Case histories: grade 2 hypertension

Headaches, weakness, shortness of breath, palpitations, nosebleeds are frequent complaints that patients come to see a general practitioner.

Every day, but not once, you have to face such complaints to the doctor, especially if people older than 40 years predominate in the queue. Some of them already know their diagnosis, while others have yet to learn about it. Be that as it may, people are not in a hurry to know the truth about their state of health, and therefore they delay the visit to the doctor as long as possible. This is especially true for men. Unfortunately, it so happened that until the “fried rooster pecks”, until the “bell rings”, you can’t lure and drag them to the clinic, despite frequent headaches, dizziness, shortness of breath and nosebleeds.

Arterial Hypertension Diagnosis Criteria

• When measuring with a tonometer, the numbers of systolic pressure are fixed at 140 mm Hg and above, diastolic - 90 mm Hg and above.
• Threefold change in pressure during the day.
• Double fixation of high blood pressure per week.

Hypertension Risk Factors

• The decrease in physical activity is a consequence of total computerization and the widespread distribution of gadgets. With a sedentary lifestyle, there is no natural training of the cardiovascular system, which would be with an active lifestyle, running, sports and outdoor children's games.
  
  
• Psycho-emotional stress, frequent stressful situations at work, at school, at the institute contribute to the activation of the sympatho-adrenal system, the emergence and eventually consolidation of a stereotype of behavior that throws all the body's resources to achieve the desired goal. Information about the negative effects of stress on the body contains far from the first medical history. Hypertension can develop gradually, gradually.
  
  
• People have forgotten how to relax. After work, it is difficult for many hyperresponsible workers to disconnect from production problems, leave everything with which a busy working day was connected at the doorstep, and tune in to a wave of calm joy from communicating with loved ones. The same goes for vacation. The best option, of course, would be to stay in nature, in the fresh air: on a hike, in the mountains, by the sea, on a rafting on the river, but just in the country! Active recreation in combination with clean, fresh air and healthy nutrition can work wonders with an organism that has withered in a busy city environment.
  
  
• Bad habits. It seems that they have always been with people. Alcoholization of the body and smoking have become epidemic in Russia. The availability of these imaginary forms of relaxation leads to an additional reduction in already relaxed willpower. Smoking a cigarette “to relieve stress” is much simpler than chopping wood, swimming in a pool or running a couple of circles around the stadium to burn excess adrenaline in the furnace's biochemical processes, so most people resort to easy and affordable ways to relieve stress, not wanting to delve into the essence of the problem and driving away from yourself thoughts about the harmfulness of their habits. So there is a prerequisite for a new medical history, hypertension in which the main.
  
  
• Having seen enough advertising, many tend to enjoy a cup of aromatic coffee or tonic tea before leaving home or already at work before a busy day. Those who have long practiced this method of starting the day have become accustomed to strong invigorating drinks. Meanwhile, numerous studies have confirmed the effect of caffeine in coffee and tea on blood pressure increase . This habit is especially detrimental in conditions when hypertension is just beginning, and a person does not feel all the negative symptoms that it hides.
  
  
• Hereditary predisposition is one of the factors that many people do not take into account due to inexperience or ignorance. If your parents, grandparents, or at least one of them suffers or has suffered from hypertension during your life, you have every chance to realize a predisposition to this disease. Not all patients tell this, and remain incomplete medical history. Hypertension can be realized through a hereditary factor.
  
  
• Obesity. In recent decades, obesity has become widespread throughout the globe. Obese people make up 20-30% of the total population of the Earth.
  
  
  Of these, only 2% have a burdened heredity, all the rest received extra pounds with food, grossly violating the daily routine, without thinking about the volume and quality of the food eaten. There is a category of people who are obese due to endocrine diseases, but there are not so many among the entire mass of overweight individuals. Obesity creates an increased burden on the whole body, including the cardiovascular system. The heart has to make more efforts to provide blood to all organs and tissues, which leads to an increase in the upper value of blood pressure (systolic). A person has pains behind the sternum, often radiating to the left arm or under the shoulder blade, a feeling of lack of air, interruptions in the work of the heart or, conversely, a strong heartbeat. All this can be accompanied by a fear of death and are symptoms of coronary heart disease, angina pectoris. This is how hypertension develops: coronary heart disease, medical history, hospital ward ...

• Excessive consumption of salty foods and water also leads to an increase in blood pressure due to the suction of fluid from the tissues surrounding the vessels into the bloodstream. This is what doctors write about in the medical history, hypertension in which takes the most "honorable" places.

