Arterial hypertension: dangerous consequences and risk of complications. Hypertension, effects on the nervous system

Unfortunately, in the vast majority of cases (90%) to identify exact reason high blood pressure fails, in this case we are talking about primary or essential hypertension. Currently, the main causes of this form of hypertension are violations in the work of the central nervous system. There are many reasons for these disorders: neuropsychic overstrain, stress, obesity, sedentary image life.
The remaining 10% of cases of hypertension can be caused by other diseases - in this case we are talking about secondary hypertension. Most often, secondary hypertension is caused by kidney diseases (renal failure, renovascular hypertension), tumors of the adrenal glands, the use of certain medications, and late toxicosis of pregnancy.

kidney disease

They account for 4% of all cases of hypertension. Pathologies such as chronic pyelonephritis, glomerulonephritis, polycystic kidney disease can lead to kidney failure. As a result of kidney failure, the amount of urine produced can decrease, which leads to an increase in the volume of circulating blood. In some cases, the cause of renal hypertension is a congenital or acquired defect. renal artery, which consists in the fact that its lumen is narrowed. As a result of this pathology, the kidney feels insufficient blood flow, releasing the enzyme renin into the blood. Renin acts on the hormone angiotensin by activating it, this mechanism leads to the fact that angiotensin binds to vascular receptors, causing an increase in the tone of arterioles. As a result, arterioles constrict, capacitance vascular bed narrows, and the volume of circulating blood remains stable. According to the laws of hydrodynamics, a decrease in the capacity of a closed vessel with a stable volume of its fluid leads to an increase in intravascular pressure.

Pathology of the adrenal glands and hypertension

In some cases, the cause of hypertension is a violation of the synthesis of special hormones (mineralocorticoids) by the adrenal cortex. These hormones affect the functioning of the filtering part of the kidney. With an increase in aldosterone, the kidney tries to retain salts, which leads to an increase in the volume of circulating blood. Aldosterone also constricts arterioles. These two mechanisms lead to an increase in blood pressure.

Pheochromocytoma
This benign tumor of the adrenal medulla leads to a sharp increase in the level of adrenaline in the blood. This pathology leads to a narrowing of the arterioles and an increase in blood pressure.

Late toxicosis during pregnancy as a cause of hypertension

At present, it has not been possible to determine the exact mechanism for the occurrence of late toxicosis of pregnancy. It is believed that the cause is immunological or hormonal changes in the mother's body during pregnancy. This pathology leads to disruption of the kidneys and an increase in blood pressure.

Complication of hypertension, heart attacks, stroke, visual impairment.

Unfortunately, long-term arterial pressure leads to the fact that the walls of blood vessels suffer - they thicken, the muscle tissue of the vessel thickens and may lose the ability to relax. As a result of prolonged spasm of blood vessels, the supply of blood with oxygen and oxygen dissolved in it to the tissues and organs is disrupted. nutrients. As a result, a decrease functional activity organs, increasing the risk of heart attack.

myocardial infarction

A common complication of hypertension. With a sharp decrease in the blood supply to the heart muscle, the ischemic area cannot for a long time maintain its efficiency and viability. Hypertonic disease contributes to myocardial infarction due to the fact that changes in the walls of blood vessels lead to the fact that the vessel becomes fragile, and another increase in blood pressure leads to the fact that in a certain area the vessel bursts and hemorrhage occurs in the tissue of the organ. Also, hypertension contributes to the development of atherosclerosis, leading to narrowing of an already stenotic vessel.

Stroke

This violation of the blood supply to a certain part of the central nervous system leads to the development of a stroke. At the same time, areas in which the blood supply has sharply decreased or stopped altogether lose their viability. Stroke is accompanied by functional disorders in the work of the central nervous system as: loss of consciousness, disruption of the internal organs, changes in consciousness, paralysis and paresis. This condition requires immediate medical attention, as it poses a threat to the health and life of the patient.

Loss of vision in hypertension.

It also occurs as a result of impaired blood supply to the retina and optic nerve. Pathologies such as hemorrhage into the retina or into vitreous body, ischemic opticopathy. An attack of hypertension can cause spasm of the supplying artery optic nerve or lead to a violation of the integrity of the retinal vessel. In this case, a retinal hemorrhage will lead to the formation of a black spot in the field of view, in the projection of the hemorrhage, and the outpouring of blood into the vitreous body can even lead to complete loss of vision in the affected eye.

Treatment of hypertension the use of diuretics, angiotensin converting factor (ACE) blockers,angiotensin receptor antagonists, calcium channel blockers, beta blockers.

Currently pharmaceutical industry manufactures many antihypertensive drugs various groups and different mechanism of action. Thanks to this, it was possible to significantly reduce the incidence of complications of hypertension. However, the disease itself cannot be cured with medication. To do this, it is necessary to completely change the daily routine, reduce the psycho-emotional load, rational image life, and practice daily sports. All these recommendations, as a rule, are completely rejected by the patient and are not observed in most cases - hence the disappointing statistics on the incidence and number of complications.

However, let us turn our attention to the groups of drugs that lower blood pressure. But before describing the preparations, we should think for ourselves how to reduce the pressure in a closed hydrodynamic system?

To do this, you can reduce the volume of fluid (blood) circulating in the system, or increase the volume of the system's capacity (circulatory), or reduce the activity of the pumping function of the heart. We can reduce the volume of circulating blood with the help of salt-free diet, with the help of special diuretic drugs. It is possible to increase the capacity of the vascular bed with the help of drugs that act on vascular receptors and lead to relaxation of the muscle tissue of the vessels, increasing the volume of the intravascular space.

Treatment of hypertension with diuretic drugs.

