Arterial hypertension. Cardiovascular risk stratification in arterial hypertension Risk stratification of hypertension

#187; Arterial hypertension #187; Risk stratification in arterial hypertension

Risk stratification in arterial hypertension is an assessment system for the probabilities of complications of the disease on the general condition of the heart and vascular system.

The general evaluation system is based on a number of special indicators that affect the quality of life and its duration for the patient.

The stratification of all risks in hypertension is based on an assessment of the following factors:

• the degree of the disease (assessed during the examination);
• existing risk factors;
• diagnosing lesions, pathologies of target organs;
• clinic (this is determined individually for each patient).

All significant risks are listed in a special Risk Assessment List, which also contains recommendations for treatment and prevention of complications.

Stratification determines which risk factors can cause the development of cardiovascular diseases, the emergence of a new disorder, the death of a patient from certain cardiac causes over the next ten years. Risk assessment is performed only after the end of the general examination of the patient. All risks are divided into the following groups:

• up to 15% #8212; low level;
• from 15% to 20% #8212; the level of risks is medium;
• 20-30% #8212; level is high;
• From 30% #8212; the risk is very high.

A variety of data can affect the prognosis, and for each patient they will be different. Factors contributing to the development of arterial hypertension and influencing the prognosis may be as follows:

• obesity, violation of body weight in the direction of increase;
• bad habits (most often it is smoking, abuse of caffeinated products, alcohol), sedentary lifestyle, malnutrition;
• changes in cholesterol levels;
• tolerance is broken (to carbohydrates);
• microalbuminuria (only in diabetes);
• the value of fibrinogen is increased;
• there is a high risk by ethnic, socio-economic groups;
• the region is characterized by an increased incidence of hypertension, diseases, pathologies of the heart and blood vessels.

All risks that affect the prognosis in hypertension, according to WHO recommendations from 1999, can be divided into the following groups:

• BP rises to 1-3 degrees;
• age: women - from 65 years old, men - from 55 years old;
• bad habits (alcohol abuse, smoking);
• diabetes;
• a history of pathologies of the heart, blood vessels;
• serum cholesterol rises from 6.5 mmol per liter.

When assessing risks, attention should be paid to damage, disruption of target organs. These are diseases such as narrowing of the retinal arteries, common signs of the appearance of atherosclerotic plaques, a greatly increased plasma creatinine value, proteinuria, and hypertrophy of the left ventricular region.

Attention should be paid to the presence of clinical complications, including cerebrovascular (this is a transient attack, as well as hemorrhagic / ischemic stroke), various heart diseases (including insufficiency, angina pectoris, heart attacks), kidney disease (including insufficiency, nephropathy), vascular pathologies (peripheral arteries, a disorder such as aneurysm dissection). Among the common risk factors, it is necessary to note the advanced form of retinopathy in the form of papilloedema, exudates, hemorrhages.

All these factors are determined by the observing specialist, who conducts a general risk assessment and predicts the course of the disease for the next ten years.

Hypertension is a polyetiological disease, in other words, a combination of many risk factors leads to the development of the disease. therefore, the probability of occurrence of GB is determined by a combination of these factors, the intensity of their action, and so on.

But as such, the occurrence of hypertension, especially if we talk about asymptomatic forms. is not of great practical importance, since a person can live for a long time without experiencing any difficulties and not even knowing that he suffers from this disease.

The danger of pathology and, accordingly, the medical significance of the disease lies in the development of cardiovascular complications.

Previously, it was believed that the probability of cardiovascular complications in HD is determined solely by the level of blood pressure. And the higher the pressure, the greater the risk of complications.

To date, it has been established that, as such, the risk of complications is determined not only by blood pressure figures, but also by many other factors, in particular, it depends on the involvement of other organs and systems in the pathological process, as well as the presence of associated clinical conditions.

In this regard, all patients suffering from essential hypertension are usually divided into 4 groups, each of which has its own level of risk of developing cardiovascular complications.

1. Low risk. Men and women who are under 55 years of age, who have arterial hypertension of the 1st degree and do not have other diseases of the cardiovascular system, have a low risk of developing cardiovascular complications, which does not exceed 15%.

2. Average level.

This group includes patients who have risk factors for the development of complications, in particular, high blood pressure, high blood cholesterol, impaired glucose tolerance, age over 55 years for men and 65 years for women, family history of hypertension. At the same time, target organ damage and associated diseases are not observed. The risk of developing cardiovascular complications is 15-20%.

3. High risk. This risk group includes all patients who have signs of target organ damage, in particular, left ventricular hypertrophy according to instrumental studies, narrowing of the retinal arteries, signs of initial kidney damage.

4. Very high risk group. This risk group includes patients who have associated diseases, in particular coronary heart disease, have had a myocardial infarction, have a history of acute cerebrovascular accident, suffer from heart or kidney failure, as well as people who have a combination of hypertension and diabetes mellitus.

Among cardiovascular pathologies, hypertension is often diagnosed - this is a condition in which persistently high blood pressure is noted.

Such an ailment is also called the "silent killer", since the symptoms may not appear for a long time, although changes are already taking place in the vessels. Other names for the disease are hypertension, arterial hypertension.

Pathology proceeds in several stages, each of which can be recognized by certain symptoms.

This disease is a persistent increase in blood pressure above 140/90 mm Hg. Art. This pathology is typical for people over 55 years old, but in the modern world, young people also face it. Any person has two types of pressure:

• systolic or upper - reflects the force with which blood presses on large arterial vessels during heart compression;
• diastolic - shows the level of blood pressure on the walls of blood vessels when the heart muscle relaxes.

Most patients are diagnosed with an increase in both pressure indicators, although isolated hypertension is sometimes noted - systolic or diastolic.

Primary arterial hypertension develops as an independent disease due to heredity, insufficient kidney performance, and severe stress.

The secondary form of hypertension is associated with pathologies of internal organs or exposure to external factors. Its main reasons are:

• psycho-emotional overload;
• blood diseases;
• kidney pathology;
• stroke;
• heart failure;
• side effects of certain medications;
• deviations in the work of the autonomic nervous system.

The main classification of hypertension divides it into several stages depending on the degree of pressure increase. On any of them, its values ​​\u200b\u200bwill be more than 140/90 mm Hg. Art.

Progressing, hypertension causes an increase in systolic and diastolic indicators up to critical values ​​that threaten human life.

Symptoms

The classification of arterial hypertension by stages is necessary for the appointment of adequate treatment. In addition, it helps doctors to guess how affected a particular target organ is and to determine the risk of developing serious complications.

The main criterion for the allocation of stages of hypertension are pressure indicators. The symptoms of the disease help to confirm the diagnosis. At each stage, certain manifestations of arterial hypertension are noted.

General signs of hypertension also help to suspect it:

• dizziness;
• headache;
• numbness of fingers;
• deterioration in performance;
• irritability;
• noise in ears;
• sweating;
• heartache;
• nosebleeds;
• sleep disorders;
• visual impairment;
• peripheral edema.

These symptoms at a certain stage of hypertension are observed in different combinations. Visual impairment manifests itself in the form of a veil or "flies" in front of the eyes.

Headache is more common at the end of the day when blood pressure is at its peak. Often it appears immediately after waking up. Because of this, a headache is sometimes attributed to a simple lack of sleep.

Some of the distinguishing features of the pain syndrome:

• may be accompanied by a feeling of pressure or heaviness in the back of the head;
• sometimes aggravated by tilting, turning the head or with sudden movements;
• may cause swelling of the face;
• has nothing to do with the level of blood pressure, but sometimes indicates its jump.

Hypertension of the first stage is diagnosed if the pressure is in the range of 140/90–159/99 mm Hg. Art. It can remain at this level for several days or weeks in a row.

The pressure drops to normal values ​​under favorable conditions, for example, after a rest or stay in a sanatorium. Symptoms in the first stage of hypertension are practically absent.

