By lifestyle modification arterial hypertension syndrome. What is arterial hypertension, how to treat it in adults. Diagnosis of arterial hypertension

In pathogenesis hypertension great importance has sympathetic activation nervous system, which is manifested by hypersecretion of catecholamines (adrenaline and norepinephrine), which increase cardiac output. The total peripheral resistance at this stage changes little.

The period of stabilization of hypertension is characterized by a decrease in the activity of the sympathetic-adrenal system, a drop in cardiac output, and an increase in total peripheral resistance and renal vascular resistance.

The renal mechanism plays an important pathogenetic role. As a result of spasm of the glomerular glomeruli of the kidneys, renin begins to be produced, which promotes the conversion of hypertensinogen into angiotensin, which increases blood pressure. Renin also promotes the production of aldosterone by the adrenal glands, which retains sodium, resulting in an increase in circulating blood volume and hypertension becoming volume-dependent.

The pathogenesis of symptomatic arterial hypertension has mechanisms similar to hypertension - an increase in cardiac output and (or) peripheral resistance or both factors.

Arterial hypertension due to stroke or intracranial hemorrhage

  • A stroke or hemorrhage can be a consequence of hypertension and vice versa.
  • In acute cases, autoregulation of cerebral blood flow and autonomic functions is disrupted. A small change in blood pressure can lead to a catastrophic decrease in cerebral blood flow.
  • Blood pressure should not be lowered until diastolic blood pressure is more than 130 mmHg. and/or signs of cerebral edema persist (with clinical manifestations).
  • In most cases, blood pressure normalizes within 24-36 hours. If indicated drug therapy, then follow the above principles of antihypertensive therapy and prescribe a combination of sodium nitro-prusside, labetalol and slow calcium channel blockers.
  • Prescription should be avoided antihypertensive drugs with a central mechanism of action, since they have a sedative effect.
  • Patients with subarachnoid hemorrhage should be prescribed the cerebroselective slow calcium channel blocker nimodipine to reduce cerebral vascular spasm.
  • A decrease in blood pressure is indicated in cases where the magnitude of its increase meets the above criteria or it remains elevated for 24 hours. There is no evidence that a decrease in blood pressure reduces the likelihood of complications of a crisis in the acute phase.

Stages of hypertensive retinopathy

  • Stage I: Tortuosity of the retinal arteries, “silver threads”
  • Stage II: Compression of arteries and veins
  • Stage III: Hemorrhages in the form of flames and spots like cotton flakes
  • Stage IV: Nipple swelling optic nerve

Clinical manifestations of arterial hypertension syndrome

The bulk (90-95%) of patients with hypertension are people with hypertension. The rest is accounted for by so-called symptomatic hypertension.

There are:

Systolic arterial hypertension, when systolic pressure is predominantly increased. This hypertension is caused by an increase in cardiac output or arterial stiffness.

Diastolic arterial hypertension, with a predominant increase in diastolic pressure.

Systole-diastolic.

For some time, hypertension may be asymptomatic and without signs of damage to internal organs. It is possible to detect hypertension in such cases only by measuring blood pressure, but only the results of long-term observation make it possible to distinguish stable hypertension from short-term increases in blood pressure.

Laboratory and instrumental examination methods

  1. General blood analysis.
  2. General urine analysis.
  3. Urine analysis according to Zimnitsky.
  4. Urinalysis according to Nechiporenko.
  5. Urine culture.
  6. Blood test for creatinine.
  7. Blood test for cholesterol.
  8. Blood test for β-lipoproteins.
  9. Blood sugar test.
  10. Determination of potassium level in the blood.
  11. Ophthalmoscopy.
  12. X-ray of the heart.

According to indications: echocardiography, reno- and aortography, kidney scanning, ultrasound of the adrenal glands, determination of renin and corticosteroid levels in the blood.

Stages of diagnostic search for arterial hypertension syndrome

  1. The basis of the diagnostic algorithm is the establishment of hypertension syndrome. For this purpose, blood pressure is measured over time.
  2. The second possible stage of the diagnostic process is the analysis of the patient’s complaints, anamnestic data and physical examination data, which allows clinical assessment, separate hypertension and symptomatic arterial hypertension and outline a preliminary diagnosis.
  3. Additional research methods will help establish a final diagnosis.

Clinical criteria for major diseases and differential diagnosis of arterial hypertension syndrome

Differential diagnosis of arterial hypertension presents certain difficulties due to their large number.

When collecting anamnesis, you should pay attention to previous diseases. Frequent exacerbations of chronic tonsillitis, indication of acute glomerulo- or pyelonephritis, presence of information about attacks renal colic and dysuric disorders makes it possible to believe that hypertension may be caused by kidney damage. A history of edema, changes in urine tests in combination with increased blood pressure (in women during pregnancy) may also be signs of kidney damage. You should also take into account unfavorable heredity: the presence of hypertension, most often in the mother. The age of the patient is also of certain importance. Hypertension is characterized by its appearance in more mature and old age. Hypertension with high blood pressure numbers is characteristic of symptomatic hypertension.

You should also pay attention to the frequency and nature of hypertensive crises. The presence of frequent hypertensive crises is characteristic of pheochromocytoma.

When high arterial hypertension is combined with transient paralysis or paresis, thirst, polyuria and nocturia, and attacks of muscle weakness, it is necessary to exclude a tumor of the adrenal cortex.

Raynaud's syndrome, persistent arthralgia, polyarthritis in combination with high blood pressure are characteristic of systemic diseases.

Puffiness of the face and anasarca are characteristic of myxedema and kidney disease. Itsenko-Cushing syndrome is characterized by a moon-shaped face, uneven obesity, and purple stretch marks. With thyrotoxicosis, exophthalmos and rare blinking are observed, and an enlargement of the thyroid gland is possible. Aortic insufficiency is characterized by pallor in combination with Musset's sign and "carotid dance".

A thorough examination of the large arteries and measurement of blood pressure in the arms and legs is of great diagnostic importance. The appearance of diastolic murmur at Botkin's point and the second intercostal space on the right at the sternum indicates insufficiency aortic valves. The final diagnosis can be made after a laboratory and instrumental examination of the patient.

Pharmacotherapy of arterial hypertension syndrome

Since a major role in the occurrence of hypertension belongs to an increase in cardiac output and vascular resistance, and a decrease in natriuresis, the main goal of pharmacotherapy for hypertension is to influence all these links in pathogenesis.

Medicines used in the treatment of hypertension

  1. β-blockers.
  2. ACE inhibitors.
  3. Calcium antagonists.
  4. Diuretics.
  5. α 1-adrenergic blockers.
  6. Peripheral sympatholytic drugs.
  7. Direct vasodilators.
  8. Agonists of central α 2 -adrenergic receptors.