As already mentioned above, a decrease in blood pressure can be achieved by reducing the volume of circulating blood, and diuretics are used for this purpose. The most commonly used diuretics at present are: Ezidrix (hydrochlorothiazide), Lasix (furosemide), Bumex (bumetanide), Demadex (torasemide), Zaroxoline (metolazone), Aldactone (spironolactone).

In order for treatment with diuretics to be safe for the patient, the following rules must be followed:

Strictly follow the regimen for the use of the drug, which was prescribed by the attending physician. If during the treatment dietary recommendations were given or drugs were prescribed that regulate the electrolyte balance, then compliance with these prescriptions is mandatory.
Before prescribing diuretics, it is recommended to determine the level of electrolytes in the blood and regularly conduct this analysis with each visit to the attending physician.
If you notice at least one of the following side effects of diuretins, immediately seek personal advice from your doctor.
Do not use additional medical preparations against the background of treatment with diuretics, without informing the attending physician about it.
Regularly it is necessary to diagnose the condition of the kidneys (general and biochemical analysis urine and blood).

Possible side effects of diuretics

Violation of the heart rhythm is a formidable complication that requires urgent medical attention. As a rule, it is associated with a change in the electrolyte balance and can lead to cardiac arrest.
Frequent urination - The natural effect of a diuretic will be to produce more urine, which will cause the bladder to fill faster. However, it should be noted that painful and frequent urination, urination in small portions is a sign of inflammation of the urinary tract, which requires a personal consultation with a specialist doctor.
Electrolyte imbalance is laboratory symptom determined during the blood ionogram. If it is detected, it is necessary to seek personal advice from the attending physician to change the treatment regimen.
Fatigue, asthenia ( muscle weakness) and intermittent cramps of the arms and legs - in the event that these symptoms increase, it is necessary to seek personal advice from your doctor.
Dizziness - can be caused by an excessive decrease in blood pressure, electrolyte imbalance, as well as as a result of dehydration. In this case, a personal consultation with your doctor is required.
Dehydration of the body is accompanied by a feeling of excruciating thirst, a decrease in daily urine output, dizziness, and in some cases even loss of consciousness. In this case, it is necessary to stop taking diuretic drugs and seek repeated advice from your doctor.

Can pregnant women take diuretics?
During pregnancy, the use of diuretics is possible only as directed by a gynecologist. Self-administration of the drug without the knowledge of your gynecologist is prohibited.

Can I take diuretics while breastfeeding?
Most diuretics pass into mother's milk, so taking these drugs during lactation will adversely affect the child's condition. The possibility of using diuretics can only be determined by your pediatrician.

Can children take diuretics?
Long-term use diuretic preparations requires careful monitoring of the ionic composition of the child's blood. Therefore, it is necessary to regularly conduct a blood test for electrolytes (ionogram).

Treatment with drugs that affect vascular tone
All drugs used in the treatment of hypertension with vascular mechanism actions can be conditionally divided into angiotensin converting factor (ACE) blockers and angiotensin receptor antagonists - the mechanism of action for these drugs is similar. Another large group of drugs are beta-blockers. Calcium channel blockers have a fundamentally different mechanism for relaxing the muscle tissue of blood vessels.

Angiotensin converting factor (ACE) blockers

These drugs block the process of activating angiotensin, a hormone that, when exposed to specific receptors on the surface of the vessel, leads to spam of muscle tissue, narrowing the arterioles. A decrease in the level of angiotensin in the blood leads to a decrease in the tone of the muscle tissue of the vessels and an increase in the volume of the vascular bed.
The most commonly used drugs from the ACE group:

Kapoten (captopril)
Vasotek (enalapril)
Prinivil, Zestril (lisinopril)
Lotensin (benazepril)

Side effects of drugs from the ACE group:

Cough is the most common side effect. The thing is that drugs in this group often have irritant effect on the mechanoreceptors of the respiratory tract, causing spontaneous coughing. In the event that the cough becomes unbearable and cough suppressants do not positive effect, it is necessary to seek a second consultation with your doctor to change the treatment regimen.
Skin rash, itching - with the development of these symptoms, it is also necessary to consult a doctor to change the treatment regimen.
dizziness and general weakness may be caused by an excessive decrease in blood pressure. With these symptoms, blood pressure should be measured regularly. Pi revealing reduced pressure repeated consultation of the attending physician is necessary in order to change the dosage of the drug.
A feeling of a metallic taste, a decrease in taste sensitivity - as a rule, this side effect occurs at the very beginning of treatment and disappears on its own over time.

Angiotensin receptor antagonists

This group drugs has a similar effect in ACE drugs action - blocking the action of angiotensin, although this drug occurs at the level of a specific receptor in the muscle cells of the vessel. By blocking the angiotensin receptor, this drug prevents the hormone from attaching to the receptor and reduces its vasoconstrictive effect, leading to an increase in the volume of the vascular bed.

The most commonly used drugs:

Cozaar (losartan)
Diovan (valsartan)
Aprovel (irbesartan)

Beta blockers

To a greater extent affect the activity of the heart. By reducing the frequency and strength of heart contractions, drugs of this pharmacological group reduce the minute volume of blood pumped by the heart. Correspondingly, the pressure in vasculature. The drugs of this group were found wide application with a combination of hypertension and angina pectoris, with a combination of cardiac arrhythmias and high blood pressure.

The most commonly used drugs from the group of Beta blockers:

Tenormin (atenolol)
Kerlon (betaxolol)
Zebeta (bisoprolol)
Coreg (carvedilol)

The drugs in this group have a number of fairly pronounced side effects:

Dizziness
decreased libido and sexual activity
Sleep disturbance
Chronic fatigue and decreased performance
Feeling of cold hands and feet, chilliness
Slow heart rate
Swelling in the knees, feet
Pulmonary edema with the development of acute heart failure
Labored breathing
In some cases depression

How to take drugs from the group of beta blockers?