I stage

How to treat grade 1 hypertension

The doctor first advises the person to change their lifestyle. Therefore, you need to regulate your sleep, attitude to stress. The patient should regularly perform special relaxation exercises. Diet is also part of therapy. It is necessary to moderate salt intake, reconsider the calorie content of the diet, its quality, frequency of meals.

Among the drugs, the doctor can choose:

• vasodilators;
• Diuretics (diuretics);
• Neurotransmitters;
• Anticholesterol drugs - statins;
• Sedative drugs.

This is a mild form of hypertension. The upper pressure is in the range of 160-179, and the lower one is 100-109. At this stage, high blood pressure is already more common, and attacks last longer. Blood pressure levels rarely return to normal on their own.

The symptoms of the second degree of hypertension include:

• Strong, long-lasting fatigue, lethargy;
• Nausea;
• Pulsation in temples;
• Hyperhidrosis;
• Visual fuzziness;
• Facial swelling;
• skin hyperemia;
• Chills of the fingers, numbness;
• Fundus defects;
• Detection of symptoms of target organ damage.

Tired, becomes lethargic and edematous appearance of the patient due to the fact that the disease affects the kidneys. Sometimes a hypertensive attack is accompanied by vomiting, stool and urinary disorders, shortness of breath.

At this stage, it is already difficult to do without medicines. The patient should take the tablets regularly. It is desirable that the reception falls at the same time. True, relying only on pills at this stage is stupid. Whatever effective medicines the patient does not drink, he must monitor his own weight, diet. Unhealthy habits, if you have not given up on them before, should be abandoned.

Arterial hypertension is... The "trick" lurks from the very beginning. It is impossible to accurately determine this disease, since pressure indicators vary greatly in the population. The risk of an increase in cardiovascular pathology is so “dense” on the corresponding curve close to the increase in blood pressure that it is quite difficult to “isolate” and show the border.

But, doctors still found a way out and the answer "what is it?" Arterial hypertension is a level of blood pressure that leads to a significant increase in cardiovascular disease, and with treatment this risk decreases.

After numerous studies using the methods of mathematical statistics, it turned out that arterial hypertension "begins" with the numbers 140/90 mm or more. rt. st, at a constantly elevated pressure.

Hypertension and hypertension. Is there a difference?

In foreign literature, there is no difference between these concepts. And in domestic publications such a difference exists, but unprincipled and more historical. Let's explain this with simple examples:

• When an increase in blood pressure of any nature is detected in a patient for the first time, he is given the primary diagnosis of “arterial hypertension syndrome”. This in no way means that you need to start treating the patient immediately, and doctors can “rest on their laurels”. This means that you need to look for the cause;
• In the event that a specific cause is found (for example, a hormonally active tumor of the adrenal glands, or stenosis of the renal vessels), then the patient is diagnosed with secondary arterial hypertension. This indirectly indicates that the disease has a cause that can be eliminated;
• In the event that, despite all the searches and analyzes, the cause of the increase in pressure could not be found, then a beautiful diagnosis of "essential" or "elementary" arterial hypertension is made. From this diagnosis is already "at hand" and to "hypertension". That is how the diagnosis sounded in the late USSR.

In Western literature, everything is simpler: if it is “arterial hypertension” and there is no indication that it is secondary, for example, it developed against the background of diabetes or injury, then this means hypertension, the cause of which is unclear.

First, we list those conditions that lead to the development of secondary hypertension syndrome, which doctors try to identify and exclude in the first place. This succeeds in no more than 10% of cases.

The main causes of secondary pressure increase are disorders in the functioning of the kidneys (50%), endocrinopathy (20%), and other causes (30%):

• diseases of the parenchyma of the kidneys, for example, polycystic, glomerulonephritis (autoimmune, toxic);
• diseases of the renal vessels (stenosis, atherosclerosis, dysplasia);
• in general vascular diseases, for example, aortic dissection or its aneurysm;
• adrenal hyperplasia, Kohn's syndrome, hyperaldosteronism;
• Cushing's disease and syndrome;
• acromegaly, chromocytoma, adrenal hyperplasia;
• disorders in the thyroid gland;
• coarctation of the aorta;
• abnormal, severe pregnancy;
• use of drugs, oral contraceptives, certain drugs, rare blood diseases.

In general, it must be said that secondary hypertension often occurs in young patients, as well as in those patients who are resistant to any therapy.

High blood pressure is detected in 43% of cases in men and in 55% of cases in women over 55 years of age. In such patients, the vessels "age" prematurely. They lose elasticity, become more rigid, and this leads to a form such as isolated systolic hypertension. Insulin increases the "elasticity" of the vascular wall, and tissue resistance to it worsens the course of diabetes.

First of all, you need to know the indicators of normal pressure: (amp) lt; 130 mm Hg. Art. in systole and (amp)lt; 85 in diastole.

There is also a "high normal" pressure range, from 130-139 and from 85-89 mmHg. Art. respectively. It is here that "white coat" hypertension "fits" and various functional disorders. Anything above refers to arterial hypertension.

There are 3 stages of arterial hypertension (syst. and dist.):

1. 140-159 and 90-99;
2. 160-179 and 100-109;
3. 180 and (amp)gt;110 respectively.

It should be clarified that at present, approaches to the meaning of various types of hypertension have changed. For example, in the past, a very significant risk factor was constantly elevated diastolic, “lower” pressure.

Then, at the beginning of the 21st century, after the accumulation of data, systolic and pulse pressure began to be considered much more important in determining prognosis than isolated diastolic hypertension.

The classic symptoms of hypertension are:

• the fact of the presence of an increase in pressure when it is measured three times during the day;
• heartache;
• shortness of breath, redness of the face;
• feeling of heat;
• trembling in the hands;
• flashing "flies" before the eyes;
• headache;
• noise and ringing in the ears.

In fact, these are symptoms of a sympathoadrenal crisis, which manifests itself, including a rise in pressure. Asymptomatic arterial hypertension often occurs.

So, in our time there is a lot of "isolated" systolic arterial hypertension, for example, associated with diabetes, in which large arteries are very stiff. But, in addition to determining the height of pressure, it is necessary to determine the risk. You can often hear: from a doctor: “arterial hypertension grade 3 risk 3”, or “arterial hypertension grade 1 risk”. What does it mean?

Which patients are at risk, and what is it? We are talking about the risk of developing cardiovascular disease. The degree of risk is assessed using the Framingham scale, which is a multivariate statistical model that is in good agreement with actual results over a large number of observations.

So, to remove the risk, take into account:

• gender is male.
• age (men over 55 and women over 65);
• blood pressure level,
• smoking habit,
• overweight, abdominal obesity;
• high blood sugar levels, the presence of diabetes in the family;
• dyslipidemia, or elevated plasma cholesterol levels;
• the presence of heart attacks and strokes in history, or in the family;

In addition, a normal, thoughtful doctor will determine the level of physical activity of a person, as well as various possible damage to target organs that can occur with a prolonged increase in pressure (myocardium, kidney tissue, blood vessels, retina).

What diagnostic methods can be used to confirm arterial hypertension?

"Our people don't take taxis to the bakery." A Russian person considers non-drug treatment (by the way, the least expensive one) as an insult.

In the event that a doctor starts talking about a “healthy lifestyle” and other “strange things”, then gradually the patient’s face is drawn out, he begins to get bored, and then leaves this doctor to find a specialist who will immediately “prescribe medicines”, and even better - "injections".

Nevertheless, it is necessary to start the treatment of "mild" arterial hypertension by following the recommendations, namely:

• reduce the amount of sodium chloride, or table salt, entering the body, up to 5 g per day;
• reduce abdominal obesity. (In general, a weight loss of only 10 kg in a 100 kg patient reduces the risk of overall mortality by 25%);
• reduce alcohol consumption, especially beer and spirits;
• increase the level of physical activity to the average, especially for people with an initially low level of it;
• quit smoking if such a bad habit exists;
• start regularly eating fiber, vegetables, fruits, drinking fresh water.

Medications

The prescription of drugs and the treatment of arterial hypertension with drugs lies entirely within the competence of the attending physician. The main groups of drugs include diuretics, beta-blockers, calcium blockers, ACE inhibitors, angiotensin receptor antagonists.

