Hypertension - the pathology of the cardiovascular device developing as a result of dysfunction of the highest centers of vascular regulation, neurohumoral and kidney mechanisms and leading to arterial hypertension, functional and organic changes of heart, TsNS and kidneys. As subjective manifestations of elevated pressure serve headaches, noise in ears, heartbeat, short wind, pains in heart, a veil before eyes, etc. Inspection at a hypertension includes monitoring HELL, the ECG, EhoKG, UZDG of arteries of kidneys and a neck, the analysis of urine and biochemical indicators of blood. At confirmation of the diagnosis selection of medicamentous therapy taking into account all risk factors is made.
The leading display of a hypertension - is permanent the high arterial pressure, i.e. HELL which is not coming back to normal level after situational rise as a result of psychoemotional or physical activities, and decreasing only after reception of hypotensive means. According to WHO recommendations, the arterial pressure which is not exceeding 140/90 mm of mercury is normal. Excess of a systolic indicator over 140-160 mm of mercury. and diastolic - over 90 — 95 mm of mercury., recorded at rest at double measurement throughout two medical examinations, it is considered a hypertension.
Prevalence of a hypertension among women and men of approximately identical 10-20%, a thicket a disease develops aged after 40 years though the hypertension quite often occurs even at teenagers. The hypertension promotes more bystry development and the heavy course of atherosclerosis and emergence of life-threatening complications. Along with atherosclerosis the hypertension is one of the most frequent reasons of premature mortality of young able-bodied population.
Distinguish primary (essentsialny) arterial hypertension (or a hypertension) and secondary (symptomatic) arterial hypertension. Symptomatic hypertensia makes from 5 to 10% of cases of a hypertension. Secondary hypertensia serves as display of the main disease: diseases of kidneys (glomerulonefrit, pyelonephritis, tuberculosis, gidronefroz, tumors, stenosis of a renal artery), thyroid gland (thyrotoxicosis), adrenal glands (feokhromotsitoma, Itsenko-Cushing's syndrome, primary giperaldosteronizm), koarktation or atherosclerosis of an aorta, etc.
Primary arterial hypertension develops as an independent chronic disease and makes up to 90% of cases of arterial hypertension. At a hypertension elevated pressure is a consequence of an imbalance in the regulating system of an organism.
Mechanism of development of a hypertension
Increase in volume of minute warm emission and resistance of the peripheral vascular course is the cornerstone of pathogenesis of a hypertension. In response to influence of a stressful factor there are violations of regulation of a tone of peripheral vessels by the highest centers of a brain (a hypothalamus and a medulla). There is a spasm on the periphery, including kidney that causes formation of diskinetichesny and distsirkulyatorny syndromes. Secretion of neurohormones system renin-angiotensin-aldosteronovoy increases. Aldosteron participating in mineral exchange causes a delay of water and sodium in the vascular course that even more increases the volume of the blood circulating in vessels and raises HELL.
At arterial hypertension viscosity of blood increases that causes reduction of speed of a blood-groove and exchange processes in fabrics. Inert walls of vessels are thickened, their gleam is narrowed that fixes the high level of the general peripheral resistance of vessels and does arterial hypertension irreversible. Further as a result of increase in permeability and plasmatic treatment of vascular walls there is a development of an ellastofibroz and arterioloskleroz that finally leads to secondary changes in fabrics of bodies: to a sclerosis of a myocardium, hypertensive encephalopathy, primary nefroangioskleroz.
Extent of defeat of various bodies at a hypertension can be unequal therefore allocate several kliniko-anatomic options of a hypertension with primary defeat of vessels of kidneys, heart and a brain.
Classification of a hypertension
The hypertension is classified by a number of signs: to the rise reasons HELL, to defeat of bodies of targets, on level HELL, on a current etc. By the etiologichesky principle distinguish: essentsialny (primary) and secondary (symptomatic) arterial hypertension. On character of a current the hypertension can have the good-quality (slowly progressing) or malignant (quickly progressing) current.
The greatest practical value represents the level and stability HELL. Depending on level distinguish:
- Optimum HELL -
- Normal HELL - 120-129 / 84 mm of mercury.
- Pogranichno normal HELL - 130-139/85-89 mm of mercury.
- Arterial hypertension of the I degree - 140 — 159/90 — 99 mm of mercury.
- Arterial hypertension of the II degree - 160 — 179/100 — 109 mm of mercury.
- Arterial hypertension of the III degree - more than 180/110 mm of mercury.
On level diastolic HELL is allocated by hypertension options:
- Easy current – diastolic HELL
- Moderate current – diastolic HELL from 100 to 115 mm of mercury.
- Heavy current - diastolic HELL> 115 mm of mercury.