The drug should be taken with meals or immediately after meals, strictly certain time days.
The frequency of taking the drug and its dosage is determined by the attending physician individually, depending on your general condition, the dynamics of the disease and the effectiveness of treatment with beta blockers in the past.
During the period of use of the drug, it is necessary to determine the heart rate daily, a sharp decrease in this indicator requires a second visit to the attending physician to change the treatment regimen.
The use of any hormonal or cardiac drugs against the background of treatment with drugs from the group of beta-blockers is possible only after a personal consultation with a cardiologist.

Calcium channel blockers

The drugs of this group, acting on the channels through which calcium is exchanged between the cell and external environment leads to relaxation of blood vessels. As a result of relaxation of the muscle tissue of the vessels, the volume of the vascular bed increases, which leads to a decrease in blood pressure.

Representatives of calcium channel blockers:

Norvasc (amplodipine)
Plendil (felodipine)
Cardin (nicardipine)
Adalat (nifedipine)
Cardizem, Dilacor, Tiazac, (diltiazem)
Isoptin, Kalan, Verelan, (verapamil)

What are the possible side effects when taking group drugs?

Dizziness is associated with sharp decline blood pressure and redistribution of blood flow.
Low blood pressure - with an inadequately selected treatment regimen and dosage of the drug, this symptom may develop.
Heart rhythm problems - can occur in some cases among patients who have a tendency to slow heart rate, blockade of the adductor tract.
Dry mouth
Swelling in the knees, feet, legs.
Headache
Asthenia - decreased performance, drowsiness. These symptoms usually accompany First stage use of drugs, in the future they disappear on their own.
Skin rashes
Constipation or diarrhea - affecting the smooth muscle tissue drug that acts along with muscle cells vessels, on the smooth muscles of the intestine, changing the activity of peristalsis.

How to take drugs from the group of calcium channel blockers?

The use of these drugs is possible only as prescribed by a general practitioner or cardiologist.
Carefully read the dosages and dosage regimen prescribed by your doctor. Do not hesitate to ask him clarifying questions about the mode of use of the drugs, the possibility of cancellation and specify the period during which a second consultation is necessary to evaluate the results of the treatment.
Measure blood pressure and pulse daily, note the results - the dynamics of changes in these indicators will help the attending physician evaluate the effectiveness of the treatment. And you to identify possible unwanted effects of the drug.
It is advisable to use this drug at the same time, according to the doctor's instructions. Take the drug during meals or with milk.

Can I drink alcohol while taking calcium channel blockers?
Definitely not! Not in any form. The fact is that alcohol changes the activity of the drug used and can cause a number of adverse reactions: a sharp decrease or increase in blood pressure, indigestion, nausea, vomiting, etc.

Man is a being of high physical organization. All its organs and systems are in close relationship and interaction with each other. A break in one link in the chain of connections will certainly lead to malfunctions in the functioning of the whole organism as a whole.

Nature and evolution provide for some mechanism of duplication. So, for example, when a blockage of a blood vessel cholesterol plaque, the blood flow does not stop, but finds detours of the affected vessel.

Unfortunately, hypertension does not make such "indulgences" for the body. An increase in blood pressure by permanent basis inevitably leads to disruption of the functioning of many organs and the body as a whole.

All information on the site is for informational purposes and is NOT a guide to action!
Give you an ACCURATE DIAGNOSIS only DOCTOR!
We kindly ask you DO NOT self-medicate, but book an appointment with a specialist!
Health to you and your loved ones!

Medical statistics state that the consequences of hypertension for a person are much more dangerous than the likelihood of the consequences of many other formidable diseases, such as oncology, tuberculosis or immunodeficiency.

The fact is that the onset of hypertension is almost asymptomatic. Diagnosed with hypertension late stages, with the destruction mechanisms already running.

Warning Signs

There are a number of signs by which one can suspect the onset of hypertension. You need to be careful about your health.

It is worth immediately suspecting something was wrong if there is rapid fatigue, unreasonable headaches, dizziness. The next stage may be weakness in the limbs, shortness of breath even with minor physical exertion, memory loss.

What to do when it appears? The main thing is to start monitoring the level of blood pressure. You need to measure it 2-3 times a day for a week. Based on the measurement results, it is already possible to identify the dynamics of the behavior of blood pressure. With these statistics, you need to consult a doctor for advice and, if necessary, he will prescribe treatment.

It is very important to know that incipient hypertension can sometimes be “slowed down” by the following measures:

change (refusal of salty and fatty foods);
renunciation of bad habits(smoking and alcohol abuse);
increased physical activity (at least up to 30 minutes a day);
getting rid of extra pounds;
maintaining a measured lifestyle, without stress and nervous strain.

Nervous system

Hypertension is a disease associated with an increase in blood pressure. Why is hypertension dangerous? If the disease becomes chronic, then the risk of damage to the vessels of the brain increases sharply.

This is due to the fact that with a sharp increase in pressure, the speed of blood flow increases, passing through the unit of the blood vessel per unit of time. It is obvious that the increased flow increases the pressure on the walls of the vessel and, thereby, expands it.

If the impact is short and irregular, then the walls have time to recover. But if the process is chronic, as in the case of hypertension, then the vessels become less protected from an increase in blood pressure inside them.

The initial stage of hypertension is characterized by frequent headaches, dizziness, nausea. Subsequently, in the absence of treatment aimed at stabilizing pressure, an intravascular catastrophe may occur -. This is a blockage of blood vessels by a thrombus or "breakage" of the vessel, causing hemorrhage.

