Diagnosis of arterial hypertension: basic rules

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Hypertension, or a persistent increase in blood pressure above 140/90, is one of the most dangerous pathological conditions. According to medical research, which covered more than 400 thousand people, an increase in diastolic blood pressure by 7.5 mmHg alone increases the risk of stroke over the next 10 years by 46%. How to detect an undetected pathology and what to pay attention to during diagnosis, we will tell in this article.

What symptoms talk about hypertension

Arterial hypertension is diagnosed by the main basis — Stable increase in pressure.

At the same time, there are also a number of non-specific accompanying symptoms, which may indicate this pathology:

  • Systematic headaches, mainly in the field of nape.
  • Sound pain in the heart.
  • Bleeding from nose.
  • Feeling heat; People with excess body — sweating, riding.
  • Dizziness, appearance in sight «Mushhek» — small black dots, noise in the ears.
  • Sharply upcoming weakness, sometimes in combination with heartbeat.

With a constant deterioration of well-being, it is recommended for several days in a row to measure pressure at the same time. The recorded testimony of the tonometer must be reported to the doctor.

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Hypertension often proceeds almost asymptomatic, and in this its main danger.

How hypertension is diagnosed

Investigation of pressure indicators is done in three ways: independently (self-control blood pressure), clinical ad and daily monitoring of blood pressure (daily blood pressure monitoring). In this case, measurement criteria will be different.

Pressure pressure measurement

At an appointment with a cardiologist or therapist, the blood pressure should be measured twice on the same arm with a 1-2 minute difference. And one additional measurement if the difference between the first two is more than 10 mmHg. The Ad level is the average of the last two measurements. With a single measurement, a decrease or increase in the readings may be episodic (anxious thoughts, recently drinking coffee).Hypertension is registered if, with two visits to a doctor, a tonometer at a twofold dimension shows more than 140/90 mmHg.

To clarify and confirm the diagnosis, the doctor prescribes independent control.

Features of individual clinical situations

In some cases, indicators for independent and under clinical pressure measurement may differ. Discrepancies require special attention, since it is more difficult to determine the presence of pathology.

«Hypertension of White Kolata»

It happens that when measuring the pressure in the clinic, the tonometer stably shows 145/85, while when measuring the house — Not higher than 130/80. This is a typical case «Hypertension of White Kolata» — states when increased indicators are registered only at the doctor's reception. Such an effect is called pressor reaction.

«Hypertension of White Kolata» Most often arises due to increased anxiety in the medical institution, when a person is worried at the doctor's reception, but according to the daily blood pressure monitoring (Daily monitoring of blood pressure) or DMAD (Hell's home monitoring) outside the medical institution The level of blood pressure is controlled adequately. Such a condition may be observed at any age, but it is especially exposed to him by the patients over 60 years old with a persistent increase in systolic blood pressure (isolated systolic hypertension). These patients have asymptomatic lesions of target organs, so they will be examined and, if necessary, prescribe therapy with drugs. «Hypertension of White Kolata» associated with a higher risk of type 2 diabetes mellitus and sustainable pressure increase, as well as with increased cardiovascular risk.

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If the risk factors and target damage in patients do not, the doctor will recommend changing lifestyle and regular observation

Masked hypertension

W «Hypertension of White Kolata» There is antipod — Masked hypertension. On the examination in the polyclinic in patients registered normal pressure — less than 140/90 mmHg, — However, independent measurement or daily monitoring record higher rates. The level of risk in this state is equal to sustainable hypertension, so patients are assigned not only research and lifestyle change, but also drug therapy.

To exclude dubious situations and confirm the diagnosis, according to the results of the survey, the doctor will recommend monitoring the state outside the polyclinic.

Measuring pressure at home

With independent control, hell measurements need to do twice a day — in the morning and in the evening. It is important to comply with the rules: the cuff must be selected in size, the hand lies at the heart level, the physical and emotional peace is observed. During the procedure, you can not talk

Optimal time for self-control: in the morning before breakfast, within an hour after waking up (from 06:00 to 09:00), and in the evening — before dinner or at least 2 hours after dinner (from 18:00 to 21:00)

The resulting indicators must be recorded in the table, be sure to point the date and time of measurement. In the terminology of doctors this is called Hell Control Diary. Also in the table may indicate the frequency of heart rate, general well-being, other data. For example, the situation of increasing indicators due to the stress setting is better to record so that the reason is understandable. Independent reception of hypotensive drugs is also preferably celebrated in the diary.

