1ST CITY CLINICAL HOSPITAL

This term refers to persistently elevated blood pressure above acceptable limits (systolic pressure above 139 mm Hg and/or diastolic pressure above 89 mm Hg). In our country, approximately 40% of the adult population have high blood pressure. At the same time, about 37% of men and 58% of women know about the presence of the disease, and only 22 and 46% of them are treated. Only 5.7% of men and 17.5% of women properly control their blood pressure. The figures presented above only confirm the high socio-medical significance of this pathology for the quality of life of the population.

For absolutely all diseases of internal organs, there are both changeable or modifiable and immutable or non-modifiable risk factors for development. Arterial hypertension is no exception. For its development, there are factors that we can influence - modifiable ones (overweight, sedentary lifestyle, drinking alcohol and a lot of salt in food, unbalanced diet, smoking, stress, severe sleep disorders) and risk factors that we cannot influence. – non-modifiable (heredity, male gender).

In approximately one in ten hypertensive patients, high blood pressure is caused by damage to an organ. In these cases, they speak of secondary or symptomatic hypertension. About 90% of patients suffer from primary or essential hypertension. The starting point for high blood pressure is at least a level of 139/89 mm Hg registered by a doctor three times. Art. and more in people not taking medications to lower blood pressure. It is important to note that a slight, even persistent increase in blood pressure does not mean the presence of the disease. If the patient in this situation does not have other risk factors and signs of end-organ damage, hypertension at this stage is potentially treatable. However, without the interest and participation of the patient, it is impossible to lower blood pressure.

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

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

The earliest and most permanent sign of persistently high blood pressure is an increase, or hypertrophy, of the left ventricle of the heart with an increase in its mass due to thickening of the heart cells. First, the thickness of the wall of the left ventricle increases, and subsequently the expansion of this chamber of the heart occurs. It is necessary to pay close attention to the fact that left ventricular hypertrophy is an unfavorable prognostic sign. A number of epidemiological studies have shown that the appearance of left ventricular hypertrophy significantly increases the risk of sudden death, coronary artery disease, heart failure, and ventricular arrhythmias. Progressive dysfunction of the left ventricle leads to the appearance of symptoms such as: shortness of breath on exertion, paroxysmal nocturnal shortness of breath (cardiac asthma), pulmonary edema (often during crises), chronic (congestive) heart failure. Against this background, myocardial infarction and ventricular fibrillation develop more often.

With gross morphological changes in the aorta (atherosclerosis), it expands, and its dissection and rupture may occur. Hyperlipidemia concomitant with hypertension contributes to the formation of an atherosclerotic process on the vascular wall. In hypertension, atherosclerotic plaques form on damaged vessels (when the integrity of the endothelium is damaged), even with normal cholesterol levels in the blood. Vascular atherosclerosis disrupts both general and cerebral hemodynamics. With fluctuations and a sharp increase in blood pressure, atherosclerotic plaques become unstable and mobile. They can break off, clog the lumen of the vessel, or can reach such large sizes that sometimes they completely cover the diameter of even a large vessel, thereby leading to local ischemia, and subsequently to a heart attack. Kidney damage is expressed by the presence of protein in the urine, microhematuria, and cylindruria. However, renal failure in hypertension, if there is no malignant course, rarely develops. Eye damage can manifest as blurred vision, decreased light sensitivity, and development of blindness.

Thus, it is clear that hypertension should be treated more carefully. Therefore, hypertension must be treated. In the very early stages of fixed high blood pressure, changing lifestyle and habits may be sufficient. But, if a diagnosis of hypertension is established, treatment should be medicinal. All doctor's recommendations must be followed.

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

• severe chest pain of a pressing nature (possibly unstable angina, acute myocardial infarction),
• increase in shortness of breath, worsening in a horizontal position (possibly acute heart failure),
• severe dizziness, nausea, vomiting, speech impairment or impaired mobility of limbs (possibly acute cerebrovascular accident),
• blurred vision, double vision (possibly retinal vascular thrombosis),

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

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

A sharp increase in blood pressure, not accompanied by the appearance of symptoms from other organs, can be treated with oral or sublingual (under the tongue) medications with a relatively rapid effect.

These include

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

Hypertension is often figuratively called the “silent killer” because of its asymptomatic nature. Know your blood pressure numbers and control them. If your blood pressure increases, be sure to consult your doctor.