Symptoms

• sleep disorders;
• pain in the head and heart;
• increased tone of the arteries of the fundus.

2 stages

• What is hypertension and its stages
• Risks of hypertension
• Reasons for the development of the disease
• Signs of illness
• Diagnosis of the disease
• Required tests
• Treatment Methods
• Medical therapy of the disease
• Diet for sickness
• Therapy with folk remedies
• Disease prevention
• Hypertension and the army

Degrees of hypertension: first degree characteristics

In addition to risks, experts classify arterial hypertension by degree. There are four of them, as well as risks.

Degrees of hypertension:

• 1 degree - easy or "soft";
• 2 degree - moderate / borderline;
• 3 degree - severe;
• Grade 4 - very severe, also systolic isolated.

The first degree is a mild form of pathology. The upper marker is in the range from 140 to 159 mm Hg. Art., lower - 90-99 mm Hg. Art. Failures in cardiac work at the same time appear abruptly. Usually, if an attack occurs, it passes without complications. This, one might say, is a preclinical form of hypertension. Exacerbations are replaced by a complete erasure of symptoms. During remission, the patient's blood pressure is fine.

Signs of the first degree include: tinnitus, headache, growing with exertion, palpitations, sleep problems, black spots before the eyes, pain in the sternum, radiating to the arm and shoulder blade.

This symptom is rare. But alarmists need to calm down: if you ran after the bus, and your eyes got a little dark, your ears buzzed and your heart began to beat strongly, this does not mean that you are hypertensive.

External factors:

• environment;
• excessive consumption of calories, the development of obesity;
• increased salt intake;
• lack of potassium, calcium, magnesium;
• excessive alcohol consumption;
• recurring stressful situations.

Primary hypertension is the most common hypertension, accounting for about 95% of cases.

There are 3 stages of hypertension:

• Stage I - high blood pressure without changes in organs;
• Stage II - an increase in blood pressure with changes in organs, but without disrupting their function (left ventricular hypertrophy, proteinuria, angiopathy);
• Stage III - changes in organs, accompanied by a violation of their function (left heart failure, hypertensive encephalopathy, stroke, hypertensive retinopathy, renal failure).

Secondary (symptomatic) hypertension is an increase in blood pressure as a symptom of an underlying disease with an identifiable cause. The classification of arterial hypertension of the secondary form is as follows:

• renoparenchymal hypertension - occurs due to kidney disease; causes: renal parenchymal disease (glomerulonephritis, pyelonephritis), tumors, kidney damage;
• renovascular hypertension- narrowing of the renal arteries by fibromuscular dysplasia or atherosclerosis, thrombosis of the renal vein;
• endocrine hypertension - primary hyperaldosteronism (Conn's syndrome), hyperthyroidism, pheochromocytoma, Cushing's syndrome;
• hypertension caused by drugs;
• gestational hypertension - high blood pressure during pregnancy, after childbirth, the condition often returns to normal;
• coarctation of the aorta.

Gestational hypertension can lead to congenital diseases of the child, in particular, retinopathy. There are 2 phases of retinopathy (premature and full-term babies):

• active - consists of 5 stages of development, can lead to loss of vision;
• cicatricial - leads to clouding of the cornea.

Hypertensive disease according to the international system (according to ICD-10):

• primary form - I10;
• secondary form - I15.

The degrees of hypertension also predetermine the degree of dehydration - dehydration. In this case, the classifier is the lack of water in the body.

There are 3 degrees of dehydration:

• degree 1 - mild - lack of 3.5%; symptoms - dry mouth, intense thirst;
• degree 2 - medium - deficiency - 3-6%; symptoms - sharp fluctuations in pressure or a decrease in pressure, tachycardia, oliguria;
• degree 3 - the third degree is the most severe, characterized by a lack of 7-14% of water; manifested by hallucinations, delusions; clinic - coma, hypovolemic shock.

Depending on the degree and stage of dehydration, decompensation is carried out by introducing solutions:

• 5% glucose isotonic NaCl (mild);
• 5% NaCl (medium);
• 4.2% NaHCO 3 (severe).

Which scheme to prescribe - a single drug, or a combination of them - is decided by the doctor. But, in any case, when mild hypertension syndrome is detected, the doctor should prescribe a complete examination to identify a secondary type of pressure increase, along with non-drug recommendations.

Timely diagnosis and treatment of arterial hypertension aims not only to normalize pressure figures, but also to significantly reduce the risk of complications. These direct complications include diseases and conditions such as:

• angina pectoris, myocardial infarction and left ventricular hypertrophy;
• cerebrovascular diseases: strokes, transient ischemic attacks, dementia and the development of hypertensive encephalopathy;
• the appearance of vascular diseases, such as aortic aneurysm and peripheral vascular occlusion;
• the occurrence of hypertensive encephalopathy and the appearance of progressive renal failure.

All these diseases, and especially heart attacks and strokes, are the "leaders" in mortality in our time. Although in a significant percentage of patients, hypertension can occur for many years without any manifestation at all, a malignant course of the disease may also appear, which is characterized by symptoms such as progressive loss of vision, headache, and confusion.

In conclusion, it must be said that we tried to make the article useful for a person who wants to be examined and find the best way to maintain health without drugs, given that arterial hypertension is the best fit for the fact that it is easier to prevent than to treat.

Diagnosis of hypertension - confirmation of the diagnosis

In most cases, hypertension is discovered during routine blood pressure measurements. Therefore, all other methods, although they are very important, are of secondary importance. These include:

• Urinalysis to determine red blood cells, proteinuria and cylindruria. Protein in the urine is an important sign of kidney damage in hypertension;
• Biochemical blood test for the determination of urea, electrolytes, blood glucose and lipoproteins;
• ECG. Since left ventricular hypertrophy is an independent factor in arterial hypertension, it must be determined;

Other studies, such as dopplerography and studies, for example, of the thyroid gland, are carried out according to indications. Many people think that making a diagnosis is difficult. This is not so, it is much more difficult to find the cause of secondary hypertension.

Description of the third degree of hypertension

This is the most complicated form of the most serious pathology. Blood pressure rises from 180/110, it no longer drops to normal. Pathological processes are simply irreversible.

Symptoms of the 3rd degree:

• Arrhythmia;
• Changed gait;
• Hemoptysis;
• Impaired motor coordination;
• Serious visual deformities;
• Paresis, paralysis associated with impaired cerebral blood flow;
• Hypertensive crises, accompanied by malfunctions of the speech apparatus, clouding of consciousness, severe pain in the sternum;
• Problems with self-service.

In severe cases, hypertensive patients are not able to do without outside help. The risk of complications increases significantly - this is a heart attack, and a stroke, and pulmonary edema. The patient is threatened with blindness, nephropathology. When the course of the disease worsens, specialists have to adjust the therapy - they choose drugs with a stronger effect.

There is also hypertension of the 4th degree, this is a very severe degree, when the patient can lose his life at any moment. Doctors are trying to alleviate the condition of such a serious patient in every possible way. As a rule, a hypertensive patient in this condition is in the hospital, possibly in the intensive care unit.

The disease develops gradually, you can not "jump" through the stage. The earlier the doctors determined the degree and stage of hypertension in you, the sooner the treatment was prescribed, the greater the chances of complete control over the disease.

What lifestyle to lead hypertension

Even if you have figured out what stages and degrees of hypertension are, you may still have many questions. Even if the doctor wrote you a detailed prescription, you bought pills and drink them, your activity against the disease should not end there. Today, at medical symposiums, the topic of the lifestyle of a patient with hypertension is increasingly heard.

