Arterial hypertension (AH) is a disease whose main manifestation is a persistent increase in blood pressure (BP). It occurs in people of all races and peoples, more often in climatic zones with sharp temperature drops, on continents with severe winters. More than 30% of the adult population of the planet suffers from this disease, after 65 years it occurs in 60% of people. Normal pressure figures are 90-140 for 60-90 mm RT. Art.
Young men have a clear predominance of hypertension in comparison with women. In the age group after 50 years, the ratio changes to the opposite. This feature is noted by domestic statistics. The importance of the problem of the presence of hypertension is determined by the damage that it causes to society. Approximately 58% of hypertensive patients have a stroke, 38% have myocardial infarction.
Causes of Hypertension
There is no consensus on the cause of arterial hypertension. The most authoritative is considered a genetic predisposition to hypertension. In people suffering from arterial hypertension, about 20 varieties of genes responsible for the development of the disease were found. Their appearance, manifestation of activity is associated with conditions called risk factors for hypertension . Their number reaches several tens.
The main risk factors for arterial hypertension:
- chronic stress is considered the most important factor. Its relationship with increased activity of AH genes has been established;
- age – the frequency of hypertension increases with age;
- gender – more common in men;
- heredity – the mother usually “gives” AH to sons, the daughters of AH may not appear;
- excess body weight increases the risk of hypertension by 5-6 times;
- nutritional defects – the habit of abuse of salt disposes to the development of hypertension (see “How much salt does a man need”);
- low physical activity. Its effect is associated with a simultaneous change in body weight, an increase in the rate of development of atherosclerosis;
- smoking can be a leading factor in nicotine-sensitive people;
- the use of alcohol and other drugs is a factor in the activation of AH genes.
Hypertension due to risk factors is also called primary.
In a smaller group of patients with hypertension (about 4% of all hypertension), the cause is associated with other diseases of the vessels and heart, endocrine, nervous, and urinary systems. Hypertension in these cases is called secondary. These diseases cause similar changes in vessels with the same organ lesions.
A distinctive feature is the high frequency of such diseases in young men, which is associated with an interest in their health as military personnel. Other features of their course are high blood pressure, frequent complications, for which they are called “malignant” hypertension.
Signs of Hypertension
Only when complications arise during the course of the illness do typical complaints appear related to the malfunction of the target organs. Most often, the brain is affected. Complaints of headaches, dizziness, changes in the perception of color, taste, nausea (or vomiting that does not bring relief), weakness of individual muscle groups appear with the so-called TIA (transient ischemic attacks).
The onset of symptoms of coronary heart disease in the form of angina pectoris, myocardial infarction, heart failure are recorded with heart damage. These are pains in the heart area, shortness of breath associated with physical exertion. Much less often is a variety of rhythm disturbances, conduction in the form of heart attacks, dizziness, fainting.
The kidneys suffer no less, but later. They have the ability to compensate for violations in the vascular bed by their mechanisms for regulating blood pressure. With the depletion of these mechanisms, persistently high arterial hypertension develops with manifestations of chronic renal failure.
Manifestations of hypertension in men differ with age, with the presence of complications. Young patients who escaped the examination of military commissions for various reasons, often do not feel any increase in blood pressure.
What is the danger of hypertension?
The essence of changes in the body with hypertension is the proliferation of the muscle layer of the vessels, the subsequent densification of their walls due to the development of connective tissue. Tissue exchange conditions worsen with an increase in the blood flow rate of narrowed vessels. The work of organs, for which full blood supply is especially important, suffers.
These organs include the brain, heart, kidneys, they are also called “target organs” in hypertension. The prolonged existence of an increase in blood pressure leads to complications that develop in target organs. Complications can develop gradually. The deterioration of blood circulation in these organs leads to partial atrophy of tissues that lack oxygen.
At the site of atrophy, connective tissue develops (the body fills it with all the defects). So cardiosclerosis is formed with a weakness of the contractility of the heart, its chronic insufficiency of work. The same processes occur in brain tissue, kidneys. Suddenly developed complications of hypertension due to damage to the integrity of blood vessels are manifested by stroke (stroke), AMI (acute myocardial infarction).
