heart disease . myocardial infarction . angina pectoris . Revascularization of the coronary arteries . Congestive heart failure kidney disease . diabetic nephropathy . Renal failure (plasma creatinine above 2.0 mg/dL) vascular disease . Dissecting aneurysm . Arterial disease with clinical manifestations Severe hypertensive retinopathy . Hemorrhages or exudates . Optic nerve edema

Note. Target organ damage corresponds to stage II of hypertension according to the classification of WHO experts in 1996, and concomitant clinical conditions correspond to stage III of the disease.

Thus, in groups of patients with high and very high risk, drug therapy should be started immediately. In the group of patients with an average risk ( ) Treatment of hypertension begins with lifestyle interventions. If non-drug interventions within 3-6 months do not lead to a decrease in blood pressure below 140/90 mm Hg. Art., it is recommended to prescribe antihypertensive drugs.
In the low-risk group, treatment also begins with non-pharmacological methods, but the observation period increases to 6-12 months. If after 6-12 months the blood pressure remains at the level of 150/95 mm Hg. Art. or higher, start drug therapy (scheme).
The intensity of antihypertensive therapy also depends on which risk group the patient belongs to. The higher the overall risk of cardiovascular complications, the more important it is to achieve a reduction in blood pressure to an appropriate level ("optimal", "normal" or "elevated normal") and to deal with other risk factors. As calculations show, with the same degree of arterial hypertension, the effectiveness of antihypertensive therapy in patients with high and very high risk is much higher than in patients with low risk. So, antihypertensive therapy, which reduces blood pressure by an average of 10/5 mm Hg. Art., allows to prevent less than 5 serious cardiovascular events per 1000 patient-years of treatment in patients with low risk and more than 10 complications in patients with very high risk.

Lifestyle change

Lifestyle modification should be recommended to all patients with arterial hypertension, although at present there is no direct evidence that non-drug interventions, by lowering blood pressure, reduce the risk of cardiovascular complications. In addition to lowering blood pressure, non-pharmacological methods have also been shown to reduce the need for antihypertensive drugs and increase their effectiveness, as well as help to combat other risk factors.
Table 3 Risk level of cardiovascular complications in patients with arterial hypertension of varying degrees in order to determine the prognosis*

Risk factors (other than hypertension) and medical history	Level of risk in arterial hypertension
	1st degree (mild hypertension) AD 140-159/90- 99 mmHg Art.
No other factors risk	Short	Average	High
1-2 other factors risk	Average	Average	Highly high
3 or more others risk factors pom or sugar diabetes	High	High	Highly high
Related disease**	Highly High	Highly high	Highly high
*Typical examples of the risk of developing a cerebral stroke or heart attack over 10 years: low risk - less than 15%; average risk - about 15-20%; high risk - about 20-30%; very high risk - 30% or higher. * . POM - target organ damage ( 2).

Smoking cessation is especially important. Smoking cessation appears to be the most effective non-pharmacological way to reduce the risk of cardiovascular and non-cardiovascular disease in patients with arterial hypertension.
Obese patients should be advised to reduce body weight by at least 5 kg. This change in body weight not only causes a decrease in blood pressure, but also has a beneficial effect on other risk factors such as insulin resistance, diabetes mellitus, hyperlipidemia and left ventricular hypertrophy. The antihypertensive effect of weight loss is enhanced with a simultaneous increase in physical activity, limiting the intake of salt and alcoholic beverages.
There is evidence that regular drinking in moderation ( up to 3 drinks a day) reduces the risk of coronary heart disease (CHD). At the same time, a linear dependence of the level of blood pressure (or the prevalence of arterial hypertension) in populations on the amount of alcohol consumed was found. It has been established that alcohol weakens the effects of antihypertensive therapy, and its pressor effect persists for 1–2 weeks. For this reason, hypertensive patients who drink alcohol should be advised to limit their alcohol intake (no more than 20-30 ml per day for men and no more than 10-20 ml per day for women). Patients who abuse alcohol should be informed of the high risk of stroke.
The results of randomized trials have shown that reducing dietary sodium intake from 180 to 80-100 mmol per day leads to a decrease in systolic blood pressure by an average of 4-6 mm Hg. Art. Even a slight restriction of dietary sodium intake (by 40 mmol per day) significantly reduces the need for antihypertensive drugs. preparations. Hypertensive patients should be advised to limit dietary sodium intake to less than 100 mmol per day, which corresponds to less than 6 g of salt per day.