What should a hypertensive patient change in his life:

1. Psychological relief. Protect your psyche from unbearable loads for it. You must, as far as possible, protect yourself from conflict situations. An instant reaction to a stimulus is an adrenaline rush. This always worsens the health of the hypertensive patient. Find your own ways to relieve stress. Some doctors even advise their patients to get a pet - pets really relieve stress, serve as a pleasant relaxation, if I may say so. But, of course, remember what is the responsibility of acquiring such a friend.
2. Physiotherapy. It should become part of your life. If you think that this is boring and monotonous, then you are mistaken. Today, it is enough to turn on the Internet, find a suitable video, and repeat everything after the instructor without leaving your own home. Very comfortably. Try to do exercise 6 days a week for 2 weeks in a row, and you will find a new habit that is good for you.
3. Walk. This advice must be taken without fanaticism. Keep an eye on your health: when you feel good, allow yourself long walks. For example, you need to go grocery shopping, choose a store that is 20 minutes walk one way. A walk of 30-40 minutes is an excellent load (under conditions of good health).
4. Do hypertonic compresses. This is a wellness event, one of many. But it must be agreed with the doctor. It is possible to use aromatic compresses, the doctor will tell you detailed recipes. They give strength and, at the same time, relax.

Doctors always mark the degree of hypertension and the degree of risk on the patient's medical record. For the patient himself, it is not so important to know these ciphers, but to understand how to respond to the diagnosis, how to be treated, what to change in life.

Overeating is a problem for a huge number of people, not only those with hypertension. But it is important not only to understand that you are overeating, but also to try to overcome it. Overeating always contributes to obesity, which will allow the disease to progress rapidly - from one stage it will move to another.

In addition, very frequent meals provoke insulin resistance, they contribute to the development of diabetes. If you have high blood pressure and excess weight, immediately take on the correction of your own diet. This, like nothing else, will help you slow down the development of hypertension, improve your overall well-being.

Salt is another enemy of hypertension. Reduce its consumption, and remember - this is not a private wish, but one of the first rules for diagnosed hypertension. Sodium, as you know, retains water in the body, disrupts the functionality of the endothelium lining the vessels, and contributes to an increase in pressure.

Remember that there is a lot of sodium in seasonings. Herring, sausages, canned foods - this is what should be rare on the table for a hypertensive patient. You need to focus on such a norm: half a teaspoon of salt without a slide per day. This is what you add to food, and what already includes salt.

Hypertension does not forgive inattention. As soon as the patient, who has discovered the first symptoms of this disease, begins to ignore them, he drives himself into a dangerous trap. Subsequently, such a patient will lament that he did not have time to respond in time, that he did not begin treatment when it was relatively easy to do so.

For citation: Ivashkin V.T., Kuznetsov E.N. Risk assessment in arterial hypertension and modern aspects of antihypertensive therapy // BC. 1999. No. 14. S. 635

Department of propaedeutics of internal diseases THEM. Sechenov

Arterial hypertension (AH) is one of the main risk factors for the development of coronary heart disease (CHD), including myocardial infarction, and the main cause of cerebrovascular diseases (in particular, stroke). In Russia, the share of mortality from cardiovascular diseases in total mortality is 53.5%, while 48% of this proportion falls on cases caused by coronary artery disease, and 35.2% - on cerebrovascular diseases. It is important to note that in the working-age population, cerebrovascular diseases were detected in 20% of individuals, of which 65% suffer from hypertension, and among patients with cerebrovascular accident, more than 60% have mild hypertension. Strokes in Russia occur 4 times more often than in the US and Western Europe, although the mean arterial pressure (BP) in these populations differs slightly (WHO/IOAG, 1993) . This explains the importance of early diagnosis and treatment of hypertension, which helps to prevent or slow down the development of organ damage and improve the patient's prognosis.

As stated in the Report of the WHO Expert Committee on the Control of Arterial Hypertension (1996), Examination of a patient with a newly diagnosed increase in blood pressure includes the following tasks:

. Confirm the stability of the increase in blood pressure; . Assess overall cardiovascular risk; . To identify the presence of organ lesions or concomitant diseases; . As far as possible, establish the cause of the disease.

Thus, the process of diagnosing hypertension consists of a fairly simple first stage - detection of elevated blood pressure and a more complex next one - identifying the cause of the disease (symptomatic hypertension) and determining the prognosis of the disease (assessment of involvement of target organs in the pathological process, assessment of other risk factors).

Until recently, the diagnosis of hypertension was made in cases where repeated measurements of systolic blood pressure (SBP) were at least 160 mm Hg. or diastolic blood pressure (DBP) - not less than 95 mm Hg. (WHO, 1978). These recommendations were based on the results of a cross-sectional (one-shot) survey of large populations. At the same time, AH was defined as a condition in which the level of blood pressure exceeds the average values ​​of this indicator in this age group by an amount greater than a double standard deviation.

In the early 1990s, the criteria for hypertension were revised in the direction of their tightening. According to modern concepts, arterial hypertension is a persistent increase in SAD-140 mm Hg. or DADі90 mm Hg. (Table 1).

In people with increased emotionality as a result of a stress reaction to the measurement, inflated numbers may be registered that do not reflect the true state. As a result, misdiagnosis of hypertension is possible. To avoid this condition, called the “white coat” syndrome, rules for measuring blood pressure have been developed. Blood pressure should be measured in the patient's sitting position, after 5 minutes of rest, 3 times with an interval of 2-3 minutes. True blood pressure is calculated as the arithmetic mean between the two closest values.

BP below 140/90 mm Hg. Art. conventionally considered normal, but this level of blood pressure cannot be considered optimal. , given the likelihood of subsequent development of coronary artery disease and other cardiovascular diseases. The optimal level of blood pressure in terms of the risk of developing cardiovascular diseases was established after the completion of several long-term studies that included large populations. The largest of these prospective studies was the 6-year MRFIT (Multiple Risk Factor Intervention Trial, 1986). The MRFIT study included 356,222 men aged 35 to 57 years without a history of myocardial infarction. Analysis of the obtained data showed that The 6-year risk of developing fatal coronary artery disease is lowest among men with baseline DBP below 75 mm Hg. Art. and SBP below 115 mm Hg. Mortality from CAD is increased at DBP levels of 80 to 89 mmHg. and SBP from 115 to 139 mm Hg. Art., which are conventionally considered “normal”. So, with an initial DBP of 85-89 mm Hg. Art. the risk of developing fatal coronary artery disease is 56% greater than in individuals with DBP below 75 mm Hg. Art. With an initial SBP of 135-139 mm Hg. Art. the probability of death from coronary artery disease is 89% higher than in individuals with SBP below 115 mm Hg. Art. Therefore, it is not surprising if in the future the criteria for diagnosing hypertension will be even more stringent.

The tactics of managing a patient when he has elevated BP numbers are discussed in detail in the VI report of the US Joint National Committee on the Prevention, Detection and Treatment of High BP (JNC-VI, 1997) (Table 2).

Similar recommendations for monitoring patients after the first measurement of blood pressure are given by the WHO Expert Committee on the control of blood pressure (1996). Depending on the specific situation (historical blood pressure levels, presence of organ damage and other cardiovascular diseases and their risk factors), the blood pressure monitoring plan should be adjusted.

Establishing the final diagnosis of hypertension with classification according to the level of blood pressure, determining the risk of developing cardiovascular complications based on the involvement of target organs in the pathological process and the presence of other risk factors means the start of treatment for the patient. Since this process can be extended in time, in some cases (severe hypertension, numerous risk factors and other circumstances), diagnosis and treatment go hand in hand.

The goal of modern antihypertensive therapy is cardio- and vasoprotection, leading to a reduction in the incidence of complications and death. Of great importance is the early diagnosis of hypertension in order to provide an effective impact before changes in target organs occur.

If elevated blood pressure values ​​are detected, the patient is given lifestyle advice , which are the first step in the treatment of hypertension (Table 3).

According to the study TOMHS (Treatment of Mild Hypertension Study, 1993), subject to the recommendations given in Table. 3, in patients with hypertension (AH) without the use of drugs, it was possible to significantly reduce blood pressure (by an average of 9.1/8.6 mm Hg compared with 13.4/12.3 mm Hg among patients who additionally received one of the effective antihypertensive drugs). As the TOMHS study showed, as a result of lifestyle changes, it is possible not only to reduce blood pressure, but to cause the regression of left ventricular hypertrophy (LV.) . Thus, in the control group of patients with AH over 4.4 years of observation, the mass of the LV myocardium decreased by 27 ± 2 g, while in the groups of patients who additionally received antihypertensive drugs, by 26 ± 1 g.