What is dangerous hypertension for internal organs

Medical research over several decades has shown that hypertension has a destructive effect on the entire body as a whole and some of its organs in particular. Why is hypertension dangerous? The defeat of the so-called "target organs". Without proper treatment, the process of damage can become irreversible.

The most common consequences of hypertension:

hypertrophy (excessive increase) of the cardiac ventricles;
rupture of the vessels of the fundus;
kidney damage;
dysfunction of the reproductive system;
diabetes;
pancreatitis;
cerebrovascular pathology.

vision problems

In the process of a sharp increase in blood pressure large vessels expand to allow for "pumping" the increased volume of blood. Small vessels, on the contrary, remain “out of work” and therefore become sclerosed over time.

The human eye is literally "entwined" with a network of tiny capillary vessels. With a lack of nutrition, they shrink, the walls become thinner, the capillaries are destroyed. As a result, the pathological process leads to changes in the optic nerve. These changes are irreversible, they can lead to complete loss of vision.

More than 70% of patients with hypertension have eye diseases.

Depending on the type of damage to the fundus, several pathologies are distinguished:

Impotence

The functional structure of the penis in men is such that its saturation with blood occurs unevenly over time.

The physiology of sexual intercourse is based on filling the cavernous bodies of the penis with blood (erection) and its subsequent outflow. Thus, the volume of filling of the veins that feed the genitals is not constant.

With increased pressure, the walls of blood vessels become inelastic and the movement of blood becomes more difficult. And with sexual arousal, the vessels are no longer able to provide proper filling of the penis with blood, i.e., there are problems with erection.

ischemic heart disease

- a serious disease leading to irreversible changes in the heart muscle, up to the death of some of its sections (). Arterial hypertension plays a huge role in the occurrence of ischemia (lack of oxygen in tissues and organs).

With hypertension, the walls of blood vessels are overstressed under the influence of increased blood pressure and become less durable. This can lead (if certain prerequisites are present) to the appearance of atherosclerotic plaques on them.

The capacity of the vessels decreases. In addition, the narrowed lumen can become clogged with blood clots. In those parts of the vessels where the walls are the least strong, aneurysms (protrusions) are likely to occur. And this can lead to internal bleeding and death.

Acute renal failure

There is a direct relationship between arterial hypertension and impaired renal function. And this relationship is circular. The kidneys are both possible cause occurrence of hypertension, and its target.

Primary hypertension is often the result of kidney failure. The problem is the insufficient excretion of water and sodium salts from the body by the kidneys.

Due to the resulting hypertension, the lumen of the blood vessels that deliver blood to the kidneys narrows. The deterioration of the blood supply leads to the death of the working cells of the kidneys (nephrons), which provokes even more serious violation removal of salts and water (due to the reduction of the total filtering surface).

The pathological process leads to an increase in the volume of circulating blood and, accordingly, pressure.

To prove this theory, back in 1975, studies were carried out on rats. So, the experimental animal, not suffering from high blood pressure, transplanted the kidney of a rat with hypertension. As a result, in an initially healthy rodent, the pressure became elevated.

The negative impact of arterial hypertension on the functioning of internal organs cannot be overestimated. The earlier the treatment of hypertension is started, the less destructive effect it can have on the internal organs of the human body.

Hypertension, or high blood pressure, is when your blood is forced to move through your blood vessels with more force than normal.

When blood pressure is high, it can damage the walls of arteries and blood vessels. It leads to dangerous complications and even death if left untreated.

Blood pressure indicators are systolic and diastolic pressure. Systolic refers to the pressure when the heart is beating and diastolic refers to the pressure between beats. For the average adult, blood pressure is considered normal if it is at least 120/80 mmHg. High blood pressure has no symptoms until you start experiencing complications. It is important to regularly check and know your operating pressure in the present period of time.

Consider the effect of pressure on various systems organism.

The cardiovascular system

The damage caused by high blood pressure starts small and builds up over time. The longer it goes undiagnosed or out of control, the more serious the consequences will be for you. Your blood vessels and major arteries carry blood throughout your body and supply it to vital important organs and fabrics. When the pressure at which the blood moves increases, it begins to damage the walls of the artery. Damage starts as small bursts. As these artery walls begin to break down, bad cholesterol, flowing through the blood, begins to attach to the gaps. More and more cholesterol accumulates on the walls, making the artery narrow. As a result, less blood flows through this area. When the proper amount of blood cannot move through a blocked artery, it causes damage to the tissue or organ it needs to reach. This may present as chest pain, an irregular heartbeat, or a heart attack. The heart has to work harder but less efficiently with high blood pressure and blocked arteries. In the end, extra work can lead to enlargement of the left ventricle, which is part of the heart and which pumps blood into the body. It also increases the risk heart attack. Heart failure is when your heart becomes so weak and damaged from high blood pressure, hard work, or a previous heart attack that it stops pumping blood efficiently through your body. Signs of heart failure include:

erratic breathing;
labored breathing;
swelling in the legs, ankles, or abdomen;
feeling tired.

High blood pressure can also cause a bulge to form in an injured artery. This is known as an aneurysm. The bulge gets bigger and bigger and often isn't discovered until it hurts by pressing on another area of the body or ruptures. A ruptured aneurysm can be fatal if it is in one of your main arteries. This can happen anywhere in the body.

Nervous system

High blood pressure may play a role in the development of dementia and cognitive impairment over time. Reduced blood flow to the brain causes memory and thinking problems. You may have trouble remembering or understanding things, or losing the content of a conversation during conversations. The same damage that high blood pressure causes in the blood vessels and arteries of the heart can happen to the arteries in the brain. When there is a large blockage of blood flow to the brain, it is called a stroke. If parts of the brain cannot get the oxygen they get from the blood, the cells begin to die. Your survival rate and chance of permanent brain damage depends on how severe the stroke is and how quickly you receive treatment. The blood vessels in the eyes can also be damaged. If they burst or bleed, it can cause vision problems such as blurring or blindness. The accumulation of fluid under the retina is called choroidopathy.

