Arterial hypertension is a condition in which it is determined that a persistent increase in blood pressure is 140/90 mm Hg.Art.This pathology is detected in 40% of the adult population and often occurs not only in older people, but also in adolescents, young adults and pregnant women.It has become a real "epidemic of the 21st century" and doctors in many countries urge everyone to measure their blood pressure regularly, starting at the age of 25.
According to statistics, only 20-30% of patients with arterial hypertension receive adequate therapy, and only 7% of men and 18% of women regularly monitor their blood pressure.In the initial stages, arterial hypertension is asymptomatic or is discovered accidentally during an examination or when patients go to the doctor for the treatment of other diseases.This leads to the progression of the pathology and significant deterioration of health.Many patients with arterial hypertension who do not seek medical help or simply ignore the doctor's recommendations and do not receive constant treatment to correct blood pressure to normal levels (not more than 130/80 mm Hg) risk serious complications of this pathology: stroke, myocardial infarction, heart failure, etc.
Development mechanisms and classification
The increase in blood pressure occurs due to the narrowing of the lumen of the main arteries and arterioles (smaller branches of the arteries), which is caused by complex hormonal and nervous processes.When the walls of blood vessels narrow, the work of the heart increases and the patient develops essential (i.e. primary) hypertension.This pathology occurs in 90% of patients.In the remaining 10%, hypertension is symptomatic (i.e. secondary) and is caused by other diseases (usually cardiovascular).
Essential hypertension (or hypertension) does not occur as a result of damage to any organ.After that, it leads to damage to the target organ.
Secondary hypertension is caused by disturbances in the functioning of systems and organs involved in blood pressure regulation, i.e. an upward change in blood pressure is a symptom of the underlying disease.They are classified into:
- renal (parenchymal and renovascular):they develop as a result of congenital or acquired hydronephrosis, acute or chronic glomerulo- and pyelonephritis, polycystic kidney disease, radiation kidney disease, diabetic glomerulonephritis, etc.;
- hemodynamic (mechanical and cardiovascular):they develop with aortic valve insufficiency, complete atrioventricular block, atherosclerosis of the aorta, open aortic canal, coarctation of the aorta, Paget's disease, arteriovenous fistulas, etc.;
- endocrine:develop with pheochromocytoma (hormonally active tumor of the adrenal gland), paragangliomas, Cohn syndrome, acromegaly, Itsenko-Cushing syndrome or disease, etc.;
- neurogenic:they develop with diseases and focal lesions of the spinal cord and brain, hypercapnia (an increase in the amount of carbon dioxide in the blood) and acidosis (a shift in the acid-base balance towards acidity);
- others:they develop with late toxicosis in pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning by excess hormones), porphyria (hereditary disorder of pigment metabolism), overdose of glucocorticoids, ephedrine, catecholamines, taking hormonal contraceptives, eating food with MAO tyramine inhibitor.
According to the nature of the flow, arterial hypertension can be:
- transitory:an increase in blood pressure is observed sporadically, lasts from a few hours to a few days and normalizes without the use of drugs;
- labile:blood pressure increases due to the influence of any provoking factor (physical or psycho-emotional stress), drugs are necessary to stabilize the condition;
- stable:the patient has a constant increase in blood pressure, and for its normalization serious and constant therapy is required;
- crisis:the patient experiences periodic hypertensive crises;
- malignant:blood pressure rises to high levels, the pathology progresses rapidly and can lead to severe complications and the death of the patient.
Arterial hypertension is classified according to severity as follows:
- I degree: blood pressure rises to 140-159_90-99 mm Hg.Art.;
- II degree: blood pressure rises to 160-170/100-109 mm Hg.Art.;
- III degree: blood pressure rises to 180/110 mm Hg.Art.and more.
In isolated systolic hypertension, only an increase in systolic pressure above 140 mmHg is typical.Art.This form of hypertension is more often observed in people older than 50-60 years, and its treatment has its own characteristic features.
Signs of arterial hypertension
Patients with arterial hypertension may experience headaches and dizziness.
For many years, patients may not be aware of the presence of arterial hypertension.Some of them in the initial period of hypertension record episodes of weakness, dizziness and discomfort in their psycho-emotional state.With the development of stable or labile hypertension, the patient begins to complain of:
- general weakness;
- flickering of flies before the eyes;
- nausea;
- dizziness;
- throbbing headaches;
- numbness and paresthesia of limbs;
- shortness of breath;
- difficulty speaking;
- pain in the heart;
- swelling of limbs and face;
- visual impairment etc.
During the examination of the patient, lesions are detected:
- kidneys: uremia, polyuria, proteinuria, kidney failure;
- brain: hypertensive encephalopathy, cerebrovascular infarction;
- heart: thickening of the heart walls, hypertrophy of the left ventricle;
- vessels: narrowing of the lumen of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
- fundus: hemorrhages, retinopathy, blindness.
Diagnosis and treatment
Patients with signs of arterial hypertension may be prescribed the following types of examinations:
- blood pressure measurement;
- general urine and blood tests;
- biochemical blood test to determine the level of total cholesterol, lipoprotein cholesterol, creatinine, potassium, glucose and triglycerides;
- EKG;
- Echo-CG;
- fund review;
- Ultrasound of the kidneys and abdominal cavity.
If necessary, an additional examination can be recommended to the patient.After analyzing the obtained data, the doctor selects a regimen of drug therapy and gives detailed recommendations on changing the patient's lifestyle.