BP Log

Table can be downloaded on the Internet or make yourself. It does not have the approved form, the main thing is that the record has been clear to the doctor

When independent pressure control and dmad is recommended

«Hypertension of White Kolata» In the question (according to the results of 1-2 visits to the doctor).

«Masked» Hypertension as a possible diagnosis.

1 Hypertension Stage — To create a complete status pattern.

High (or so-called high normal) pressure at the doctor's reception at low cardiovascular risk and the absence of targeted organs.

Normal pressure at the doctor's reception in the presence of lesions of target organs and high cardiovascular risk.

Sharp pressure fluctuations on the same reception at the doctor and with different appeals.

Various types of hypotension, or reduced pressure: during daytime sleep, after taking drugs, when changing the position of the body from horizontal to vertical.

Suspected preeclampsia in pregnant women.

Suspicion of resistant (poorly combined combination therapy) hypertension.

Term «Cardiovascular risk» Determines the risk of developing cardiovascular diseases and their complications. Hypertension – One of the leading risk factors.

Measuring hell in a medical facility gives enough information to diagnose and choose therapy. But in some situations, the doctor may assign 24-hour control using a special device.

Daily arterial pressure monitoring

The most accurate method of diagnosing hypertension — Daily blood pressure monitoring. A cuff with an electronic control device is fixed on the patient's shoulder, which automatically pumps air and fixes the indicators once in half an hour and once a hour at night. Such a study reflects the full picture of the pressure change in 24 hours.

Exact details that give daily blood pressure monitoring:

Daily index — The difference between day and night pressure;

daily rhythm of pressure change;

Pressure level during sleep — if not dropped by 10–20% by mid night, it speaks of a high risk of complications for the heart and blood circulation system;

Dynamics of changes in the early morning clock — The gap from 4 to 10 in the morning is considered a period of the highest recovery. At this time, the sympathetic system that regulates almost all the physiological functions of the body is part of the greatest daily activity mode.

If according to the results of the monitoring, the average daily pressure is 130/80 mmHg Or exceeds these numbers, diagnosed «arterial hypertension» Considered.

Daily monitoring is interesting and from the point of view of studying the lifestyle, as it reveals pressor reactions — The answer of the body on physical activity, emotional stress and other stimuli. For example, harsh pressure lifts during working hours and its stable reduction outside work — Direct indicator of the limit level of stress in specific conditions.

When daily monitoring is assigned

Strong discrepancy between clinical and home dimensions (from 20 mmHg and more).

Suspicion of the night hypertension or increased night pressure — For example, in chronic kidney disease or breathing night delays.

To collect additional data on illness, estimates of the daily rhythm and the pressure change range.

In all situations where home control is recommended, the daily monitoring can be appointed to it — At the discretion of the doctor.

Diagnostics — main

Independent control and daily monitoring of blood pressure — Main in the diagnosis of hypertension. But in addition to them, other types of surveys may be appointed.

Additional studies that a doctor may appoint

General blood test and general urine analysis — To assess the condition of the body.

ECG and ultrasound hearts — To eliminate heart lesions.

Study of creatinine concentration in blood and ultrasound kidneys — To eliminate kidney lesions.

Investigation of blood cholesterol concentration — To identify violations of lipid metabolism, which are additional risk factors.

Inspection of the eye dna — To identify changes in vessels characteristic of hypertension (retinal angiopathy and angiosclerosis).

Ultrasound vessels — To determine the state of the vessels and the presence of atherosclerotic plaques in the arteries.

CT and MRI brain — In suspected brain damage.

In addition to the listed studies, the doctor may also require other data — Depending on the patient's condition. The more information it is, the more precisely the diagnosis and purpose of therapy will be.

The main thing is to remember with hypertension: the higher the pressure, the higher the risk — and vice versa.

If you start the treatment of arterial hypertension on time, the risk of ischemic heart disease decreases by 20–30%, and risk of stroke — By 30–40%. Timely appeal to the therapist or cardiologist, correction of cardiovascular risk factors, the correct selection of drugs and compliance with the recommendations of the attending physician — Golden standard assistance in arterial hypertension.