Hypertension symptoms. Arterial hypertension (hypertension)

Arterial hypertension - This is perhaps the most common disease in all of cardio-vascular system. The word “hypertension” means persistently elevated arterial pressure. An increase in blood pressure occurs when there is a narrowing of the arteries and/or their smaller branches, the arterioles. Arteries are the main transport routes through which blood is delivered to all tissues of the body. In some people, the arterioles often narrow, first due to spasm, and later their lumen remains constantly narrowed due to thickening of the wall, and then, in order for the blood flow to overcome these narrowings, the work of the heart increases and more blood is released into the vascular bed. Such people, as a rule, develop hypertension.

In our country, approximately 40% of the adult population have high blood pressure. At the same time, about 37% of men and 58% of women know about the presence of the disease, and only 22 and 46% of them are treated. Only 5.7% of men and 17.5% of women properly control their blood pressure.

Arterial hypertension

Arterial hypertension- This chronic illness accompanied by a persistent increase in blood pressure above acceptable limits (systolic pressure above 139 mm Hg and/or) diastolic pressure above 89 mmHg).

In approximately one in ten hypertensive patients, high blood pressure is caused by damage to an organ. In these cases we talk about secondary or symptomatic hypertension. About 90% of patients suffer from primary or essential hypertension. The starting point for high blood pressure is at least a level of 139/89 mm Hg registered by a doctor three times. Art. and more in people not taking medications to lower blood pressure. It is important to note that a slight, even persistent increase in blood pressure does not mean the presence of the disease. If in this situation you do not have other risk factors and signs of target organ damage, hypertension at this stage is potentially treatable. However, without your interest and participation it is impossible to lower blood pressure. The question immediately arises: is it worth taking arterial hypertension seriously if I feel quite well? The answer to this question is clear: yes.

Arterial pressure

To understand what blood pressure is, let’s first understand some numbers and “dance” from them. It is known that the total amount of blood in the body is 6–8% of body weight. Using a simple calculation, you can easily find out the blood volume of each person. So, with a weight of 75 kilograms, the blood volume is 4.5 - 6 liters. And all of it is enclosed in a system of vessels communicating with each other. So, when the heart contracts, blood moves along blood vessels, puts pressure on the wall of the arteries, and this pressure is called arterial pressure. Blood pressure helps blood move through the vessels. There are two indicators of blood pressure:

Systolic blood pressure (SBP), also called “upper”, reflects the pressure in the arteries that is created when the heart contracts and releases blood into the arterial part of the vascular system;

Diastolic blood pressure (DBP), also called “lower,” reflects the pressure in the arteries at the moment the heart relaxes, during which it fills before the next contraction. Both systolic blood pressure and diastolic blood pressure are measured in millimeters of mercury (mmHg).

How to measure blood pressure correctly

You can measure your blood pressure yourself using special devices - so-called “tonometers”. Measuring blood pressure at home provides valuable information. Additional information, both during the initial examination of the patient and during further monitoring of the effectiveness of treatment.

When measuring blood pressure at home, you can estimate it on different days under conditions Everyday life and eliminate the “white coat effect.” Self-monitoring of blood pressure disciplines the patient and improves adherence to treatment. Measuring your blood pressure at home can help you more accurately assess the effectiveness of treatment and potentially reduce its cost. An important factor influencing the quality of self-monitoring of blood pressure is the use of devices that meet international accuracy standards. We do not recommend using blood pressure devices on your finger or wrist. You should strictly follow the instructions for measuring blood pressure when using automatic electronic devices.

There are mandatory rules that must be followed when measuring blood pressure:

Situation. The measurement should be carried out in a quiet, calm and comfortable stop at a comfortable temperature. You should sit in a straight-backed chair next to a desk. The height of the table should be such that when measuring blood pressure, the middle of the cuff placed on the shoulder is at the level of the heart.

Preparation for measurement and duration of rest. Blood pressure should be measured 1-2 hours after eating. You should not smoke or drink coffee for 1 hour before measurement. You should not be wearing tight, constricting clothing. The arm on which blood pressure will be measured must be bare. You should sit leaning against the back of a chair with relaxed, uncrossed legs. It is not recommended to talk while taking measurements, as this may affect your blood pressure levels. Blood pressure measurements should be taken after at least 5 minutes of rest.

Cuff size. The cuff width should be sufficient. The use of a narrow or short cuff leads to a significant false increase in blood pressure.

Cuff position. Determine with your fingers the pulsation of the brachial artery at the level of the middle of the shoulder. The center of the cuff balloon should be located exactly above the palpable artery. The bottom edge of the cuff should be 2.5 cm above the cubital fossa. Cuff tightness: a finger should fit between the cuff and the surface of the patient's shoulder.

How much to pump? Determining the maximum level of air injection into the cuff is necessary to accurately determine systolic blood pressure with minimal discomfort for the patient and avoid “auscultation failure”:

• determine the pulsation of the radial artery, the nature and rhythm of the pulse
• While continuing to palpate the radial artery, quickly inflate the cuff to 60 mmHg. Art., then pump 10 mm Hg. Art. until the pulsation disappears
• The air from the cuff should be deflated at a speed of 2 mmHg. Art. per second. The level of blood pressure at which the pulse appears again is recorded
• completely deflate the cuff. To determine the level of maximum air injection into the cuff, the value of systolic blood pressure determined by palpation is increased by 30 mm Hg. Art.

Stethoscope position. Using your fingers, you determine the point of maximum pulsation of the brachial artery, which is usually located immediately above the cubital fossa on inner surface shoulder The membrane of the stethoscope should be in full contact with the surface of the shoulder. Should be avoided too strong pressure stethoscope, and the head of the stethoscope should not touch the cuff or tubes.

Inflating and deflating the cuff. Inflation of air into the cuff to the maximum level should be carried out quickly. Air is released from the cuff at a rate of 2 mmHg. Art. per second until the appearance of tones (“dull blows”) and then continue to be released at the same speed until the sounds disappear completely. The first sounds correspond to systolic blood pressure, the disappearance of sounds (last sound) corresponds to diastolic blood pressure.

Repeated measurements. Data obtained once are not true: it is necessary to take repeated measurements of blood pressure (at least twice with an interval of 3 minutes, then the average value is calculated). It is necessary to measure blood pressure in both the right and left arms.

Symptoms of arterial hypertension

Clinic, i.e. manifestations of hypertension do not have specific symptoms. Patients may not know about their illness for many years, have no complaints, and have high vital activity, although sometimes they may experience attacks of “lightheadedness,” severe weakness and dizziness. But even then everyone believes that it is due to overwork. Although it is at this moment that you need to think about blood pressure and measure it. Complaints with hypertension arise when the so-called target organs are affected; these are the organs that are most sensitive to increases in blood pressure. The patient experiences dizziness, headaches, noise in the head, decreased memory and performance indicate initial changes cerebral circulation. This is then followed by double vision, flashing spots, weakness, numbness of the limbs, difficulty speaking, but at the initial stage, changes in blood circulation are intermittent. An advanced stage of arterial hypertension can be complicated by cerebral infarction or cerebral hemorrhage. The earliest and most permanent sign of constantly elevated blood pressure is an increase, or hypertrophy, of the left ventricle of the heart, with an increase in its mass due to the thickening of heart cells, cardiomyocytes.

First, the thickness of the wall of the left ventricle increases, and subsequently the expansion of this chamber of the heart occurs. It is necessary to pay close attention to the fact that left ventricular hypertrophy is an unfavorable prognostic sign. A number of epidemiological studies have shown that the occurrence of left ventricular hypertrophy significantly increases the risk of developing sudden death, IHD, heart failure, ventricular arrhythmias. Progressive dysfunction of the left ventricle leads to the appearance of symptoms such as: shortness of breath on exertion, paroxysmal nocturnal dyspnea (cardiac asthma), pulmonary edema (often during crises), chronic (congestive) heart failure. Against this background, they develop more often myocardial infarction, ventricular fibrillation.

For rough morphological changes in the aorta (atherosclerosis), it expands, and its dissection and rupture may occur. Kidney damage is expressed by the presence of protein in the urine, microhematuria, and cylindruria. However, renal failure in hypertension, if there is no malignant course, rarely develops. Eye damage can manifest itself as blurred vision, decreased light sensitivity, and development of blindness. Thus, it is clear that hypertension should be treated more carefully.

So, what are the manifestations of hypertension?

Headache, which with further progression of the disease remains one of the main manifestations of arterial hypertension. Headache does not have a clear connection with the time of day; it can occur at any time of the day, but usually at night or early in the morning, after waking up. It feels like heaviness or fullness in the back of the head and can affect other areas of the head. Typically, patients describe headaches due to arterial hypertension as a feeling of a “hoop.” Sometimes the pain intensifies when severe cough, tilting the head, straining, may be accompanied by slight swelling of the eyelids and face. Improvement venous outflow (vertical position patient, muscle activity, massage, etc.) is usually accompanied by a decrease or disappearance of the headache.

Headache with increased blood pressure can be caused by tension in the muscles of the soft integument of the head or the tendon helmet of the head. It occurs against a background of pronounced psycho-emotional or physical stress and subsides after rest and resolution of conflict situations. In this case, they speak of a tension headache, which is also manifested by a feeling of squeezing or tightening of the head with a “bandage” or “hoop”, and may be accompanied by nausea and dizziness. Long-term continuous pain leads to irritability, short temper, hypersensitivity to external stimuli (loud music, noise).

Pain in the heart area with arterial hypertension differ from typical attacks of angina:

• localized in the area of ​​the apex of the heart or to the left of the sternum;
• occur at rest or during emotional stress;
• usually not provoked by physical activity;
• last long enough (minutes, hours);
• are not relieved by nitroglycerin.

Shortness of breath, which occurs in patients with hypertension, first during physical activity and then at rest, may indicate significant damage to the heart muscle and the development of heart failure.

Swelling of the legs may indicate the presence of heart failure. However, moderate peripheral edema in arterial hypertension may be associated with sodium and water retention due to impaired renal excretory function or the use of certain medications.

