Treatment of hypertension

Arterial hypertension (AH), or hypertension, is a persistent increase in blood pressure. Normally, in an adult, it is 120/80 mmHg. If the pressure regularly rises to 140/90 mmHg and higher, a diagnosis of hypertension is made.

Hypertension is a common disease that occurs in almost a quarter of people, and in those over 65 years old — in 50%. In some patients, it causes dizziness, headache, increased pulse rate, and other symptoms, while in others it develops unnoticed.

Blood pressure is the pressure that blood exerts on the walls of blood vessels. When measuring it, 2 parameters are taken into account:

• systolic (or upper) pressure — is formed at the moment of myocardial contraction and blood flow toward the internal organs;

• diastolic (or lower) — is recorded during relaxation of the heart muscle and the reverse flow of blood through the vessels.

In hypertension, the pressure on the vascular walls increases, which first leads to thickening and decreased elasticity, and later to thinning. This can provoke angina pectoris, heart failure, heart attack, stroke, or other pathology.

Many internal and external factors influence blood pressure. It changes depending on the condition of the blood vessels, the level of certain hormones, physical activity, emotional state, etc. For example, in the morning blood pressure is usually lower than in the evening.

Most often, cardiac hypertension develops when certain vessels narrow as a result of atherosclerosis, spasm, or other pathology. In this case, the heart muscle has to push blood through the vessels with greater effort, which provokes an increase in pressure. It can also be caused by chronic diseases and lifestyle characteristics.

The likelihood of hypertension increases with:

• heredity;

• heart and vascular diseases;

• atherosclerosis;

• endocrine diseases and hormonal imbalance;

• kidney and adrenal gland diseases;

• diabetes mellitus;

• high blood cholesterol levels;

• obesity;

• long-term use of certain medications;

• physical inactivity;

• unbalanced diet;

• smoking and alcohol consumption;

• frequent stress;

• pregnancy;

• male sex;

• age over 55 years.

With hypertension, not all, but only some of these symptoms may appear.

They may also be mild or, on the contrary, cause significant discomfort.

In any case, it is necessary to monitor blood pressure levels and consult a doctor, undergo the examinations prescribed by the doctor, and determine the cause of poor health.

The listed symptoms may develop in various diseases, and hypertension itself often occurs against the background of other pathologies.

Hypertension can be:

• primary — develops as an independent disease (often called essential hypertension or hypertensive disease);

• secondary — is a symptom or complication of another disease.

Depending on the level of blood pressure, the degree of arterial hypertension is distinguished:

• Grade 1 — blood pressure remains at the level of 140/90 mmHg, and no disturbances in the functioning of the cardiovascular system are observed;

• Grade 2 — blood pressure reaches 160/100 mmHg, which is accompanied by damage to the so-called target organs (brain, heart, kidneys, and others);

• Grade 3 — blood pressure rises above 180/110 mmHg, which causes dysfunction of certain organs.

At stages 2 and 3, the severity of hypertension symptoms increases, and signs of other diseases are added.

Hypertension can be:

• primary — develops as an independent disease (often called essential hypertension or hypertensive disease);

• secondary — is a symptom or complication of another disease.

Depending on the level of blood pressure, the degree of arterial hypertension is distinguished:

• Grade 1 — blood pressure remains at the level of 140/90 mmHg, and no disturbances in the functioning of the cardiovascular system are observed;

• Grade 2 — blood pressure reaches 160/100 mmHg, which is accompanied by damage to the so-called target organs (brain, heart, kidneys, and others);

• Grade 3 — blood pressure rises above 180/110 mmHg, which causes dysfunction of certain organs.

At stages 2 and 3, the severity of hypertension symptoms increases, and signs of other diseases are added.

In arterial hypertension, the pressure of blood on the vessel walls increases significantly.

If the disease is not controlled, over time it leads to thinning of the vascular walls and a decrease in their elasticity, which entails other complications.

First of all, the heart suffers in hypertension, but the disease can also provoke damage to the vessels of the fundus with subsequent vision loss, diseases of the kidneys, the brain, and others.