1. β-blockers

Mechanism of action. Non-selective and selective β-blockers have membrane-stabilizing properties; weaken the influence of sympathetic impulses on heart receptors. They reduce the strength and frequency of heart contractions; reduce cardiac output; reduce myocardial oxygen consumption; increase the tone of the bronchi and peripheral vessels; inhibit platelet aggregation; reduce renal blood flow and volume glomerular filtration; have a depressant effect on the central nervous system.

Indications:

Combination of AG with:

  • Angina pectoris.
  • Painless myocardial ischemia.
  • Ventricular extrasystole.
  • Supraventricular arrhythmias.
  • Migraine.

Contraindications:

  • Chronic obstructive pulmonary diseases.
  • Hypoglycemia.
  • Arterial hypotension.
  • Raynaud's syndrome.

2. AIF inhibitors

Mechanism of action. Drugs in this group suppress the renin-angiotensin-aldosterone system. When taken systematically, everything ACE inhibitors give the same effect; reduce blood pressure due to the vasodilating effect on arterioles and venules without changing heart rate, improve peripheral blood flow, including renal diuresis and natriuresis, reduce myocardial hypertrophy, and improve the patient’s quality of life. The drugs do not have any effect negative influence on lipid and carbohydrate metabolism.

Indications:

Combination of AG with:

  • Chronic heart failure.
  • Diabetes mellitus.
  • Post-infarction cardiosclerosis.

Contraindications:

  • Bilateral renal artery stenosis.
  • Chronic renal failure.
  • Hyperkalemia (>5.5 mmol/l).
  • Pregnancy.

3. Calcium antagonists

Mechanism of action. Causes antianginal and hypotensive effects. They block the flow of calcium through calcium channels of the cell membrane into the cell. This leads to a decrease in myocardial contractility, a decrease in heart function and a decrease in the heart's need for oxygen. They improve myocardial relaxation in diastole, reducing pressure in the left ventricle and pulmonary circulation. Relaxes the smooth muscles of blood vessels. They dilate coronary and peripheral arteries, reduce total peripheral resistance (afterload). They have an antiarrhythmic effect and some diuretic effect.

Indications:

Combination of AG with:

  • Angina pectoris.
  • Post-infarction cardiosclerosis.
  • Supraventricular arrhythmias.
  • In the elderly.
  • When hypertension is combined with asthma, physical effort.
  • For renal hypertension.

Contraindications:

  • Intracardiac blockades.
  • Sinus tachycardia (for group nifedipine).
  • Pregnancy.
  • Heart failure (for finoptin and diltiazem).
  • Aortic stenosis.

4. Diuretics

Mechanism of action. They cause a decrease in sodium and water in the extracellular space and vascular bed; reduce cardiac output; have a vasodilating effect; increase the activity of depressor systems, which helps reduce blood pressure.

Indications:

  • Combination of hypertension with chronic heart failure.
  • In the elderly.
  • Predominantly systolic hypertension.

Contraindications:

  • Diabetes.
  • Gout.
  • Kidney failure.

5. α 1 -blockers

Mechanism of action. The drugs block postsynaptic α 1 -adrenergic receptors, in particular in blood vessels, and prevent the vasoconstrictor effects of sympathetic innervation and catecholamines circulating in the blood. They cause dilatation of peripheral arteries, reduce peripheral vascular resistance and lower blood pressure. Reduce afterload on the heart. They cause dilatation of peripheral veins and reduce preload on the heart. By reducing pre- and afterload on the heart, they help improve systemic and intracardiac hemodynamics in chronic heart failure.

Indications:

  • Combination of AG with:
  • Diabetes mellitus.
  • Hyperlipidemia.
  • With pheochrocytoma.

Contraindications:

  • Angina pectoris.
  • Orthostatic hypotension.

6. Peripheral sympatholytic drugs

Mechanism of action. Drugs in this group disrupt the transmission of nerve impulses both in the nervous system itself and in the periphery. This leads to a decrease in blood pressure. Slow down heart rate, lower venous pressure, reduce peripheral resistance.

Indications:

  • Initial stages of headache.
  • Hypertension in thyrotoxicosis.

Contraindications:

  • Bronchial asthma, obstructive bronchitis.
  • Sinus bradycardia.
  • Violation of atrioventricular conduction.
  • Depression.
  • Parkinsonism.

7. Direct vasodilators

Mechanism of action. They lower blood pressure by relaxing the smooth muscles of blood vessels, reducing the peripheral vascular resistance without changing the tone of the veins (except for dibazole).

Indications:

  • As auxiliary drugs used in combination with other antihypertensive drugs.
  • For malignant hypertension (minoxidil).

Contraindications:

For hydralazine (apressin):

  • Left ventricular heart failure.
  • Tachycardia.
  • Angina pectoris.
  • Systemic lupus erythematosus.
  • Bronchial asthma.

For minoxidil:

  • Kidney failure.

Central α 1 -adrenergic receptor agonists

Mechanism of action. These are antihypertensive drugs that affect the central mechanisms of blood pressure regulation (they inhibit the vasomotor center). They have a moderate sedative effect.

Indications:

Combination of AG with:

  • Excitement, anxiety.
  • Insomnia.

Contraindications:

  • Depression.
  • Bradyarrhythmias and intracardiac blockades.
  • Car driving.
  • Concomitant use of alcohol, antidepressants, barbiturates and sedatives.

Tactics of using antihypertensive drugs

Hypertonic disease. Pharmacotherapy should be used if ineffective non-drug methods blood pressure correction. When choosing an antihypertensive drug, a stepwise approach is used. First, treatment is carried out with one antihypertensive drug(monotherapy). β-blockers, ACE inhibitors, and calcium antagonists are often used as monotherapy. Then the effectiveness of the drug is assessed. If monotherapy is ineffective, other antihypertensive drugs are added.

Currently, preference is given to individualized antihypertensive therapy, which is selected for the patient in a specialized hospital.

Symptomatic arterial hypertension

1. For kidney disease. At acute glomerulonephritis furosemide is used orally, in severe cases- lasix i.v.

In patients with chronic kidney disease, loop diuretics (furosemide, ethacrynic acid) are used, and in the presence of chronic renal failure, a combination is used loop diuretics with β-blockers.

2. Treatment of revascular hypertension. A good hypotensive effect in these patients is achieved by prescribing a combination of a diuretic (loop or thiazide), a beta-blocker and a peripheral vasodilator. High effectiveness of ACE inhibitors (Capoten) has been noted.

3. Endocrine forms of arterial hypertension. In hyperaldosteronism, spironolactone and amiloride have a good hypotensive effect. For malignant hypertension, an effective combination of drugs includes a diuretic (furosemide, veroshpiron), a sympatholytic (clonidine), a vasodilator (hydralazine, minoxidil) and an ACE inhibitor (captopril).
To relieve a hypertensive crisis in pheochromocytoma, phentolamine or tropafen and sodium nitroprusside are used.