Visual impairment typical for patients with arterial hypertension. Often, when blood pressure rises, fog, a veil, or flickering “flies” appear before the eyes. These symptoms are mainly associated with functional circulatory disorders in the retina. Severe changes in the retina (vascular thrombosis, hemorrhages, retinal detachment) can be accompanied by a significant decrease in vision, double vision (diplopia) and even complete loss of vision.

Risk factors for arterial hypertension

Absolutely for all diseases internal organs There are both modifiable or modifiable and non-modifiable or non-modifiable risk factors for development. Arterial hypertension is no exception. For its development, there are factors that we can influence - modifiable and risk factors that we cannot influence - non-modifiable. Let's dot the i's.

Unchangeable risk factors include:

N heredity- people who have relatives with hypertension are most predisposed to developing this pathology.

Male gender - it has been established that the incidence of men arterial hypertension significantly higher than the incidence of women. But the fact is that lovely ladies are “protected” by female sex hormones, estrogens, which prevent the development of hypertension. But such protection, unfortunately, is short-lived. Coming menopause, the saving effect of estrogens ends and women become equal in morbidity to men and often overtake them.

Modifiable risk factors include:

P increased body weight– people with excess body weight have a higher risk of developing arterial hypertension;

M sedentary lifestyle– otherwise, physical inactivity, a sedentary lifestyle and low physical activity lead to obesity, which in turn contributes to the development of hypertension;

U alcohol consumption– excessive use alcohol promotes arterial hypertension. As for alcohol, it is better not to drink alcoholic beverages at all. There is already a sufficient amount of ethyl alcohol produced in the body. Yes, drinking red wine, according to researchers, really has a beneficial effect on the cardiovascular system. But with frequent consumption of wine under the guise of getting rid of and preventing arterial hypertension, you can easily acquire another disease - alcoholism. Getting rid of the latter is much more difficult than getting rid of high blood pressure.

U consumption large quantity salt for food– A high-salt diet increases blood pressure. Here the question arises: how much salt can you consume per day? The answer is short: 4.5 grams or a level teaspoon.

N unbalanced diet with an excess of atherogenic lipids, excess calories, leading to obesity and contributing to the progression of type II diabetes. Atherogenic, i.e., literally, “creating atherosclerosis” lipids are found in large quantities in all animal fats, meat, especially pork and lamb.

Urine is another variable and dangerous factor in the development of arterial hypertension and its complications. The fact is that tobacco substances, including nicotine, create a constant spasm of the arteries, which, when consolidated, leads to stiffness of the arteries, which entails an increase in pressure in the vessels.

From stress - lead to activation of the sympathetic nervous system, which performs the function of an instant activator of all body systems, including the cardiovascular system. In addition, pressor hormones, i.e., those that cause spasm of the arteries, are released into the blood. All this, as with smoking, leads to stiffness of the arteries and arterial hypertension develops.

G general sleep disorders such as sleep apnea syndrome, or snoring. Snoring is truly the scourge of almost all men and many women. Why is snoring dangerous? The fact is that it causes an increase in pressure in the chest and abdominal cavity. All this is reflected in the blood vessels, leading to their spasm. Arterial hypertension develops.

Causes of arterial hypertension

The cause of the disease remains unknown in 90-95% of patients - this is essential(i.e. primary) arterial hypertension. In 5-10% of cases, an increase in blood pressure has established cause- This symptomatic(or secondary) hypertension.

Causes of symptomatic (secondary) arterial hypertension:

• Primary kidney damage (glomerulonephritis) is the most common cause of secondary arterial hypertension.
• unilateral or bilateral narrowing (stenosis) renal arteries.
• coarctation (congenital narrowing) of the aorta.
• pheochromocytoma (tumor of the adrenal glands that produces adrenaline and norepinephrine).
• hyperaldosteronism (tumor of the adrenal gland that produces aldosterone).
• thyrotoxicosis (increased function thyroid gland).
• consumption of ethanol (wine alcohol) more than 60 ml per day.
• medicines: hormonal drugs(including oral contraceptives), antidepressants, cocaine and others.

Note. In older people it is often observed isolated systolic arterial hypertension (systolic pressure > 140 mm Hg and diastolic pressure< 90 мм рт.ст.), что обусловлено снижением упругости сосудов.

Risk factors for cardiovascular complications in arterial hypertension

Basic:

• men over 55 years old;
• women over 65 years of age;
• total blood cholesterol level > 6.5 mmol/l, increased low-density lipoprotein cholesterol (> 4.0 mmol/l) and low lipoprotein cholesterol high density;
• family history of early cardiovascular disease (in women< 65 лет, у мужчин < 55 лет);
• abdominal obesity (waist circumference ≥102 cm for men or ≥88 cm for women);
• level of C-reactive protein in the blood ≥1 mg/dl;
• diabetes(fasting blood glucose > 7 mmol/l).

Additional:

• impaired glucose tolerance;
• low physical activity;
• increased fibrinogen levels.

Note: The accuracy of determining the overall cardiovascular risk directly depends on how complete the clinical and instrumental examination of the patient was.

Consequences of arterial hypertension

Many people have asymptomatic hypertension. However, if arterial hypertension If not treated, it is fraught with serious complications. One of the most important manifestations of hypertension is damage to target organs, which include:

• Heart (left ventricular myocardial hypertrophy, myocardial infarction, development of heart failure);
• brain (dyscirculatory encephalopathy, hemorrhagic and ischemic strokes, transient ischemic attack);
• kidneys (nephrosclerosis, renal failure);
• vessels (dissecting aortic aneurysm, etc.).

Complications of arterial hypertension

Among the most significant complications arterial hypertension include

• hypertensive crises,
• cerebrovascular accidents (hemorrhagic or ischemic strokes),
• myocardial infarction,
• nephrosclerosis (primarily shriveled kidney),
• heart failure,
• dissecting aortic aneurysm.

Hypertensive crisis

Hypertensive crisis- this is a sudden increase in blood pressure, accompanied by a significant deterioration in cerebral, coronary, and renal circulation, which significantly increases the risk of severe cardiovascular complications: stroke, myocardial infarction, subarachnoid hemorrhage, dissection of the aortic wall, pulmonary edema, acute renal failure.

They arise under the influence of severe psycho-emotional stress, alcoholic excesses, inadequate treatment of arterial hypertension, discontinuation of medications, excess salt consumption, and the influence of meteorological factors.

During a crisis, there is excitement, anxiety, fear, tachycardia, and a feeling of lack of air. Characterized by a feeling of “internal trembling”, cold sweat, goose bumps, hand tremors, redness of the face. Impairment of cerebral blood flow is manifested by dizziness, nausea, and single vomiting. Weakness in the limbs, numbness of the lips and tongue, and speech impairment are often observed. In severe cases, signs of heart failure (shortness of breath, suffocation), unstable angina (chest pain) or other vascular complications appear.

Note. Hypertensive crises can develop at any stage of the disease. The development of repeated hypertensive crises in a patient with arterial hypertension often indicates the inadequacy of the therapy.

Malignant arterial hypertension

Malignant arterial hypertension is a syndrome characterized by high blood pressure, rapid progression of organic changes in target organs (heart, brain, kidneys, aorta) and resistance to therapy. The syndrome of malignant arterial hypertension develops in approximately 0.5–1.0% of patients, more often in men aged 40–50 years.

Prognosis of malignant syndrome arterial hypertension extremely serious. In the absence of adequate treatment, about 70–80% of patients die within 1 year. The most common cause of death is hemorrhagic stroke, chronic renal and heart failure, dissecting aortic aneurysm. Active modern treatment can reduce the mortality rate of this category of patients several times. As a result, about half of patients survive for 5 years.

Blood pressure measurement

The following conditions are important for measuring blood pressure:

1. Patient position:
   • Sitting in a comfortable position; hand on the table;
   • The cuff is placed on the shoulder at the level of the heart, its lower edge 2 cm above the elbow.

2. Circumstances:

   • Avoid drinking coffee and strong tea for 1 hour before the test;
   • do not smoke for 30 minutes before measuring blood pressure;
   • discontinuation of sympathomimetics (medicines that increase blood pressure), including nasal and eye drops;
   • Blood pressure is measured at rest after a 5-minute rest. If the procedure for measuring blood pressure was preceded by significant physical or emotional stress, the rest period should be increased to 15-30 minutes.

3. Equipment:

   • The size of the cuff must correspond to the size of the arm: the rubber inflated part of the cuff must cover at least 80% of the circumference of the arm; for adults, a cuff 12-13 cm wide and 30-35 cm long (average size) is used;
   • The mercury column or tonometer needle must be at zero before starting the measurement.

4. Measurement ratio:

   • to assess the blood pressure level in each arm, at least two measurements should be taken, with an interval of at least a minute; with a difference ≥ 5 mmHg. make 1 additional measurement; the final (recorded) value is taken to be the average of the last two measurements;
   • To diagnose the disease, at least 2 measurements must be taken with a difference of at least a week.

5. Measuring technique:

   • quickly inflate the cuff to a pressure level of 20 mm Hg. exceeding systolic (upper) blood pressure (by disappearance of the pulse);
   • blood pressure is measured with an accuracy of 2 mm Hg. Art.
   • reduce the pressure in the cuff by 2 mm Hg. per second.
   • the pressure level at which the first sound appears corresponds to systolic (upper) blood pressure;
   • the pressure level at which sounds disappear - diastolic blood pressure;
   • if the tones are very weak, then you should raise your hand and perform several squeezing movements with the brush; then the measurement is repeated; you should not strongly compress the artery with the membrane of the phonendoscope;
   • The first time you should measure the pressure on both arms. Subsequent measurements are made on the arm where the blood pressure level is higher;
   • It is advisable to measure pressure in the legs, especially in patients< 30 лет; измерять артериальное давление на ногах желательно с помощью широкой манжеты (той же, что и у лиц с ожирением); фонендоскоп располагается в подколенной ямке.

Studies for arterial hypertension

All patients with arterial hypertension the following studies need to be carried out:

1. general analysis blood and urine;
2. creatinine level in the blood (to exclude kidney damage);
3. level of potassium in the blood without taking diuretics ( a sharp decline potassium level is suspicious for the presence of an adrenal tumor or renal artery stenosis);
4. electrocardiogram (signs of left ventricular hypertrophy - evidence of a long course of arterial hypertension);
5. determination of blood glucose levels (fasting);
6. 6) the content of total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides in the blood serum, uric acid;
7. echocardiography (determining the degree of left ventricular myocardial hypertrophy and the state of cardiac contractility)
8. fundus examination.