Patients with arterial hypertension should reduce the consumption of meat and fatty foods and at the same time increase the consumption of fish, fruits and vegetables. Patients leading a sedentary lifestyle should be advised to exercise regularly in the open air (30-45 minutes 3-4 times a week). Brisk walking and swimming are more effective than running and reduce systolic blood pressure by about 4-8 mmHg. Art. Conversely, isometric exercise (eg, weight lifting) may increase BP.

Medical therapy

The main antihypertensive drugs are diuretics, b -blockers, calcium antagonists, angiotensin converting enzyme (ACE) inhibitors, AT blockers 1 -angiotensin receptors and a 1 - adrenoblockers. In some countries of the world, reserpine and methyldopa are often used in the treatment of arterial hypertension.
Different classes of antihypertensive drugs reduce blood pressure to about the same extent, but differ in the nature of side effects.
Table 4. Recommendations for the choice of antihypertensive drugs

Drug group	Indications		Contraindications
	Mandatory	Possible	obligatory	possible
Diuretics	Heart failure Accuracy + Elderly age + systolic hypertension	Diabetes	Gout	Dyslipidemia Men who are sexually active
b-Blockers	Angina + After myocardial infarction + tachyarrhythmia	Heart failure Precision + Pregnant- ness + sugar di- abet	Bronchial asthma and chronic structural disease lung function + heart block*	Dyslipidemia + Athletes and physicists chesky active sick + Defeat peripheral ar- terium
ACE inhibitors	Heart failure accuracy + Dysfunction left ventricular ka + After a heart attack myocardial + Diabetic nephropathy		Pregnancy + Hyperkalemia	double-sided nos of renal arte- riy
Calcium antagonists tion	Angina + Life loy age + systo- personal hypertension(****)	The defeat of the periphery ric arteries	Heart block**	congestive heart failure***
a1 blockers	Hypertrophy pre- static gland	Violation of tolerance affinity to glucose + Dyslipidemia		Orthostatic Hy- sweating
AT blockers 1 - Angiotensin receptors	Cough, called ACE inhibitors	Heart failure- Accuracy	Pregnancy + double-sided nos of renal arte- Rium + Hyperkalemia
* Atrioventricular block II - III degree. ** Atrioventricular block II-III degree in the treatment of verapamil or diltiazem. *** For verapamil or diltiazem. ****In fact, in patients with isolated systolic hypertension, only the beneficial effect of calcium antagonists of the dihydropyridine series and, in particular, nitrendipine has been established. With regard to verapamil and diltiazem, their efficacy and safety in isolated systolic hypertension, to the best of our knowledge, have not been studied in controlled studies. (Authors' note).

Several dozen randomized controlled trials have proven the ability of long-term therapy with diuretics and b-blockers to prevent cardiovascular complications in patients with arterial hypertension. There is much less evidence of a beneficial effect of calcium antagonists and ACE inhibitors on long-term prognosis. So far, there are no sufficiently convincing data that a 1 - adrenoblockers and AT blockers 1 -angiotensin receptors may improve long-term prognosis in patients with arterial hypertension. However, in hypertensive patients, the beneficial effect of antihypertensive therapy on prognosis is thought to depend primarily on the degree of BP reduction achieved, rather than on drug class.
Each of the main classes of antihypertensive drugs has certain advantages and disadvantages that must be considered when choosing a drug for initial therapy ().
For initial therapy, it is recommended to use low doses of antihypertensive drugs to minimize side effects. In cases where a low dose of the first drug produces a good antihypertensive effect, it is advisable to increase the dose of this drug in order to lower blood pressure to the desired level. If the first antihypertensive drug is ineffective or poorly tolerated, its dose should not be increased, but another drug with a different mechanism of action should be added. You can also replace one drug with another.