Arterial hypertension in case of thyrotoxicosis, it responds well to treatment with β-blockers and reserpine.

Antihypertensive therapy in elderly and senile people, as well as during pregnancy, has its own characteristics.

Paramedic tactics and emergency care for arterial hypertension syndrome

Paramedic tactics for hypertension syndrome

Provide emergency assistance in case of hypertensive crisis. Further tactics depend on the result of treatment:

  • If the crisis cannot be stopped, it is necessary to call an ambulance.
  • If the dynamics are positive, the patient is monitored and undergoes planned treatment. If necessary, consult a doctor.

If arterial hypertension is detected for the first time, the patient should be referred to a doctor.

Work with dispensary group patients with hypertension:

  • Patients are monitored (home visits, calls to outpatient appointment, control of dispensary visits to the doctor).
  • The treatment of patients is monitored (if necessary, treatment is corrected).
  • Preparation of medical documentation.

Emergency care for hypertensive crises

Hypertensive crisis is a sudden increase in systolic and diastolic blood pressure to individually high values ​​in patients suffering from hypertension or symptomatic hypertension.
There is no single classification of crises. WHO experts suggest dividing crises into 2 groups: first- and second-order crises. First-order crises include complicated hypertensive crises that require an immediate reduction in blood pressure within one hour by 15-20% of the initial level, then within 6 hours to 160 and 100 mm Hg. Art.:

  • hypertensive crisis complicated by hemorrhagic stroke;
  • hypertensive crisis complicated by acute left ventricular failure;
  • hypertensive crisis complicated by preeclampsia and eclampsia;
  • hypertensive crisis with pheochromocytoma.

Second-order crises include uncomplicated hypertensive crises, without the threat of complications, requiring a decrease in blood pressure within 2-6 hours by 15-20% of the original level.

Among diseases, cardiovascular diseases firmly hold the first place in prevalence throughout the world, and their complications (heart attacks and strokes) are the leading causes of mortality. In turn, in cardiovascular pathology, the first place is occupied by hypertension, which is based on the most common syndrome of arterial hypertension among the population. What he really is?

What is the difference between a syndrome and a symptom?

Medical science, like any long-established type of knowledge, has its own terminology. Words such as “symptoms” or “syndromes” are common, but each has its own specific meaning. A syndrome is an elementary “unit” of any diagnosis.

Each diagnosis is “constructed” from syndromes, just as a house has floors, foundations and attics. Syndromes are divided into individual symptoms (signs) of the disease. And if the syndrome can be compared to “large structural elements” of the diagnosis building, then the symptoms are like individual bricks.

Structure of hypertensive syndrome

Since hypertension results in the formation of hypertensive syndrome (which is logical), let’s take a closer look at its internal structure. In arterial hypertension, the key damaging factor is high blood pressure, which affects almost the entire body. Arterial hypertension syndrome consists of the following elements:

  • the basis of the syndrome is an increase in blood pressure above 140\90 mmHg. Art.;
  • damage to target organs (myocardium, kidneys, retina) are signs of long-term exposure high pressure; the myocardium of the left ventricle hypertrophies, signs of hypertensive nephropathy and retinopathy appear in the vessels of the kidneys and retina;
  • the kidneys begin to leak protein into the urine due to an increase in incoming pressure, this protein is found in the urine (microalbuminuria);
  • signs of left ventricular overload during ECG;
  • indicators of the level of cholesterol and low-density lipoproteins in the blood (the degree of “clogging” of blood vessels);
  • a consequence of the previous point is atherosclerosis of the main arteries (carotid, iliac, aorta).

Please note that the listed symptoms may be completely invisible to the patient, since he may not feel “high pressure numbers”, have no idea about vascular damage and hemodynamic overload of the left side of the heart. But these signs are extremely important for diagnosis arterial hypertension, since they can be quantified and the degree of development of the syndrome can be assessed. Even the degree of myocardial hypertrophy is easily determined during cardiac ultrasound, when it can simply be calculated by assessing the thickness. Using simple ECG formulas, you can derive a quantitative indicator. This indicator is called the Sokolov-Lyon index.

In addition to these independent signs, which are especially valuable because they are not influenced by the patient’s changing opinion, there are many subjective signs that appear in the first stages of the disease. These symptoms are:

  • headache associated with increased blood pressure;
  • decreased visual acuity, the appearance of transient disorders during an increase in pressure (flickering “flies” before the eyes - photopsia);
  • redness of the face and skin;
  • the appearance of palpitations;
  • nocturia (predominance of nighttime urine volume over daytime).

In later stages, complications are pronounced. The following symptoms appear:

  • signs of hypertensive encephalopathy;
  • angina pectoris;
  • the appearance of congestive heart failure due to a breakdown of compensatory mechanisms;
  • ischemic strokes;
  • other diseases based on advanced hypertension.

About secondary hypertension

It should be said that arterial hypertension syndrome may not necessarily be primary. Only when the patient has been thoroughly examined and doctors have not found any reason for the development of this syndrome, a diagnosis of “essential arterial hypertension” or “hypertension” is made.

If the cause of the high blood pressure is found and can be treated, then hypertension is considered syndromic and does not dominate the diagnosis. For example, with renal artery stenosis, the pressure in the closed circulatory system will increase. After the operation, the pressure will return to normal. This is where renal arterial hypertension occurs.

With a hormonally active tumor of the adrenal cortex, pheochromocytoma, a lot of adrenaline enters the blood, since it produces it. As a result, blood pressure rises to significant levels, and with bilateral damage to the adrenal glands, the course of hypertension acquires a malignant, crisis character. In this case, there is also a case of symptomatic hypertension.

Since hypertension never develops instantly (it is preceded by a long period of hidden changes), you need to carefully monitor your health, avoid gaining excess weight, and observe motor activity, eat right, give up bad habits and regularly monitor blood pressure.

Arterial hypertension syndrome is the most common disease of the cardiovascular system, which is associated with a chronic increase blood pressure. According to statistics, approximately 44% of the Russian population suffers from one form or another of this disease.

The disease is characterized by a sluggish course. Nevertheless, people with a similar diagnosis require qualified help. Lack of therapy is fraught with the development dangerous complications until the death of the patient. So what is a disease? What are the risk factors for hypertension? What do the symptoms look like? initial stage? Is it possible to somehow prevent the development of the disease? Are there effective methods treatment? The answers to these questions are of interest to many people who are faced with a similar problem.

Arterial hypertension (ICD-10): description of the disease

First, it’s worth understanding what the disease is. Heart function and vascular tone are controlled by the nervous system and a number of hormones secreted by the endocrine glands. Normally, diastolic pressure is 70-90 mmHg. Art., and systolic - 120-140 mm Hg. Art. If these indicators are elevated, doctors talk about a disease such as arterial hypertension.