The JNC-VI report states that limiting lifestyle changes is acceptable only in people with blood pressure less than 160/100 mmHg, who have neither target organ damage, nor cardiovascular disease, nor diabetes mellitus. In all other cases, antihypertensive drugs should be given in combination with lifestyle changes. In patients with heart failure, renal failure, or diabetes mellitus, antihypertensive drugs are recommended even at blood pressure levels in the range of 130–136/85–89 mmHg. rt. Art. (Table 4).

In addition to lifestyle changes and drug therapy, it is necessary to mention non-drug therapy, which includes normalized physical activity, autogenic training, behavioral therapy using the biofeedback method, muscle relaxation, acupuncture, electrosleep and physiological bioacoustic effects (music) .

With a good effect from the use of an antihypertensive drug, many patients continue to lead their previous lifestyle, considering it easier to take one tablet of a prolonged drug in the morning than following recommendations that deprive the “joys of life”. It is necessary to conduct conversations with patients, explaining that with lifestyle changes over time, it is possible to reduce the doses of the drugs taken.

It is necessary to dwell separately on the issue of blood pressure level to aim for in the treatment of hypertension . Until the mid-1980s, there was an opinion that lowering blood pressure in elderly people with hypertension was not only not necessary, but it could cause undesirable consequences. At present it is convincing demonstrated a positive result in the treatment of hypertension in the elderly. The SHEP, STOP-Hypertension, and MRC trials have convincingly shown a reduction in morbidity and mortality in these patients.

Situations when a doctor is forced to admit an increased level of blood pressure in a patient with HA are relatively rare and, as a rule, refer to patients with a long and severe disease. Overwhelmingly In most cases of HD, one should strive to lower blood pressure to a level below 135-140 / 85-90 mm Hg. Art. In patients younger than 60 years of age with mild hypertension, as well as in patients with diabetes mellitus or kidney disease, blood pressure should be maintained at 120-130/80 mm Hg. Art. . However, uncompromising “normalization” of blood pressure may be unfavorable in elderly patients and in various forms of local circulatory failure (cerebral, coronary, renal, peripheral), especially if hypertension is partly compensatory. Statistically, this is described as an iota-like dependence of vascular complications on the level of blood pressure. In this age group, atherosclerotic changes are more pronounced, and with a sharp decrease in blood pressure, ischemia may increase (for example, ischemic strokes against the background of clinically significant atherosclerosis of the carotid arteries). The pressure in such patients should be reduced gradually, assessing the general well-being and the state of regional blood flow. The principle of "do no harm" in such patients is especially relevant. Besides, comorbidity needs to be taken into account : for example, the appointment of calcium channel antagonists (rather than b-blockers) with signs of obliterating atherosclerosis of the vessels of the lower extremities; reduction in the dosage of drugs excreted by the kidneys, in the presence of signs of renal failure, etc.

When choosing drugs, one should, if possible, give preference to those that do not cause a significant deterioration in the quality of life of the patient and which can be taken 1 time per day. Otherwise, it is very likely that an asymptomatic patient with HD will not take a drug that worsens his well-being. A modern antihypertensive drug should have a sufficient duration of action, stability of the effect, and a minimum of side effects. We should not forget about its price.

The relative value of drugs is determined at the present stage by carefully designed multicentric studies, the criteria are absolute indicators: a decrease in mortality from cardiovascular diseases (taking into account total mortality), the number of non-fatal complications, objective indicators of the impact on the quality of life of patients and on the course of concomitant diseases.

Antihypertensive drugs suitable for both long-term monotherapy and combination therapy are:. thiazide and thiazide-like diuretics;

. b-blockers; . ACE inhibitors; . antagonists of ATI receptors for angiotensin II; . calcium antagonists; . a 1 -blockers.

All of these drugs can be used to start hypertension monotherapy. In addition, it is necessary to mention the recently appeared group imidazoline receptor blockers (moxonidine) , close in action to central a 2 -adrenergic agonists, however, unlike the latter, they are better tolerated and favorably affect carbohydrate metabolism, which is especially important in patients with diabetes mellitus.

Loop diuretics are rarely used to treat hypertension. Potassium-sparing diuretics (amiloride, spironolactone, triamterene), direct vodilators (hydralazine, minoxidil) and sympatholytics of central and peripheral action (reserpine and guanethidine), as well as central a 2 -adrenergic receptor agonists, which have many side effects, have been used in recent years only in combination with other antihypertensive drugs.

The expansion of the spectrum of antihypertensive drugs has allowed some authors to put forward the concept of individualized choice of first-line drugs in the treatment of hypertension . It should be noted that it is not the “strength” of the drug that is decisive, since contrary to popular belief new antihypertensive agents are not significantly superior to diuretics and b -blockers for antihypertensive activity . Given the similar efficacy of antihypertensive drugs, their choice should primarily take into account tolerability, ease of use, effects on LV hypertrophy, kidney function, metabolism, etc. When prescribing treatment, it is also necessary to take into account the allergic history.

In accordance with modern requirements for antihypertensive therapy, it is also necessary individual selection of the drug taking into account risk factors . In past years, until the early 90s, hypertension was considered only as a problem of lowering blood pressure. Today, hypertension should be considered and treated in a single complex with risk factors for cardiovascular disease.

Factors affecting prognosis in hypertension (m.tab.5 I. Risk factors for cardiovascular disease (CVD) 1. Used for risk stratification in hypertension:. levels of systolic and diastolic blood pressure (grade I-III); . men > 55 years; . women > 65 years; . smoking; . total cholesterol > 6.5 mmol/l; . diabetes; . family history of early development of cardiovascular disease. 2. Other factors that adversely affect the prognosis:. reduced HDL cholesterol; . elevated LDL cholesterol; . microalbuminuria in diabetes mellitus; . impaired glucose tolerance; . obesity; . "passive lifestyle; . elevated fibrinogen levels; . high-risk socioeconomic group; . high-risk ethnic group; . geographic region of high risk. II. Target Organ Injury (TOM): . LV hypertrophy (ECG, echocardiography or radiograph); . proteinuria and / or a slight increase in plasma creatinine (1.2-2 mg / dl);

Ultrasound or x-ray signs of atherosclerotic plaque (carotid iliac and femoral arteries, aorta);

. generalized or focal narrowing of the retinal arteries. III. Associated Clinical Conditions (ACS) Cerebrovascular diseases: . ischemic stroke; . hemorrhagic stroke; . transient ischemic attack. Heart disease:. myocardial infarction; . angina; . revascularization of the coronary arteries; . congestive heart failure. Kidney disease:. diabetic nephropathy; . renal failure (plasma creatinine > 2 mg/dl). Vascular disease:. dissecting aneurysm; . clinical manifestations of peripheral arterial disease. Severe hypertensive retinopathy:. hemorrhages and exudates; . swelling of the nipple of the optic nerve.

The presence of several risk factors in a patient increases the risk of developing cardiovascular complications. The risk increases especially sharply with a combination of hypertension, obesity, hypercholesterolemia and hyperglycemia, known as the “deadly quartet” (Table 5).

Comparison of blood pressure levels and factors influencing the prognosis in hypertension allows the doctor to determine the risk of complications in patients with elevated blood pressure, which is an important factor in choosing a regimen and timing of treatment. However, even with such a balanced and balanced approach to the treatment of hypertension, monotherapy does not normalize blood pressure in all patients. If antihypertensive therapy is ineffective, the drug taken should be changed or switched from mono- to combination therapy. When choosing drugs for combination therapy of hypertension, it is important to take into account the additional pharmacological properties of these drugs, which may be useful for the treatment of concomitant diseases or syndromes (Table 6).

