Essential( primary) hypertension - Causes, symptoms and treatment. MF.

In recent decades, due to the deterioration of the environment, increased stress, consumption of food with excessive content of chemicals, increased levels of diseases of the cardiovascular system and hypertension in general. Hypertension is a disease not only causing subjective discomfort, but also dangerous with long-term consequences and complications.

So, arterial hypertension is a long, persistent increase in figures above 140 mm Hg for systolic, "upper" pressure and 90 for diastolic, "lower" pressure, measured by the cuff on the shoulder of the patient at rest. Hypertension may be secondary, or symptomatic, and may occur in diseases of various human organs, for example, heart and aorta, thyroid, adrenal, kidney, brain, kidney vessels. But more often( in 90 - 95% of cases) develops primary, or essential hypertension. This type of pressure increase, in which visible diseases of other organs are absent.

Previously, primary hypertension was called hypertensive disease, currently the terms hypertension and hypertension are considered to be equivalent.

In a healthy body, the maintenance of a dynamic balance of blood pressure is ensured by the vascular tone and their neurohumoral regulation, the volume of circulating blood( BCC), and the concentration of sodium in the blood. With primary hypertension, there is a disruption in the regulation of these parameters. What causes can cause violations, so it is still unclear.

Distribution of primary hypertension is 20-25% among people over 40 years of age, and the disease is more common in women. As well as symptomatic hypertension, the essential is divided into degrees and stages of the flow, which is important to consider for the purpose of treatment and to determine the risk of complications and sudden cardiac death.

Depending on the maximum pressure figures, the primary hypertension may be:

1 degree of severity - at a blood pressure level of 140/90 - 159/99
2 degrees - 160/100 to 179/109
3 degrees - above 180/110 mm.gt;Art.

The following stages of the disease progression are distinguished:

I stage. Not characterized by a constant increase in the level of pressure, during emotional stress, physical activity. The defeat of organs - targets and complications are absent. Can last for many years.

II stage. The pressure is increased constantly, but it is well reduced by hypotonic drugs. Hypertensive crises occur more often. The defeat of the target organs, the most sensitive to the constantly increased blood pressure in the arteries, is diagnosed clinically and instrumentally.
These include

- myocardial hypertrophy,
- retinal angiopathy( retinal vascular pathology), atherosclerosis of the aorta, carotid, femoral and other arteries,
- dyscirculatory encephalopathy,
- renal damage - presence of protein in the urine, increase in creatinine level in the urineblood serum.

III stage. Significant, persistent increase in pressure, dosed only by combinations of antihypertensive drugs. Frequent hypertensive crises. At this stage complications already occur - stroke, heart attack, angina pectoris, heart failure, nephropathy, exfoliating aortic aneurysm, bleeding in the retina of the eye.

Causes of primary hypertension

Unlike symptomatic hypertension, the basis of the essential does not lie some visible organic damage to other organs. This type of hypertension develops more often with prolonged psychoemotional stress, especially in people engaged in mental work, and in residents of large cities with a large number of mental stimuli. People with an anxious, suspicious type of personality who are constantly in a state of chronic stress and anxiety are also prone to primary hypertension. This is due to an increased level of stress hormones in the blood( adrenaline, norepinephrine), produced in the adrenal glands, as well as in the constant stimulation of the adrenoreceptors of blood vessels. Vessels are constantly in increased tonus, increasing resistance to the blood flow, resulting in increased blood pressure. Narrowing of the arteries of the kidneys leads to a violation of the formation in them of substances that regulate the volume of blood in the vascular bed( renin, angiotensinogen).There is a vicious circle, because at this stage the kidneys trigger the mechanism of sodium and water retention in the body, which further provokes a pressure increase.

In addition to the psychogenic causes of the disease, the following risk factors may influence the development of primary hypertension:
- heredity
- increased intake of table salt( more than 6 g per day)
- malnutrition
- male sex
- age over 55 - 60years, although often hypertension occurs in individuals 35 to 40 years old
- smoking
- obesity
- menopause in women
- sedentary lifestyle
- increased cholesterol in the blood
- diabetes
- vegetative dystonia

Symptoms of primary hypertension

Over the years, the increase in pressure may go unnoticed for a person, since he associates a poor state of health with fatigue and does not control the level of pressure. The main complaints with essential hypertension:

- headache in the occipital region, which occurs more frequently in horizontal position after stress or physical exertion
- nasal bleeding
- nausea
- general weakness
- fatigue
- irritability
- a feeling of constant fatigueand "brokenness"
- dizziness
- a feeling of rapid heart beat

When the organs of the target are affected, symptoms such as:
- from the eyes - vision impairment,
-of the brain - emotional instability, anxiety, sleep disorders, hearing loss, gait unsteadiness,
- kidneys - increase or decrease in the daily volume of urination, increased nighttime urination, morning swelling of the face, especially the areas under the eyes
- heart - shortness of breath when walking or at rest, pain in the left half of the chest, rapid, slowed or irregular heartbeat, edema of the lower extremities

In the development of complications, the clinical picture is supplemented by a corresponding clinical picture.