ICD-10 classifies this disease as a class of diseases accompanied by increased blood pressure. In the international classification system, diseases are assigned codes from I10 to I15.

It is worth understanding that a short-term increase in blood pressure is not a sign of hypertension. A change in this indicator may be associated with various factors, including severe stress, emotional tension, physical activity, etc. The disease is indicated if hypertension becomes stable.

Classification of arterial hypertension

This disease can develop under the influence various factors, accompanied different symptoms and contribute to the development of various complications. That is why there are many schemes for systematizing the forms of the disease. For example, the classification of arterial hypertension depending on the origin of the disease includes two main groups:

  • Essential form of the disease. In fact, this is primary arterial hypertension, the causes of which are not always clear. However, chronic elevation of blood pressure in in this case not associated with lesions of other organs.
  • Symptomatic hypertension. This is a secondary form of the disease that develops against the background of other diseases. For example, a chronic increase in blood pressure can occur due to damage to the kidneys, nervous system, endocrine glands, or taking a number of medications.

It is also worth noting that there are four stages of development of the disease, each of which is accompanied by a set of specific symptoms.

The main reasons for the development of the disease

First degree hypertension: symptoms and treatment

Arterial hypertension of the 1st degree is accompanied by fluctuations in blood pressure within the range of 140-150/90-100 mm Hg. Art. Patients complain of frequent headaches that occur during physical activity. Sometimes pain appears in the left side of the chest, which radiates to the shoulder blade. People suffer from dizziness, which can result in fainting. Other symptoms include sleep disturbance, the appearance of black spots before the eyes, rapid heartbeat, and tinnitus. Signs appear only sometimes; the rest of the time the patient feels well.

Vasoconstriction affects the blood supply to organs. Tissues do not receive enough oxygen and nutrients, which is accompanied by gradual necrosis. This, in turn, affects metabolism. Arterial hypertension of the 1st degree affects the functioning of the entire body. The most common complications include cardiac muscle hypertrophy, microinfarctions, and renal sclerosis.

Patients with a similar diagnosis are prescribed a special diet, exercise, relaxation exercises, etc. As for drug treatment, therapy includes vasodilators, diuretics (help remove excess fluid from the body), neurotransmitters, anticholesterol and sedatives.

Second degree hypertension: symptoms and features

Arterial hypertension of the second degree is accompanied by a more pronounced increase in pressure - 160-179/100-109 mm Hg. Art. Patients have to deal with constant discomfort; the symptoms of hypertension rarely disappear completely. Their list includes:

  • chronic fatigue;
  • periodic nausea, pulsation in the head;
  • constriction of arterioles, hyperemia;
  • blurred vision, progressive fundus pathologies;
  • swelling of facial tissues;
  • increased sweating;
  • the presence of albumin in the urine;
  • numbness of fingers.

Hypertensive crises periodically appear, which are accompanied by a sharp jump in blood pressure (sometimes even by 50-60 mm Hg).

Treatment methods and possible complications

At this stage, each patient requires drug treatment - patients take all the same drugs as for stage 1 hypertension. You need to take pills responsibly (doctors recommend taking them at the same time). Of course, it is important to watch your diet and avoid fatty foods, completely give up coffee, minimize the amount table salt.

If left untreated, dangerous complications may develop. The most common include atherosclerosis (which only aggravates the situation), encephalopathy, aortic aneurysm (pathological protrusion of the vessel walls), angina pectoris, and thrombosis of cerebral vessels.

Features of the course and symptoms of third-degree hypertension

The third stage is a severe chronic form of the disease, in which the risk of complications is extremely high. Blood pressure rises above 180/110 mm. This figure never drops closer to normal. In addition to the above symptoms, patients also have others:

  • arrhythmia develops;
  • a person’s gait changes, coordination of movements is disrupted;
  • violation cerebral circulation entails the development of paresis and paralysis;
  • persistent visual impairment;
  • frequent and prolonged hypertensive crises, which are accompanied by the appearance of sharp chest pain, clouded consciousness, and speech disorders;
  • Gradually, patients lose the ability to move freely, communicate, and care for themselves.

As the disease progresses, more and more organs are involved in the process. Against the background of high blood pressure and oxygen starvation possible complications such as myocardial infarction, stroke, pulmonary edema, cardiac asthma, peripheral artery disease. Patients are often diagnosed with renal failure, diabetic nephropathy, nephroangiosclerosis. Visual impairment often results in complete blindness.

Therapy for the third degree of development of the disease

Drug therapy is determined depending on the patient’s condition and the presence of concomitant diseases. As a rule, patients are prescribed beta-blockers ("Atenolol", "Nadolol", "Betaxolol"), diuretics ("Hypothiazide", "Xipamide", "Indapamide"), ACE inhibitors ("Ramipril", "Fosinopril", " Enaoapril"), calcium antagonists ("Plendil", "Verapamil", "Nifedipine"). Additionally, medications may be prescribed to support the normal functioning of the kidneys, endocrine glands, brain, and vision organs.

What is the prognosis for patients diagnosed with hypertension? Treatment, drugs, proper diet, gymnastics - all this certainly helps to cope with some of the symptoms of the disease. However, at the third stage, the disease is difficult to treat - patients are assigned first-degree disability, since they are practically unable to work.

Arterial hypertension of the fourth degree

It is extremely rare in modern medical practice to diagnose stage 4 hypertension. Unfortunately, at this stage the disease is practically untreatable. Hypertensive crises become constant companions of the patient. At such moments he needs urgent health care. As a rule, the disease at this stage of development sooner or later ends in death.

Effective preventive measures

Are there ways to prevent the development of a disease such as arterial hypertension? Clinical recommendations in this case are quite simple. If people have bad heredity, they should carefully monitor their blood pressure and undergo periodic medical examinations. It is extremely important to give up all bad habits, including taking drugs, alcohol, and smoking.

Positive condition circulatory system Regular physical exercise has an effect. One of the risk factors is stress - you should avoid nervous strain, practice meditation, adhere to a normal work and rest schedule, and spend time in the fresh air. An important element prevention is nutrition - doctors recommend reducing the amount of sugar, fat and table salt in the diet. The menu should contain products containing unsaturated fatty acid and vitamins. It's worth giving up coffee.

What should people who have already been diagnosed with arterial hypertension do? In this case, the help of a doctor is necessary. The earlier the disease is detected, the easier it is to cope with it. Prevention in this case is aimed at preventing complications. The regimen includes taking medications and healthy image life.

What is arterial hypertension? We will discuss the causes, diagnosis and treatment methods in the article by Dr. Zafiraki V.K., a cardiologist with 18 years of experience.