• Lack of calcium and magnesium in food. Calcium is involved in the contraction of muscle cells, including the myocardium and smooth muscles, located in the walls of blood vessels of the arterial bed, and magnesium relaxes these muscles, increasing the lumen of the vessel and lowering blood pressure. The optimal ratio of calcium and magnesium in food is 2: 1. Deficiency of one trace element leads to an excess of another over time, there is an imbalance in the processes of reduction and relaxation of the vascular walls.

Modern features of the course of arterial hypertension

Our life is very dynamic. Some 20-40 years ago, it flowed much more calmly, from most citizens did not require work to wear out. Now, constant stressful situations have become the norm of the workflow. A person ceases to notice headaches, malaise, tingling in the heart, so asymptomatic or mild hypertension of the 1st degree passes into the second. If the patient is aware of the danger of his situation, will seek help and will regularly follow medical instructions, he will be able to equalize the pressure and avoid vascular catastrophes. If he ignores the symptoms and recommendations of the doctor, he will quickly move to the third degree of the disease. And this has recently been happening more and more often due to chronic employment and increased responsibility of people. Therefore, very often such a medical history occurs. Therapy: hypertension requires complex treatment aimed at maintaining a normal level of pressure, preventing vascular accidents and structural changes in internal organs.

Stages of the development of the disease

• Under the influence of increased pressure, small vessels come into a state of spasm. The kidneys that suffer the most are blood filtration through the small capillary network. The kidneys receive less blood and oxygen, a condition of ischemia occurs.
• In response to ischemia, the renin complex is activated: the kidneys begin to produce substances that increase blood pressure, and the fluid is retained in the vascular bed, aggravating the condition and closing the vicious circle.

Classification of degrees of arterial hypertension

The degrees of the disease are characterized by blood pressure figures.

• 1st degree - from 140 to 160 systolic pressure and from 90 to 100 mm RT. Art. diastolic pressure.
• 2nd degree - from 160/100 to 179/109 mm RT. pillar.
• 3rd degree - above 180/110 mm Hg. pillar.

Stage classification

The staged process reflects the occurrence of pathological changes in organs and tissues.

• Stage 1 - there are no complications of the disease and structural changes.
• Stage 2 - there are signs of functional and structural changes in the internal organs (enlargement of the left heart; wrinkled due to proliferation of the connective tissue of the kidney) and blood vessels (discirculatory encephalopathy, changes in the vessels of the fundus, and so on).
• Stage 3 - the occurrence of vascular accidents (stroke and heart attack).

Hypertension Risk Classification

In addition to the degree and stage, hypertension also has risk factors. They indicate a risk of developing complications of hypertension in each of the patients in particular. This risk stratification is designed to provide greater control over those patients who especially need to take care of their health because of the greater likelihood of complications. It includes all factors that affect the course of the disease, as well as the prognosis of the disease.

1. A low risk (less than 15%) is characteristic of men and women under the age of 55 years who suffer from first-degree hypertension and do not have concomitant damage to internal organs and heart.
2. A moderate degree of risk (15-20%) is typical for patients with grade 1-2 hypertension with the simultaneous presence of 1-2 risk factors and the absence of changes in the structure of internal organs under the influence of the disease.
3. A high risk (from 20% to 30%) is typical for patients with degree 1-2 hypertension, having 3 or more risk factors, structural changes in internal organs, tissues, blood vessels, characteristic degree 2 hypertension.
4. A very high risk (above 30%) is typical for patients with grade 2 hypertension, many risk factors that caused the disease, and the presence of structural changes in organs and tissues of the body under the influence of high pressure.

Diagnosis Examples

We will analyze what the diagnoses that the medical history contains contain. "Hypertension stage 2, degree 2, risk 3". To understand this entry, recall the classification.

Such a diagnosis is made to a person over 55 years of age, whose blood pressure several times a week exceeds 160/100 mmHg, for example, reach 170/120 mm. He has a pronounced increase in the left parts of the heart, in particular, the ventricle, dyscirculatory encephalopathy, and obesity of 1-2 degrees. Such a person for a long time occupies a leadership position, is nervous a lot, smokes, occasionally abuses alcohol, eats unsustainably, loves salty and spicy foods. These are the facts that the history of the disease can hide (hypertension, stage 2, degree 2, risk 3). Other options are possible.