Skeleton system

High blood pressure can cause bone loss, known as osteoporosis, by increasing the excretion of calcium, which your body gets rid of when you urinate. Women who have already gone through menopause are especially at risk. Osteoporosis weakens your bones and increases your risk of fractures.

Respiratory system

The arteries in the lungs can be damaged by high pressure and blocked. When an artery that carries blood to your lungs becomes blocked, it's called a pulmonary embolism. This is very serious and requires immediate medical attention. Aneurysms can also occur in the lungs. Sleep apnea is a sleep disorder that causes loud snoring and cessation of breathing during a night's sleep. People with sleep apnea often don't feel rested when they wake up in the morning. The study links the condition to high blood pressure, as many people diagnosed with sleep apnea also have high blood pressure.

reproductive system

Your sexual organs use the extra blood flow during arousal. When high blood pressure causes a blockage in the blood vessels leading to the penis or vagina, sexual dysfunction can occur. Men may have difficulty getting and maintaining an erection, and women may experience:

decreased arousal;
dryness of the vagina;
orgasm problem.

urinary system

Your kidneys help remove waste from your blood, regulate blood volume and pressure, and filter waste as you pass it through your urine. To do this well, they need healthy blood vessels. High blood pressure can damage the large blood vessels leading to your kidneys and the smaller vessels in your kidneys. Over time, this damage prevents the kidneys from working properly. This is called kidney disease and can lead to kidney failure. High blood pressure is one of the main causes of kidney failure. People with kidney failure no longer able to remove waste from their body through urine and need dialysis or a transplant.

Outcome

Hypertension causes damage slowly over a long period of time without noticeable symptoms. That's why it's important to practice healthy habits, such as regular physical exercise and eating foods with low content sugar, salt and bad fats. You should also check your blood pressure and find out your numbers. Blood pressure can be controlled, and being aware of your high blood pressure can help you and your doctor manage it better.

The heart consists of four chambers and is divided into right and left parts. Each part in turn consists of an atrium and a ventricle. The atria play the role of a reservoir for venous blood and have a low contractile (pumping) function to ensure the filling of the ventricles. The ventricles provide the movement of blood throughout the vascular bed, so normally their contractility is high. The blood supply of the heart itself is carried out from the right and left coronary arteries, which, located on the surface of the heart, give branches that reach the innermost layer of the heart muscle - the myocardium. Blood flow in the coronary vessels occurs during diastole (heart relaxation), since during systole (heart contraction), the vessels in the myocardium are pinched. An increase in heart rate (HR) reduces the time of diastolic filling (rest of the heart), which reduces the delivery of oxygen to the myocardium and can provoke its ischemia (malnutrition).
For uninterrupted work, the heart, and more specifically, the myocardium, requires a lot of oxygen: up to 65% of all oxygen in arterial blood is consumed for the needs of the myocardium. This is normal. And with any physical or emotional stress, when the heart rate increases (tachycardia occurs - an accelerated heartbeat), as well as when blood pressure rises, the heart's need for oxygen increases. It is the coronary arteries that are called upon to satisfy these needs.

How does high blood pressure affect the heart?

Blood pressure becomes high, primarily as a result of vasoconstriction. To push blood into narrowed vessels, the heart muscle has to work with a much greater load than normal. Like other muscles in the body, the myocardium, overcoming a constant load, "grows", increases in size. Doctors call this hypertrophy of the heart muscle. It would seem that there is nothing wrong with this - the myocardium is "training". In fact, myocardial hypertrophy is fraught with serious danger. This danger arises as a result of the fact that the rate of hypertrophy (“growth”) of the heart muscle significantly exceeds the rate of “growth” of its vessels. In fact, the same vessels that provided the myocardium with blood when it had normal sizes, should provide oxygen to the enlarged heart. Since the coronary vessels do not cope with this task, the body (namely the central nervous system) includes the so-called compensatory - adaptive - mechanisms. These mechanisms consist in even greater vasoconstriction and increased heart rate. Thus a vicious circle is formed.
The longer the high pressure lasts, the faster and more malignant myocardial hypertrophy is formed and the vicious circle closes. As a result, the supply of oxygen to the myocardium is not provided at the proper level. Metabolic (exchange) disorders begin in the heart muscle, which are manifested by heart pain - angina pectoris. At first, pain in the heart occurs only after physical exertion, stress, increased pressure. In the future, these phenomena progress and already “insignificant” factors will trigger this reaction.
With age, blood circulation in the coronary arteries deteriorates due to the development of atherosclerotic processes that cause narrowing of the lumen of the vessel. Arterial hypertension this process only stimulates, because with increased pressure, the blood “beats” with greater force vascular wall and injures it, and in this place a “scar” is formed from which an atherosclerotic “plaque” is rapidly formed. There is cardiosclerosis (atherosclerosis with predominant damage to the vessels of the heart), which increases the number and strength of angina attacks and, very often, leads to myocardial infarction. Similar situations arise in the vessels of the brain (cerebral sclerosis), vessels of the kidneys (nephrosclerosis), etc. Thus, another vicious circle arises.
The formation of "vicious circles" self-stimulates the further development of diseases. "Break" these circles can only competent treatment hypertension, there are no other ways to stop these processes.

