Isolated systolic arterial hypertension: labile, stable

When the diagnosis is formulated as systolic hypertension, it means that the arterial pressure in the systole-heart contraction phase exceeds the physiological norm (and is at least 140 mmHg), and the diastolic pressure (when the heart muscle relaxes between contractions) is fixed at the level 90 mm Hg. Art.

This type of hypertension is more common in the elderly, especially in women. And in fact, in most patients with hypertension older than 60 years, it is isolated systolic hypertension.

The importance of systolic pressure was established in the 1990s when it was found that the diastolic blood pressure fluctuates less and the risk of coronary heart disease and stroke is increased systolic pressure that grows throughout life.

[1], [2], [3], [4], [5], [6]

Epidemiology

The diagnosis of hypertension, according to the statistical data of the Ministry of Health of Ukraine, has 12.1 million citizens, which exceeds the indicators of 2000 by 37.2%.

In this case, isolated systolic hypertension in patients aged 60-69 years is from 40% to 80% of cases, and older than 80 years - 95%.

According to the Journal of Hypertension, isolated systolic hypertension in the elderly is a prognostic factor in the development of cardiovascular disease, even at a systolic blood pressure level of 150-160 mm Hg. That provokes complications of available cardiological problems in a third of patients.

Arterial hypertension  is the main cause of morbidity and mortality due to its association with coronary heart disease, cerebrovascular disease and renal insufficiency. Studies have shown that hypertension is the main pathogenetic factor of 500,000 strokes in patients in North America (half of which end up lethal) and nearly one million myocardial infarctions per year. In patients with high blood pressure, the cumulative frequency of the first cardiovascular signs within 10 years is 10% in men and 4.4% in women.

And NHANES (The National Health and Nutrition Examination Survey) data show that systolic hypertension in young (at the age of 20-30 years) has more than doubled over the past decades - up to 2.6-3.2% of cases.

The prevalence of systolic hypertension in hyperthyroidism is 20-30%.

[7], [8], [9], [10]

Causes of the systolic hypertension

The clinical reasons for systolic hypertension are related to:

• with an age-related decrease in the elasticity of large arteries due to the accumulation of fat (cholesterol) deposits on the inner side of the walls of the vessels (atherosclerosis);
• with aortic insufficiency - a violation of the aortic valve of the heart (located at the exit of the aorta from the left ventricle);
• with granulomatous autoimmune arteritis of the aortic arch (aortoarterioth Takayasu);
• with hyperaldosteronism (increased activity of the adrenal cortex and an increase in the production of the hormone aldosterone, which contributes to an increase in the volume of circulating blood);
• with increased activity of the thyroid gland (thyrotoxicosis or hyperthyroidism);
• with kidney diseases, in particular, stenosis of the renal artery;
• with metabolic syndrome;
• with anemia.

In this systolic arterial hypertension in the absence of aortic valves, arteritis of the aortic arch, hyperthyroidism or anemia is symptomatic or secondary.

Among the most common causes, due to which systolic hypertension can develop in young people, experts call age hormonal changes. However, hypertension in young and middle age increases the risk of severe cardiovascular pathologies in the future.

[11], [12], [13], [14], [15], [16]

Risk factors

In the development of hypertension, an important role is played by such risk factors as the elderly; hypodynamia; the abuse of fats, salt and alcohol; increased cholesterol in the blood; deficiency of calcium in the body; presence of diabetes and obesity.

The likelihood of systolic hypertension increases if the disease is present in blood relatives, as some features of regulation of blood pressure are transmitted with genes.

[17], [18], [19], [20], [21], [22], [23], [24],

Pathogenesis

The pathogenesis of the development of isolated systolic hypertension is explained by a number of violations of the complex process of regulation and control of arterial pressure, the result of cardiac output and systemic vascular resistance.

With arterial hypertension, there may be either an increase in cardiac output, or an increase in systemic vascular resistance, or both disorders simultaneously.

Neurogenic control of blood pressure is carried out by the vasomotor center - a cluster of baroreceptors of the medulla oblongata, which react to the dilatation of the walls of the vessels, increasing the afferent impulse activity. This, in turn, reduces efferent sympathetic activity and enhances the tone of the vagus nerve, which reduces the frequency of cardiac contractions and dilates the vessels. However, with age, the sensitivity of baroreceptors gradually decreases, which is a feature of systolic hypertension in the elderly.