Abbreviations: SBP, systological BP; DBP - diastolic blood pressure;
AG - arterial hypertension;
POM - damage to target organs; SCS - comorbid clinical conditions

In the HOT (Hypertension Optimal Treatment) study, a staggered regimen of antihypertensive drugs has worked well. For initial therapy, a prolonged form of the calcium antagonist felodipine at a dose of 5 mg/day was used. At the second stage, an ACE inhibitor or b - adrenoblocker. In the third degree, the daily dose of felodipine retard was increased to 10 mg. At the fourth stage, the doses of the ACE inhibitor were doubled or b-blocker, and on the fifth - if necessary, a diuretic was added.
It is best to use long-acting antihypertensive drugs that provide 24-hour BP control when taken once a day. Examples of long-acting antihypertensive drugs are: -blockers such as betaxolol and metoprolol retard, ACE inhibitors such as perindopril, trandolapril and fosinopril, calcium antagonists such as amlodipine, verapamil and felodipine retard, such AT blockers 1-angiotensin receptors, such as valsartan and irbesartan. Controls blood pressure within 24 hours a 1 long-acting adrenoblocker doxazosin.
The advantages of long-acting drugs are that they improve the adherence of patients with arterial hypertension to treatment and reduce blood pressure fluctuations during the day. It is believed that antihypertensive therapy,which provides a more uniform decrease in blood pressure throughout the day, more effectively prevents the development of cardiovascular complications and damage to target organs in patients with arterial hypertension.
Diuretics . Diuretics remain one of the most valuable classes of antihypertensive drugs. They are significantly less expensive than other classes of antihypertensive drugs. Diuretics are highly effective and generally well tolerated when administered at low doses (no more than 25 mg hydrochlorothiazide or equivalent doses of other drugs). Controlled studies have shown the ability of diuretics to prevent serious cardiovascular complications such as stroke and coronary artery disease. In the 5-year randomized SHEP study (S y stolic Hypertension in the Elderly Program), in which chlorthalidone was used for initial therapy, the incidence of stroke and coronary events in the main group was 36% and 27% lower, respectively, than in the control group. That's why diuretics are considered especially indicated for the treatment of elderly patients with isolated systolic hypertension.
b -Adrenoblockers . b-blockers are inexpensive, effective and safe antihypertensive drugs. They can be used both for monotherapy of arterial hypertension and in combination with diuretics, calcium antagonists of the dihydropyridine series and a-blockers. Although heart failure is certainly a contraindication to conventional doses of β-blockers, there is evidence of a beneficial effect of some β-blockers (particularly bisoprolol, carvedilol, and metoprolol) in some patients with heart failure when used early in therapy at very low doses. doses. Should not be given b -blockers in patients with chronic obstructive pulmonary disease and peripheral arterial disease.
ACE inhibitors. ACE inhibitors are effective and safe antihypertensive drugs, the cost of which has decreased significantly in recent years. In randomized trials, the efficacy and safety of ACE inhibitors such as captopril, lisinopril, enalapril, ramipril, and fosinopril have been best studied. It has been established that ACE inhibitors and especially effectively reduce mortality in patients with heart failure and prevent the progression of nephropathy in patients with insulin-dependent diabetes mellitus (I type). The most common side effect of ACE inhibitors is a dry cough, the most dangerous is angioedema, which, however, is extremely rare.
calcium antagonists. All calcium antagonists have high antihypertensive efficacy and good tolerability. The ability of calcium antagonists (in particular, nitrendipine) to prevent the development of cerebral stroke in elderly patients with isolated systolic hypertension has been proven. Preferably, long-acting calcium antagonists (eg, amlodipine, verapamil, and felodipine retard) should be used, and short-acting agents should be avoided whenever possible.
AT blockers 1 -angiotensin receptors. AT blockers 1 -angiotensin receptors have many properties that bring them closer to ACE inhibitors. In particular, they, like ACE inhibitors, are especially useful in patients with heart failure. The advantage of AT blockers 1 -angiotensin receptors (for example, such as valsartan, irbesartan, losartan, etc.) before ACE inhibitors is a low incidence of side effects. For example, they do not cause coughing. While there is insufficient evidence for the ability of AT blockers 1 -angiotensin receptors to reduce the increased risk of cardiovascular complications in patients with arterial hypertension.
a 1 - Adrenoblockers. a 1 -Adrenergic blockers are effective and safe antihypertensive drugs, but so far there is no sufficient evidence of their ability to prevent the development of cardiovascular complications in patients with arterial hypertension. Main side effect a 1 -blockers - orthostatic hypotension, which is especially pronounced in elderly patients. Therefore, at the beginning of treatment a 1 -adrenergic blockers, it is important to measure blood pressure in the position of the patient, not only sitting, but also standing. a 1 -Adrenergic blockers may be useful in the treatment of hypertension in patients with dyslipidemia or impaired glucose tolerance. When treating a 1 Doxazosin, whose antihypertensive effect lasts up to 24 hours after oral administration, should be preferred over short-acting prazosin as β-blockers.