Arterial hypertension is classified according to the level of blood pressure, the presence of lesions of target organs. Domestic classification is somewhat different from international. This is a tribute to the work in the field of hypertension of the famous domestic cardiologist G.F. Lang. There are three degrees of hypertension in terms of blood pressure. Stages of the course are distinguished by the presence of damage to target organs, associated diseases (those in which hypertension necessarily appears – concomitant diseases of the heart, brain, kidneys, large vessels).
Table 1 – Degrees and stages of arterial hypertension.
|Power||Blood pressure (mmHg) systolic / diastolic||Stage||The presence of organ damage|
|one||≥140-160 / ≥ 90||one||No|
|2||≥160-180 / ≥ 100||2||there is|
|3||≥180 / ≥ 110||3||There are + associated diseases, complications of hypertension|
Separate isolated systolic hypertension (with the same degrees, stages) was isolated.
One of the most serious complications of the disease is a hypertensive crisis. This relatively rapid increase in blood pressure to the maximum tolerated by the body of numbers (220 or more), manifests itself in completely different ways. The difference in the manifestations of the crisis is related to the rate of rise in blood pressure, the presence of simultaneous damage to target organs (stroke, hypertensive encephalopathy, myocardial infarction, angina pectoris), and other pathology (aortic rupture, acute renal or heart failure, pheochromocytoma).
Young men. A feature of crises in young men is its rapid onset, a relatively short duration. Manifestations of it arise at the time of a traumatic situation or with severe physical exertion. This is redness of the face, palpitations, a sharp headache, agitation, a feeling of heat.
High blood pressure does not decrease when resting for more than 15 minutes. Other complaints that have appeared (pain in the heart, lack of independent movements in some arm, leg, shortness of breath) are the reason for emergency medical care.
Older men. In older men, crises of a different type are more often observed. Over the course of several days, blood pressure rises gradually to high numbers, despite treatment. Well-being suffers in the form of insomnia, constant headache, pallor, weakness, a feeling of overwhelming.
Such conditions can suddenly be complicated by a stroke, acute myocardial infarction, aortic rupture, and rapid death. An urgent correction of the treatment of such patients with the help of a doctor is needed (in hospital or at home). It is difficult for older men to persuade to see a doctor if their health worsens; they wait until “it will become very bad” and they call doctors.
It is important to diagnose arterial hypertension when there are no complaints yet. The start of treatment in this case gives a proven effect of prolonging the life of a patient with hypertension if it is possible to maintain a normal level of blood pressure. To this end, regular medical examinations are conducted, to which men are prejudiced. There is a group of techniques that establishes the fact of the presence, stability of increasing blood pressure.
Diagnosis of hypertension
To establish a diagnosis of hypertension, it is not enough to detect high blood pressure once. Even high blood pressure values measured during periods of stress, immediately after severe physical exertion, do not mean that it is arterial hypertension. There are standard rules for measuring blood pressure to diagnose the disease.
The measurement should take place at rest, after resting for at least 15 minutes in a sitting position, done three times, on both hands with an interval of 1-2 minutes. The result is taken into account on the hand where the blood pressure is greater, but the smallest numbers. For the objectivity of measurements, devices are used with an indication of the results on the display, even better if there is a function for storing them.
If hypertension is suspected, it is recommended that measurements be taken 1-2 times a day for 2 weeks regularly with the results recorded. A subsequent visit to the doctor will make it possible to assess the level of blood pressure, the need for treatment, his choice. This is a method of self-monitoring of blood pressure. The patient should be trained in the rules of blood pressure measurement, the doctor must make sure that the procedure is carried out correctly.
A method for the diagnosis of hypertension is blood pressure monitoring (BPM). This is a multiple measurement of blood pressure during the day (at least 50 times) with recording the results on a digital medium. The analysis of the results is carried out using computer programs with the output of the results in the form of curves, trends, tables. Deciphering the study allows you to establish or reject the diagnosis, determine the degree of hypertension, and adjust the dose of drugs.
