Case histories: grade 2 hypertension

Headaches, weakness, shortness of breath, palpitations, nosebleeds are frequent complaints that patients are referred to for a doctor-therapist.

Every day, and not once, you have to deal with such complaints to the doctor, especially if people in the queue are over 40 years old. Some of them already know their diagnosis, and someone else is to learn about it. Be that as it may, people are not really in a hurry to know the truth about their health, and therefore they are delayed with a visit to the doctor as long as possible. This is especially true of men. Unfortunately, it so happened that until the "roasted cock does not bite" until the bell rings, you can not entice them to the clinic and not drag them, despite frequent headaches, dizziness, shortness of breath and nosebleeds.

Criteria for diagnosing arterial hypertension

• When measuring with a tonometer, fixing the digits of systolic pressure 140 mm Hg or higher, diastolic - 90 mm Hg and above.
• Three-fold change in pressure during the day.
• Double fixation of high blood pressure for a week.

Risk factors for hypertension

• Reduction in physical activity is the result of total computerization and 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 active children's games.
  
  
• Psycho-emotional stress, frequent stressful situations at work, at school, at the institute contribute to the activation of the sympathetic adrenal system, the emergence and eventually reinforcement of the stereotype of behavior that casts all the resources of the body to achieve the desired goal. Information on the negative impact of stress on the body contains far from the first history of the disease. Hypertensive disease can develop gradually, gradually.
  
  
• People forgot how to rest. After work, many hyperintelligent employees find it hard to disconnect from production problems, leave everything behind the threshold of the house with which a busy working day was connected, and tune in to a wave of quiet joy from communication with loved ones. The same applies to vacation. The best option, of course, will be staying in nature, in the fresh air: on a hike, in the mountains, at the sea, on rafting along the river, but just at the dacha! Active rest in combination with clean, fresh air and healthy nutrition can work wonders with a body that has withered in a bustling urban 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 decrease in the already relaxed willpower. It is much easier to smoke a cigarette "to relieve stress" than to chop wood, swim in the pool or run a couple of circles around the stadium to burn excess adrenaline in the furnace of the body'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 the thought of the perniciousness of one's habits. So there is a prerequisite for a new medical history, the main hypertension.
  
  
• After watching the ads, many seek before going out of the house or already at work before the work day enjoy a cup of aromatic coffee or tonic tea. Those who have long practiced such a way to start the day, managed to get used to strong invigorating drinks. Meanwhile, numerous studies have confirmed the effect of caffeine, contained in coffee and tea, on increasing blood pressure. Particularly harmful is the habit 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, due to inexperience or ignorance, do not take into account. If your parents, grandparents or even one of them suffers or suffered during the life of hypertensive disease, you have every chance to realize a predisposition to this disease. Not all patients tell this, and the case history is incomplete. Hypertensive disease can be realized through a hereditary factor.
  
  
• Obesity. In recent decades, obesity has become widespread throughout the world . People with obesity make up 20-30% of the total population of the Earth.
  Of these, only 2% have a hereditary burden, all others received extra kilograms of food, grossly violating the daily routine, without thinking about the volume and quality of food eaten. There is a category of people who are obese due to endocrine diseases, but they are not so many among the entire mass of individuals with overweight. Obesity creates an increased burden on the entire 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). The person has pain behind the sternum, often radiating to the left arm or under the scapula, a feeling of lack of air, interruptions in the work of the heart or, conversely, a strong palpitation. All this can be accompanied by fear of death and are symptoms of coronary heart disease, angina pectoris. So hypertensive disease develops: IHD, medical history, hospital ward ...

• Excessive consumption of salty foods and water also leads to increased blood pressure by sucking fluid from the surrounding tissues into the bloodstream. This is what doctors write about in the medical history, the hypertension in which occupies 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 optimum ratio of calcium and magnesium in food is 2: 1. Deficiency of one trace element over time leads to an excess of another, there is an imbalance in the processes of contraction and relaxation of the vascular walls.