Antiplatelet and hypocholesterolemic therapy

Considering that in patients with arterial hypertension, a high overall risk of cardiovascular complications is associated not only with elevated blood pressure, but also with other factors, it is not enough to use only antihypertensive drugs to reduce the risk.
The randomized HOT trial showed that in patients with arterial hypertension receiving effective antihypertensive therapy, the addition of small doses of aspirin(75 mg/day) can significantly reduce the risk of serious cardiovascular complications (by 15%), including myocardial infarction (by 36%).
A number of randomized trials have established high efficacy of hypocholesterolemic drugs from the statin group in primary and secondary prevention of coronary artery disease in individuals with different levels of cholesterol in the blood. The long-term efficacy and safety of statins such as lovastatin, pravastatin, and simvastatin have been best studied. The use of atorvastatin and cerivastatin, which are superior to other statins in terms of the severity of hypocholesterolemic action, seems promising.
The data obtained in these studies allow us to recommend the use of aspirin and statins (in combination with antihypertensive drugs) in the treatment of patients with arterial hypertension and a high risk of developing coronary artery disease. Thus, the new WHO-ISH guidelines for the treatment of arterial hypertension propose slightly different approaches to the assessment and management of patients with elevated blood pressure than in the 1993 recommendations. WHO-ISH experts draw attention to the importance of assessing the overall risk of cardiovascular - vascular complications, and not just the state of target organs. In this regard, treatment should be aimed at both reducing elevated blood pressure and other modifiable risk factors. The goal of antihypertensive therapy has been determined, which is to maintain blood pressure at a level below 130/85 mm Hg. Art. in young and middle-aged patients and those suffering from diabetes mellitus and at a level below 140/90 mm Hg. Art. in elderly patients. Blockers
AT 1 -angiotensin receptors are included in the number of first-line drugs for the treatment of arterial hypertension.

Hypertonic disease

Hypertonic disease (GB) -(Essential, primary arterial hypertension) is a chronic disease, the main manifestation of which is an increase in blood pressure (Arterial Hypertension). Essential arterial hypertension is not a manifestation of diseases in which an increase in blood pressure is one of the many symptoms (symptomatic hypertension).

HD classification (WHO)

Stage 1 - there is an increase in blood pressure without changes in internal organs.

Stage 2 - an increase in blood pressure, there are changes in internal organs without dysfunction (LVH, coronary artery disease, changes in the fundus). Presence of at least one of the following lesions

target organs:

Left ventricular hypertrophy (according to ECG and echocardiography);

Generalized or local narrowing of the retinal arteries;

Proteinuria (20-200 mcg / min or 30-300 mg / l), creatinine more

130 mmol/l (1.5-2 mg/% or 1.2-2.0 mg/dl);

Ultrasound or angiographic features

atherosclerotic lesions of the aorta, coronary, carotid, iliac or

femoral arteries.

Stage 3 - increased blood pressure with changes in internal organs and violations of their functions.

Heart: angina pectoris, myocardial infarction, heart failure;

- Brain: transient cerebrovascular accident, stroke, hypertensive encephalopathy;

Fundus of the eye: hemorrhages and exudates with swelling of the nipple

optic nerve or without it;

Kidneys: signs of CKD (creatinine more than 2.0 mg/dl);

Vessels: dissecting aortic aneurysm, symptoms of occlusive lesions of peripheral arteries.