Hypertension and angina pectoris
Angina or " angina pectoris" - sharp pain or chest discomfort caused by a lack of blood supply to a specific part of the heart. Angina pectoris is the leading symptom coronary disease heart disease (IHD), which develops as a result of narrowing or blockage of the vessels of the heart. With hypertension, the risk of coronary artery disease (and of course angina pectoris) increases by 3-4 times. This is caused by earlier and more extensive atherosclerosis coronary vessels, a more pronounced violation of cardiac circulation (due to constricted high pressure lumen of blood vessels). The higher the pressure and the longer the hypertension, the more pronounced the manifestations of coronary artery disease - angina pectoris.
Subjective sensations in angina pectoris can be described as squeezing or pressing pain behind the sternum, often giving (radiating) to the shoulder, arm, neck or jaw. Typically, pain lasts less than 5 minutes and resolves with appropriate medication or rest. However, at different people Angina attacks can last from 30 seconds to 30 minutes.
As already noted, episodes of sharp pain in the heart appear in cases where the needs of the heart muscle for oxygen are not replenished by the bloodstream. Attacks of angina pectoris occur after physical exertion, emotional overstrain, sudden hypothermia or overheating of the body, after taking heavy or spicy food, drinking alcohol. In all the above cases, the work of the heart increases, respectively, the lack of oxygen is felt more acutely. There is a pain effect. An attack of angina pectoris is the result of only a temporary lack of oxygen in the working heart muscle.

Heart failure
So, increased pressure forces the heart muscle to work harder to ensure an adequate supply of oxygen to the tissues. Such work leads to an increase in the size of the heart. In the early stages, the enlarged heart has more strength to pump blood more efficiently into the narrowed arteries when pressure is increased. However, over time, the enlarged heart muscle becomes weak and ceases to provide sufficient the body's need for oxygen. The diagnosis of "heart failure" means that the heart has ceased to adequately supply tissues and organs with oxygen and nutrients.
This disease is usually chronic and the patient may live with it for many years before a diagnosis is made. Up to 900,000 new cases of chronic heart failure (CHF) are diagnosed annually. Two-year mortality from chronic heart failure is at least 40%, and 5-year mortality is about 65%.

How does heart failure manifest itself?
The main symptoms of heart failure are shortness of breath, weakness, palpitations, swelling, and fatigue. Let's consider them all in order.
Shortness of breath (shortness of breath). In the early stages of the disease, shortness of breath occurs only with significant physical exertion, then with little effort (for example, when climbing stairs). Over time, shortness of breath occurs at rest and during sleep. In the supine position, the patient feels worse than sitting or standing. Painful shortness of breath alternates with bouts of coughing, sometimes with sputum.
Night shortness of breath
characteristic feature heart failure is a feeling of lack of air at night, from which the patient suddenly wakes up. This condition is usually relieved by changing horizontal position to the seat.
Cardiopalmus
With heart failure, patients are concerned about rapid heartbeat (tachycardia). At the beginning of the disease, palpitations occur with little physical exertion, and with the progression of the disease and at rest. Sometimes there are attacks of palpitations lasting from several minutes to several hours and even days. In such a situation, you should immediately consult a doctor.
Edema of the lower extremities
Puffiness appears in the ankles by the end of the day and goes away after rest, and then the swelling may spread and not disappear after a night's rest. Due to a violation of the pumping function of the heart, stagnation of blood occurs in organs and tissues, which leads to the release of its liquid part beyond the vascular bed and the occurrence of edema. Fluid retention in the body leads to frequent urination more often occurring at night.
Fatigue
At first, fatigue occurs only after performing the usual physical activity, but with the progression of the disease, there is a feeling of unmotivated fatigue and weakness throughout the day, and night rest does not bring a feeling of cheerfulness.

Treatment
Our newspaper does not miss a chance to remind that the best treatment any disease is a treatment prescribed by a competent doctor. Such difficult cases as a combination of hypertension with one or another pathology of the heart requires not only specialist advice and the right medication, but also constant medical supervision. Self-treatment according to the method: “it helped her, but it’s the same for me, she knows, and it will help me!” Absolutely forbidden.
There are many drugs that lower blood pressure, but not all patients benefit from them. There are significant differences in the treatment of hypertension in combination with various diseases heart, with a pronounced renal pathology, depending on the age of the patient, sex and other factors. For example, if a patient with hypertension does not have coronary heart disease (CHD), then the statement “the lower the pressure, the longer the life expectancy” is true for such a patient, i.e., a decrease in pressure to normal is possible. A significant decrease in blood pressure in the presence of coronary artery disease can cause a deterioration in coronary circulation.
However, trusting the choice of drug treatment to a doctor, the patient should not shift all responsibility for his health to him. Much depends on the patient himself. First of all, of course, we are talking about strict adherence to all the recommendations of the doctor and the medication regimen. It is known that up to 50% of patients with newly established diagnosis"hypertension" within a year stop taking antihypertensive drugs, and among those who continue therapy, a significant proportion often miss the next dose of medication. Under no circumstances should this be done. It is necessary to understand that ALL cardiovascular diseases are chronic and incurable, which means that medications will have to be taken for life.
But, even strictly observing the regimen of taking medications, one cannot neglect non-pharmacological measures, which include: normalization of excess body weight; limiting alcohol consumption; regular feasible physical exercises; restriction of salt intake; to give up smoking; reduction of mental stress.