Definition of disease. Causes of the disease

Main criterion arterial hypertension (or arterial hypertension) as a whole group of diseases - stable, that is, identified through repeated measurements in different days, increased blood pressure (BP). The question of what kind of blood pressure is considered elevated is not as simple as it might seem. The fact is that among practically healthy people The range of blood pressure values ​​is quite wide. The results of long-term observation of people with different blood pressure levels showed that already starting from the level of 115/75 mm Hg. Art., each additional increase in blood pressure by 10 mm Hg. Art. is accompanied by an increased risk of developing diseases of the cardiovascular system (primarily coronary heart disease and stroke). However, the benefits of modern methods of treating arterial hypertension have been proven mainly only for those patients whose blood pressure exceeded 140/90 mmHg. Art. It is for this reason that it was agreed to consider this threshold value as a criterion for identifying arterial hypertension.

An increase in blood pressure can be accompanied by dozens of different chronic diseases, and hypertension is only one of them, but the most common: approximately 9 cases out of 10. The diagnosis of hypertension is established in cases where there is a stable increase in blood pressure, but no other diseases that lead to an increase in blood pressure, is not detected.

Hypertension is a disease for which a stable increase in blood pressure is its main manifestation. Risk factors that increase the likelihood of its development have been established through observations of large groups of people. In addition to the genetic predisposition that some people have, these risk factors include:

  • obesity;
  • inactivity;
  • excessive consumption of table salt, alcohol;
  • chronic stress;
  • smoking.

In general, all those features that accompany the modern urban lifestyle in an industrial developed countries. This is why hypertension is considered a lifestyle disease, and targeted changes for the better should always be considered as part of a hypertension treatment program on a case-by-case basis.

What other diseases are accompanied by increased blood pressure? These are many kidney diseases (pyelonephritis, glomerulonephritis, polycystic disease, diabetic nephropathy, stenosis (narrowing) of the renal arteries, etc.), a number of endocrine diseases (adrenal tumors, hyperthyroidism, Cushing's disease and syndrome), obstructive sleep apnea syndrome, some others, more rare diseases. Regular use of medications such as glucocorticosteroids, non-steroidal anti-inflammatory drugs, and oral contraceptives can also lead to a persistent increase in blood pressure. The diseases and conditions listed above lead to the development of so-called secondary, or symptomatic, arterial hypertension. The doctor makes a diagnosis of hypertension if, during a conversation with the patient, ascertaining the history of the disease, examination, as well as based on the results of some, mostly simple laboratory and instrumental research methods, the diagnosis of any of the secondary arterial hypertension seems unlikely.

Symptoms of arterial hypertension

High blood pressure itself does not manifest itself in any subjective sensations for many people. If high blood pressure is accompanied by symptoms, this may include a feeling of heaviness in the head, headache, flashing before the eyes, nausea, dizziness, unsteadiness when walking, as well as a number of other symptoms that are rather nonspecific for high blood pressure. The symptoms listed above manifest themselves much more clearly during a hypertensive crisis - a sudden significant increase in blood pressure, leading to a clear deterioration in condition and well-being.

It would be possible to continue listing separated by commas possible symptoms GB, but there is no particular benefit in this. Why? Firstly, all these symptoms are nonspecific for hypertension (i.e., they can occur both individually and in various combinations and in other diseases), and secondly, to establish the presence of arterial hypertension, the very fact of a stable increase in blood pressure is important. And this is revealed not by assessing subjective symptoms, but only by measuring blood pressure, moreover, repeatedly. This means, firstly, that “in one sitting” one should measure blood pressure twice or three times (with a short break between measurements) and take the arithmetic mean of two or three measured values ​​as true blood pressure. Secondly, the stability of the increase in blood pressure (a criterion for diagnosing hypertension as chronic disease) should be confirmed by measurements on different days, preferably with an interval of at least a week.

If a hypertensive crisis develops, there will definitely be symptoms, otherwise it is not a hypertensive crisis, but simply an asymptomatic increase in blood pressure. And these symptoms can be either those listed above or others, more serious - they are discussed in the “Complications” section.

Symptomatic (secondary) arterial hypertension develops as part of other diseases, and therefore their manifestations, in addition to the actual symptoms of high blood pressure (if any), depend on the underlying disease. For example, with hyperaldosteronism, this can be muscle weakness, cramps, and even transient (lasting hours - days) paralysis in the muscles of the legs, arms, and neck. With obstructive sleep apnea syndrome - snoring, sleep apnea, daytime sleepiness.

If hypertension over time - usually many years - leads to damage various organs(they are called “target organs” in this context), this can manifest itself as a decrease in memory and intelligence, stroke or transient cerebrovascular accident, an increase in the thickness of the heart walls, accelerated development of atherosclerotic plaques in the vessels of the heart and other organs, myocardial infarction or angina pectoris, a decrease in the rate of blood filtration in the kidneys, etc. Accordingly, clinical manifestations will be caused by these complications, and not by an increase in blood pressure as such.

Pathogenesis of arterial hypertension

In hypertension, dysregulation vascular tone and high blood pressure are the main content of this disease, so to speak, its “quintessence”. Factors such as genetic predisposition, obesity, inactivity, excessive consumption of table salt, alcohol, chronic stress, smoking and a number of others, mainly associated with lifestyle characteristics, lead over time to disruption of the functioning of the endothelium - the inner layer of arterial vessels one cell layer thick, which actively participates in the regulation of tone, and therefore the lumen of blood vessels. The tone of microvasculature vessels, and hence the volume of local blood flow in organs and tissues, is autonomously regulated by the endothelium, and not directly by the central nervous system. This is a system of local blood pressure regulation. However, there are other levels of blood pressure regulation - the central nervous system, endocrine system and kidneys (which also realize their regulatory role largely due to their ability to participate in hormonal regulation at the level of the whole organism). Violations in these complex regulatory mechanisms lead, in general, to a decrease in the ability of the entire system to finely adapt to the constantly changing needs of organs and tissues for blood supply.

Over time, persistent spasm develops small arteries, and subsequently their walls change so much that they are no longer able to return to their original state. In larger vessels, due to constantly elevated blood pressure, atherosclerosis develops at an accelerated pace. The walls of the heart become thicker, myocardial hypertrophy develops, and then dilation of the cavities of the left atrium and left ventricle. High blood pressure damages renal glomeruli, their number decreases and, as a result, the ability of the kidneys to filter blood decreases. In the brain, due to changes in the blood vessels supplying it, negative changes also occur - small foci of hemorrhages appear, as well as small areas of necrosis (death) of brain cells. When an atherosclerotic plaque ruptures in a sufficiently large vessel, thrombosis occurs, the lumen of the vessel is blocked, and this leads to a stroke.

Classification and stages of development of arterial hypertension

Hypertension, depending on the magnitude of elevated blood pressure, is divided into three degrees. Moreover, given the increased risk cardiovascular diseases on a “year-decade” scale, already starting from a blood pressure level above 115/75 mm Hg. Art., there are several more gradations of blood pressure levels.