Classification of GB according to the level of blood pressure:

Optimal BP: DM<120 , ДД<80

Normal blood pressure: SD 120-129, DD 80-84

Elevated normal blood pressure: SD 130-139, DD 85-89

AG - 1 degree of increase SD 140-159, DD 90-99

AG - 2nd degree of increase SD 160-179, DD 100-109

AH - 3rd degree increase DM >180 (=180), DD >110 (=110)

Isolated systolic AH DM>140(=140), DD<90

If SBP and DBP fall into different categories, then the highest reading should be taken into account.

Clinical manifestations of GB

Subjective complaints of weakness, fatigue, headaches of various localization.

visual impairment

Instrumental Research

Rg - slight left ventricular hypertrophy (LVH)

Changes in the fundus of the eye: dilation of the veins and narrowing of the arteries - hypertensive angiopathy; with a change in the retina - angioretinopathy; in the most severe cases (swelling of the nipple of the optic nerve) - neuroretinopathy.

Kidneys - microalbuminuria, progressive glomerulosclerosis, secondarily wrinkled kidney.

Etiological causes of the disease:

1. Exogenous causes of the disease:

Psychological stress

Nicotine intoxication

Alcohol intoxication

Excess intake of NaCl

Hypodynamia

Binge eating

2. Endogenous causes of the disease:

Hereditary factors - as a rule, 50% of descendants fall ill with hypertension. Hypertension in this case proceeds more malignantly.

Disease pathogenesis:

Hemodynamic mechanisms

Cardiac output

Since about 80% of the blood is deposited in the venous bed, even a slight increase in tone leads to a significant increase in blood pressure, i.e. the most significant mechanism is an increase in total peripheral vascular resistance.

Dysregulation leading to the development of HD

Neurohormonal regulation in cardiovascular diseases:

A. Pressor, antidiuretic, proliferative link:

SAS (norepinephrine, adrenaline),

RAAS (AII, aldosterone),

arginine vasopressin,

Endothelin I,

growth factors,

cytokines,

Plasminogen activator inhibitors

B. Depressor, diuretic, antiproliferative link:

Natriuretic Peptide System

Prostaglandins

Bradykinin

Tissue plasminogen activator

Nitrogen oxide

Adrenomedullin

An increase in the tone of the sympathetic nervous system (sympathicotonia) plays an important role in the development of GB.

It is usually caused by exogenous factors. Mechanisms for the development of sympathicotonia:

facilitation of ganglionic transmission of nerve impulses

violation of the kinetics of norepinephrine at the level of synapses (violation of the reuptake of n / a)

change in sensitivity and / or number of adrenoreceptors

desensitization of baroreceptors

The effect of sympathicotonia on the body:

Increase in heart rate and contractility of the heart muscle.

An increase in vascular tone and, as a result, an increase in the total peripheral vascular resistance.

An increase in the tone of capacitive vessels - an increase in Venous return - An increase in blood pressure

Stimulates the synthesis and release of renin and ADH

Insulin resistance develops

The endothelium is damaged

Effect of insulin:

Increases Na reabsorption - Water retention - Increased blood pressure

Stimulates hypertrophy of the vascular wall (because it is a stimulator of the proliferation of smooth muscle cells)

The role of the kidneys in the regulation of blood pressure

Regulation of Na homeostasis

Regulation of water homeostasis

synthesis of depressor and pressor substances, at the beginning of GB both pressor and depressor systems work, but then the depressor systems are depleted.

The effect of Angiotensin II on the cardiovascular system:

Acts on the heart muscle and promotes its hypertrophy

Stimulates the development of cardiosclerosis

Causes vasoconstriction

Stimulates the synthesis of Aldosterone - increased Na reabsorption - increased blood pressure

Local factors in the pathogenesis of HD

Vasoconstriction and hypertrophy of the vascular wall under the influence of local biologically active substances (endothelin, thromboxane, etc...)

During GB, the influence of various factors changes, first neurohumoral factors prevail, then when the pressure stabilizes at high numbers, local factors predominantly act.