Test
Test yourself
The American Heart Society recommends a 6-minute walk test:
In 6 minutes, a person walks some distance with quick steps on a flat place. If he started too fast and stopped to catch his breath, then the stopwatch is not turned off, i.e. time is running, and meters are not added. As a result, if you are able to walk 563 m or more in 6 minutes, then you do not have heart failure. If only 420 m, then you need to go to the doctor, start an examination, and, possibly, treatment. If your "record" is 372 m or less, you are a sick person and you need a cardiological hospital.

hypertension, according to modern ideas, is a neurogenic suffering caused by traumatization and overstrain of the sphere of higher nervous activity. According to the views of the domestic therapeutic school, the development of hypertension is caused by a primary violation of the cortical regulation of the blood pressure apparatus. Violation of higher nervous activity underlying hypertension, G. F. Lang considers as a neurosis, characterized by pathological inertness or stagnation of irritation processes in the field of higher regulation of blood pressure. Thus, in the early stages, the disease is a neurosis. The resulting dysfunction of the vasopressor system leads to vasospasm, followed by their organic changes. Both, in turn, lead to secondary brain damage. However, it should be borne in mind that the same phenomena from the nervous system can be observed with symptomatic hypertension caused by nephritis, Cushing's syndrome, pheochromocytoma, aortic coarctation.

Symptoms from the nervous system in the initial phases of hypertension. Decisive in the mechanism of pathological changes, leading, ultimately, to anatomical changes, is a violation of innervation, causing narrowing (spasm) of small arteries. Already in the first stages of suffering, this spasm can cause symptoms from the nervous system. When questioning the patient, it is possible to find out that long before the appearance pronounced signs illness, migraine attacks, seizures were sometimes noted nervous weakness, dizziness and faintness after taking wine, on a stuffy day. Some patients complain about bad feeling in a room where there are many people, with sharp fluctuations in barometric pressure. Often, with minor emotional stimuli, excessive autonomic reactions are detected.

In the initial phase of hypertension, nervous symptoms often appear, sometimes forcing the patient to consult a doctor before signs of cardiac or vascular insufficiency. The first place in frequency among these symptoms is occupied by headache, which may be the only complaint of the patient.

Headaches due to hypertension can have different character. Similarly, their localization is also diverse. Most often they are localized in the occipital region, but they can also be in the frontal, parietal and temporal regions, unilateral, bilateral. Diffuse headaches are less common than local headaches. There are "typical" headaches that occur early in the morning or at night. Over the next few hours, the headache gradually subsides, but recurs regularly every morning and becomes more severe as the disease progresses. This kind of headache may sometimes disappear for many months, but then reappear. Along with these "typical" headaches, there are pains of a different nature - in the form of attacks that occur during fatigue, emotional stress, sleepless night. In more advanced phases of hypertension, headaches may become permanent; sometimes they are accompanied by vomiting. Recent studies have shown that irritation of the cranial vascular receptors plays a leading role in the pathogenesis of headache.

Numerous observations during operations revealed that the pia mater and choroid plexus brain, like the medulla itself, are insensitive to pain. Raise intracranial pressure in itself also does not cause headache, because sometimes it can be observed that a rapid decrease in intracranial pressure during a lumbar puncture can lead to a temporary increase in headache. All tissues covering the skull are more or less sensitive to pain stimuli, especially the arteries of the skull. Of the intracranial structures, pain sensitivity is venous sinuses veins flowing into them, part of the solid meninges covering the base of the brain, arteries of the dura mater. Scull, medulla, most of the dura mater, soft membranes and choroid plexuses are not sensitive to pain.

Headaches in hypertension are similar in pathogenesis to migraine pains. Changes in the intensity of headache in migraine and hypertension are associated with fluctuations in the pulsation of the cranial arteries, mainly branches of the external carotid artery. Factors that reduce the amplitude of the pulsation reduce the intensity of the headache. So, ergotamine, reducing the amplitude of the pulsations of the cranial arteries, weakens or stops the headache. A decrease in the amplitude of the pulsations of the temporal artery during its compression is often accompanied by a decrease in pain on the corresponding side. Ligation of the temporal or middle meningeal artery may lead to the cessation of headache.

A. M. Grinshtein distinguishes three types of headache, the localization of which is determined by which of the vascular receptors are irritated. Pain in the area eyeballs, behind them, at the root of the nose and in the lower part of the forehead occur with "dystonia" of the ophthalmic artery. In this case, a sharp pain is detected with pressure at the inner corner of the upper edge of the orbit on the frontal artery passing here, the terminal branch of the ophthalmic artery. The second type corresponds to the distribution of the middle meningeal artery. Pain when stretching it is felt in the scalp to the external occipital protuberance. The third type corresponds to the territory of distribution of the branches of the vertebral artery. Pain is experienced in the occipital region and along the back of the neck. A. A. Kedrov and A. I. Naumenko believe that headaches are caused by irritation of the receptors not of the arteries, but of the sinuses of the dura mater.

The level of blood pressure in itself does not affect the occurrence and degree of headache. Of the 400 patients with hypertension who were admitted to the clinic of nervous diseases for stroke, 225 had not previously complained of a headache. In 50 patients in whom headache was the leading symptom, there was an average of the same pressure as in 50 others who had never experienced headache. Thus, a direct relationship between blood pressure and headache cannot be established. Nevertheless, it should be noted that in many patients headaches occur after an increase in pressure. From this we can conclude that the cranial artery, only slightly relaxed, does not stretch enough to cause a headache if the blood pressure is low. When the pressure increases, the stretching of the artery increases and can cause a headache.

As already mentioned, headache is often the only sign in the initial phase of hypertension. Its symptomatic treatment is a difficult task. First of all, it is necessary general treatment hypertension, a discussion of which is beyond the scope of this work. Pyramidone with caffeine and codeine can be prescribed to relieve headaches. L. F. Dmitrenko recommends taking small doses of caffeine until the headache stops. Sometimes it is useful to prescribe sodium amytal at night. Some patients are relieved by inhaling oxygen for a few minutes. For others, the appointment gives a favorable effect. nicotinic acid. Reserpine acts not only as antihypertensive but also as a sedative. Long-term use reserpine in many patients reduces the severity and frequency of headaches.