• radiography chest;
• Ultrasound of the kidneys and adrenal glands;
• Ultrasound of the brachiocephalic and renal arteries;
• Serum C-reactive protein;
• urine analysis for the presence of bacteria (bacteriuria), quantitative assessment of protein in the urine (proteinuria);
• determination of microalbumin in urine (required in the presence of diabetes mellitus).

In-Depth Study:

• grade functional state cerebral blood flow, myocardium, kidneys;
• study of blood concentrations of aldosterone, corticosteroids, renin activity; determination of catecholamines and their metabolites in daily urine; abdominal aortography; CT scan or magnetic resonance imaging of the adrenal glands and brain.

Degree of arterial hypertension

Classification of blood pressure levels (mm Hg)

	Systolic blood pressure	Diastolic blood pressure
Optimal blood pressure
Normal blood pressure
High normal blood pressure
Arterial hypertension I degree (mild)
Arterial hypertension II degree (moderate)
Arterial hypertension stage III (severe)
Isolated systolic arterial hypertension

Treatment of arterial hypertension

The main goal of treating patients with arterial hypertension is to minimize the risk of developing cardiovascular complications and death from them. This is achieved through long-term lifelong therapy aimed at:

• reduction in blood pressure to normal level(below 140/90 mmHg). When arterial hypertension is combined with diabetes mellitus or kidney damage, it is recommended to lower blood pressure< 130/80 мм рт.ст. (но не ниже 110/70 мм рт.ст.);
• “protection” of target organs (brain, heart, kidneys), preventing their further damage;
• active influence on adverse risk factors (obesity, hyperlipidemia, carbohydrate metabolism disorders, excess salt intake, physical inactivity) that contribute to the progression of arterial hypertension and the development of its complications.

Treatment of arterial hypertension should be carried out in all patients whose blood pressure level consistently exceeds 139/89 mmHg.

Non-drug treatment of arterial hypertension

Non-drug treatment arterial hypertension is aimed at eliminating or reducing the effect of risk factors that contribute to the progression of the disease and the development of complications. These measures are mandatory, regardless of the level of blood pressure, the number of risk factors and concomitant diseases.

Non-drug methods include:

• to give up smoking;
• normalization of body weight (body mass index< 25 кг/м 2);
• reducing alcohol consumption< 30 г алкоголя в сутки у мужчин и 20 г/сут у женщин;
• increasing physical activity - regular physical exercise 30-40 min. at least 4 times a week;
• reduction in consumption table salt up to 5 g/day;
• change in diet with increased consumption plant food, reducing the consumption of vegetable fats, increasing the diet of potassium, calcium contained in vegetables, fruits, grains, and magnesium contained in dairy products;

How to lower blood pressure without medications

A few simple exercises for cervical spine spine exercises will help normalize blood circulation and lower blood pressure if performed systematically. It is important to do such gymnastics slowly and smoothly, without sudden movements or straining the neck. These are turning the head to the right and left, moving back and forth, alternately bending to the shoulders, raising the arms above the head.

Gymnastics that effectively reduce blood pressure

Blood pressure medications

In approximately half of patients with mild arterial hypertension (BP 140/90 - 159/99 mmHg) it is possible to achieve optimal level blood pressure only through non-drug correction of risk factors. In people with higher blood pressure, non-pharmacological treatment, carried out in parallel with antihypertensive drugs, can significantly reduce drug doses and reduce the risk of developing side effects these medicines. Refusal to carry out non-drug measures aimed at changing lifestyle is one of the most common reasons resistance to therapy.

Principles of drug therapy for arterial hypertension

Basic principles drug therapy arterial hypertension:

1. Drug treatment should begin with minimal doses of any class of antihypertensive drugs (taking into account relevant contraindications), gradually increasing the dose until a good therapeutic effect is achieved.
2. The choice of drug must be justified; The antihypertensive drug should provide a stable effect throughout the day and be well tolerated by the patient.
3. It is most advisable to use long-acting drugs to achieve a 24-hour effect with a single dose. The use of such drugs provides a milder hypotensive effect with more intensive protection of target organs.
4. If monotherapy (therapy with one drug) is ineffective, it is advisable to use optimal combinations of drugs to achieve maximum hypotensive effect and minimal side effects.
5. Should be implemented long(almost lifelong) taking medications to maintain optimal blood pressure levels and prevent complications of arterial hypertension.

Selection of necessary medications:

Currently, seven classes of drugs are recommended for the treatment of arterial hypertension:

1. diuretics;
2. b-blockers;
3. calcium antagonists;
4. angiotensin-converting enzyme inhibitors;
5. angiotensin receptor blockers;

1. imidazoline receptor agonists;

Drug class Clinical situations in favor of use Absolute contraindications Relative contraindications Thiazide diuretics (hypothiazide) Chronic heart failure, isolated systolic arterial hypertension, arterial hypertension in the elderly Pregnancy, dyslipoproteinemia Loop diuretics (Furosemide, Uregit) Chronic renal failure, chronic heart failure Aldosterone blockers receptors (Veroshpiron) Chronic heart failure after myocardial infarction Hyperkalemia, chronic renal failure b-blockers (Atenolol, Concor, Egilok, etc.) Angina pectoris, after myocardial infarction, chronic heart failure (starting with low doses), pregnancy, tachyarrhythmias AV block II-III degree, BA. Atherosclerosis peripheral arteries, impaired glucose tolerance, chronic obstructive pulmonary disease, athletes and people who are physically active Dihydropyridine calcium antagonists (Corinfar, Amlodipine) Isolated systolic arterial hypertension, arterial hypertension in the elderly, angina pectoris, atherosclerosis of peripheral arteries, atherosclerosis carotid arteries, pregnancy. Tachyarrhythmias, chronic heart failure Non-dihydropyridine calcium antagonists (Verapamil, Diltiazem) Angina pectoris, atherosclerosis of the carotid arteries, supraventricular tachycardia AV block II-III degree, chronic heart failure Angiotensin-converting enzyme inhibitors (Captopril, Enalapril, Monopril, Prestarium, etc.) Chronic heart failure, after myocardial infarction, nephropathy, proteinuria Pregnancy, hyperkalemia, bilateral renal artery stenosis. Angiotensin receptor blockers (Losartan, Valsartan, Candesartan) Diabetic nephropathy in diabetes mellitus, diabetic proteinuria, left ventricular hypertrophy, cough caused by angiotensin-converting enzyme inhibitors Pregnancy, hyperkalemia, bilateral renal stenosis arteries α-blockers (Prazosin) Benign prostatic hyperplasia, dyslipoproteinemia Orthostatic hypotension Chronic heart failure Imidazoline receptor agonists (Physiotens) Metabolic syndrome, diabetes Severe heart failure, AV block II-III degree

Reasons for resistance (refractoriness) of arterial hypertension to therapy

Refractory or treatment-resistant arterial hypertension is called arterial hypertension in which the prescribed treatment - lifestyle changes and rational combination therapy using adequate doses of at least three drugs, including diuretics, does not lead to a sufficient reduction in blood pressure.

The main causes of refractory hypertension:

• undetected secondary forms of arterial hypertension;
• lack of adherence to treatment;
• continued use of medications that increase blood pressure;
• violation of recommendations for lifestyle changes: weight gain, alcohol abuse, continued smoking;
• volume overload caused by for the following reasons: inadequate diuretic therapy, progression of chronic renal failure, excessive consumption of table salt;

Pseudo-resistance:

• isolated office arterial hypertension (“white coat hypertension”);
• using a cuff of the wrong size when measuring blood pressure.

Cases of hospitalization for arterial hypertension

Indications for hospitalization of patients with arterial hypertension are:

• uncertainty of diagnosis and the need for special, often invasive, research methods to clarify the form of arterial hypertension;
• difficulties in selecting drug therapy - frequent hypertensive crises, refractory arterial hypertension.

Indications for emergency hospitalization:

• Hypertensive crisis that does not respond to prehospital stage;
• Hypertensive crisis with pronounced manifestations hypertensive encephalopathy (nausea, vomiting, confusion);
• complications of hypertension requiring intensive care and constant medical supervision: cerebral stroke, subarachnoid hemorrhage, acute visual impairment, pulmonary edema, etc.

Emergency treatment for arterial hypertension

If the rise in blood pressure is accompanied by the following symptoms:

• severe chest pain of a pressing nature (possibly unstable angina, acute myocardial infarction),
• increase in shortness of breath, increasing in horizontal position(possibly acute heart failure),
• severe dizziness, nausea, vomiting, difficulty speaking, or impaired mobility of limbs (possibly acute disorder cerebral circulation),
• blurred vision, double vision (possibly retinal vascular thrombosis),

It is necessary to seek emergency medical help to immediately (within minutes and hours) lower blood pressure using parenterally administered drugs (vasodilators, diuretics, ganglion blockers, antipsychotics).

Note. Blood pressure should be reduced by 25% in the first 2 hours and to 160/100 mmHg. over the next 2 - 6 hours. Blood pressure should not be reduced too quickly to avoid ischemia of the brain, kidneys and myocardium. If the blood pressure level is > 180/120 mmHg. it should be measured every 15 - 30 minutes.

Actions when sharp increase blood pressure:

A sharp increase in blood pressure, not accompanied by the appearance of symptoms from other organs, can be stopped by oral or sublingual (under the tongue) administration of drugs with relatively quick action. These include

• Anaprilin (a group of β-blockers, usually if a rise in blood pressure is accompanied by tachycardia),
• Nifedipine (its analogues - Corinfar, Cordaflex, Cordipin) (a group of calcium antagonists),
• Captopril (a group of angiotensin-converting enzyme inhibitors),
• Clonidine (its analogue is Clonidine) and others.

Hypertension is already considered the “plague” of our century. This disease is observed in almost 20% of the world's population. Most often, the disease affects people after 40 years of age. The main cause of hypertension is not correct image life and complete ignorance of the first signs of an incipient disease.