If the systolic and diastolic blood pressure values ​​fall within different categories, then the degree of arterial hypertension is assessed by the highest of the two values, and it does not matter - systolic or diastolic. The degree of increase in blood pressure when diagnosing hypertension is determined by repeated measurements on different days.

In our country, stages of hypertension continue to be distinguished, while in European recommendations for the diagnosis and treatment of arterial hypertension, no stages are mentioned. The identification of stages is intended to reflect the phasing of the course of hypertension from its onset to the appearance of complications.

There are three stages:

  • Stage I implies that there is still no obvious damage to those organs that are most often affected by this disease: there is no enlargement (hypertrophy) of the left ventricle of the heart, there is no significant decrease in the filtration rate in the kidneys, which is determined taking into account the level of creatinine in the blood, protein is not detected in the urine albumin, no wall thickening detected carotid arteries or atherosclerotic plaques in them, etc. Such damage to internal organs is usually asymptomatic.
  • If there is at least one of the listed signs, diagnose Stage II hypertension.
  • Finally, about Stage III hypertension is said when there is at least one cardiovascular disease with clinical manifestations associated with atherosclerosis (myocardial infarction, stroke, angina pectoris, atherosclerotic artery disease lower limbs), or, for example, serious kidney damage, manifested by a marked decrease in filtration and/or significant loss of protein in the urine.

These stages do not always naturally replace one another: for example, a person suffered a myocardial infarction, and after a few years an increase in blood pressure occurred - it turns out that such a patient immediately has stage III hypertension. The purpose of staging is mainly to rank patients according to their risk of cardiovascular complications. Treatment measures also depend on this: the higher the risk, the more intensive the treatment. When formulating a diagnosis, risk is assessed in four gradations. At the same time, the 4th gradation corresponds to the greatest risk.

Complications of arterial hypertension

The goal of treating hypertension is not to “bring down” high blood pressure, but maximum reduction risk of cardiovascular and other complications in the long term, since this risk - again, when assessed on a “year-decade” scale - increases for every additional 10 mm Hg. Art. already from a blood pressure level of 115/75 mm Hg. Art. This refers to complications such as stroke, coronary heart disease, vascular dementia(dementia), chronic renal and chronic heart failure, atherosclerotic vascular lesions of the lower extremities.

Most patients with hypertension do not worry about anything for the time being, so they do not have much motivation to be treated, regularly taking a certain minimum of medications and changing their lifestyle to a healthier one. However, in the treatment of hypertension there are no one-time measures that would allow you to forget about this disease forever without doing anything more to treat it.

Diagnosis of arterial hypertension

With the diagnosis of arterial hypertension as such, everything is usually quite simple: this requires only repeatedly recorded blood pressure at the level of 140/90 mm Hg. Art. and higher. But hypertension and arterial hypertension are not the same thing: as already mentioned, an increase in blood pressure can manifest itself in a number of diseases, and hypertension is only one of them, although the most common. When conducting a diagnosis, the doctor, on the one hand, must verify the stability of the increase in blood pressure, and on the other hand, assess the likelihood of whether the increase in blood pressure is a manifestation of symptomatic (secondary) arterial hypertension.

To do this, at the first stage of the diagnostic search, the doctor finds out at what age blood pressure first began to rise, whether there are symptoms such as, for example, snoring with breathing stops during sleep, attacks of muscle weakness, unusual impurities in the urine, attacks of sudden heartbeat with sweating and headache. pain, etc. It makes sense to clarify what medications and dietary supplements the patient is taking, because in some cases, they can lead to an increase in blood pressure or aggravation of an already elevated one. Several routine (performed in almost all patients with high blood pressure) diagnostic tests, along with information obtained during a conversation with a doctor, help assess the likelihood of some forms of secondary hypertension: a general urine test, determination of blood concentrations of creatinine and glucose, and sometimes potassium and other electrolytes. In general, taking into account the low prevalence of secondary forms of arterial hypertension (about 10% of all its cases), further search for these diseases as possible reason elevated blood pressure must have good reasons. Therefore, if at the first stage of the diagnostic search no significant data are found in favor of the secondary nature of arterial hypertension, then in the future it is considered that blood pressure is increased due to hypertension. This judgment may sometimes be subsequently revised as new data about the patient becomes available.

In addition to searching for data on the possible secondary nature of the increase in blood pressure, the doctor determines the presence of risk factors for cardiovascular diseases (this is necessary to assess the prognosis and a more targeted search for damage to internal organs), as well as, possibly, pre-existing diseases of the cardiovascular system or their asymptomatic damage - this affects the assessment of the prognosis and stage of hypertension, the choice therapeutic measures. For this purpose, in addition to talking with the patient and examining him, a number of diagnostic studies(eg electrocardiography, echocardiography, ultrasonography vessels of the neck, and, if necessary, some other studies, the nature of which is determined by the medical data already obtained about the patient).

Daily blood pressure monitoring using special compact devices allows you to assess changes in blood pressure during the patient’s usual lifestyle. This study is not necessary in all cases - mainly, if the blood pressure measured at a doctor’s appointment differs significantly from that measured at home, if it is necessary to evaluate nighttime blood pressure, if episodes of hypotension are suspected, sometimes to assess the effectiveness of the treatment.

Thus, some diagnostic methods when examining a patient with high blood pressure are used in all cases; the use of other methods is more selective, depending on the data already obtained about the patient, to check the assumptions that the doctor made during the preliminary examination.

Treatment of arterial hypertension

With regard to non-drug measures aimed at treating hypertension, the most convincing evidence has accumulated on the positive role of reducing salt intake, reducing and maintaining body weight at this level, regular physical training (exercise), no more than moderate alcohol consumption, as well as increasing the content of vegetables and fruits in the diet. Only all these measures are effective as part of long-term changes in the unhealthy lifestyle that led to the development of hypertension. For example, a decrease in body weight by 5 kg led to a decrease in blood pressure by an average of 4.4/3.6 mmHg. Art. - it seems like a little, but in combination with the other measures listed above to improve your lifestyle, the effect can be quite significant.