AD and the whole process of blood circulation is also controlled by the renin-angiotensin system of the body. Under the influence of renin, the enzyme of the near-lobe apparatus of the kidneys, a biochemical transformation of the angiotensin convergent angiotensin receptor into an inactive angiotensin I peptide occurs. The latter, through ACE (angiotensin converting enzyme), is converted to an active octapeptide, angiotensin II, which acts on specific receptors (AT1 and AT2) the lumen of the blood vessels and the release of the corticosteroid hormone of the adrenal cortex of aldosterone. In turn, an increase in the level of aldosterone in the blood contributes to an increase in the volume of circulating blood, a violation of the balance of sodium ions (Na +) and potassium (K +) in the blood, as well as an increase in blood pressure. This is what happens with hyperaldosteronism.

By the way, the release of renin also increases with the stimulation of the β-adrenoreceptors of the sympathetic nervous system with catecholamines (epinephrine, norepinephrine, dopamine), which are excessively secreted with excessive physical exertion; long-term state of psychoemotional overexcitation; increased aggressiveness and stress; adrenal tumors (pheochromocytoma).

Relaxing muscle fibers of the walls of the blood vessels atrial natriuretic peptide (ANP) is released from the cells of the myocardium (cardiomyocytes) of the atria as it stretches and causes urinary excretion (diuresis), removal of Na by the kidneys and a moderate decrease in blood pressure. With problems with the myocardium, the level of ANP decreases and the blood pressure on the systole increases.

In addition, in patients with this type of hypertension, vascular endothelial cell functions may be impaired. The endothelium lining the cavity of the vessels synthesizes endothelin - the most powerful vasoconstrictor peptide compounds. Their increased synthesis or sensitivity to endothelin-1 can cause a reduction in the formation of nitric oxide, which contributes to vasodilation - relaxation of the walls of blood vessels.

And the pathogenesis of isolated systolic hypertension in hyperthyroidism is due to the fact that the hormone triiodothyronine increases cardiac output and BP at the time of cardiac contraction.

[25], [26], [27], [28], [29], [30],

Symptoms of the systolic hypertension

It should be borne in mind that in mild form the symptoms of systolic hypertension may be weak and rare - a periodic sensation of severe head and / or neck pain, dizziness, tinnitus, restless sleep.

As the pathology progresses, the symptoms intensify, attacks of more intense headache and nausea, increased heart rate, shortness of breath and pain on the left behind the sternum are added.

When the cause of the increase in blood pressure lies in the hyperactivity of the adrenal cortex and the excessive level of aldosterone, patients also feel the first symptoms of the disease

In the form of general weakness, pain in the head and heart.

For more information, see:  Symptoms of High Blood Pressure

Stages

Also, hypertension has three stages:

• the first stage is fixed at the indices of blood pressure of 140-159 / 90-99 mm Hg. P.
• the second stage - BP 160-179 / 100-109 mm Hg. P.
• the third stage - AD≤180 / ≤110 mm Hg. Art.

[31], [32], [33], [34], [35], [36], [37]

Forms

In clinical practice, these types of systolic hypertension are distinguished:

• isolated systolic arterial hypertension - if the systolic blood pressure index is more than 140 mm Hg. St., and the diastolic does not exceed 90 mm Hg. P.
• unstable or labile systolic arterial hypertension is manifested by a periodic increase in blood pressure (usually no more than 140 mm Hg) at the time of contraction of the heart muscle. The main causes are associated with excessive release of adrenaline, norepinephrine and dopamine, which causes an increase in cardiac output in the bloodstream;
• stable systolic hypertension is characterized by constantly elevated systolic blood pressure with gradation of indices - 140-159 mm Hg. Art. (light form) and more than 160 mm Hg. Art. (moderate form).

[38]

Complications and consequences

The effects and complications associated with systolic hypertension affect the target organs (heart, kidney, brain, retina, peripheral arteries) and look like this:

• hypertrophy of the left ventricle of the heart;
• arrhythmia and atrial fibrillation;
• pulmonary hypertension;
• heart failure;
• sclerosis of the cerebral arteries with acute impairment of cerebral circulation (stroke) or with chronic encephalopathy in the background of insufficient blood supply to brain tissue;
• sclerotic changes in blood vessels and renal parenchyma with chronic renal failure (impaired glomerular filtration);
• deterioration of vision (due to narrowing of the vessels of the retina).

[39], [40], [41], [42], [43], [44], [45], [46],

Diagnostics of the systolic hypertension

Standard diagnosis of systolic hypertension begins with the collection of patient complaints and blood pressure measurement with a tonometer, as well as listening to heart tones with a phonendoscope.

Instrumental diagnostics can include ECG (electrocardiogram), echocardiography (ultrasound of the heart), ultrasound of the kidney and thyroid, x-ray arteries (arteriography), and ultrasound examination of vascular blood flow (dopplerography).

Basic tests: blood test (for cholesterol and glucose, thyroid hormones, aldosterone, creatinine and urea); general urine analysis.