Diagnosis of essential hypertension

The diagnosis of primary hypertension can be established on the basis of a survey in which there were no significant organic changes in other organs that caused high blood pressure. If during the examination of internal organs there was no disease causing secondary hypertension, the doctor assumes the patient has primary hypertension. If pathological changes in the internal organs are detected, the doctor should carefully interpret the results and understand whether this condition was the cause or consequence of hypertension.

In order to exclude the initial diseases of the brain, kidneys, heart and aorta, the endocrine system, it may take a long time at the level of the polyclinic link, so many patients are hospitalized in a therapeutic hospital for examination. Especially if there is a malignant course of hypertension in people younger than 30 years - a persistent, significant increase in pressure to very high figures. In the latter case, the physician should think about symptomatic hypertension.

In the differential diagnosis of primary and secondary hypertension, the physician, in addition to examining the patient and measuring pressure on both hands, uses such diagnostic methods:

1. Laboratory methods.
- blood and urine tests - routine studies of
- biochemical blood test - cholesterol level, glucose, hepatic enzymes, renal function - urea and creatinine.
- hormonal blood tests can be prescribed for suspected hypo- and hyperthyroidism, pituitary and adrenal tumors( Iscenco-Cushing's disease, pheochromocytoma)
-glycemic profile, glucose tolerance test -disorders of carbohydrate metabolism( diabetes mellitus)

2. Instrumental methods.
- ECG.At the first stage it can be without features. In 11 - 111 stages there are signs of hypertrophy and myocardial ischemia, myocardial infarction transferred.
- ultrasound of the thyroid gland, kidneys, internal organs. It allows not only to reveal the pathology of the kidneys, which caused the cause of hypertension( glomerulonephritis, pyelonephritis), but also vice versa, to assess the extent of renal tissue damage in primary hypertension.
- Echocardiography. Heart and aortic malformations, myocardial hypertrophy, breach of contractility, enlargement of the heart chambers, violation of the blood flow in them, reduction of cardiac output, atherosclerosis of the aorta can be detected.
- Daily monitoring of blood pressure and ECG.It is carried out for a more complete picture of the conditions for increasing pressure during the day, the connection with physical activity, rest, eating, etc.
- Radiography of the chest cavity. Auxiliary method in the diagnosis of heart defects, which can cause secondary hypertension. With primary hypertension, 11 - 111 stages can detect myocardial hypertrophy, dilatation of the heart cavities with congestive heart failure.
- Coronary angiography. It is carried out if the patient develops angina pectoris manifested clinically and / or by ECG, myocardial infarction was transferred, as well as to assess the degree of coronary artery disease with atherosclerosis.
- MRI of the brain can be prescribed if there is a suspicion of the neurogenic nature of secondary hypertension, for example, in a brain tumor, head injury, meningoencephalitis. With secondary hypertension, the degree of dyscirculatory encephalopathy is assessed.
- MRI of the kidney and adrenal gland is indicated for suspected renin( kidney tumor from cells that produce renin), chromaffin, pheochromocytoma( adrenal tumors).

Treatment of primary hypertension

Treatment of hypertension begins with the correction of lifestyle and non-drug therapies. The lifestyle for a patient with essential hypertension consists of the following activities:

- Smoking and alcohol abstinence. It is proved that the poisons contained in cigarettes and alcohol, getting into the body, act toxic on the inner wall of the vessels and cause damage to it.
- Restriction of consumption of table salt in food up to 5 - 6 g per day. Salt, namely the sodium contained in it, promotes fluid retention in the body, increasing the volume of blood in the vessels.
- Proper nutrition. It is necessary to exclude from the diet "harmful" foods - fast food, spicy, smoked, spicy, salty, fatty and fried foods. It is recommended to increase the content of fresh fruits and vegetables, dairy products, cereals and cereals in food. For the proper functioning of the entire body, food should be taken at the same time, about 4 to 6 times a day. The choice of low-calorie foods without artificial additives, along with diet, will also help to normalize blood cholesterol and reduce obesity.
- The correct organization of physical activity. To maintain a good state of the cardiovascular system, it is not necessary to engage in weightlifting, extreme sports or spending every evening in the gym. It is quite enough morning and evening exercises with a set of simple exercises, if the patient is currently not in this contraindication, and the doctor is not recommended to comply with strict bed rest.