Speaking about the adequacy of antihypertensive therapy, one cannot help but dwell on modern methods for monitoring its effectiveness. In recent years, medical practice has increasingly included blood pressure monitoring systems . Compact wearable monitors based on the Korotkoff method and/or using the oscillometric method allowed doctors to monitor not only blood pressure at night (bedside monitors also provide such an opportunity), but also in the patient's usual conditions, during physical and mental stress. In addition, the accumulated experience made it possible to separate patients depending on the nature of daily fluctuations in blood pressure into groups in which the risk of developing cardiovascular complications was significantly different.

. Dippe s - persons with a normal nocturnal decrease in blood pressure (by 10-22%)- 60-80% of patients with essential hypertension (EAH). This group has the lowest risk of complications.

. Non-dippe s - persons with insufficient reduction in blood pressure (less than 10%)- up to 25% of patients with EAH.

. Over-dipper, or extreme-dippers - persons with an excessive nighttime drop in blood pressure (more than 22%)- up to 22% of patients with EAH.

. Night-peake s - persons with nocturnal hypertension in which nighttime blood pressure exceeds daytime - 3-5% of patients with EAH.

Disturbed circadian rhythm of blood pressure in EAH is observed in 10-15%, and in symptomatic hypertension and some other conditions (sleep apnea syndrome, condition after kidney or heart transplantation, eclampsia, diabetic or uremic neuropathy, congestive heart failure, widespread atherosclerosis in the elderly , normotonics with aggravated heredity for hypertension, impaired glucose tolerance) - in 50-95% of patients, which allows the use daily BP index (or the degree of nocturnal decrease in blood pressure) as an important diagnostic and prognostic criterion.

The cumulative analysis of national projects and individual studies conducted in the last 5 years allowed J. Staessen et al. (1998) to propose the following standards for the average values ​​of blood pressure according to daily monitoring data (Table 7).

Taking into account the high consistency of the results of individual national studies, the proposed values ​​can be taken as base ones in other countries as well.

Currently, large-scale studies are ongoing on groups of healthy volunteers to clarify the levels of average daily, average daily and average night blood pressure, corresponding to the norm.

In addition to the average blood pressure figures, an equally important indicator of the effectiveness of the therapy is time index , which indicates in what percentage of the time of the total duration of monitoring the blood pressure level was above normal values. Normally, it does not exceed 25%.

However, in some patients with severe hypertension, it is not possible to completely normalize blood pressure, the level of which decreases, but does not reach the norm, and the time index remains close to 100%. In such cases, to determine the effectiveness of therapy, in addition to indicators of the average daily, average daily and average night blood pressure, you can use area index , which is defined as the area on the graph of elevated blood pressure above the normal level. By the severity of the decrease in the area index in dynamics, one can judge the effect of antihypertensive therapy.

In conclusion, we note that the arsenal of modern antihypertensive drugs that allow you to quickly reduce and effectively control the level of blood pressure is currently quite large. According to the results of multicenter studies, b - blockers and diuretics reduce the risk of developing cardiovascular diseases and complications and increase the life expectancy of patients. Of course, preference is given to selective prolonged b 1 -blockers and the thiazide-like diuretic indapamide, which has a much lesser effect on lipid and carbohydrate metabolism. There is evidence of a positive effect on the life expectancy of the application ACE inhibitors (enalapril) . Data on the results of the use of calcium antagonists are heterogeneous, some multicenter studies have not yet been completed, but today we can already say that long-acting drugs are preferred. The final analysis of ongoing multicenter studies will allow in the coming years to determine the place of each group of antihypertensive drugs in the treatment of hypertension.

Literature

1. Arabidze G.G., Belousov Yu.B., Karpov Yu.A. arterial hypertension. Reference guide for diagnosis and treatment. - M. 1999; 40.

1. Arabidze G.G., Belousov Yu.B., Karpov Yu.A. arterial hypertension. Reference guide for diagnosis and treatment. - M. 1999; 40.

2. Sidorenko B.A., Preobrazhensky D.V. A short guide to the treatment of hypertension. M. 1997; 9-10.

3. Sidorenko B.A., Alekseeva L.A., Gasilin V.S., Gogin E.E., Chernysheva G.V., Preobrazhensky D.V., Rykova T.S. Diagnosis and treatment of arterial hypertension. M. 1998; eleven.

4. Rogoza A.N., Nikolsky V.P., Oshchepkova E.V., Epifanova O.N., Rukhinina N.K., Dmitriev V.V. Daily monitoring of blood pressure in hypertension (Methodological issues). 45.

5. Dahlof B., Lindholm L.H., Hansson L. et al. Morbidity and mortality in the Swedish trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 338:1281-5.

6. MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: Principal results. Br Med J 1992; 304:405-12.

7. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265:3255-64.

8. Gogin E.E. Hypertonic disease. M. 1997; 400 s.

9. Kaplan N. Clinical hypertension. Williams and Wilkins. 1994.

10. Laragh J. Modification of stepped care approach to antihypertensive therapy. Am.J.Med. 1984; 77:78-86.

11. Kobalava Zh.D., Tereshchenko S.N. How to live with arterial hypertension? - Recommendations for patients. M. 1997; 9.

13. Olbinskaya L.I., Martynov A.I., Khapaev B.A. Monitoring of arterial pressure in cardiology. Moscow: Russian doctor. 1998; 99.

Daily BP index (the degree of nighttime decrease in blood pressure) is an important diagnostic and prognostic criterion

There is probably no person who has never encountered high blood pressure throughout his life. Hypertension is short-term - caused by severe stress or excessive physical exertion. But for many, hypertension becomes chronic, and then doctors in the course of diagnosis must determine the degree of arterial hypertension (AH) and assess potential health risks.

What is arterial hypertension

The pressure in the arteries of the systemic circulation plays an important role in human life. If it is constantly elevated, this is arterial hypertension. Depending on the degree of increase in systolic and diastolic pressure, 4 stages of arterial hypertension are distinguished. In the early stages, the disease is asymptomatic.

The reasons

The first degree of arterial hypertension often develops due to an unhealthy lifestyle. Lack of sleep, nervous strain and bad habits provoke vasoconstriction. Blood begins to press on the arteries with more force, which leads to hypertension. The factors provoking the appearance of primary and secondary hypertension include:

• hypodynamia;
• obesity;
• hereditary predisposition;
• vitamin D deficiency;
• sodium sensitivity;
• hypokalemia;
• elevated cholesterol levels;
• the presence of chronic diseases of internal organs.

Classification

The disease is divided depending on the causes of its development and indicators of blood pressure. According to the nature of the course of the disease, primary and secondary hypertension are distinguished. With primary, or essential arterial hypertension, the pressure in patients simply rises, but there are no pathologies of the internal organs. There are several types of it: hyperadrenergic, hyporenin, normorenin, hyperrenin. The main problem in the treatment of primary hypertension is that the causes of its occurrence have not yet been studied.

The classification of secondary hypertension is as follows:

• neurogenic;
• hemodynamic;
• endocrine;
• medicinal;
• nephrogenic.

In the neurogenic type of the disease, patients experience problems in the peripheral and central nervous system caused by brain tumors, circulatory failure or stroke. Hemodynamic symptomatic hypertension is accompanied by heart disease and aortic pathologies. The endocrine form of the disease can be caused by the active work of the adrenal glands or the thyroid gland.

Nephrogenic hypertension is considered the most dangerous, because. often accompanied by polycystic, pyelonephritis and other pathologies of the kidneys. The dosage form occurs against the background of uncontrolled intake of medications that affect the density of blood vessels or the functioning of the endocrine system.

Degrees of hypertension - table

Currently, when examining patients with suspected hypertension, the Korotkoff method is used. This method of examining patients was officially approved by the World Health Organization (WHO) in 1935. Before diagnosing a patient with any degree of arterial hypertension, pressure measurements are made on each arm 3 times. A difference of 10-15 mm indicates the pathology of peripheral vessels. Degrees of hypertension in relation to blood pressure indicators:

Blood pressure (BP)	Systolic BP	Diastolic BP
Optimal
Normal
Upper limit of normal
AG 1 degree
AG 2 degrees
AG 3 degrees
AH 4 degrees
Isolated systolic hypertension

Risk stratification in arterial hypertension

All patients, depending on the state of health and the degree of hypertension, are divided into several groups. Stratification (risk assessment) is influenced not only by the blood pressure indicator, but also by the age and lifestyle of the patient. The main risk factors include dyslipidemia, a family history of early development of cardiovascular disease, an excess of C-reactive protein, abdominal obesity, and smoking. In addition, take into account:

• impaired glucose tolerance;
• high fibrinogen level;
• hypodynamia;
• the presence of diabetes;
• target organ damage;
• diseases of the endocrine system;
• the appearance of signs of thickening of the arteries;
• diseases of the kidneys, heart;
• circulatory disorders.