In young patients (especially draftees), the reaction of blood pressure to physical activity is studied using a VEM or a treadmill test. This helps to distinguish hypertension from the emotional hypertensive response obtained by the doctor’s measurement of blood pressure.
Setting the stage of hypertension
Other diagnostic methods for hypertension specify the degree of damage to target organs to establish the stage of the disease. This echocardiography, dopplerography of the carotid arteries, the study of the vessels of the ocular fundus, the state of the kidneys.
- On echocardiography you can detect a thickening of the walls of the left ventricle, typical for stages 2-3 of hypertension. Diagnostic findings are possible in the form of HCM (hypertrophic cardiomyopathies), aortic heart defects, stenosis of large vessels, as causes of hypertension.
- Dopplerography of the carotid arteries is a type of ultrasound with a special sensor, the thickness of the muscle layer of the carotid arteries is studied (they are convenient for research). Deviations from the norm is an indicator of the development of hypertension (as a form of hypertrophy of the muscles of the vessels).
- The vessels of the fundus are examined by an ophthalmologist, revealing the degree of narrowing of the lumen of the arteries (the oculist does not see hypertrophy of the muscle layer, it is implied). Similar changes in the vessels of the fundus can be with other diseases. More serious changes in the fundus (hemorrhage, swelling of the optic nerve nipple) are found in the late stages of hypertension.
- The study of the state of the kidneys is carried out using a study of urine tests using various methods (general analysis, according to Nechiporenko, according to Zimnitsky, other functional tests), blood tests for urea, potassium, creatinine. If there is suspicion of another pathology that may be the cause of hypertension, additional studies are chosen.
How to treat hypertension?
The principles of treatment of hypertension are divided into non-drug and drug. The first group includes measures to normalize the regime of work and rest, and the elimination of psycho-traumatic circumstances (if possible, of course). These measures are applicable at all stages of the course of the disease.
The most complete elimination of risk factors for hypertension is necessary:
- bad habits;
- excess weight;
- irrational nutrition with a large consumption of salt, liquid (see the list of foods useful for the cardiovascular system).
Men can hardly change their established life habits, which with confidence allows us to recommend their formation in childhood.
Do I need medication?
The principles of drug therapy include normalization of blood pressure, maintaining its normal level indefinitely. If treatment is started early in the illness, complications can be prevented. Medications are used in combinations of several drugs in small doses, which reduce the side effects of taking medications. Treatment takes place under the supervision of a physician.
Men who read the instructions for the use of medicines, pay attention to the fact that almost all of them can cause impotence. This fact often leads to refusal of treatment, especially by young men.
Consider all the pros and cons of hypertension treatment:
- Without treatment, a violation of potency will occur even earlier. This will be organic (irreversible) impotence due to narrowing of the lumen of the penial artery (as a manifestation of hypertrophy of the muscle layer of one of the vessels).
- Without treatment for hypertension, rapidly occurring complications will significantly limit sexual activity. The same restrictions will appear due to the need to take nitrates (only they can relieve coronary pain). The use of nitrates is contraindicated when using potency stimulants. Without stimulants, sexual function in hypertensive patients is rapidly declining, starting at the age of 30 years.
- Life itself without treatment of hypertension will be much shorter than declared by the genes (approximately 30%). Treatment increases life expectancy, postpones or prevents the onset of complications (including the organic nature of impotence). Treatment improves mental abilities, changing the state of blood supply to the brain, improves the quality of life, physical activity.
There are still many reasons, each man decides for himself how fully he wants to live his life. Prevention of hypertension, like all diseases of the cardiovascular system, is one: an active lifestyle without bad habits, with a good mood, a regime of work, rest, taking care of yourself and loved ones.
Arterial hypertension is a serious problem for the male body. You can deal with it at any age, if you do not rely only on your own strengths. The best assistant in this matter is the doctor.