Hypertension
What pressure is considered normal?
Yaroslav Ashikhmin, Post-science
Arterial hypertension, or hypertension, is an increase in blood pressure in the body when there are no clear reasons for this. There is another type of hypertension when there is a specific cause – symptomatic hypertension. One of these symptoms is a change in the level of thyroid hormones. Currently, 45% of the population suffers from standard hypertension. Hypertension – pressure above 140 to 90 at a doctor's appointment and above 135 to 85 when measured at home. The average pressure in the population does not mean normal – this is the most important paradigm of cardiology. A disease is a condition in which mortality increases with increasing pressure. It is wrong to say that my working pressure is 160 over 100 and I am used to it. It's still a disease, because mortality is higher than in people with lower blood pressure.
There is no explanation for the increased pressure. Perhaps, against the background of chronic stress, there is a change in the activity of brain structures. I believe that the person who finally solves the causes of hypertension will receive the Nobel Prize. Perhaps the immune system plays an important role. Immune cells infiltrate areas of the brain, which may affect the increase in pressure. Then comes the activation of the sympathoadrenal system and the connection of the renal systems, the renin-angiotensin-aldosterone system. Salt retention also plays a role in the pathogenesis of increased pressure, so the pressure increases gradually. Today, hypertension is also found in people over the age of 25.
To begin with, let's deal with the therapy of hypertension. First of all, the criteria for making a diagnosis: an increase in pressure above 140 by 90 millimeters of mercury, which was recorded twice during consecutive measurements in two different visits. If the increase in pressure is persistent, it leads to damage to blood vessels, heart, kidneys, eyes, brain. Vascular damage in hypertension differs from damage in atherosclerosis. Atherosclerosis is a local vascular lesion when atherosclerotic plaques grow in fragments of vessels. With arterial hypertension, all the vessels of the body are affected, their function is disrupted, their stiffness increases, a thickening of the media develops – hypertrophy of the middle shell of the vessels.
Other consequences are retinal edema and a violation of the structure of retinal vessels, which can lead to blindness. As for the heart, the thickness of its walls increases, myocardial hypertrophy develops, it becomes difficult for the heart to pump blood, heart failure develops. Prolonged hypertension often leads to heart failure. Shortness of breath in patients with arterial hypertension is not associated with ischemia or atherosclerosis, but with a malfunction of the left ventricle, which pumps blood poorly from the vessels of the lungs. If we talk about the consequences for the brain, then with arterial hypertension, the risk of stroke increases. An increase in blood pressure by 5 millimeters of mercury increases the risk of stroke by 15%. There is also a lesion of the white matter of the brain, the ligaments between various nerve cells, therefore, on MRI (magnetic resonance imaging. – Ed.) vascular changes are visible. If there are such changes, then this is a serious degree of damage to the body associated with arterial hypertension. In men, erectile function may be impaired, which is tied to the function of the inner lining of the vessels – the endothelium.
Arterial hypertension also damages the kidneys and reduces their filtration function. In some cases, the kidneys simply skip the protein. Violation of the filtration function of the kidneys is expressed in an increase in the level of creatinine in the blood. The presence of protein is checked using a urine test. If the protein gets into the urine, it means that the kidneys are affected. With the progression of kidney damage on the background of arterial hypertension, the situation often reaches hemodialysis.
If we want to figure out whether to treat hypertension or not, we first need to look at the damage to the target organs: check for protein in the urine, look at the appearance of left ventricular myocardial hypertrophy, check for changes in the fundus, white matter damage on MRI. If there are such changes, then the blood pressure figures are no longer important – it is necessary to treat. For example, a young man, a pressure of 140 over 90, the appearance of protein in the urine – everything, treatment is necessary. A person will take the prescribed drug throughout his life in order to achieve pressure figures below 140 to 90. Now there is a liberalization of blood pressure thresholds. Even elderly people should reduce their blood pressure to numbers below 140 by 90. The optimal pressure is 120 or 130 per 70 or 80 millimeters of mercury. If a person calmly tolerates pressure below 140 and below 90, then further it is necessary to reduce the pressure to a level below 130 millimeters of mercury. It is very important. The arsenal of medicines to reduce blood pressure is large today.
Patients with blood pressure above 160 per 100 require the appointment of medications regardless of the damage to the target organs. If there is a lesion of target organs, then treatment of arterial hypertension of the first degree is necessary, with pressure figures of 140 or 149 and 90 or 99 millimeters of mercury. If protein appears in the urine and myocardial hypertrophy, treatment of elevated and normal blood pressure may be required – a lifelong appointment and constant medication, even when the pressure is within 135 by 85 millimeters of mercury. There is no option to take the drug by the course. When the doctor decides that you need to take medications, they are taken throughout your life.
There are non–drug measures that are being tried in patients who have mild arterial hypertension - hypertension of the first degree. To begin with, it is necessary to reduce the consumption of table salt, because it retains liquid. Fluid retention leads to an increase in the volume of circulating blood and an increase in pressure. At the beginning of the development of arterial hypertension, this measure often works. Then it is necessary to increase the level of physical activity, lose weight if there is an excess of body weight. Eat vegetables, fruits, whole grains, nuts. We also recommend that patients with hypertension stop smoking. Smoking cessation does not directly affect the pressure level, but the risk of stroke and heart attack decreases. Stress level control. I am surprised by doctors who say that it is necessary to limit stress. In the Russian Federation, it seems to me, this is impossible, but there are psychotherapeutic techniques. Today, the effectiveness of psychotherapy or the prescription of antidepressants is not fully known, but in most cases of hypertension with damage to target organs, drugs help control blood pressure.
Today, most patients require combination therapy consisting of two drugs. Starting with inhibitor drugs - angiotensin converting enzyme or sartan in combination with a diuretic or calcium channel blocker. If it is not possible to achieve the numbers 140 to 90, a triple combination is assigned, available in one tablet. It is an ACE inhibitor or sartan plus a calcium channel blocker, plus a diuretic. Here it is important to look at the fact that a diuretic drug is present in the scheme. The standard error occurs when five different medications are prescribed, and the pressure does not decrease because a diuretic is not prescribed. If the combination with a diuretic no longer works, then stronger medications are prescribed. In these cases, before prescribing, it is necessary to repeat the search for rare causes that can lead to an increase in blood pressure. If a triple or double combination does not work in high doses, you need to look at the presence of a special type of adrenal dysfunction, narrowing of the renal arteries, unusual causes that lead to an increase in blood pressure.
The main goal of therapy is to reduce the risk of stroke and heart attack. Therapy should prevent white matter damage, memory impairment. Experience shows that drug therapy aimed at lowering blood pressure in patients with hypertension actually leads to a reduction in the risk of cardiovascular disasters and to an increase in life expectancy, so I urge patients not to be afraid to take medications. Today's drugs are well tolerated and have a minimum of side effects. In most cases, taking into account the arsenal of medicines that exist, it is difficult to imagine a situation when a person has not been selected for a drug therapy scheme. If it is not possible to cope in the polyclinic, then go to the regional center, where experienced cardiologists will select therapy in difficult cases.
About the author:
Yaroslav Ashikhmin is a Candidate of Medical Sciences, cardiologist, Advisor to the Director General of the International Medical Cluster Foundation.
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