Improving lifestyle is justified for almost all patients with hypertension, but drug treatment is indicated, although not always, in most cases. If patients with increased blood pressure of 2 and 3 degrees, as well as with hypertension of any degree with a high calculated cardiovascular risk, drug treatment is mandatory (its long-term benefit has been demonstrated in many clinical studies), then with hypertension of 1 degree with a low and average calculated cardiovascular risk, the benefit of such treatment has not been convincingly proven in serious clinical trials. In such situations, the possible benefit of prescribing drug therapy assessed individually, taking into account the patient's preferences. If, despite improving lifestyle, the increase in blood pressure in such patients persists for a number of months during repeated visits to the doctor, it is necessary to re-evaluate the need for medication use. Moreover, the magnitude of the calculated risk often depends on the completeness of the patient’s examination and may turn out to be significantly higher than initially thought. In almost all cases of treatment of hypertension, they strive to achieve stabilization of blood pressure below 140/90 mmHg. Art. This does not mean that in 100% of measurements it will be below these values, but the less often the blood pressure, when measured under standard conditions (described in the “Diagnostics” section), exceeds this threshold, the better. Thanks to this treatment, the risk of cardiovascular complications is significantly reduced, and hypertensive crises, if they occur, are much less common than without treatment. Thanks to modern medications, those negative processes that, in hypertension, inevitably and latently destroy internal organs over time (primarily the heart, brain and kidneys), these processes are slowed down or suspended, and in some cases they can even be reversed.

Of the medications for the treatment of hypertension, the main ones are 5 classes of drugs:

  • diuretics (diuretics);
  • calcium antagonists;
  • angiotensin-converting enzyme inhibitors (names ending in -adj);
  • angiotensin II receptor antagonists (names ending in -sartan);
  • beta blockers.

IN Lately The role of the first four classes of drugs in the treatment of hypertension is especially emphasized. Beta blockers are also used, but mainly when their use is required by concomitant diseases - in these cases, beta blockers serve a dual purpose.

Nowadays, preference is given to combinations of drugs, since treatment with any one of them rarely leads to achieving the required level HELL. There are also fixed combinations of drugs that make treatment more convenient, since the patient takes only one tablet instead of two or even three. The selection of the necessary classes of medications for a particular patient, as well as their doses and frequency of administration, is carried out by the doctor, taking into account such data about the patient as blood pressure level, concomitant diseases, etc.

Thanks to the multifaceted positive effects of modern drugs, treatment of hypertension involves not only lowering blood pressure as such, but also protecting internal organs from negative impact those processes that accompany high blood pressure. Moreover, since the main objective treatment - to minimize the risk of its complications and increase life expectancy, then it may be necessary to correct the level of cholesterol in the blood, take medications that reduce the risk of blood clots (which leads to myocardial infarction or stroke), etc. Quitting smoking, no matter how trivial it is no matter how it sounds, it allows you to significantly reduce the risks of stroke and myocardial infarction associated with hypertension, and slow down the growth of atherosclerotic plaques in blood vessels. Thus, treating hypertension involves addressing the disease in many ways, and achieving normal blood pressure is only one of them.

Forecast. Prevention

The overall prognosis is determined not only and not so much by the fact of high blood pressure, but by the number of risk factors for cardiovascular diseases, the degree of their severity and the duration of the negative impact.

These risk factors are:

  1. smoking;
  2. increased blood cholesterol levels;
  3. high blood pressure;
  4. obesity;
  5. sedentary lifestyle;
  6. age (with each decade lived after 40 years, the risk increases);
  7. male gender and others.

In this case, not only the intensity of exposure to risk factors is important (for example, smoking 20 cigarettes a day is undoubtedly worse than 5 cigarettes, although both are associated with a worse prognosis), but also the duration of their exposure. For people who do not yet have obvious cardiovascular diseases other than hypertension, the prognosis can be assessed using special electronic calculators, one of which takes into account gender, age, blood cholesterol level, blood pressure and smoking. The SCORE electronic calculator is suitable for estimating the risk of death from cardiovascular diseases in the next 10 years from the date of risk assessment. At the same time, the risk obtained in most cases, which is low in absolute numbers, can produce a misleading impression, because the calculator allows you to calculate exactly the risk cardiovascular death. The risk of non-fatal complications (myocardial infarction, stroke, angina pectoris, etc.) is many times higher. The presence of diabetes mellitus increases the risk compared to that calculated using a calculator: for men by 3 times, and for women - even by 5 times.

With regard to the prevention of hypertension, we can say that since the risk factors for its development are known (inactivity, excess weight, chronic stress, regular lack of sleep, alcohol abuse, increased consumption of table salt, etc.), then all lifestyle changes that reduce the impact of these factors also reduce the risk of developing hypertension. However, it is hardly possible to reduce this risk completely to zero - there are factors that do not depend on us at all or depend little on us: genetic characteristics, gender, age, social environment, and some others. The problem is that people begin to think about the prevention of hypertension mainly when they are already unhealthy, and blood pressure is already increased to one degree or another. And this is not so much a question of prevention as of treatment.

Bibliography

  • 1. Lewington S. et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360:1903-1913
  • 2. Piepoli M.F. et al. European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Journal of Preventive Cardiology. 2016; 23:1-96
  • 3. Litvin A.Yu. et al. Obstructive sleep apnea syndrome and arterial hypertension: a bidirectional relationship. Consilium Medicum. 2015. 10: 34-39
  • 4. Belovol A.N., Knyazkov I.I. Diagnosis of secondary forms of arterial hypertension. Mystery of jubilation. 2014. No. 7/8: 98-106
  • 5. Rodionov A.V. Non-steroidal anti-inflammatory drugs and arterial hypertension: relevance of the problem and patient management tactics. Attending doctor. 2013.2
  • 6. Gogin E.E. Optimization problems of basic (pathogenetic) and symptomatic therapy arterial hypertension. Cardiology and cardiovascular surgery. 2009; 3:4-10
  • 7. Barsukov A.V. et al. Left ventricular hypertrophy and the renin-angiotensin-aldosterone system: AT1-angiotensin receptor blockers are in focus. Systemic hypertension. 2013. 1: 88-96
  • 8. Yakhno N.N. et al. Dementia. M.: MEDpress-inform., 2010. 272 ​​p.
  • 9. Recommendations for the treatment of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology. Russian Journal of Cardiology. 2014. 1:7-94
  • 10. Diagnosis and treatment of arterial hypertension: clinical guidelines Russian Medical Society about arterial hypertension. Cardiological Bulletin. 2015. 1: 5-30

Arterial hypertension- a group of diseases in which the leading symptom is a persistent increase in blood pressure above 140/90 mm. rt. Art.e for persons not receiving antihypertensive therapy

By etiology it is divided:

1. Essential or primary arterial hypertension (hypertensive disease).

2. Secondary (symptomatic) hypertension (renal, endocrine, hemodynamic, neurogenic).

n Hypertension is a disease of the cardiovascular system that develops as a result of primary dysfunction (neurosis) of higher vascular regulatory centers and subsequent neurohormonal and renal mechanisms, characterized by arterial hypertension, functional, and expressed stages– organic changes in the kidneys, heart, central nervous system. Accounts for up to 95% of all cases of chronic high blood pressure.

n The causes of essential hypertension have not been precisely established. It is believed to develop through a combination of hereditary predisposition to the disease and adverse influences external factors(stress, excessive consumption of table salt, low levels physical activity, smoking, alcohol abuse); Obesity plays an important role. An increase in blood pressure may be due to an increase in total peripheral resistance as a result of arterial vasoconstriction, an increase in cardiac output, or a combination of these factors. Activation of the sympathoadrenal and renin-giotensin systems plays an important role in this process.

