Clinical recommendations for arterial hypertension
Arterial hypertension - persistent increase in blood pressure: systolic - above 140 mm Hg. art., diastolic - above 90 mm Hg. Art. provided that the measurements were taken in a calm state and at least three times at different times. Arterial hypertension - what is it and what are its clinical manifestations?
Clinical signs of hypertension
Clinical signs of arterial hypertension are:
- headache;
- dizziness;
- increased heart rate;
- shortness of breath;
- a feeling of inexplicable anxiety;
- cold;
- hyperemia of the skin of the face;
- hyperhidrosis (increased sweating);
- irritability;
- flashing spots before the eyes;
- numbness of fingers.
Arterial hypertension is a dangerous pathology, which in some cases is asymptomatic. Usually, high blood pressure is diagnosed for the first time during a hypertensive crisis - a sharp increase in blood pressure, which is accompanied by the appearance of clinical symptoms.
If the causes of hypertension are not identified, primary or essential arterial hypertension is diagnosed. When the cause of hypertension is identified, it is considered secondary.
Diagnosis of symptomatic arterial hypertension
Secondary hypertension is considered if it occurs against the background of some disease - for example, renovascular arterial hypertension. If hypertension is not the main symptom, then it is not noted in the diagnosis, for example, in Itsenko-Cushing syndrome.
Diagnosis of symptomatic arterial hypertension is carried out taking into account the pathologies that are accompanied by the development of hypertension. About 70 diseases are known that are accompanied by an increase in blood pressure. Conditionally, they can be divided into several groups: pathologies of the kidneys, endocrine system, heart and blood vessels, central nervous system. The diagnosis is made after studying the anamnesis (medical history of the patient with arterial hypertension) and examination of the patient.
Degrees of risk of arterial hypertension
High blood pressure increases the risk of cardiovascular diseases and mortality. Studies have shown that the probability of complications increases even with an increase in blood pressure within the normal range, and most complications are observed in patients with a slight increase in blood pressure. The doctors came to the conclusion that the prognosis depends both on the blood pressure level and on the degree of involvement of the target organs in the process. Therefore, stratification of patients depending on the degree of risk was introduced into the classification.
Division of patients according to the degree of risk of arterial hypertension allows for a more accurate assessment of the individual prognosis. The overall probability of complications is calculated taking into account the risk of CHD: with a risk of CHD of 30%, the probability of cardiovascular complications is 40%. The nuance of this approach is that the blood pressure level is not the main criterion when choosing a treatment regimen. This approach proved to be justified: mortality among patients with hypertension is gradually decreasing.
Risk stratification by groups:
- group of low risk of complications (less than 15% in the next 10 years). It includes patients of both sexes under the age of 55, with grade I hypertension, absence of target organ lesions);
- medium risk group (about 15-20% in the next 10 years). These are men over 55 years old, women over 65 years old, with blood cholesterol over 6.5 mmol/l and a heavy history of early cardiovascular diseases (in the absence of target organ damage);
- high-risk group (in the next 10 years, the risk of complications exceeds 20%). Patients with damage to target organs in the presence of concomitant risk factors;
- a very high-risk group (over 30% in the next 10 years). Patients with associated diseases (previous myocardial infarction, stroke or TIA, heart failure, CKD, grade III-IV retinopathy).
Treatment of arterial hypertension
Clinical recommendations for arterial hypertension include prescribing drugs from one of the groups listed below or their combinations:
- diuretics - lower blood pressure by increasing the excretion of salts and water;
- beta-blockers - reduce blood pressure by reducing cardiac output, baroreceptor sensitivity, reducing the activity of the renin-angiotensin system, and affecting the central nervous system;
- blockers of calcium channels - cause relaxation of the muscular layer of blood vessels, and also reduce peripheral vascular resistance, due to which blood pressure decreases;
- blockers of angiotensin II receptors - prevent the narrowing of blood vessels, improve the excretion of salts and water, as a result of which the pressure decreases;
- ACE inhibitors (angiotensin-converting enzyme) - cause systemic arterial vasodilatation (widening of arteries) and lowering of blood pressure;
- drugs of central action - regulate the activity of the sympathetic nervous system and eliminate vasospasm;
- renin inhibitors.
Treatment of arterial hypertension should take place under the supervision of a doctor. In case of ineffectiveness of the drugs, it is necessary to adjust the dose and/or replace the drugs.
Prevention of hypertension syndrome includes a low-salt diet, limiting the amount of alcohol, and weight control. Physical activity and playing sports are a very important point in the prevention and treatment of high blood pressure.
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