[47], [48], [49], [50], [51]

Differential diagnosis

Differential diagnosis is designed to distinguish systolic hypertension, for example, from the  syndrome of a white coat.

[52], [53], [54]

Treatment of the systolic hypertension

According to the world-wide recommendations, the treatment of systolic hypertension includes both non-drug methods and drug therapy. The first include recommendations for getting rid of excess weight, quitting smoking, limiting consumption of table salt, alcoholic beverages, animal fats. Read more -  Diet under increased pressure. In addition, doctors recommend that you move more and take vitamins.

The medicines used in the treatment of systolic hypertension include:

• diuretics (thiazide and thiazide-like) Hydrochlorothiazide (Hydrothiazide), Klopamid, Indapamide (other trade names are Acrypamide, Indap, In-dapsan), Torasemide (Triface).
• drugs inhibiting the action of ACE and blocking the synthesis of angiotensin II - Enalapril (Enap, Renital, Vasotec, Vazolapril), Captopril, Lizinopril, Monopril, Sinopril;
• calcium antagonists - Diltiazem (Dilatam, Diacordin, Altiazem, Cordiazem), Verapamil, Nifedipine;
• β-adrenoblockers with a vasodilating effect - Labetolol (Abetol, Labetol, Lamitol, Presolol), Pindolol (Viskin, Pinadol, Prindolol), Carvedilol (Carvidil, Carvenal, Corvazan, Vedicardol), Nebivolol, Celiprolol;
• renin blockers Aliskiren (Racileus), Cardosal;
• angiotensin II receptor blockers (angiotensin II inhibitors) - Valsartan, Losartan, etc .;
• vasodilators Nepressol (Dihydralazine, Hypopresol, Tonolysin).

Diuretic drug Hydrochlorothiazide appoint one or two tablets during the day. Possible side effects such as dry mouth, thirst, decreased appetite, nausea and vomiting, as well as convulsions, decreased heart rate, decreased potassium levels. This remedy is contraindicated in case of kidney problems, pancreatitis, diabetes, gout and pregnancy.

Tablets for reducing blood pressure Enalapril are taken once a day (0.01-0.02 g). Side effects include dizziness, headache, nausea, diarrhea, convulsions.

Diltiazem helps to expand the lumen of blood vessels and reduce blood pressure in a daily dose of 180-300 mg, but the drug is contraindicated for patients with cardiac arrhythmias and severe cardiac and renal insufficiency, as well as children and pregnant women.

The drug Labetolol is taken up to three times a day for one tablet (0.1 g); possibly the appearance of dizziness, headache, nausea, intestinal disorders, increased fatigue. Labetalol is not prescribed if patients have severe heart failure.

Drug Nepressol - in the absence of cerebral arteriosclerosis - it is recommended to take two or three times a day for one tablet (25 mg). The most common side effects include headache and dizziness, tachycardia and heart pain.

Complex means for reducing blood pressure The Kaptopres has hydrochlorothiazide and captopril in its composition. The usual dosage is 12.5-25 mg (half tablet and whole tablet) twice a day. The drug is contraindicated in cases of severe kidney failure, stenosis of the aortic aorta, hyperaldosteronism, hypokalemia and hyponatremia. And side effects can manifest as urticaria, dry mouth, loss of appetite, nausea, diarrhea, tachycardia, diuresis, etc.

See also -  High-pressure tablets

Homeopathy in this disease: Acidum aceticum D12, Varita muriatica, Magnesium phosphoricum D6, Celsemium, Strontiana carbonica, Arsenicum album.

Practiced physiotherapeutic treatment of isolated systolic arterial hypertension, the main methods are given in the publication -  Physiotherapy with arterial hypertension

And alternative treatment, which usually uses herbal treatment described in the material -  Herbs that lower the pressure

Prevention

What measures contribute to preventing high blood pressure, detailed in the article -  Prevention of hypertension

[55], [56], [57], [58], [59], [60], [61], [62], [63],

Forecast

Patients should understand that the prognosis of systolic arterial hypertension, especially its stable form, depends on many factors. First of all, on the degree of increase in blood pressure and the presence of cardiac and cerebral complications.

According to cardiologists, in men with this disease (in comparison with men who have normal blood pressure), the increased risk of death from coronary heart disease is 28%. And for women - almost 40%.

Systolic hypertension and the army

The systolic hypertension of the first or second stage discovered by the conscript imposes certain restrictions on its suitability for service in the army and is formalized by the medical staff of the military commissariat in the form of appropriation of the category - limited-fit. Hypertension of the third stage means unsuitable for conscription into the army.

[64], [65], [66], [67], [68], [69], [70],