CLASSIFICATION OF HYPERTENSION DISEASE

By stage

Stage I – there are no changes in target organs.

Stage II – there is target organ damage (LV myocardial hypertrophy, retinal angiopathy, moderate proteinuria).

Stage III – the presence of one or more concomitant

(associated) clinical conditions:

Consequences of stroke;

Hypertensive retinopathy (hemorrhages and

exudates, swelling of the optic nerve nipple);

Creatinemia (more than 2.0 mg/dl);

Dissecting aortic aneurysm.

According to the degree of blood pressure increase.

Degree IBP 140-159/90-99 mmHg.

Grade IIBP 160-179/100-109 mmHg.

Grade IIIBP 180/110 mmHg. and higher

n Isolated systolic hypertension – systolic blood pressure >140 mmHg. and diastolic<90 мм.рт.ст.

n Malignant hypertension – diastolic blood pressure more than 110 mmHg. and the presence of pronounced changes in the fundus (retinal hemorrhages, papilledema

In patients with hypertension, the prognosis depends not only on blood pressure levels, but also on associated risk factors and the degree of target organ involvement and associated clinical conditions. In this connection, stratification of patients depending on the degree of risk has been introduced into the modern classification.

RISK FACTORS for headache:

1. Men over 55 years of age;

2. Women over 65 years of age;

3. Smoking;

4. Cholesterol >6.5 mmol/l;

5. Heredity (for women under 65 years of age;

6. for men under 55 years old);

7. Diabetes mellitus.

8. Abdominal obesity(waist circumference more than 102 cm in men, more than 88 cm in women)

Target organ damage:

1. Left ventricular hypertrophy;

2. Narrowing of retinal vessels;

3. Proteinuria, hypoalbuminuria or higher. creatinine level up to 2 mg/dl (up to 175 µmol/l);

4. Atherosclerotic changes in the arteries.

Accompanying illnesses or complications of hypertension:

n heart: HF, angina pectoris, MI;

n brain: cerebrovascular accidents;

n ocular fundus: hemorrhages and exudates in the retina, swelling of the optic nerves;

n kidneys: renal dysfunction, increased. creatinine above 2 mg/dl (above 175 mol/l);

n vessels: aortic dissection, occlusive arterial diseases;

n diabetes mellitus

Syndromes in hypertension

1. Arterial hypertension syndrome.

Clinical manifestations :

Blood pressure is more than 139/90 mm Hg. Art.;

upon examination, you may notice pallor or hyperemia of the face;

the pulse is usually symmetrical, firm, high and rapid;

expansion upon percussion vascular bundle;

on auscultation: accent of the second tone over the aorta,

On ECHO-CS, aortic dilatation is > 40 mm.

2. Target organ damage syndrome:

· myocardium (sd cardiomegaly; sd rhythm and conduction disturbances; sd heart failure, sd cardialgia);

· kidneys (initial manifestations of nephropathy – microalbuminuria, proteinuria, a slight increase in creatinine from 1.2 to 2.0%; chronic renal failure).

cerebral vessels (vascular encephalopathy),

includes symptoms associated with functional and organic changes in cerebral vessels. Initial signs are headache, dizziness, tinnitus, decreased memory, and mental performance.

Changes in the fundus

I degree- segmental or diffuse changes in arteries and arterioles.

II degree - thickening of the walls, compression of the veins, Salus-Hun symptom (tortuosity and dilatation of the veins).

III degree- pronounced sclerosis and narrowing of arterioles, their unevenness, large and small hemorrhages (foci, stripes, circles), exudations (whipped cotton wool, cotton spots - retinal infarction).

IV degree- the same + bilateral swelling of the optic nerve nipple, blurring of its edges, retinal detachment, star sign.

COMPLICATIONS OF HYPERTENSION:

Left ventricular failure; with a combination of hypertension and coronary artery disease - increased frequency of angina attacks; there is a high probability of myocardial infarction; dissection of aortic aneurysm; cerebral or cerebellar hemorrhages, hypertensive encephalopathy, thrombosis of cerebral arteries; retinal hemorrhages and exudates with and without papilledema; decreased renal blood flow and glomerular filtration rates, slight proteinuria, renal failure; hypertensive crisis.

Hypertensive crisis- this is a relatively sudden, individually excessive increase in blood pressure, with a violation of regional hemodynamics (disorders of cerebral, coronary and renal circulation of varying degrees of severity).

Clinical manifestations :

1. Relatively sudden onset (from several minutes to several hours)

2. Individually high blood pressure levels

3. Cardiac complaints (palpitations, irregularities and pain in the heart area, shortness of breath)

4. Complaints of a cerebral nature ("bursting" headaches in the back of the head or diffuse, non-systemic dizziness, a feeling of noise in the head and ears, nausea, vomiting, double vision, flashing spots, flies).

5. Complaints of a general neurotic nature (chills, trembling, feeling hot, sweating).

6. With extremely high blood pressure values ​​and a protracted nature of the crisis, the development of acute left ventricular failure (cardiac asthma, pulmonary edema) is possible. psychomotor agitation, stunning, convulsions, short-term loss of consciousness.

When combined sudden increase AD with headache, the diagnosis of crisis is probable, but if there are, in addition, other complaints, it is undoubted.

CORONARY INSUFFICIENCY SYNDROME

Essence: the syndrome is caused by a discrepancy between the myocardial oxygen demand and the possible amount of coronary blood flow caused by the lesion coronary arteries.

Myocardial oxygen demand depends on the hemodynamic load on cardiovascular system, heart mass and metabolic rate in cardiomyocytes.

The delivery of oxygen with blood to the myocardium is determined by the state of coronary blood flow, which can decrease in both organic and functional disorders in the coronary arteries.

Main reasons :

1. Atherosclerosis of the coronary arteries with a narrowing of their lumen by 50%.

2. Functional spasm of the coronary arteries by 25% (always against the background of atherosclerosis).

3. Transient platelet aggregates.

4. Hemodynamic disorders (aortic valve defects).

5. Coronaritis.

6. Cardiomyopathies.

Ischemic disease hearts

IHD is an acute and chronic heart disease caused by a decrease or cessation of blood supply to the myocardium due to obstruction (atherosclerotic) of one or more coronary arteries (sd coronary insufficiency).

CLASSIFICATION OF CORONARY HEART DISEASE:

1. Sudden coronary death.

2. Angina:

· stable (4 functional classes)

· unstable (new, progressive, spontaneous, resting, early post-infarction)

3. Myocardial infarction (with and without Q)

4. Post-infarction cardiosclerosis.

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