Medical history. Hypertension at a young age

Every year, experts observe a steady rejuvenation of diseases of the cardiovascular and nervous systems. Already in the last century, cardiovascular pathology was called the scourge of the century. In the coming century, the negative trend continues to gain momentum. Now it’s hard to surprise anyone with 30-year-old hypertensive patients, some people already have their “experience” by the age of 20. Each of them has its own medical history. Hypertension can develop very quickly, in weeks, and maybe very slowly, gradually, overgrowing with concomitant pathology or manifesting itself as one of the symptoms of the disease. Given the tendency to rejuvenation, 16-18-year-old people suffer from this ailment.

Medical history. Young people

In medical practice, there is such a medical history of therapy: hypertension developed in a young man at the age of 15 years. In the history of life, several factors attract attention:

• Hereditary predisposition on the part of the father, grandmother, grandfather on his part and on the maternal side of the grandfather.
• A funnel-shaped chest since childhood, not corrected either by therapeutic exercises or by surgery.
• An additional factor provoking the disease is smoking, starting in adolescence and periodically moderate alcoholization.

From the anamnesis of the disease: headaches and chest pains appear and become more frequent in adolescence and elevated blood pressure numbers are recorded: systolic rises to 130-140 mmHg, and diastolic rises to 90-110 mm Hg. The patient does not pay attention to these “bells”, takes analgesics and does not seek medical help, therapy is not carried out, the condition worsens, and by the age of 18 he receives hospitalization. Such a medical history. Hypertension of the 2nd stage, hypertensive crisis, which first appeared in life by adolescence.

Below is an example of another young man. He has a standard medical history. Stage 2 hypertension developed as a result of a careless attitude to one’s health. This is a medical history of therapy. IHD: hypertension 1 tbsp. was diagnosed in a patient aged 14 years. By this time, he already had obesity (body mass index reached 31), shortness of breath with little physical exertion, pathological changes in the knee joints. By the way, the whole family suffered from obesity, so the child began to get sick from childhood. Recommendations of pediatricians on nutrition correction, maintaining a healthy lifestyle, increasing mobility, the need to visit the pool or other sports and recreational classes according to the age of the parents passed their ears. With weight gain, the child’s health condition worsened. At the age of 15 years, blood pressure figures reached 150 mmHg, visual impairment, pain behind the sternum, and physical exertion expressed shortness of breath joined. Here's a medical history of therapy. Hypertension is an insidious thing and you should not launch it. Of course, everyone wants to be cured without much effort, therefore, neglecting the doctor’s prescriptions for taking daily drugs that support normal blood pressure, they get a hypertensive crisis. The medical history of some people begins with him.

All the negative trends in the state of health did not alarm young people, nor did they make us think about normalizing their lifestyle. Unfortunately, without correction, the state of health will not improve, and the prognosis of the development of pathology is unfavorable.

Many obese people believe that they will lose weight from smoking and everything will be fine, but this opinion is erroneous. Smoking only exacerbates the course of the disease. So far, he has a hundred of the diagnosis (which contains the medical history of the therapy) - hypertension of 2 degrees, 2 stages. Without systematic treatment, which most people consider optional, the patient will receive a “bouquet” of concomitant pathology. And his medical history for therapy will contain such a diagnosis: hypertension of 3 degrees, 3 stages. Isn't it worth it to think about?

Hypertonic disease. Academic medical history

A 58-year-old patient was delivered to the admission department of the therapeutic building of the city hospital with complaints of severe pain behind the sternum, shortness of breath, palpitations. Pain does not go away after taking nitroglycerin. Blood pressure when measuring 185/110 mmHg.

When collecting an anamnesis, it turns out that similar pain attacks appeared in him more than 20 years ago, increased pressure has been noted since 35 years. During this time, a hypertensive crisis occurred 2 times with an increase in pressure up to 210 mm RT. Art.

8 years ago he was treated in a hospital for high blood pressure. There was such a medical history: hypertension of the 2nd degree. The tablets prescribed at discharge from the hospital, including Enap, are taken irregularly. Before a real attack, I did not take them for a week because of my well-being. He works as a technical director in a large construction company, the work is connected with psycho-emotional stress. Bad habits are smoking.

At the last medical examination, a decrease in vision by 0.4 units, protein, red blood cells in the urine, an increase in the voltage on the ECG, a shift of the electrical axis of the heart to the left were detected. He was sent for additional examination and treatment at the place of residence, but did not reach the doctor - affairs, work.

An examination in a hospital revealed: acute myocardial infarction, numerous structural changes in the internal organs, blood vessels, ECHO - KG - dilatation of the left heart, and ultrasound of the internal organs - revealed “wrinkled kidneys”.

After the treatment, he was discharged in satisfactory condition. Here is an example when, even after a vascular catastrophe, the situation was successfully resolved (medical history - grade 3 hypertension, stage 3).

Conclusion