Non-drug therapies include:
- auto-training
- psychotherapy
- acupuncture
- phytotherapy( valerian, St. John's wort, sage, motherwort, mint, lemon balm, etc.)
- electrosleep

These methods can help with the initial stage of hypertension whenthere is still no defeat of organs - targets and complications. Otherwise, medications are prescribed, one or a combination thereof:

- ACE inhibitors( angiotensin converting enzyme) and ARA II( angiotensin II receptor antagonists) not only act on the main mechanism of sodium and liquid retention in the body, but also protect the target organs from further detrimental effects of high blood pressure. Preparations - lysigamma, prestan, focicard, zokardis, hartil;lorist, valsartan, etc.
- betta - adrenoblockers and calcium antagonists reduce the tone of peripheral vessels, reducing vascular resistance. Preparations - betalkov, rekardium, nebilet;amlodipine, felodipine, etc.
- diuretics remove excess fluid from the body. Diver, arifon, indapamide, veroshpiron, hydrochlorothiazide, and others.
- other groups of drugs for angina pectoris, heart failure, heart attack and other complications - nitrates, antiplatelet agents, statins.

It is preferable to start treatment with non-pharmacological methods( at stage I), in the absence of effect, to prescribe any one drug with a small dose. At the stage of target organ damage, with the development of complications, with a persistent increase in pressure to significant digits, it is recommended that a combination of drugs be taken. Combined drugs - Exforge( valsartan + amlodipine), Lozap plus( hydrochlorothiazide + losartan), Aritel plus( hydrochlorothiazide + bisoprolol) and many others.

Complications of hypertension

Uncontrolled high blood pressure without treatment can lead to the development of a hypertensive crisis. This condition, lasting from several hours to several days, characterized by a persistent increase in pressure to significant figures, sometimes above 220 mm.gt;Art. For patients who suffer a bad even a slight increase in pressure, a crisis can be considered an increase in blood pressure to 150/100 or higher, accompanied by a pronounced deterioration in well-being.

The crisis is characterized by a very sharp headache that does not stop with anesthetics, migraine, nausea, vomiting that does not bring relief, dizziness, inability to be upright, redness of the face, pain in the heart, lack of air or shortness of breath.

The first help in hypertensive crisis is the taking of captopril or nifedipine under the tongue. Hospitalization is indicated for myocardial ischemia, diabetes mellitus, advanced myocardial infarction or stroke.

During the crisis other complications of essential hypertension may develop:
- acute myocardial infarction
- transient ischemic attack
- acute hemorrhagic or ischemic stroke
- dissecting aortic aneurysm
- retinal bleeding with loss of vision
- acute heart failure
- edemalungs
- acute renal failure

Each of these conditions requires emergency admission to the therapeutic or cardiological department. Prevention of complications is a regular, continuous intake of prescribed medications. Dosage should be reduced gradually until the drug is completely discontinued.

Forecast

To assess the prognosis of patients with hypertension, a scale for the assessment of risk factors was developed( Framingham model).It uses five risk groups for complications and death from cardiovascular causes within the next 10 years.
1. Insignificant risk - less than 5%
2. Low risk - 5-15%
3. Moderate risk - 15-20%
4. High risk - 20-30%
5. Very high risk - more than 30%.

The risk group in which a patient is located is determined by the following criteria:
- absence or presence of risk factors
- degree of increase in blood pressure
- presence of affection of target organs and associated clinical conditions( infarction, stroke, nephropathy, angina pectoris, etc.).

For example, a patient with no risk factors, without the defeat of other organs and without complications, with a slight unstable increase in blood pressure falls into the group of insignificant risk, that is, the forecast is favorable. A patient with several risk factors, with organ damage, after a heart attack or stroke, with a constant increase in blood pressure of more than 180/100 mm.gt;Art.has a very high risk of cardiac death, that is, the forecast is unfavorable.

Doctor therapist Sazykina O.Yu.