You can hear two designations for the disease:

- arterial hypertension.

The first term is considered not entirely correct, since it literally means a persistent increase in pressure. Arterial hypertension is an increase in tone, that is, not necessarily an increase in blood pressure. Hypertension can also develop with a decrease in vascular tone. At the same time, both terms are constantly used in everyday life.

Blood pressure is considered normal at 130/85 mmHg. If the column of the measuring device rises to 140 and 90, then we can already say that there is an increase in blood pressure, and the development of the disease may have already begun.

The upper, or systolic, pressure indicates the contraction of the heart muscle.

The lower, diastolic, determines the moment when the heart muscle relaxes.

The third indicator must also be taken into account. This is the average value between the derivatives of systolic and double diastolic pressure, then the resulting figure is divided by 3.

Why does high blood pressure occur?

Almost any pathology is curable if the causes of its occurrence are known. Why blood pressure rises is determined only in 15% of cases. This may be due to excess weight, poor diet and lifestyle, kidney disease, and age. In other cases, the diagnosis is essential hypertension, that is, of unknown origin.

Causes of essential hypertension:

• Excess salt in the diet. In ancient times, about 200 years ago, salt was very expensive, so its consumption was minimal. Now, there is no shortage, and a person consumes much more salt than the body needs. Excessive amounts of salt retain water in the body, which causes swelling, kidney disease and high blood pressure;
• Poor diet and alcohol consumption. Late dinner, and to the point of saturation, is a direct path to hypertension. A cup of tea or a glass of wine at night is also not a good habit. In order not to know how blood pressure increases, it is better to forget about such traditions from a young age;
• Sedentary lifestyle or physical inactivity. The development of technology has practically brought people to the table. At work all day on the computer, in the evening - dinner and TV. While sitting, the movement of blood is difficult, it is reduced and, as a result, blood pressure increases;
• Nocturnal lifestyle. Lack of daily routine, sleepless nights – these are hormonal disorders and hypertension;
• Poor nutrition or lack of nutrients, magnesium and potassium in the diet. Lack of water in the body;
• Coffee addiction. 1 cup a day is normal, but if you drink 3 or more, there is a high probability of a stable increase in blood pressure over time;
• Vanity and haste are also not the best “friends” for health.. Many studies have been conducted on this topic and it has been found that even simple problems solved in a hurry lead to an increase in blood pressure;
• Negative information. Some people “collect” only negative information, they are constantly unhappy, worry about everything, and this is constant stress, therefore, hypertension will soon appear.

Classification

Over the course of a century of monitoring patients with high blood pressure, doctors have created a certain classification of the disease.

Symptoms manifested by external signs

The ideologist of this classification is Volgardu, a doctor from Germany who practiced in the 20s of the last century. His hypothesis was based on the division of patients by complexion:

• pale, meant that spasm occurs in small vessels, and the limbs only get colder;
• pink color indicates the expansion of skin capillaries, the body and face are covered with red spots.

By origin

This means that there is a primary or idiopathic form of hypertension, which leads to the disease. Symptomatic type– this is not a regular increase in blood pressure associated with specific circumstances, stress or taking the “wrong” medications, and is diagnosed in only 10% of patients.

Symptoms characterized by the nature of their course. In the 30s of the last century, Lang G.F. identified 2 types of hypertension:

• Benign type. The disease develops slowly and progresses in 3 stages;
• Malignant type. The disease can begin not only in adolescence, but also in childhood against the background endocrine diseases. The disease has a severe clinical picture, with damage to the blood vessels of the eye, headaches, and vomiting. The main thing is that this type occurs today in isolated cases.

Blood pressure level

European countries have created their own classification:

• soft form hypertension is diagnosed if blood pressure increases no higher than 140/90 and does not require treatment with medications;
• moderate form, with a pressure of 180/110, refers to stages 1 and 2 of the disease;
• severe hypertension, as a rule, does not respond well to drug treatment, the disease is characterized by complications.

According to the degree of damage to other organs

On first stage When the blood pressure level does not exceed 160/100, the pressure during rest stabilizes and returns to normal. No pathologies on at this stage are not diagnosed.

Second stage characterized by an increase in blood pressure at rest at a level of at least 160/110. Already appearing pathological changes, the ventricle of the heart hypertrophies, arterial vessels narrow.

Third stage characterized by blood pressure of 220/115 and above. Angina pectoris, heart failure develops, cerebral circulation is impaired, hemorrhage and swelling occur optic nerve.

IMPORTANT! A condition in which there is no malaise is equally dangerous as in the presence of severe symptoms.

Video on how to deal with persistent high blood pressure by simply cleaning your liver and kidneys, even at home.

Hypertensive crisis

The pathology is characterized by a sharp increase in blood pressure and cerebral hyperemia. The patient develops severe headache, nausea and dizziness. This condition can be observed for 24 hours, then the symptoms gradually subside.

Isolated hypertension

The pathology is typical for older people. Diastolic pressure remains at 90 mmHg, and systolic pressure is elevated, from 160. It is believed that this condition is associated with age-related loss of vascular elasticity. As a result, a heart attack occurs, hypertrophy of the left ventricle of the heart muscle. Although this type occurs in no more than 9% of patients.

Refractory pathology, that is, hypertension that cannot be treated

Even the use of a combination of three drugs does not achieve a blood pressure lowering effect. The condition may be associated with improper selection of medications or the patient’s violation of doctor’s instructions.

“White coat hypertension”

This type of pathology is diagnosed when a patient’s blood pressure increases only when pressure is measured, mainly in a medical facility.

NOTE! The effectiveness of hypertension treatment largely depends on the patient’s psychological comfort.

Symptoms

Hypertension is also called the “silent killer”. In the first stages, the symptoms are barely noticeable. Troubled by tinnitus, mild headache pain. The human condition is more reminiscent of a tired state, so the symptoms are rarely given due importance.

Lack of treatment leads to deterioration of health and the disease manifests itself with increased symptoms:

• constant headaches;
• dizziness;
• the heartbeat becomes faster or, on the contrary, weak;
• the face takes on a reddish tint;
• anxious and constantly tired state;
• swelling of the face and body, especially after sleep;
• “flies” before the eyes;
• memory impairment.

If such symptoms appear periodically, this is not a reason to relax and not undergo a medical examination.

Making a diagnosis in a medical institution

Hypertension is often detected during a routine medical examination.

The doctor collects anamnesis and tries to identify the causes of increased blood pressure. Blood pressure measurements must be taken throughout the month. IN at a young age it is recommended to carry out full examination body. If there is a suspicion of nephrological problems, the patient is referred to a specialized specialist.

Minimum required laboratory tests:

• urine test for glucose and protein;
• blood test for hemoglobin level and hematocrit;
• determining the amount of glucose during fasting;
• electrocardiogram.

In some cases, diagnosis requires determination of serum cholesterol or calcium levels. Held x-ray examination chest.

Drug treatment

There are several groups of drugs for the treatment of hypertension:

ACE inhibitors. The action of medications is aimed at inhibiting the synthesis of a substance that is located in the kidneys, promoting vasoconstriction.

Angiotensin receptor blocking drugsІІ . The essence is the same as that of inhibitors, but the drug acts according to a different scheme; the drug blocks the production of the enzyme angiotensin not in the kidneys, but in the blood vessels.

Diuretics or diuretics. Such medications are the first line in the treatment of hypertension. If one diuretic is not suitable, you can always use another.

Adrenergic blockers. After taking the medicine, beta-adrenergic receptors in the heart muscle are blocked. As a result, the heart begins to contract less frequently, and the pressure decreases accordingly.

Medicines that block calcium channels.

To treat a hypertensive crisis, vasolidators and ganglion blockers are used, as well as other drugs that can only be used as emergency drugs.

Features of nutrition for hypertension

In addition to having to resort to drug treatment, a hypertensive patient must change his lifestyle and diet. Depending on the characteristics of the body, the patient’s age, and type of activity, it will be necessary to create a specific menu that will help lower blood pressure.

Basic nutrition rules:

• meals should be small, at least 5 times a day;
• calorie content should be minimal, with an emphasis on carbohydrates and proteins; it is better to reduce the consumption of vegetable fats to a minimum;
• reduce the amount of salt in your diet to 5 grams per day; ideally, it is better to eliminate it from your diet altogether.

IMPORTANT! Carbohydrates should prevail in the hypertensive menu. It is necessary to eat buckwheat and oatmeal. Don't forget about proteins, but only as lean meat.

It is best to reduce the caloric content of your daily diet. If there are signs of excess weight or obesity, then you should definitely reduce your body weight.

Traditional medicine in the fight against hypertension

Flax seeds- the first remedy that helps lower blood pressure, due to the high content of unsaturated fatty acids. Using seeds, you don’t need to spend money on hyped and expensive dietary supplements called Omega-3 and the like.

Garlic not only normalizes blood pressure, but also strengthens the walls of blood vessels, preventing the formation of blood clots.

Regular consumption of this root vegetable reduces blood pressure by 8%.

Prevention

Despite the long-term development of hypertension and weak initial symptoms, the disease poses a threat to human life. To maintain your health, just taking pills is not enough; hypertension is a chronic disease and requires lifestyle adjustments.

Emotions

You need to try to become emotional calm person. Quarrels and negative emotions should be avoided. If necessary, you can contact a psychologist and jointly develop a plan for dealing with stress. You can take sedatives medicinal teas. Only complete control over your emotions will allow you to feel psychological comfort.

Nutrition

In some cases, even drug treatment for hypertension is not required, you just need to adjust your diet.

Limiting the intake of high-calorie foods- This is not only the fight against excess weight, but also the prevention of hypertension and help the whole body.

Limiting the amount of salt you consume. It has long been established that excess salt in the body contributes to vasoconstriction and, as a result, an increase in blood pressure. Never add salt to your food, avoid eating chips and visiting fast foods

Reduce your intake of animal fats. This means that you should not get carried away with oil, internal parts of animals, caviar, or fried foods. This approach to creating a menu will even allow you to lose weight.

Avoid "stimulant" drinks. Strong tea and coffee can also be called energy drinks that increase blood pressure. Don't get carried away with them like you do with trendy energy drinks and carbonated sugary drinks. In addition to excitement, the body will also receive a “shock” dose of sugar and dyes.