In women, the chances of getting complications increase after the age of 65, in men - earlier, at 55 years. The risk of complications will be low if the patient is exposed to no more than one or two adverse factors. These patients almost always have grade 1 hypertension. When assessing the condition of elderly patients (over 65 years), doctors rarely indicate a low risk in the medical history, because. in this age category, the chance of developing vascular atherosclerosis is 80%. They are immediately placed in the high-risk group.

Hypertension 1 degree

The disease is often iatrogenic, ie. occurs against the background of taking drugs containing artificial hormones. Arterial hypertension of the 1st degree can be primary and secondary. The essential form of the disease is accompanied only by an increase in pressure. In the secondary form, the patient's history contains other pathologies that provoke the development of hypertension. The disease often occurs during pregnancy and occurs in 90% of patients asymptomatically.

Normalization of blood pressure is facilitated by weight loss and increased physical activity. The patient does not need to start hard and exhausting workouts. Daily 30-minute walks in the fresh air will help to cure 1 degree of arterial hypertension. A hypertensive patient should correct the diet by excluding too salty and fatty foods from the menu. For a while, you should limit the use of liquids. Medicines for the first type of hypertension are not prescribed.

Risk 1

This group includes patients under 55 years of age suffering from a slight increase in pressure. Other risk factors should be absent. With normal pressure indicators, non-drug therapy is recommended. It is also suitable for labile arterial hypertension, when the symptoms of the disease appear periodically. Primary prevention of complications includes normalization of the body mass index, diet correction and elimination of muscular dystrophy.

Risk 2

Patients suffering from exposure to 2-3 adverse factors fall into this group. The first degree of arterial hypertension with risk 2 is characterized by the appearance of the first symptoms of high blood pressure. Patients complain of migraine, flies in the eyes and dizziness. The patient can get rid of the disease only with the help of drug therapy. Complications in patients at moderate risk occur in 15-20% of cases.

Risk 3

Many patients assume that type 1 hypertension is mild and goes away on its own. But without treatment, any person can develop complications. At risk 3, patients develop edema, lethargy, angina pectoris, and fatigue; kidneys begin to suffer from pathology. Hypertensive crises may occur, characterized by an increase in heart rate and hand tremors. Further complications develop with a probability of 20-30%.

Risk 4

In this group, cardiovascular complications occur in more than 30% of patients. This risk is diagnosed in a patient if there are potential aggravating factors. These include chronic renal failure, congenital lesions of the vessels of the brain and other organs. At risk 4, the disease progresses to the second or third degree within 6-7 months.

Hypertension 2 degrees

The mild form of the disease is accompanied by typical signs of high blood pressure: nausea, fatigue, headache. With hypertension of the 2nd degree, the likelihood of left ventricular hypertrophy increases. Muscles begin to contract more strongly to resist the flow of blood, which leads to the growth of muscle tissue and disruption of the heart. Clinical manifestations of this form of hypertension:

• vascular insufficiency;
• constriction of arterioles;
• feeling of pulsation in the temples;
• numbness of the limbs;
• pathology of the eye.

Arterial hypertension of the 2nd degree can be diagnosed if only diastolic or systolic blood pressure is exceeded. With this form of the disease, monotherapy shows itself well. It is used when high blood pressure does not pose risks to the life of the patient and does not affect his ability to work. If it is difficult for the patient to work during attacks, start treatment with combined drugs.

Risk 2

Hypertension is mild. The patient complains of migraine and pain in the region of the heart. At risk 2, the patient is exposed to one or two unfavorable factors, so the percentage of complications in this group is less than 10. In sensitive people, hyperemia of the skin is observed. There are no target organ damage. Treatment consists of taking one type of antihypertensive drug and adjusting the diet.

Risk 3

Arterial hypertension can be detected by the presence of albumin proteins in the urine. The patient swells not only the limbs, but also the face. A hypertensive patient complains of blurred vision. The walls of blood vessels become thicker. The risk of complications reaches 25%. Treatment consists of taking medications that normalize blood pressure and restore the work of organs damaged by the disease.

Risk 4

With an unfavorable course of the disease, symptoms of target organ damage appear. Patients suffer from sudden pressure surges of 59 units or more. The transition of hypertension to the next stage without treatment will take 2-3 months. With a persistent violation of body functions, hypertensive patients with a risk of 4 are assigned a disability of 2 or 3 groups. The state of health continues to deteriorate in 40% of patients.

Hypertension grade 3

The systolic pressure at this stage of the disease is equal to or greater than 180 mm Hg. Art., and diastolic - 110 mm Hg. and higher. Vascular tissues in the third degree of arterial hypertension are damaged very much. Patients often suffer from hypertensive crises and angina pectoris. Pressure readings are always elevated. The disease is accompanied by the following symptoms:

• dizziness and constant migraines;
• the appearance of flies before the eyes;
• muscle weakness;
• damage to retinal vessels;
• deterioration in the clarity of vision;

Treatment for high blood pressure in grade 3 hypertension includes drug therapy, diet, and exercise. A hypertensive person must give up smoking and alcohol. Taking one drug will not help to cope with high blood pressure in this form of the disease. Doctors prescribe diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors to patients. The disease is considered resistant if the use of 3-4 drugs failed to normalize the patient's condition.

Risk 3

The group includes patients who may become disabled. Grade 3 hypertension with risk 3 is accompanied by extensive damage to target organs. Suffer from high blood pressure kidneys, heart, brain, retina. The left ventricle expands, which is accompanied by the growth of the muscle layer. The myocardium begins to lose its elastic properties. The patient develops hemodynamic instability.

Risk 4

The group consists of patients with malignant arterial hypertension. Patients suffer from periodic transient attacks, which leads to the development of severe complications, including the occurrence of a stroke. Mortality in this group of patients is high. With increased severity of arterial hypertension, patients are assigned 1 disability group.

Hypertension 4 degrees

This stage of hypertension is considered very severe. In 80% of patients, death occurs within a couple of months after the transition of the disease to this form. In a hypertensive crisis, it is important to quickly provide first aid to the patient. It is necessary to lay it on a flat surface, slightly raise its head. The patient is given antihypertensive pills that sharply lower blood pressure.

For the 4th degree of arterial hypertension, 2 forms of the course are characteristic: primary and secondary. The main difference between this type of disease and others is the complications that accompany seizures. At the time of pressure increase, patients experience disorders of the cerebral, coronary, and renal circulation. The cardiovascular system suffers from constant overload, which leads to disability of the patient.

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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 throughout 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 edema of the optic nerve 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 life, 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;
• unconditionally 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 was pressing 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, and 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 noradrenaline (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 “squeezing blood 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 formed. 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 the state of the body), but German doctors have proven that age over 38 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 constantly drink alcohol 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 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 04.07.2013 N 565 "On approval of the Regulations on military medical examination", 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 issued (“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 permanently get rid of painful attacks 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: 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!

Risk factors	AH Grade 1	AH Grade 2	AH Grade 3
1. No risk factors	low risk	Medium Risk	high risk
2. 1-2 risk factors	Medium Risk	Medium Risk	Very high risk
3. 3 or more risk factors and/or target organ damage and/or diabetes	high risk	high risk	Very high risk
4. Associated (comorbid clinical) conditions	Very high risk	Very high risk	Very high risk

Low risk group (risk 1) . This group includes men and women under 55 years of age with grade 1 hypertension in the absence of other risk factors, target organ damage, and associated cardiovascular disease. The risk of developing cardiovascular complications in the next 10 years (stroke, heart attack) is less than 15%.