Modern features of the course of arterial hypertension

Our life is very dynamic. Some years 20-40 years ago it flowed much more calmly, most of the citizens did not require work for wear. Now constant stressful situations have become the norm of the working process. 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 realizes the danger of his situation, seeks help and will follow the medical prescriptions regularly, he will be able to equalize the pressure and avoid vascular accidents. If he ignores the symptoms and recommendations of the doctor, then quickly go to the third degree of the disease. And this is happening more and more often due to chronic employment and increased responsibility of people. Therefore, very often such a history of the disease 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 disease development

• Under the influence of increased pressure, small vessels come into a spasm. Most of all, the kidneys, in which the blood is filtered through a fine capillary network, suffer. The kidneys receive less blood and oxygen, a state 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 lingers in the vascular bed, aggravating the condition and closing the vicious circle.

Classification by degrees of arterial hypertension

The degree of the disease is characterized by the numbers of blood pressure.

• First degree - from 140 to 160 systolic pressure and from 90 to 100 mm Hg. Art. Diastolic pressure.
• The second degree is from 160/100 to 179/109 mm Hg. Pillar.
• The third degree is above 180/110 mm Hg. Pillar.

Classification by stages

Stages of the process reflect the appearance of pathological changes in organs and tissues.

• 1 st stage - no complications of the disease and structural adjustment.
• 2nd stage - there are signs of functional and structural changes in the internal organs (enlargement of the left heart, wrinkled due to proliferation of connective tissue of the kidney) and vessels (discirculatory encephalopathy, changes in the vessels of the fundus, etc.).
• 3rd stage - the occurrence of vascular accidents (stroke and heart attack).

Classification by risk factors for hypertension

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

1. Low risk (less than 15%) is typical for men and women under 55 who suffer from hypertension of the first degree and do not have concomitant damage to the internal organs and heart.
2. The average degree of risk (15-20%) is typical for patients with grade 1-2 hypertension with simultaneous presence of 1-2 risk factors and absence of changes in the structure of internal organs under the influence of the disease.
3. High risk (from 20% to 30%) is typical for patients with grade 1-2 hypertension having 3 or more risk factors, structural changes in the internal organs, tissues, vessels characteristic of grade 2 hypertension.
4. A very high risk (above 30%) is typical for patients with hypertension of the 2nd degree, a number of risk factors that caused the onset of the disease, and the presence of structural rearrangement of the organs and tissues of the organism under the influence of high pressure.

Examples of diagnoses

Let us examine what the diagnoses mean that contain the medical history. "Hypertensive disease 2 stage, 2 degree, risk 3". To understand this record, let us recall the classification.

Such a diagnosis is put to a person older than 55 years, whose blood pressure figures several times a week exceed 160/100 mm of mercury, for example, reach 170/120 mm. He has a marked increase in the left heart, in particular, the ventricle, dyscirculatory encephalopathy, obesity of the 1-2 degree. Such a person holds a leading position for a long time, is nervous, smokes, occasionally abuses alcohol, irrationally eats, loves salty and spicy food. These facts can hide the medical history (hypertension 2 stage, 2 degree, risk 3). There are other options.

Case histories. Hypertensive disease at a young age

Every year, experts observe the 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 is difficult to surprise anyone with 30-year-old hypertensives, some people already have their "experience" by the age of 20. Each of them has his own medical history. Hypertensive illness can develop very quickly, in a few weeks, and maybe very slowly, gradually, with the concomitant pathology or manifesting itself as one of the symptoms of the disease. Taking into account the tendency to rejuvenate, this illness affects 16-18-year-old people.

Disease history. Young people

In medical practice, there is such a medical history of therapy: hypertensive disease developed in a young person 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 line of his grandfather.
• Funnel chest since childhood, not corrected either by curative gymnastics, or surgically.
• An additional factor provoking the disease is smoking, beginning with adolescence and periodically moderate alcoholization.