Complications of hypertension may include:

• hypertensive crisis — a sharp increase in arterial and intracranial pressure, which can provoke a heart attack, stroke, or another complication (symptoms: blood pressure above 180/110 mmHg, nausea, vomiting, headache, confusion, shortness of breath, chest pain, etc.);

• angina pectoris — chest pain and shortness of breath during physical exertion;

• arrhythmia — heart rhythm disorder with a risk of cardiac arrest;

• bradycardia — a decrease in heart rate to 60 beats per minute and below;

• heart failure — impairment of heart function and, as a result, reduced blood supply to other organs;

• myocardial infarction;

• cerebral stroke;

• aneurysm — dilation of an artery with protrusion of one wall, accompanied by a high risk of rupture and internal bleeding;

• renal failure;

• hypertensive retinopathy — damage to the vessels of the retina;

• dementia and memory problems — may develop when arteries supplying blood to the brain are damaged.

Heart attack, stroke, and rupture of an aneurysm are acute conditions that pose a threat to life.

Often, before their development, the patient has no symptoms of hypertension or other pathology.

Therefore, even with mild manifestations of the disease or in the presence of risk factors, it is necessary to monitor blood pressure.

With the help of modern devices, this can easily be done at home.

Primary diagnosis of hypertension is carried out by measuring blood pressure.

It is measured at different times over several days.

If the blood pressure is elevated, the doctor prescribes additional examinations to establish an accurate diagnosis.

In hypertension, it is important to determine the cause of the disease and the risk of complications.

For this purpose, the doctor may prescribe:

• laboratory blood tests (complete blood count, biochemical analysis, lipid profile, and others);

• electrocardiogram (ECG);

• echocardiography (heart ultrasound);

• 24-hour Holter ECG monitoring;

• Doppler examination of blood vessels;

• ultrasound of internal organs and other examinations.

The doctor determines which examinations are necessary during the consultation after reviewing the patient’s symptoms and medical history.

At home, blood pressure can be measured using an automatic or semi-automatic blood pressure monitor.

To ensure the readings are as accurate as possible, several rules should be followed:

• do not smoke or drink coffee for half an hour before measuring blood pressure;

• rest for 5 minutes, sit or lie down calmly;

• it is advisable to measure blood pressure while sitting, with your feet resting on the floor and not crossed;

• it is preferable to measure blood pressure on the right arm;

• the arm should be straight and supported;

• the cuff should be placed on the arm 20 cm above the elbow;

• inflate the cuff to a level that is 30 mmHg higher than the point where the pulse disappears;

• release the pressure in the cuff at a rate not exceeding 2 mmHg per second;

• measure blood pressure 2–3 times with an interval of a few minutes;

• measure blood pressure every day at the same time.

In hypertension, combined therapy is used, which consists of pharmacological and non-pharmacological treatment.

Its goal is to normalize blood pressure and reduce the risk of complications.

For each patient, the doctor selects medications individually, taking into account the stage of hypertension, the tendency to complications, and the presence of other chronic diseases.

The doctor may prescribe antihypertensive, vasodilator, and other medications.

Therapy is carried out at home, but the patient is advised to measure blood pressure daily.

Special attention is given to non-pharmacological methods, that is, correction of habits and lifestyle that affect blood pressure.

Patients should:

• follow a special diet and reduce salt intake;

• give up alcohol;

• stop smoking;

• perform moderate physical activity several times a week;

• normalize weight if necessary;

• control stress levels and get more rest;

• undergo massage sessions, physiotherapy, etc.

In some cases, at the initial stage of hypertension in young patients, this may be sufficient to normalize the condition even without pharmacological treatment.

The risk of developing hypertension and its complications is higher in people aged 55 years and older, as well as in patients with obesity, diabetes mellitus, atherosclerosis, and other cardiovascular diseases.

Patients who belong to this group are advised to follow a healthy lifestyle and measure their blood pressure at least once every few months, even if it is within the normal range.

According to WHO recommendations, methods of hypertension prevention include:

• consuming no more than 5 g of salt per day;

• reducing the amount of saturated fats, trans fats (fatty meats, smoked products, etc.) and fast carbohydrates (bakery products, etc.) in the diet;

• eating more fresh vegetables and fruits;

• regular physical activity;

• quitting smoking and alcohol;

• maintaining a normal body weight;

• reducing stress levels.

With a healthy lifestyle, the likelihood of developing arterial hypertension and its complications decreases.

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