The benign, slowly progressing hypertension depending on damage of target organs and development of the associated (accompanying) states passes three stages:
The stage of I (soft and moderate hypertension) - HELL unstably, fluctuates within a day from 140/90 to 160-179/95-114 mm of mercury., hypertensive crises arise seldom, proceed not hard. Signs of organic defeat of TsNS and internals are absent.
Stage of II (heavy hypertension) - HELL within 180-209/115-124 mm of mercury., hypertensive crises are typical. Objectively (at a fizikalny, laboratory research, an echocardiography, an electrocardiography, a X-ray analysis) narrowing of arteries of a retina, a mikroalbuminuriya, increase in creatinine in blood plasma, a hypertrophy of the left ventricle, passing ischemia of a brain is registered.
Stage of III (very heavy hypertension) – HELL from 200-300/125-129 mm of mercury. above, heavy hypertensive crises often develop. The damaging action of hypertensia causes the phenomena of the hypertensive encephalopathy, left ventricular insufficiency, development of thromboses of brain vessels, gemorragiya and hypostasis of an optic nerve stratifying aneurisms of vessels, a nefroangioskleroz, a renal failure etc.
Risk factors of development of a hypertension
The leading role in development of a hypertension is played by violation of regulatory activity of the highest departments of TsNS controlling work of internals, including cardiovascular system. Therefore development of a hypertension can be caused by often repeating nerve strain, long and strong disorders, frequent nervous shocks. Developing of a hypertension is promoted by the excessive tension connected with intellectual activity, work at night, influence of vibration and noise.
Risk factor in development of a hypertension is the increased salt use causing a spasm of arteries and a delay of liquid. It is proved that consumption in days> 5 g of salt significantly increases risk of development of a hypertension, especially, if there is a hereditary predisposition.
The heredity burdened on a hypertension plays an essential role in its development in the immediate family (parents, sisters, brothers). The probability of development of a hypertension significantly increases in the presence of hypertensia at the 2nd and closer relatives.
Promote development of a hypertension and vzaimopodderzhivat each other arterial hypertension in combination with diseases of adrenal glands, a thyroid gland, kidneys, diabetes, atherosclerosis, obesity, chronic infections (tonsillitis).
At women the risk of development of a hypertension increases in the climacteric period in connection with a hormonal imbalance and an aggravation of emotional and nervous reactions. 60% of women get sick with a hypertension in the period of a climax.
The age factor and sex define the increased risk of development hypertensive diseases at men. At the age of 20-30 years the hypertension develops at 9,4% of men, after 40 years – at 35%, and after 60-65 years – already at 50%. In age group up to 40 years the hypertension meets at men more often, in the field advanced age the ratio changes in favor of women. It is caused by higher rate of male premature mortality in the middle age from hypertension complications, and also menopausal changes in a female body. Now even more often the hypertension comes to light at people at young and mature age.
Extremely alcoholism and smoking, an irrational diet, excess weight, a hypodynamia, unsuccessful ecology favor to development of a hypertension.
Options of a course of a hypertension are various and depend on increase level HELL and on involvement of target organs. At early stages the hypertension is characterized by neurotic violations: dizziness, passing headaches (is more often in a nape) and weight in the head, noise in ears, a pulsation in the head, a sleep disorder, fatigue, slackness, feeling of weakness, heartbeat, nausea.
Further short wind at bystry walking, run, loading, rise in a ladder joins. Arterial pressure is resistant higher than 140-160/90-95 mm of mercury. (or 19 — 21/12 gp). Perspiration, face reddening, an oznobopodobny tremor, a sleep of toes and hands is noted, dull long aches in heart are typical. At a delay of liquid puffiness of hands ("a ring symptom" - difficult to remove a ring from a finger), persons, puffiness a century, constraint is observed.
At patients with a hypertension the veil, flashing of front sights and lightnings before eyes is noted that it is connected with an angiospasm in a retina of eyes; the progressing decrease in sight is observed, hemorrhages in a retina can cause total loss of sight.
At the long or malignant course of a hypertension chronic defeat of vessels of target organs develops: brain, kidneys, heart, eyes. Instability of blood circulation in these bodies against the background of with firmness raised HELL can cause development of stenocardia, myocardial infarction, hemorrhagic or ischemic stroke, the cardiac asthma, hypostasis of lungs stratifying aorta aneurisms, peeling of a retina, uraemia. Development of sharp medical emergencies against the background of a hypertension demands decrease HELL the first minutes and hours since it can lead of the patient to death.
The course of a hypertension quite often is complicated by hypertensive crises – periodic short-term rises HELL. The emotional or physical overstrain, a stress, change of weather conditions etc. can precede development of crises. At hypertensive crisis sudden rise HELL which can proceed several hours or days is observed and to be followed by dizziness, sharp headaches, feeling of heat, heartbeat, vomiting, a kardialgiya, disorder of sight.