Proper nutrition- these are not only lean, not fried and not over-salted foods. Eating right means saturating the body with vitamins and nutrients. Potassium and magnesium and vitamin C are very important in preventing the onset of hypertension.

Physical activity. Regardless of the presence or absence of hypertension, sports should be present in the life of every person. We are not talking about becoming a marathon runner; physical activity can be minimal, but daily and enjoyable. This could be walking, swimming, yoga.

If hypertension has already been identified, then it is better to consult a doctor before training, and if you are over 40, you should definitely undergo an ECG.

The increase in physical activity should be gradual. If you experience the slightest discomfort or increase in heart rate, you should stop training.

INTERESTING! Normal pulse during long-term cardio exercises, this is 180 minus the person’s age in years.

Refusal bad habits . Surely, so much has already been said about the dangers of smoking and alcohol that there is no need to even talk about it in the context of hypertension. Naturally, smoking and alcoholic drinks will only worsen the condition of a hypertensive patient.

Debunking myths about hypertension

Increased blood pressure is observed in everyone and it is not fatal. In fact, in a hypertensive person, the normal functioning of all organs, including the heart and blood vessels, is disrupted. One of the most common causes of death is heart attack and stroke, which develop against the background of high blood pressure.

Hypertension appears in old age. According to statistics, in hypertensive patients, the disease began at the age of 30, the lack of treatment and ignoring the symptoms leads to the fact that after 15 years the person already has an advanced form of the disease.

Genetic predisposition is to blame for everything. Heredity is of great importance, but it is just a predisposition, so the disease can appear only under certain conditions, that is, when a person does not monitor his health.

The presence of hypertension can be determined by the face. In fact, facial redness is already a symptom of an advanced disease and it does not appear in everyone.

Summarizing the above, we should emphasize that every person is simply obliged to take care of their health, give up bad habits, eat right and be in motion.

– this is a systematic stable increase in blood pressure (systolic pressure above 139 mmHg and/or diastolic pressure above 89 mmHg). Hypertension is the most common disease of the cardiovascular system. An increase in blood pressure in the vessels occurs as a result of narrowing of the arteries and their smaller branches called arterioles .

It is known that the total amount of blood in the human body is approximately 6 - 8% of the total body weight, thus, it is possible to calculate how much blood is in the body of each individual person. All the blood moves through circulatory system vessels, which is the main main blood flow route. The heart contracts and moves blood through the vessels, the blood presses on the walls of the vessels with a certain force. This force is called blood pressure . In other words, blood pressure helps blood move through the vessels.

Blood pressure indicators are considered: systolic blood pressure (SBP), also called “upper” blood pressure. Systolic pressure shows the amount of pressure in the arteries created by the contraction of the heart muscle when a portion of blood is released into the arteries; diastolic blood pressure (DBP), it is also called “lower” pressure. It shows the amount of pressure during relaxation of the heart, at the moment when it is filled before the next contraction. Both indicators are measured in millimeters of mercury (mmHg).

In some people, due to various reasons, arterioles narrow, first due to vasospasm. Then their lumen remains narrowed constantly, this is facilitated by the thickening of the walls of the vessels. To overcome these narrowings, which are an obstacle to the free flow of blood, more intense work of the heart is required and a greater release of blood into the vascular bed. Developing hypertonic disease .

In approximately every tenth hypertensive person, an increase in blood pressure is caused by damage to some organ. In such cases, we can talk about symptomatic or secondary hypertension. Approximately 90% of patients with arterial hypertension suffer from essential or primary hypertension .

The cut-off point for high blood pressure is usually at least three times the physician-reported level of 139/89 mmHg, provided the patient is not taking any medications. drugs to lower blood pressure.

A slight, sometimes even persistent increase in blood pressure does not mean the presence of the disease. If, however, you do not have any risk factors and there are no signs organ damage, at this stage hypertension is potentially reversible. But, nevertheless, if your blood pressure increases, you must consult a doctor; only he can determine the extent of the disease and prescribe treatment for arterial hypertension.

Hypertensive crisis

A sudden and significant increase in blood pressure accompanied by sharp deterioration coronary, cerebral and renal circulation, called hypertensive crisis . It is dangerous because it significantly increases the risk of developing severe cardiovascular complications, such as: myocardial infarction , subarachnoid hemorrhage, aortic wall dissection, acute renal failure .

Arises hypertensive crisis, most often, after stopping medication without the consent of the attending physician, due to the influence of meteorological factors, unfavorable psycho-emotional stress, systematic excess salt consumption, inadequate treatment, and alcoholic excesses.

A hypertensive crisis is characterized by the patient's agitation, anxiety, fear, tachycardia, and a feeling of lack of air. The patient experiences cold sweat, facial redness, sometimes significant, “ goose pimples", a feeling of internal trembling, numbness of the lips and tongue, speech impairment, weakness in the limbs.

A disruption of the blood supply to the brain is manifested primarily by nausea or even single vomiting. Signs of heart failure often appear: unstable, expressed in chest pain, or other vascular complications.

Hypertensive crises can develop at any stage of arterial hypertension. If crises recur, this may indicate improper therapy.

Hypertensive crises can occur 3 types:

1. Neurovegetative crisis , is characterized by an increase in pressure, mainly systolic. The patient feels agitated, looks scared, and is worried. A slight increase in body temperature is possible, observed.

2. Edema hypertensive crisis occurs most often in women, usually after eating salty foods or drinking large amounts of liquid. Both systolic and diastolic pressure increase. Patients are drowsy, slightly lethargic, and swelling of the face and hands is visually noticeable.

3. Convulsive hypertensive crisis - one of the most severe, usually occurs with malignant hypertension. Severe brain damage occurs, accompanied by cerebral edema and possible cerebral hemorrhage.

As a rule, a hypertensive crisis is caused by disturbances in the intensity and rhythm of blood supply to the brain and its membranes. Therefore, during a hypertensive crisis, the pressure does not increase very much.

To avoid hypertensive crises, it is necessary to remember that the treatment of arterial hypertension requires constant maintenance therapy and stopping medication without a doctor’s permission is unacceptable and dangerous.

Malignant arterial hypertension

A syndrome characterized by very high blood pressure, unresponsiveness or poor sensitivity to therapy, rapidly progressing organic changes in organs is called malignant arterial hypertension.

Malignant arterial hypertension occurs rarely, in no more than 1% of patients and most often in males aged 40–50 years.

The prognosis of the syndrome is unfavorable; in the absence of effective treatment, up to 80% of patients suffering from this syndrome die within one year from chronic heart and/or renal failure, dissection or hemorrhagic stroke .

Timely treatment in modern conditions reduces the fatal outcome of the disease several times and more than half of patients survive for 5 years or even more.

In Russia, approximately 40% of the adult population suffers from increased level blood pressure. It is dangerous that at the same time, many of them do not even suspect the presence of this serious disease and, therefore, do not monitor their blood pressure.

Over the years, there were several different classifications of arterial hypertension, however, since 2003, at the annual International Symposium of Cardiologists, a unified classification by degree was adopted.

1. Mild degree arterial hypertension, when blood pressure is in the range of 140-159 mm Hg. systolic and 90-99 mm Hg. Art. distolic.

2. Second degree or moderate degree is characterized by pressure from 160/100 to 179/109 mmHg. Art.

3. Severe degree hypertension is an increase in blood pressure above 180/110 mmHg. Art.

The severity of arterial hypertension is not usually determined without risk factors. Among cardiologists, there is a concept of risk factors for the development of arterial hypertension. This is what they call those factors that, with a hereditary predisposition to this disease, serve as an impetus that triggers the mechanism for the development of arterial hypertension. TO risk factors include:

Once the diagnosis is confirmed, further in-depth examination is carried out to assess the severity of the disease and prescribe adequate treatment. Such diagnostics are needed to assess the functional state of cerebral blood flow, myocardium, kidneys, to identify the concentration of corticosteroids, aldosterones, and activity in the blood; Magnetic resonance imaging or computed tomography of the brain and adrenal glands is prescribed, as well as abdominal aortography .

Diagnosis of arterial hypertension is greatly facilitated if the patient has information about cases of this disease in the family among close relatives. This may indicate a hereditary predisposition to the disease and will require close attention to the state of their health, even if the diagnosis is not confirmed.

For correct diagnosis, it is important to regularly measure the patient’s blood pressure. For objective diagnosis and monitoring of the course of the disease, it is very important to regularly measure your blood pressure yourself. Self-control, among other things, gives positive effect from carrying out treatment, because disciplines the patient.

Doctors do not recommend using devices that measure pressure in the finger or on the wrist to measure blood pressure. When measuring blood pressure with automatic electronic devices, it is important to strictly adhere to the appropriate instructions.

Measuring blood pressure using tonometer enough simple procedure, if you carry it out correctly and comply with the necessary conditions, even if they seem petty to you.

The pressure level should be measured 1-2 hours after eating, 1 hour after drinking coffee or smoking. Clothing should not constrict your arms and forearms. The hand on which the measurement is taken must be free of clothing.

It is very important to carry out the measurement in a calm and comfortable environment with a comfortable temperature. The chair should have a straight back, place it next to the table. Sit on a chair so that the middle of the cuff on your forearm is at heart level. Lean your back against the back of the chair, do not talk or cross your legs. If you have moved or worked before, rest for at least 5 minutes.

Place the cuff so that its edge is 2.5 -3 cm above the elbow cavity. Apply the cuff snugly, but not tightly, so that your finger can fit freely between the cuff and your arm. It is necessary to properly inflate the air into the cuff. Inflate quickly until minimal discomfort occurs. You need to deflate at a speed of 2 mmHg. Art. per second.

The pressure level at which the pulse appeared, and then the level at which the sound disappeared, is recorded. Membrane stethoscope located at the point of maximum pulsation of the brachial artery, usually just above the cubital fossa on the inner surface of the forearm. The head of the stethoscope should not touch the tubes and cuff. The membrane should also be firmly attached to the skin, but not pressed. The appearance of a pulse sound in the form of dull beats indicates the level systolic blood pressure, disappearance of pulse sounds - level diastolic pressure. For reliability and to avoid errors, the study should be repeated at least once every 3-4 minutes, alternately, on both hands.

