Major Causes of High Blood Pressure and Treatment

Hypertension, or arterial hypertension, is a condition characterized by a stable, that is, detected by repeated measurements, increase in blood pressure. Accompanying many diseases, it is considered a risk factor for the development of dangerous complications from the cardiovascular system, including stroke and myocardial infarction. Hypertension, as the main cause of the pathology under consideration, requires taking medications, normalizing the patient’s lifestyle and nutrition.

Blood pressure is the force with which circulating blood acts on the walls of blood vessels. This pressure at the time of contraction of the heart is called systolic, and during its relaxation – diastolic. The range of normal values ​​for these indicators is quite wide.

In the course of numerous observations [1], scientists came to the conclusion that the risk of cardiovascular complications increases with each additional increase in blood pressure by 10 mm Hg. Art. already starting from the level of 115/75 mm Hg. Art. However, it turned out to be expedient to reduce pressure with medication only above 140/90 mm. rt. Art., therefore, it is this value that is taken as the criterion for determining arterial hypertension.

The Reasons For High Blood Pressure

In about 90% of cases, the cause of a stable increase in blood pressure is hypertension. Such a diagnosis is made to the patient when no other diseases accompanied by hypertension are found during the examination. Among the latter:

• kidney pathology – pyelonephritis, glomerulonephritis, polycystic, diabetic nephropathy, renal artery stenosis;
• endocrine disorders – neoplasms of the adrenal glands, pancreas or pituitary gland, hyperfunction of the thyroid gland, Itsenko-Cushing’s disease or syndrome, pheochromocytoma;
• obstructive sleep apnea syndrome;
• valve defects or atherosclerotic lesions of the aorta.

Regular use of a number of drugs can also cause an increase in blood pressure. These include oral contraceptives, non-steroidal anti-inflammatory drugs, amphetamines, corticosteroids, drugs containing erythropoietin, cyclosporine, cocaine.

The likelihood of developing cardiovascular diseases, including hypertension, is closely related to the following risk factors:

• Unhealthy diet, including excessive amounts of salt, saturated fats and trans fats, lack of leafy greens, vegetables and fruits in the diet;
• Obesity;
• Pathology of the heart and blood vessels in close relatives;
• Age over 65;
• Sedentary lifestyle;
• Chronic stress;
• Bad habits – smoking, excessive alcohol consumption.

Classification of High Blood Pressure

If it was possible to identify a disease leading to an increase in blood pressure, arterial hypertension is called secondary or symptomatic. In the case of an unidentified cause, hypertension is considered primary, caused by hypertension.

The latter has a staged course:

1. I stage. There are no obvious signs of disruption of the target organs affected by a stable increase in blood pressure – the heart, kidneys, arterial and venous vessels.
2. II stage. One of the listed signs or their combination is present, such as an increase in the left ventricle of the heart, a pronounced decrease in the filtration rate in the kidneys, albumin in the urine, an increase in the thickness of the walls of the carotid arteries, or the appearance of atherosclerotic plaques in their lumen. In this case, clinical manifestations of the disease may be absent.
3. III stage of hypertension. There is one or more pathologies associated with atherosclerotic processes in the heart and blood vessels – myocardial infarction, acute cerebrovascular accident, angina pectoris, atherosclerosis of the arteries of the lower extremities, or severe kidney damage, manifested by a pronounced decrease in filtration and / or a significant loss of protein in the urine.

Arterial hypertension is divided into several degrees depending on the maximum values ​​of the measured blood pressure:

1. First degree. Systolic blood pressure from 140 to 159 mm. rt. Art. and / or diastolic – from 90 to 99 mm. rt. Art.
2. Second degree. Systolic blood pressure from 160 to 179 mm. rt. Art. and / or diastolic – from 100 to 109 mm. rt. Art.
3. Third degree. Systolic blood pressure over 180 mm. rt. Art. and/or diastolic over 110 mm. rt. Art.

There is also an isolated form of arterial hypertension, in which only the systolic pressure figures are increased with normal diastolic pressure.

Symptoms of High Blood Pressure

Often, an increase in blood pressure is not accompanied by a deterioration in well-being and may go unnoticed by the patient, which is why it is so important to regularly measure blood pressure, especially in middle-aged and elderly people.

Symptoms of hypertension may include the following:

• headache, mostly in the morning after waking up;
• nosebleeds;
• hemorrhage under the mucous membrane of the eye;
• violation of the heart rhythm;
• blurred vision, flies flickering;
• tinnitus.