Patients during hypertensive crisis are frightened, excited or slowed down, sleepy; at the heavy course of crisis can faint. Against the background of hypertensive crisis and the available organic changes of vessels quite often there can be a myocardial infarction, sharp violations of brain blood circulation, sharp insufficiency of the left ventricle.
Diagnosis of a hypertension
Inspection of patients with suspicion of a hypertension pursues the aims: to confirm stable increase HELL, to exclude secondary arterial hypertension, to reveal existence and a damage rate of target organs, to estimate a stage of an arterial hypertension and degree of risk of development of complications. When collecting the anamnesis special attention is paid on susceptibility of the patient to influence of risk factors on hypertensions, complaints, increase level BY HELL, existence of hypertensive crises and associated diseases.
For definition of existence and degree of a hypertension dynamic measurement HELL is informative. For receiving reliable indicators of level of arterial pressure it is necessary to meet the following conditions:
- Measurement HELL is taken in a comfortable quiet situation, after 5-10-minute adaptation of the patient. It is recommended to exclude in 1 hour prior to measurement smoking, loadings, meal, tea and coffee, application of nasal and eye drops (simpatomimetik).
- Position of the patient – sitting, standing or lying, the hand is flush with heart. The cuff is imposed on a shoulder, poles of an elbow bend are 2,5 cm higher.
- At the first visit of the patient HELL is measured on both hands, with repeated measurements after a 1-2-minute interval. At asymmetry HELL> 5 mm hg, the subsequent measurements have to be taken on a hand with higher rates. In other cases, HELL is measured, as a rule, on a "non-working" hand.
If indicators HELL at repeated measurements differ among themselves, then take an arithmetic average for true (excepting the minimum and maximum indicators HELL). At a hypertension HELL in house conditions is extremely important self-checking.
Laboratory researches include clinical blood tests and urine, biochemical determination of level of potassium, glucose, creatinine, general cholesterol of blood, triglycerides, an urine research on Zimnitsky and Nechiporenko, Reberg's test.
On an electrocardiography in 12 assignments at a hypertension the hypertrophy of the left ventricle is defined. Data of the ECG are specified by carrying out an echocardiography. Oftalmoskopiya with a research of an eye bottom reveals degree of a hypertensive angioretinopatiya. Increase in the left departments of heart is defined by performing ultrasonography of heart. For definition of damage of target organs carry out ultrasonography of an abdominal cavity, EEG, urography, an aortografiya, KT of kidneys and adrenal glands.
Treatment of a hypertension
At treatment of a hypertension not only decrease HELL, but also correction and the greatest possible decrease in risk of complications is important. Completely it is impossible to cure a hypertension, but quite really to stop its development and to reduce the frequency of developing of crises.
The hypertension demands combination of efforts of the patient and the doctor for achievement of a common goal. At any stage of a hypertension it is necessary:
- To keep to a diet with the increased consumption of potassium and magnesium, restriction of consumption of table salt;
- To stop or limiting sharply alcohol intake and smoking;
- To get rid of excess weight;
- To increase physical activity: it is useful to do swimming, physiotherapy exercises, to make pedestrian walks;
- Systematically it is also long to accept the appointed medicines under control HELL and dynamic observation of the cardiologist.
At a hypertension appoint the hypotensive means which are oppressing vasomotorial activity and slowing down synthesis of noradrenaline, diuretics, β-adrenoblokator, dezagregant, gipolipidemichesky and hypoglycemic, sedative medicines. Selection of medicamentous therapy carry out strictly individually taking into account all range of risk factors, level HELL, existence of associated diseases and damage of target organs.
Criteria of efficiency of treatment of a hypertension is achievement:
- short-term objectives: the maximum decrease HELL to the level of good tolerance;
- sredenesrochny purposes: preventions of development or progressing of changes from target organs;
- long-term goals: prevention cardiovascular, etc. complications and extension of life of the patient.
The forecast at a hypertension
The remote consequences of a hypertension are defined by a stage and character (good-quality or malignant) courses of a disease. The heavy course, bystry progressing of a hypertension, the III stage of a hypertension with severe defeat of vessels significantly increases the frequency of vascular complications and worsens the forecast.
At a hypertension the risk of developing of a myocardial infarction, stroke, heart failure and premature death is extremely high. Adversely the hypertension at the people who got sick at young age proceeds. Early, systematic performing therapy and control HELL allows to slow down progressing of a hypertension.
Prevention of a hypertension
Primary prevention of a hypertension requires an exception of the available risk factors. Moderate physical activities, a low-salt and hypocholesteric diet, psychological unloading, refusal of addictions are useful. Early detection of a hypertension by control and self-checking HELL, the dispensary accounting of patients, observance of individual hypotensive therapy and maintenance of optimum indicators HELL is important.