Treatment of arterial hypertension

Treatment of hypertension directly depends on the stage of the disease. The main goal of the treatment is to minimize the risk of developing cardiovascular complications and prevent the threat of death.

If grade 1 hypertension is not burdened by any risk factor, then the possibility of developing dangerous complications cardiovascular system, such as stroke or myocardial infarction over the next 10 years is very low and amounts to no more than 15%.

Treatment tactics for low-risk stage 1 hypertension include lifestyle changes and non-drug therapy lasting up to 12 months, during which a cardiologist observes and controls the dynamics of the disease. If the blood pressure level is above 140/90 mm Hg. Art. and does not tend to decrease, the cardiologist must select drug therapy .

The average degree means that the possibility of developing cardiovascular complications of essential hypertension over the next 10 years is 15-20%. The tactics for treating the disease at this stage are similar to those used by a cardiologist for stage 1 hypertension, but the period of non-drug therapy is reduced to 6 months. If the dynamics of the disease are unsatisfactory and high blood pressure persists, it is advisable to transfer the patient to drug treatment.

Severe arterial hypertension means that, in the next 10 years, complications of arterial hypertension and other diseases of the cardiovascular system may occur in 20-30% of cases. The tactics for treating hypertension of this degree consists in examining the patient and then drug treatment in combination with non-drug methods.

If the risk is very high, this indicates that the prognosis of the disease and treatment is unfavorable and the possibility of developing severe complications is 30% or higher. The patient needs urgent clinical examination and immediate drug treatment.

Drug treatment of arterial hypertension is aimed at reducing blood pressure to normal indicators, eliminating the threat of target organ damage: hearts , kidney , brain , their maximum possible cure. For treatment, antihypertensive drugs are used that lower blood pressure, the choice of which depends on the decision of the attending physician, who is based on the criteria of the patient’s age, the presence of certain complications from the cardiovascular system and other organs.

Treatment is started with minimal doses of antihypertensive drugs and, monitoring the patient’s condition, gradually increase it until a noticeable therapeutic effect is achieved. The prescribed drug must be well tolerated by the patient.

Most often, in the treatment of essential or primary hypertension, combined drug therapy, including several drugs. The advantages of such treatment include the possibility of simultaneous impact on several different mechanisms of disease development and the administration of medication in reduced dosages, which significantly reduces the risk of side effects. This risk, in addition, explains the strict prohibition of self-use of drugs that lower blood pressure or arbitrary changes in dosage without consulting a doctor. All antihypertensive drugs have such powerful action that their uncontrolled use can lead to unpredictable results.

The dosage of the medicine is reduced or increased as needed only by a cardiologist and after careful clinical examination patient's condition.

Non-drug treatment of arterial hypertension is aimed at reducing and eliminating risk factors and includes:

• refusal to drink alcohol and smoke;
• weight loss to an acceptable level;
• maintaining a salt-free diet and a balanced diet;
• transition to an active lifestyle, morning exercises, walking, etc., giving up physical inactivity.

The doctors

Medicines

Prevention of arterial hypertension

For people with a hereditary predisposition to arterial hypertension and burdened with risk factors, disease prevention is of great importance. First of all, this is a regular examination by a cardiologist and adherence to healthy lifestyle standards, which will help delay, and often eliminate, the disease of arterial hypertension. If you have a history of relatives with hypertension, you should reconsider your lifestyle and radically change many habits And way of life, which are risk factors.

It is necessary to lead active lifestyle, move more, depending on age, running, swimming, walking, cycling and skiing are ideal for this. Physical activity should be introduced gradually, without overloading the body. Physical education classes are especially useful for fresh air. Exercise strengthens the heart muscle and nervous system and helps prevent stress.

You should reconsider your nutritional principles, stop eating salty and fatty foods, switch to low calorie diet , including large quantities of fish, seafood, fruits and vegetables.

Don't get carried away alcoholic drinks and, especially, beer. They contribute to obesity, uncontrolled consumption of table salt, and have a detrimental effect on the heart, blood vessels, liver and kidneys.

Give up smoking , the substances contained in nicotine provoke changes in the walls of the arteries, increase their rigidity, and therefore may be responsible for the increase in pressure. In addition, nicotine is very dangerous for the heart and lungs.

Try to have a positive environment around you psycho-emotional environment . If possible, avoid conflicts; remember, a weakened nervous system very often triggers the development of arterial hypertension.

Thus, we can briefly say that the prevention of arterial hypertension includes regular examinations by a cardiologist, a correct lifestyle and a favorable emotional background in your environment.

If signs of a regular increase in blood pressure appear, you should immediately contact a medical facility. Remember that by doing this you can save your health and life!

Complications of arterial hypertension

It should be clearly understood that neglecting the treatment of arterial hypertension leads to severe and dangerous complications. As hypertension progresses, various organs are seriously affected.

• Heart . Acute or chronic heart failure develops, left ventricular myocardial hypertrophy and myocardial infarction are observed.
• Kidneys . Kidney failure and nephrosclerosis develop.
• Brain . Discirculatory encephalopathy, transient ischemic attack, ischemic and hemorrhagic strokes often occur.
• Vessels . An aortic aneurysm occurs, etc.
• Hypertensive crises.

To avoid dangerous complications, if your blood pressure rises, you should immediately contact a medical facility for help and treatment.

How to treat hypertension? Treatment of hypertension or arterial hypertension depends on the characteristics of the course of the disease, the causes that cause it, and the individual reaction of the body. If a diagnosis of hypertension is established, treatment is prescribed by a specialist, but there are a number of additional measures and ways to improve well-being based on changing the regimen and diet. Similar traditional methods Treatments for hypertension are most often effective in the so-called hypertensive syndrome. When diagnosed with hypertension, the most effective methods Treatments are those that act on the cause that causes the increase in blood pressure, and not those that reduce it temporarily. The doctor decides how to treat hypertension, but the patient’s first priority should be lifestyle changes. Treatment of hypertension in its first stages responds well to non-drug therapy, provided that the doctor’s prescriptions are followed.

Diagnosis of the cause of the disease and treatment of hypertension

Hypertension is one of the most common cardiovascular diseases, especially in developed countries. Statisticians say that up to 30% of the adult population of Russia suffers from arterial hypertension. The prevalence of the disease increases with age and reaches 65% in people of retirement age.
Persistent increases in blood pressure can have a variety of causes. More than 20 combinations in the human genetic code contribute to the occurrence of hypertension. Essential or primary hypertension is the most common form of hypertension (up to 95%), diagnosed by excluding hypertension of other etiologies.
The remaining cases of hypertension are called secondary, symptomatic, based on the symptom of high blood pressure due to renal, endocrine, hemodynamic dysfunction, as well as due to the use of certain medications, dietary supplements (most often this is a combination of long-term use oral contraceptives, smoking and excess weight). Arterial hypertension in pregnant women is also distinguished.
Arterial hypertension develops as a consequence of overstrain of mental activity under the influence of psycho-emotional factors that cause disturbances in the cortical and subcortical regulation of the vasomotor system and hormonal mechanisms of blood pressure control. Experts from the World Health Organization identify a number of risk factors for hypertension. These include the following:

• age (after 65 years the risk increases significantly);
• gender (women get sick more often);
• physical inactivity, sedentary lifestyle;
• consuming excess amounts of table salt with food;
• alcohol abuse;
• hypocalcium diet, lack of calcium in water, unbalanced diet;
• smoking, active and passive;
• diabetes;
• obesity, overweight;
• heredity and other factors.

Treatment of hypertension is based on identifying the main factors contributing to its development. The syndrome of primary hypertension at the initial stage is often characterized by a fairly long period of labile arterial hypertension, sometimes complicated by hypertensive crises. A person may not feel a deterioration in health until the onset of a hypertensive crisis and may not suspect the disease until a doctor makes a diagnosis.
Symptoms of arterial hypertension at this stage include:

• headache;
• cardialgia, pain in the heart area;
• general weakness, hypotension;
• sleep disturbances, often caused by increased urine production at night.

Night shifts or a nocturnal lifestyle also contribute to the development of hypertension. U healthy person, even in the presence of high blood pressure occasionally during the day, blood pressure levels are normalized at night during sleep and rest. In patients with hypertension, blood pressure remains elevated throughout the day, regardless of the regimen.
Hypertension belongs to the category of multifactorial polyetiological diseases, which means that several factors play a role in its occurrence and development. Thus, with a pronounced hereditary tendency to develop arterial hypertension, it is possible with the help of preventive measures (healthy lifestyle, regimen, right choice medications) to delay or avoid hypertension.
There are internal and external factors that influence the development of the disease. TO internal factors include:

• • abnormalities of intrauterine development (for example, low or high birth weight);
  • symptomatic components, for example those associated with obstetric practices during the birth of the child;
  • heritable polygenic factors influencing the processes of blood pressure regulation.
    Among external factors In addition to those listed above, there are the following that have a negative effect on the body:
    • climate, countries with hot and humid climates have a higher incidence rate;
    • harmful working conditions;
    • residential microclimate;
    • unbalanced work and rest regime, energy-consuming types of recreation;
    • deficiency of vitamins, essential bioelements;
    • relationships with people, especially in the aspect of individual psycho-emotional reaction.

Manifestations of hypertensive crisis

A hypertensive crisis is the result of a sharp disruption of the mechanisms of blood pressure regulation, which provokes a significant increase in blood pressure and disruption of blood circulation in the internal organs. During a hypertensive crisis, symptoms of impaired blood supply to the brain and heart are observed. Patients experience the following complaints and symptoms:

• • • a sudden and significant increase in blood pressure, while in people with usually normal or reduced performance blood pressure they may not reach high values;
    • hyperemia, redness of the face, chest area;
    • blurred vision, “midges”, flashing before the eyes;
    • insomnia, sleep disorders, anxiety, fears;
    • headaches, especially in the back of the head;
    • noise, ringing in the ears, hearing impairment, feeling of being “stunned”;
    • dyspnea;
    • chest pain;
    • neurological disorders, numbness of the limbs, dizziness, confusion.