Psychogenic factors are of great importance. The patient should be reassured, if possible eliminate irritating and depressing factors and excessive stress. Sometimes a month's rest away from the usual irritants eliminates headaches for a long time.

In a more advanced form of hypertension or if there are signs of cerebral edema, you can put leeches on the mastoid processes, intravenous or intramuscular infusions magnesium sulfate. Lumbar puncture should only be recommended for patients who have signs of increased intracranial pressure. Our experience has shown that lumbar puncture usually does not bring significant relief to patients.

Dizziness with hypertension rarely has the character of Meniere's attacks with a distinct sensation of rotation, as is observed with spasm a. auditiva interna. More often it is expressed in a sudden feeling of weakness, darkening in the eyes, so that the patient is often forced to lean against a wall or sit down. This is accompanied by a feeling of heaviness in the head, sometimes a slight and short-term blackout of consciousness. Headache, indicating a violation of the tone of the cranial arteries, is a prognostically less formidable sign than dizziness, which indicates functional insufficiency intracerebral vessels. Sometimes dizziness occurs when moving to a supine position, which is explained by the ensuing hyperemia of the brain. At healthy people in the supine position, there is usually a temporary slight congestion in the veins and an increase in venous pressure. Due to the reflex contraction of the arterioles of the brain, the blood flow through the capillary network increases, thus leveling this stagnation. The altered vessels of the brain of a patient suffering from hypertension are incapable of such a rapid compensatory change. As a result, transient symptoms occur in the form of dizziness, ringing and noise in the ears, redness of the face. The feeling of noise in the ears and head with hypertension can be not only short-term, but also permanent.

3. Yu. Svetnik and G. A. Safonova studied vegetative disorders in patients with hypertension and drew attention to flushing of the face with a sharp reddening of the skin on the neck and chest, and sometimes the whole body, accompanied by a feeling of heat and other unpleasant sensations. In other cases, on the contrary, there is a coldness of the extremities, marbling of the skin of the extremities and trunk. Sometimes, especially in young women suffering from angioedema, a peculiar syndrome can be observed: red spots appear on the face, neck, torso, the eyes fill with tears, the body is covered with sweat, the limbs become cold, the pulse quickens, blood pressure rises. Seizures may occur spontaneously or emotional arousal. The syndrome somewhat resembles diencephalic epilepsy. GF Lang observed it in a pronounced form in patients with hypertension.

In the picture of hypertension, pseudo-neurasthenic symptoms occupy a lot of space: easy fatigue, depressed mood, up to depression and complete exhaustion, poor health, attacks of fear, fear of society, conversations, mood variability. These symptoms create a vicious circle. An increase in blood pressure makes the patient more excitable, irritable and causes other neurasthenic phenomena, which in turn increase blood pressure. The same factor is insomnia, in which the patient does not receive the necessary rest.

N. I. Ozeretsky on the basis a large number clinical observations distinguishes the following psychopathological symptom complexes in hypertension: 1) cerebrasthenic symptom complex, in which patients have a depressed mood with a touch of fear, memory loss, decrease or loss of ability to work; 2) an agitated-depressive symptom complex, the main features of which are depressed mood, anxiety, fear, and sometimes an ecstatic state. Most often, according to N. I. Ozeretsky, asthenization of the psyche occurs with self-doubt, suspiciousness, and anxiety. In other cases, mood instability is noted, increased irritability, short temper. More rarely, paranoid and pseudoparalytic syndromes occur.

V. A. Gilyarovsky and V. F. Zelenin distinguish changes in the psyche in different phases of the process. For the premorbid state, they consider active, less often - anxious and suspicious nature, during the period of unstable increases in pressure - neurasthenic manifestations with preserved activity, mood instability, heightened perceptions, with a persistent increase - episodic fall mental tone, increased fatigue.

These differences are largely arbitrary. Mental changes in hypertension often include only some sharpening of premorbid character traits. Sometimes we are talking about the reaction of the patient "and his suffering, in other cases, the organic changes in the brain caused by hypertension, which some authors refer to as" the psyche of hypertensive patients ". E, S. Averbukh believes that with the slow development of vascular brain process neurosis-like states may arise as a result of identifying features of a premorbid personality. Sometimes, at the same time, the former compensated for many years are disinhibited. psychopathic traits character.

N. K. Bogolepov, on the basis of his observations, believes that changes in the psyche of people suffering from hypertension are characterized by: 1) a change in character in the sense of increased irritability, excitability, irascibility and, along with this, asthenia (patients become weak, insecure, note easy fatigue) ; 2) violation emotional sphere with depressed mood, dreary anxiety; 3) violation of formal abilities: slowing down mental processes, difficulty in changing mental attitudes, weakening of memory, attention. G. F. Lang notes that in this description of N. K. Bogolepov, features are found that indicate a weak type of higher nervous activity with inertia of mental processes and increased emotional excitability. However, G. F. Lang doubts whether this condition is a consequence or a cause of the disease.

The question of the types of higher nervous activity in hypertension was studied by L. B. Gakkel, V. V. Yakovleva and B. I. Stozharov. L. B. Gakkel found that among those suffering from hypertension, persons with a weak type of higher nervous activity predominate. This conclusion is somewhat unexpected, since among those suffering from hypertension very often there are people who are energetic, active and enterprising. V. V. Yakovleva and B. I. Stozharov in 46 ° / about the patients examined by them found strong type higher nervous activity: from; Of the 142 patients, 52 had a strong balanced type, 77 had a weak type, and 13 had a strong excitable type. The study of conditioned reflex activity was carried out according to the motor technique with speech reinforcement proposed by A. G. Ivanov-Smolensky. The obtained data require further study.