A sharp jump in blood pressure to high numbers, accompanied by a pronounced deterioration in well-being, is called a hypertensive crisis. Most often, it occurs when the systolic pressure rises more than 180 mm Hg. Art. and / or diastolic over 120 mm Hg. Art. In this case, the patient has weakness, nausea, vomiting that does not bring relief, impaired consciousness, anxiety and fear, muscle tremors, chest pain.

Complications

A stable increase in blood pressure in hypertension significantly increases the risk of cardiovascular pathologies, including life-threatening ones. These include:

• acute violation of cerebral circulation (stroke);
• angina pectoris, myocardial infarction;
• vascular dementia (dementia);
• chronic renal and heart failure;
• atherosclerotic lesions of the vessels of the lower extremities.

Diagnosis

The main sign of hypertension is a stable increase in blood pressure, detected in at least three measurements on different days in a calm environment. When measuring blood pressure for the first time in a hospital or clinic, for the correctness of the results obtained, it is important to comply with the following rules:

• before the examination, the patient needs to sit for several minutes in a quiet room to calm down;
• the size of the tonometer cuff should correspond to the thickness of the arm, and the device itself should be attached at the level of the heart;
• two measurements are taken with an interval of 1-2 minutes on each hand, with a large difference in the numbers obtained, an additional measurement is taken;
• in elderly patients, as well as persons suffering from diabetes mellitus, or if a decrease in blood pressure is suspected in case of a change in body position, the measurement is carried out at the first and fifth minutes in a standing position;
• additionally, heart rate is measured for 30 seconds.

The doctor, in a conversation with the patient, specifies at what age the pressure first began to rise, whether there are symptoms such as snoring with pauses in breathing during sleep, attacks of muscle weakness or sudden palpitations with sweating and headache, unusual impurities in the urine. It is also important to find out what medications and supplements he is taking.

As part of the first stage of the examination for hypertension, the following tests are performed:

• clinical blood test;
• general urine analysis, detection of microalbumin in its single and daily portions;
• blood chemistry(level of cholesterol, lipoproteins to assess the risk of atherosclerosis, blood electrolytes – potassium, sodium, chlorine, calcium, as well as glucose and creatinine);
• determination of the level of glycated hemoglobin;
• determining the concentration of hormones -thyroxine, triiodothyronineandthyroid-stimulating hormone,antibodies to thyroperoxidaseandthyroglobulin,aldosterone.

If a hereditary predisposition to the disease is suspected, it is possibledetermination of gene polymorphisms associated with the development of arterial hypertension.

In order to clarify the risk factors for development and identify existing cardiovascular pathologies in hypertension, instrumental diagnostic methods are used:

• daily monitoring of blood pressure;
• electrocardiographic study;
• echocardiography;
• Holter daily monitoring;
• duplex scanning of brachiocephalic, renal or iliac-femoral arteries;
• ultrasound examination of the kidneys and adrenal glands;
• eye examination.

With hypertension, it is important to control blood pressure at home with keeping a diary, in which it is necessary to record all the results of measurements over time, taking medications and episodes of stress that can provoke a rise in blood pressure. At the same time, measurements should be taken in a sitting position, after several minutes of rest, holding the hand at the same level with the heart.

Treatment For High Blood Pressure

With a moderate and low risk of cardiovascular complications, the patient is recommended only a change in lifestyle, diet correction, weight loss, increased physical activity and special gymnastics for hypertension, giving up bad habits against the background of regular blood pressure measurement. Often these activities are enough to normalize blood pressure.

The diet for hypertension involves limiting salt, caffeine, spicy, salty, smoked, and spicy foods, high-fat foods, offal, buttercream confectionery, and alcoholic beverages. It is permissible to consume no more than 5 g of salt per day without exacerbation of the disease. The recommended daily fluid intake is 1-1.2 liters.

In case of unsuccessful non-drug treatment for several months, as well as at a high risk of complications, they resort to antihypertensive therapy with antihypertensive drugs, the purpose of which is to reduce blood pressure to less than 140/90 mm. rt. Art. For patients with diabetes mellitus or those already suffering from pathologies of the cardiovascular system, the target pressure level is even lower – 130/80 mm. rt. Art.

Modern drug treatment of hypertension includes a combination of two or more drugs from the following groups:

• calcium antagonists;
• angiotensin-converting enzyme inhibitors;
• blockers to angiotensin II;
• diuretics (diuretics);
• b-blockers;
• alpha blockers.

The vast majority of them are available in the form of tablets for hypertension.

Prevention

Prevention of exacerbations of hypertension includes timely diagnosis and treatment of diseases of the cardiovascular, nervous, urinary and endocrine systems, relentless adherence to all doctor’s recommendations, including non-drug treatment and medication, as well as regular measurement of blood pressure.