A hypertensive crisis can be complicated, life-threatening, when medical care must be provided within an hour to save life, or uncomplicated (up to 24 hours). In case of a hypertensive crisis, which is complicated by malignant hypertension, treatment should begin immediately, regardless of the symptoms, since damage to the organs most affected during the crisis depends on the time before the start of therapy and is noted in all crises and in malignant hypertension in non-crisis periods.
Hypertensive crisis is always considered complicated when combined the following diseases and/or factors:

• • • hypertensive encephalopathy;
    • acute cerebrovascular accident;
    • acute coronary syndrome;
    • acute left ventricular failure;
    • dissecting aortic aneurysm;
    • pheochromocytoma;
    • taking drugs: amphetamines, cocaine, etc.;
    • preeclampsia and eclampsia, especially dangerous during the gestational period;
    • severe arterial hypertension combined with subarachnoid hemorrhage or brain injury;
    • hypertension in postoperative period, especially if there is a risk of bleeding.

A hypertensive crisis poses a danger to all patients, regardless of the presence or absence of dysfunction of the cardiovascular system and brain. Hypertension is dangerous due to damage to target organs.

How to treat arterial hypertension in crisis stage

Treatment of hypertension of any etiology in the crisis stage is carried out exclusively by specialists. Folk remedies for hypertension are not acceptable for the treatment of life-threatening conditions.
Therapy begins with ensuring the patient's rest and accurately measuring pressure: for three times with an interval between each measurement. When providing first medical care and in a medical institution, according to indications, drugs such as Enalaprilat parenterally, Nitroglycerin (for acute coronary syndrome and acute failure left ventricle); sodium nitroprusside (for hypertensive encephalopathy), beta-blockers (Metoprolol, Esmolol), diuretics, antipsychotic medications, and so on.
The choice of drug in the treatment of hypertensive crisis is based on the etiology, symptoms of damage to internal organs and contraindications and when trying to independently select medications, and especially relying on folk remedies from hypertension can cause significant harm to health, including death.
Complications of a hypertensive crisis caused by the lack of urgent therapy or treatment of arterial hypertension in the crisis stage include such severe organ damage and dysfunction as retinopathy, papilledema, impaired and complete loss of vision, arrhythmic heart disease, heart failure, myocardial infarction, syndrome disseminated intravascular coagulation (DIC syndrome), hemolytic anemia, acute cerebrovascular accident, pulmonary edema, cerebral edema, renal failure and death.

Hypertension: treatment based on diagnostic results

Unpleasant sensations associated with increased blood pressure: tinnitus, headaches and other symptoms of incipient hypertension largely coincide with the signs of ordinary fatigue. Most patients, noting a deterioration in their health and unsuccessfully trying to fight it different ways, do not even think about their blood pressure, and also do not imagine the real scale of the danger - the numerous complications of hypertension.
For this property of masking symptoms as symptoms of ordinary fatigue, hypertension has received the name “invisible killer.” It is not so rare that the diagnosis is made only by ambulance doctors during an emergency call, when the disease has already had the opportunity to progress quite long time. At the same time, high blood pressure does not require complex diagnostics and can be detected during routine preventive examination or independently, if the treatment of hypertension of any etiology is started at the initial stage, the development of the disease can in most cases be successfully prevented.
Self-diagnosis methods include monitoring your condition, as well as checking your blood pressure, preferably by a specialist. The following symptoms noted on a regular basis are manifestations of hidden hypertension:

• • • headaches, especially in the occipital region;
    • dizziness, confusion;
    • weak, rapid heartbeat (tachycardia);
    • sweating;
    • redness of the face, chest;
    • sensation of pulsation in the head;
    • chills for no apparent reason;
    • increased anxiety;
    • memory impairment, decreased concentration;
    • feeling internal tension, difficulty achieving a relaxed state;
    • irritability, anger;
    • decreased performance;
    • “flies” before the eyes;
    • swelling of the eyelids and face after sleep;
    • swelling of the hands, numbness of the fingers.

Diagnosis and treatment of hypertension should begin as soon as such symptoms are noticed on a regular basis. Their appearance and disappearance on their own does not mean that hypertension cannot be detected. The most effective treatments for this disease are those that are started as early as possible.
When contacting a specialist, three main methods are used for diagnosis: blood pressure measurement, physical examination, and electrocardiogram. If hypertension is diagnosed, the most effective treatments are those that target the factors that cause persistent hypertension. high blood pressure before the onset of changes in the target organs of the disease, therefore, to accurately determine the direction of treatment for hypertension of various etiologies The specialist may also prescribe the following types of examinations: general blood test, general urine test, specific tests blood and urine, ultrasound of the heart and internal organs, ECG, Dopplerography of blood vessels, various tests, etc. Based on the examination and medical history, a diagnosis of arterial hypertension is made. The doctor will tell you what to treat and how to influence the cause of the disease.

Folk remedies for hypertension

Effective traditional methods of treating hypertension are a rather dubious misconception from the point of view of specialists. Although experts distinguish both arterial hypertension and hypertensive syndrome, the body’s reaction to stress, anxiety, anxiety or non-compliance with a diet or regimen in the form of increased blood pressure.
Such episodes, indicating the initial stage of development of arterial hypertension, are often successfully corrected with sedatives, diuretics, calcium-containing products, and so on.
At the initial stage of a disease such as hypertension, traditional methods of treatment are based on the consumption of vegetable juices, herbal teas, vegetables, berries, fruits, and products of natural origin.
If you do not rely only on folk remedies for hypertension, effective methods of therapy are possible by combining intake, for example, crushed cranberries with honey, diuretic preparations (lingonberry leaf) and medications prescribed by a doctor.
However, self-medication of hypertension based solely on alternative medicine is dangerous. If you treat arterial hypertension caused by endocrinological factors with diuretic preparations, the disease will progress. When diagnosed with hypertension, traditional methods of treatment are not excluded, but complement the general course of therapy prescribed by the doctor.

Among the foods useful for high blood pressure are the following: garlic, hawthorn, baked potatoes, viburnum, beets, chokeberries, carrots, cranberries, honey, ginger and others. Moderate consumption of these foods, provided there are no contraindications, can help improve health and improve well-being not only when diagnosed with hypertension.

How to treat hypertension without medications?

If a specialist has diagnosed primary hypertension, treatment for the initial stage may not include taking medications, especially on an ongoing basis. Treatment of primary hypertensive syndrome is based primarily on restoring impaired body functions through its recovery. Thus, to treat the most common forms of hypertension, it is often enough to return to a healthy lifestyle.

Motivation for sports: how physical activity affects health
So, if the initial stage of the disease arterial hypertension is detected, how to treat the patient without resorting to medications? Since bad habits contribute to the development of the disease, first of all, when diagnosing hypertension, treatment methods will be as follows:

• • • exclusion of foods and drinks that cause nervous excitement and increased blood pressure (caffeine-containing drinks increase blood pressure by 5 or more points after drinking an average cup of coffee, not to mention tonic drinks, medications, etc.);
    • reducing the amount of salt in food, both added during the cooking process and already present in semi-finished products, canned food, baked goods and factory-made products. Sodium levels need to be closely monitored;
    • quitting smoking, both active and active;
    • active lifestyle, increasing the amount of physical activity during the day: walking instead of traveling by transport, walking while relaxing instead of watching TV, exercising in the morning, swimming pool help not only keep the body in good shape, but also strengthen the walls of blood vessels;
    • remove foods from the diet high content fats and cholesterol;
    • Add foods high in magnesium: Studies have shown that 85% of people with hypertension are deficient in magnesium, and magnesium correlates with calcium absorption, which directly affects blood pressure levels. Such products include cabbage, baked potatoes, seafood, dairy products (cottage cheese, milk), meat, fish, poultry, eggs, seeds, nuts, dried fruits, dark chocolate, etc. If necessary, the doctor may prescribe magnesium supplements orally or in the form of injections;
    • give up alcohol-containing drinks, including beer;
    • If you are overweight, you need to take measures to reduce it, possibly with the help of a nutritionist. Studies show that overweight people who suffered from hypertension in 60% of cases after losing weight do not feel the need to take medications;
    • control of medications taken: dietary supplements, hormone-containing drugs, including oral contraceptives. Arterial hypertension while taking contraceptive medications is not at all uncommon, therefore, at the beginning of the course and throughout it, experts advise monitoring blood pressure readings on a regular basis, and if they increase, choosing other methods of protection;
    • in the absence of contraindications, it is necessary to enrich the daily diet with foods containing fiber, as well as vitamin C. Research scientists have proven that a lack of vitamin C is one of the factors predisposing to high blood pressure;
    • The duration of sleep for symptoms of arterial hypertension should be at least 7-8 hours a day. It is advisable to get up and go to bed at the same time every day; it is recommended to change the nature of your work: limit frequent business trips and night shifts;
    • stress is one of the main factors that provoke an increase in blood pressure, so patients with hypertension are recommended to master psychological relaxation methods: meditation, self-hypnosis, auto-training. It is important to learn to see positive sides things and work on your character, react less expressly to stimuli, reducing the likelihood of an increase in blood pressure in response to conflict situations or unpleasant news.

In fact, as with any other disease, the primary purpose is to normalize lifestyle. In the case of symptoms of arterial hypertension, this is especially important, regardless of the person’s age. Cardiovascular diseases and a decrease in the tone of arterial walls are observed today even in 30-year-old people, and the increase in the diagnosis of “arterial hypertension” begins at the age barrier of 40 years. Therefore, no matter how trite it sounds, a healthy lifestyle should begin in childhood. Laying in early age healthy eating habits, instilling active recreation as opposed to sitting at the computer, promoting through their behavior the refusal of alcohol and nicotine abuse, parents are doing both themselves and their children a great service in preventing future diseases, including hypertension.
Besides healthy image In life, experts also have unusual advice for those who have been diagnosed with hypertension. How to treat? Not only with medications, changing your diet and giving up bad habits, but also in such amazing ways as:

• • • always tell the truth. As scientists have proven, lying causes vascular spasms and surges in blood pressure;
    • laugh more. Laughter not only improves your mood, watching a comedy, reading jokes, accompanied by laughter, helps saturate the body with energy, promotes light vibration massage of internal organs, improves blood circulation, and relaxes muscle tissue;
    • get an animal. Firstly, it adds much-needed physical activity, especially if the animal is an inquisitive puppy, and secondly, according to research, cats and dogs with direct contact help to calm down, relieve stress, and lower blood pressure.