From the anamnesis of the disease: in adolescence, headaches and chest pains appear and gradually increase, and elevated blood pressure figures are recorded: systolic increases to 130-140 mmHg, and diastolic - up to 90-110 mmHg. The patient does not pay attention to these "little bells", takes analgesics and does not seek medical help, the therapy is not carried out, the condition is aggravated, and by the age of 18 he gets hospitalization. Such a medical history. Hypertensive disease of the 2nd stage, hypertensive crisis, first appeared in life to adolescence.

Below is an example of another young man. He has a standard medical history. Hypertensive disease of the 2nd stage has developed due to careless attitude towards one's health. This is a medical history of the therapy. IHD: hypertensive disease 1 tbsp. Was diagnosed in a patient at the age of 14 years. By this time he already had obesity (body mass index reached 31), dyspnea with insignificant physical exertion, pathological changes of knee joints. By the way, the whole family was suffering from obesity, so the child began to get sick from the very childhood. Recommendations pediatricians on the correction of nutrition, the maintenance of a healthy lifestyle, increased mobility, the need to visit the pool or other sports and recreational activities according to age parents were overlooked. With a set of body weight, the child's health deteriorated. At the age of 15 years, blood pressure readings reached 150 mm Hg, vision impairment, chest pain, dyspnoea with physical exertion were added. Here is a medical history of therapy. Hypertensive illness is a tricky thing and you should not run it. Of course, everyone wants to be cured without much effort, therefore, neglecting appointments of a doctor about the daily intake of drugs that maintain normal blood pressure, get a hypertensive crisis. The history of the disease of some people begins precisely with him.

All the negative trends in the state of health did not alarm the young people, they did not make us think about the normalization of the way of life. Unfortunately, without correction, the state of health will not improve, and the prognosis for the development of pathology is unfavorable.

Many people with obesity believe that they will lose weight from smoking and everything will be fine, but this opinion is mistaken. Smoking only aggravates the course of the disease. While one hundred at it or him the diagnosis (which contains a case history on therapy) - an idiopathic hypertensia of 2 degrees, 2 stages. Without systematic treatment, which most people consider optional, the patient will receive a "bouquet" of concomitant pathology. And he will be diagnosed with his medical history according to therapy: hypertension of the 3rd degree, 3 stages. Is not it really worth thinking about?

Hypertonic disease. Medical history

The 58-year-old patient was admitted to the admission department of the therapeutic building of the city hospital with complaints of severe pain behind the sternum, shortness of breath, and palpitations. The pain does not pass after taking nitroglycerin. BP at a measurement of 185/110 mm of mercury.

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

8 years ago, I was treated in the hospital for hypertension. There was such a case history: hypertensive disease of the 2nd degree. Appointed at discharge from the hospital tablets, including "Enap", takes irregularly. Before the present attack I did not take them for a week because of well-being. He works as a technical director in a large construction company, the work is connected with psycho-emotional stresses. Bad habits - smoking.

At the last medical examination, a 0.4-unit vision loss, a protein, erythrocytes in the urine, an ECG increase in voltage, a displacement of the electrical axis of the heart to the left, were detected. It is directed at doobsledovanie and treatment in a residence, but has not reached the doctor - business, work.

During the examination in the hospital, there were: acute myocardial infarction, numerous structural changes in the internal organs, vessels, ECHO-CG dilatation of the left heart, ultrasound of internal organs, "wrinkled kidneys".

After the treatment was discharged in a satisfactory condition. This is an example, when even after a vascular accident the situation was safely resolved (the case history is hypertensive disease grade 3, stage 3).

Conclusion

Pay attention to the slow, gradual in most cases, the development of hypertension. Take a rule several times a week to measure blood pressure, especially when you do not feel well, and do not neglect prophylaxis: an active lifestyle, proper nutrition, stress management will help you stay healthy and happy for a long time!