Medium risk group (risk 2) . This group includes patients with arterial hypertension of 1 or 2 degrees. The main sign of belonging to this group is the presence of 1-2 other risk factors in the absence of target organ damage and associated (concomitant) diseases. The risk of developing cardiovascular complications (stroke, heart attack) in the next 10 years is 15-20%.

High risk group (risk 3) . This group includes patients with grade 1 or 2 hypertension, 3 or more other risk factors, or end-organ damage or diabetes mellitus. The same group includes patients with arterial hypertension of the 3rd degree without other risk factors, without damage to target organs, without associated diseases and diabetes mellitus. The risk of developing cardiovascular complications in this group in the next 10 years ranges from 20 to 30%.

Very high risk group (risk 4) . This group includes patients with any degree of arterial hypertension who have associated diseases, as well as patients with arterial hypertension of the 3rd degree with the presence of other risk factors and / or damage to target organs and / or diabetes mellitus, even in the absence of associated diseases. The risk of developing cardiovascular complications in the next 10 years exceeds 30%.

In 2001, experts from the All-Russian Scientific Society of Cardiology developed "Recommendations for the Prevention, Diagnosis and Treatment of Arterial Hypertension" (hereinafter referred to as the "Recommendations").

Hypertonic diseaseIstages assumes no changes in target organs.

Hypertonic diseaseIIstages characterized by the presence of one or more changes in target organs.

Hypertonic diseaseIIIstages is set in the presence of one or more associated (accompanying) states.

Clinical picture

Subjective manifestations

The uncomplicated course of primary arterial hypertension may not be accompanied by subjective symptoms, in particular, headaches, for a long time, and the disease is detected only with an accidental measurement of blood pressure or during a routine examination.

However, persistent and purposeful questioning of patients allows us to ascertain the subjective manifestations of primary (essential) arterial hypertension in the vast majority of patients.

The most common complaint is on the headache . The nature of headaches varies. In some patients, the headache manifests itself mainly in the morning, after waking up (many cardiologists and neuropathologists consider this a characteristic feature of the disease), in others, the headache appears during a period of emotional or physical stress during the working day or at the end of the working day. The localization of the headache is also diverse - the neck area (most often), temples, forehead, parietal region, sometimes patients cannot even accurately determine the location of the headache or say that "the whole head hurts." Many patients note a clear dependence of the appearance of headaches on changes in weather conditions. The intensity of headaches ranges from mild, perceived rather as a feeling of heaviness in the head (and this is typical for the vast majority of patients), to very significant in severity. Some patients complain of severe stabbing or squeezing pains in various parts of the head.

Headache is often accompanied dizzy, shaky iem when walking, the appearance of circles and flickering "flies" before the eyes ami, feeling full or tinnitus . However, it should be noted that intense headache, accompanied by dizziness and other complaints mentioned above, is observed with a significant rise in blood pressure and may be a manifestation of a hypertensive crisis.

It should be emphasized that as arterial hypertension progresses, the intensity of headache and the frequency of dizziness increase. It must also be remembered that sometimes a headache is the only subjective manifestation of arterial hypertension.

Approximately 40-50% of patients with primary hypertension have neurotic disorders . They are manifested by emotional lability (unstable mood), irritability, tearfulness, sometimes depression, fatigue, asthenic and hypochondriacal syndromes, depression and cardiophobia are often observed.

17-20% of patients have pain in the heart . Usually these are pains of moderate intensity, localized mainly in the region of the apex of the heart, most often appearing after emotional stress and not associated with physical stress. Cardialgia can be persistent, prolonged, not relieved by nitrates, but, as a rule, pain in the region of the heart decreases after taking sedatives. The mechanism of the appearance of pain in the region of the heart in arterial hypertension remains unclear. These pains are not a reflection of myocardial ischemia.

However, it should be noted that in patients with arterial hypertension with concomitant coronary heart disease, classic angina attacks can be observed, and often they are provoked by a rise in blood pressure.

About 13-18% of patients complain of heartbeat (usually we are talking about sinus tachycardia, less often - paroxysmal tachycardia), feeling of interruption in the region of the heart (due to extrasystolic arrhythmia).

Characteristic are visual impairment complaints (flickering flies before the eyes, the appearance of circles, spots, a feeling of a veil of fog before the eyes, and in severe cases of the disease - progressive loss of vision). These complaints are due to hypertensive angiopathy of the retina and retinopathy.

With the progression of arterial hypertension and the development of complications, complaints appear due to progressive atherosclerosis of the cerebral and peripheral arteries, cerebrovascular accidents, aggravation of the course of coronary heart disease, kidney damage and the development of chronic renal failure, heart failure (in patients with pronounced myocardial hypertrophy).

Analyzing data history , the following important points should be clarified:

the presence of arterial hypertension, diabetes mellitus, cases of early development of coronary heart disease in the next of kin (these factors are taken into account in the subsequent risk stratification);

the patient's lifestyle (abuse of fats, alcohol, salt; smoking, physical inactivity; the nature of the patient's work; the presence of psycho-emotional stressful situations at work; the situation in the family);

features of the character and psycho-emotional status of the patient;

the presence of anamnestic information suggesting symptomatic arterial hypertension;

dynamics of blood pressure indicators both at home and when visiting a doctor;

effectiveness of antihypertensive therapy;

dynamics of body weight and lipid metabolism (cholesterol, triglycerides, lipoproteins).

Obtaining this anamnestic information makes it possible to more accurately determine the risk group, the likelihood of developing coronary heart disease and cardiovascular complications, and more rationally apply antihypertensive therapy.

Objective examination of patients

Inspection. When examining patients with arterial hypertension, attention should be paid to assessing body weight, calculating the body mass index (Quetelet index), identifying obesity and the nature of the distribution of fat. Once again, attention should be paid to the frequent presence of metabolic syndrome. Cushingoid type of obesity (predominant deposition of fat on the face, in the cervical spine, shoulder girdle, chest, abdomen) with purple-red stripes of skin stretching (striae) immediately allows you to associate the presence of arterial hypertension in a patient with hypercortisolism (Itsenko-Cushing's disease or syndrome). ).

In patients with primary arterial hypertension in its uncomplicated course, usually, in addition to excess body weight (in 30-40% of patients), no other characteristic features are found. With severe hypertrophy of the left ventricle and a violation of its function, circulatory failure may develop, which will manifest itself as acrocyanosis, swelling in the feet and legs, shortness of breath, and in severe heart failure, even ascites.

The radial arteries are easily accessible for palpation, it is necessary to evaluate not only the pulse rate and its rhythm, but also its value on both radial arteries and the condition of the wall of the radial artery. Arterial hypertension is characterized by a tense, hard-to-compress pulse.

Heart study . Arterial hypertension is characterized by the development of left ventricular hypertrophy. This is manifested by a lifting cardiac impulse, and when the dilatation of the cavity of the left ventricle is added, the left border of the heart increases. When listening to the heart, the accent of the II tone over the aorta is determined, and with the prolonged existence of the disease, the systolic ejection murmur (based on the heart). The appearance of this noise in the II intercostal space on the right is extremely characteristic of aortic atherosclerosis, and is also found during a hypertensive crisis.

With significantly pronounced hypertrophy of the myocardium of the left ventricle, an abnormal IV tone may appear. Its origin is due to the active contraction of the left atrium with high diastolic pressure in the cavity of the left ventricle and impaired relaxation of the ventricular myocardium in diastole. Usually the IV tone is not loud, so it is more often recorded during phonocardiographic examination, less often it is auscultated.

With severe dilatation of the left ventricle and a violation of its contractility, III and IV heart sounds can be heard simultaneously, as well as systolic murmur in the apex of the heart due to mitral regurgitation.

The most important symptom of arterial hypertension is, of course, high blood pressure. The value of systolic blood pressure of 140 mm Hg indicates arterial hypertension. Art. and more and / or diastolic 90 mm Hg. Art. and more.