Arterial hypertension is a disease that can be corrected and treated with timely treatment and compliance with doctor’s prescriptions. However, when undergoing a course of treatment, medicinal or alternative, you should remember that hypertension dictates your lifestyle, and you cannot stop the course on your own, even if you feel better and the symptoms have disappeared. Moreover, you cannot return to bad habits.

According to statistics, hypertension is the most common cardiovascular disease. The nature of the current and possible consequences give reason to rank it among the most dangerous pathologies. At the same time, there is no asymptomatic stage in the development of hypertension. That is, if you pay close attention to your health, there is every chance for early diagnosis and timely treatment. The disease is not completely cured, but its progression can be successfully controlled.

Arterial hypertension is a chronic disease, the main symptom of which is persistent hypertension, high blood pressure. Pathology is indicated when the tonometer records a blood pressure level of more than 140/90 mm Hg. Art.

Men are more prone to hypertension; in the stronger sex, the disease develops at an earlier age. One of the main reasons for this phenomenon is female sex hormones, which inhibit the development of the disease. In the postmenopausal period, natural protection disappears, the incidence among women and men levels off.

The symptoms of hypertension in men and women are almost the same, the causes and risk factors for developing the disease are somewhat different.

Before talking about increased blood pressure, it is advisable to understand what indicators are normal. In children of the first year of life, blood pressure is considered normal at 90/40 ± 5 mm Hg. Art. With age, the indicators gradually increase, reaching 120/80 ± 10 mm Hg. Art.

According to the World Health Organization, the upper limit of normal blood pressure is set at 140/90 mmHg. Art.

It should be noted that blood pressure values ​​vary depending on the time of day and the corresponding physical activity of a person. Blood pressure drops at night, reaching a physiological minimum between midnight and three o'clock. By the end of the working day, at approximately 17:00, blood pressure reaches a maximum and begins to decrease from 20:00. A situational increase in pressure occurs during unusual or excessive physical activity, in stressful situations, against the background of particularly vivid and strong emotions.

The basis for examination for suspected hypertension is at least three episodes of increased blood pressure recorded in different days within a month. Instrumental confirmation of increased pressure is necessary to differentiate the disease from other pathologies. Early symptoms of hypertension are quite characteristic, but in the absence special knowledge they are mistakenly mistaken for manifestations of other diseases. In addition, primary hypertension in hypertension should be distinguished from symptomatic (secondary) hypertension, which develops against the background of kidney disease and pathologies of the endocrine system.

Causes and risk factors

The main role in the pathogenesis of hypertension is played by disorders of the regulatory function of the central nervous system, in particular, the departments that control the functioning of vital organs.

The connection between hypertension and disturbances in the processes of nervous regulation is indirectly confirmed by the fact that it is often provoked by prolonged and severe anxiety, fears, deep nervous shocks, and repeated episodes nervous overstrain. Prerequisites for the development of primary arterial hypertension may be gross disturbances in the daily cycle of activity associated with the characteristics of professional activity(work on night shifts, irregular working hours), exposure to noise and vibration.

The development of hypertension is also facilitated by an imbalance in the ion balance caused by excess sodium. When consuming table salt in quantities exceeding 5 g per day, the risk of developing hypertension increases. With a burdened heredity, an addiction to salty foods is almost tantamount to a death sentence.

Predisposition to hypertension is genetically determined. Symptoms of hypertension that appear in close blood relatives are a fairly clear signal about the need to pay close attention to your health.

Hypertension and its further progression are also provoked by atherosclerosis, obesity, dysfunction of the adrenal glands, thyroid gland, and chronic infections.

Age and gender contribute to the manifestations of pathology. Among people under 40 years of age, symptoms of hypertension are more common in men than in women. After 60 years, hypertension is diagnosed in every second patient. The incidence of the disease in women increases after menopause and in the older age group of patients it is women who predominate. Changes in sex ratios are associated with increased premature mortality among men who become ill at an earlier age.

In addition, provoking factors are:

• Violations of quality and diet;
• Bad habits and chronic intoxication;
• Caffeine abuse;
• Physical inactivity and heavy physical labor;
• Socio-economic status.

Main symptoms of the disease

Typical signs of hypertension in women and men are the same and appear already at early stage. A sustained increase in blood pressure is accompanied by the following symptoms:

• Dizziness;
• Headache;
• Visual impairment;
• Numbness of fingers;
• Sleep disorders;
• Deterioration in performance;
• Irritability;
• Nosebleeds;
• Noise in ears;
• Peripheral edema (mainly in women);
• Sweating;
• Heartache.

Symptoms of hypertension appear in different combinations, not all at once, but as the disease progresses. Headache attacks can develop at the end of the day, coinciding in time with the physiological peak in blood pressure levels. It is not uncommon to have a headache immediately after waking up. This symptom is often mistaken for ordinary lack of sleep, overwork, or the manifestation of other diseases not related to the cardiovascular system.

A headache caused by an attack of hypertension is accompanied by a feeling of pressure or heaviness in the back of the head, sometimes worsening when turning, tilting the head, sudden movements, sneezing, coughing, and may be accompanied by swelling of the face, general or partial. The intensity of pain is in no way related to the level of blood pressure, but sometimes indicates its abrupt increase. In some patients, the headache is combined with nosebleeds, after which the condition usually improves. Nosebleeds can be painless, especially in the first stage of hypertension.

Excruciating headaches provoke irritability. The patient reacts painfully to bright lighting, loud and sharp sounds.

Visual impairment is described as a veil before the eyes, “spots”, double vision.

Heart pain and a vague feeling of anxiety as a symptom of hypertension are more typical for more late stages development of the disease. The pain is localized in the upper part of the heart or to the left of the sternum, and is not always associated with emotional or physical stress. Unlike angina attacks, the pain may not subside for several hours and is not relieved by taking vasodilators from the organic nitrate class of drugs.

Shortness of breath can occur as a reaction to physical activity, as the disease progresses, and at rest.

Peripheral edema with hypertension may indicate the development of heart failure. Swelling can develop after taking certain medications, impaired renal function, or excess sodium in the body.

During hypertension, three stages are distinguished, which differ in the symptoms they manifest and the severity of the patient’s condition.

When blood pressure rises to 140-149/90-99 mmHg. Art. hypertension is characterized as mild. The attacks are accompanied by dizziness, and nosebleeds are possible. Characteristic deterioration in performance, lethargy, possible attacks of nausea and tachycardia.

Hypertension medium degree severity is diagnosed at levels from 150-179/100-109 mm Hg. Art. Patients experience sweating, chills, swelling, numbness of the fingers; during an attack, possible dull pain in heart. Retinal vascular spasms manifest themselves as the flickering of flies or lightning before the eyes; progressive deterioration of vision is possible, up to blindness due to hemorrhage in the retina.

Severe hypertension leads to problems with the functioning of the heart and other organs.

Hypertensive crisis

With a sharp increase in blood pressure, a hypertensive crisis is possible. The consequences of a crisis can affect the heart, brain, and kidneys. Most characteristic crisis - an increase in diastolic (upper) pressure.

The crisis begins suddenly, and the following are possible:

• Dyspnea;
• Nausea, sometimes vomiting;
• blurred vision and other visual disturbances;
• Sharp redness of the face;
• Strong headache;
• Constrictive pain in the region of the heart.

Symptoms that appear during a crisis can vary; according to the characteristics of the symptom complex, the following types of crisis are distinguished:

• Neurovegetative. Prevail neurological symptoms. The patient is overexcited, restless or frightened. Possible hand tremors, sweating, and fever. As a rule, only systolic pressure increases; an attack of hypertension is accompanied by tachycardia.

• Hydropic. Both pressure indicators increase, patients quickly develop swelling of the face and hands, lethargy, and drowsiness. The man is disoriented. The edematous form of crisis develops mainly in women after eating salty foods or large amounts of liquid.

• A rare convulsive form of crisis is possible in patients with a malignant course of hypertension. During a convulsive crisis, the likelihood of a hemorrhagic stroke is especially high.

Features of the course of hypertension in women

Women of childbearing age develop hypertension less frequently than men. At the same time, hormonal changes associated with pregnancy, lactation and menopause are often accompanied by symptomatic hypertension. If the main signs of hypertension appear against the background of menopausal changes, a final diagnosis is possible after complete extinction reproductive function. Particularly female risk factors include taking oral contraceptives.

Intoxication with alcohol and nicotine has a much greater impact on women than on the stronger sex. Even one cigarette can provoke a hypertensive crisis with diagnosed hypertension.

Another risk factor is the increased emotionality of women. Due to this psychological characteristics representatives of the fair sex more often suffer from hypertensive crises.

The symptoms of hypertension in women are usually stronger; women are more attentive to their health and consult a doctor, on average, much earlier than men.

Features of the development and course of hypertension in men

Since the male body does not undergo such frequent and profound hormonal changes, the main risk factors are somewhat different from those in women.

First of all, these are severe and chronic stress, causing an increase adrenaline levels, and therefore blood pressure. Chronic intoxications of various origins also play an equally important role, ranging from air pollution in industrial regions, hazardous working conditions and ending with alcohol or tobacco addiction.

Diabetes mellitus, physical inactivity, and excess body weight can also provoke the development of arterial hypertension.

A hereditary predisposition to hypertension increases the risk of its development in both sexes.

Signs of hypertension in men are less pronounced, early symptoms are not always taken seriously. The first visit to a doctor often occurs at a fairly advanced stage of the disease.

Hypertension in children

Since one of the key factors in the development of hypertension is family history, parents with hypertension should know how to identify hypertension in children.

Hypertension can affect children of different ages, adolescents during puberty are especially susceptible to it. The triggering factors, development mechanisms and symptoms of hypertension are similar to those in adults. The basis for examining a child to confirm/exclude the diagnosis of hypertension is a sustained increase in blood pressure above 140/90 mmHg. Art.