Arterial hypertension is a condition of persistently increased blood pressure defined as 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 true “epidemic of the 21st century” and doctors in many countries urge everyone to have their blood pressure measured regularly, starting at age 25.
According to statistics, only 20-30% of hypertensive patients receive adequate treatment, only 7% of men and 18% of women regularly monitor their blood pressure.In the early stages, arterial hypertension has no symptoms or is discovered accidentally during examination or when the patient sees a doctor for treatment of other diseases.This leads to the progression of the pathology and a significant deterioration in health.Many patients with arterial hypertension who do not seek medical help or simply ignore the doctor's recommendations and do not receive continuous treatment to regulate blood pressure to normal levels (no more than 130/80 mm Hg) are at risk of serious complications of this pathology: stroke, myocardial infarction, heart failure, etc.
Mechanism of development and classification
Increased blood pressure occurs due to the narrowing of the lumens of the main arteries and arterioles (smaller branches of the arteries), which is caused by complex hormonal and neurological processes.When the walls of blood vessels narrow, the work of the heart increases and the patient develops essential (ie primary) hypertension.This pathology occurs in 90% of patients.In the remaining 10%, hypertension is symptomatic (ie, secondary) and is caused by other (usually cardiovascular) diseases.
Essential hypertension (or hypertension) does not develop due to damage to any organ.It then leads to target organ damage.
Secondary hypertension is caused by dysfunction of the systems and organs involved in regulating blood pressure, i.e. elevated blood pressure is a symptom of an underlying disease.They are classified into:
- Kidney (parenchyma and blood vessels regenerate):develops due to congenital or acquired hydronephrosis, acute or chronic glomerulonephritis and pyelonephritis, polycystic kidney disease, radiation nephropathy, diabetic glomerulonephritis, etc.;
- hemodynamics (mechanical and cardiovascular):develops with aortic valve insufficiency, complete atrioventricular block, aortic atherosclerosis, aortic regurgitation, coarctation of the aorta, Paget's disease, arteriovenous fistula, etc.;
- endocrine:develops with pheochromocytoma (a hormonally active tumor of the adrenal gland), paragangliomas, Cohn syndrome, acromegaly, Itsenko-Cushing syndrome or disease, etc.;
- nerve:develops with focal diseases and lesions of the spinal cord and brain, hypercapnia (increased amount of carbon dioxide in the blood) and acidosis (change in acid-base balance in the direction of acid);
- others:develops with late toxicosis during pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning due to excess hormones), porphyria (hereditary pigmentation disorders), overdose of glucocorticoids, ephedrine, catecholamines, taking hormonal contraceptives, eating foods with tyramine while taking MAO inhibitors.
According to the nature of the course, arterial hypertension can be:
- transient:Increased blood pressure is observed infrequently, lasts from a few hours to several days and normalizes without medication;
- Unstable:increased blood pressure due to the influence of any provoking factor (physical or psycho-emotional stress), requiring medication to stabilize the condition;
- stable:Patients with persistently increased blood pressure require serious and continuous treatment to normalize blood pressure;
- crisis:The patient experiences periodic attacks of hypertension;
- malignant:High blood pressure causes the disease to progress rapidly and can lead to serious complications and death for the patient.
Arterial hypertension is classified according to severity as follows:
- Grade I: blood pressure increases to 140-159_90-99 mm Hg.Art.;
- Grade II: blood pressure increases to 160-170/100-109 mm Hg.Art.;
- Grade III: blood pressure increases to 180/110 mm Hg.Art.and higher.
With isolated systolic hypertension, only an increase in systolic blood pressure above 140 mmHg is typical.Art.This form of hypertension is often observed in people over 50-60 years old, and its treatment has its own characteristics.
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 early stages of hypertension, note periods of weakness, dizziness and discomfort in the psycho-emotional state.With the development of stable or unstable hypertension, patients begin to complain of:
- general weakness;
- Flies buzz before eyes;
- nausea;
- dizzy;
- throbbing headache;
- numbness and paresthesias in the limbs;
- shortness of breath;
- difficulty speaking;
- heart attack;
- swelling of limbs and face;
- visual impairment, etc.
When examining the patient, the following lesions were discovered:
- Kidney: azotemia, polyuria, proteinuria, renal failure;
- Brain: encephalopathy due to hypertension, stroke;
- heart: thickened heart wall, left ventricular hypertrophy;
- blood vessels: narrowing of the lumen of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
- Fundus of the eye: hemorrhage, retinopathy, blindness.
Diagnosis and treatment
Patients with signs of arterial hypertension may be prescribed the following types of examination:
- measure blood pressure;
- General urine and blood tests;
- biochemical blood tests to determine levels of total cholesterol, lipoprotein cholesterol, creatinine, potassium, glucose, and triglycerides;
- electrocardiogram;
- Echo-CG;
- fundus examination;
- Ultrasound of the kidneys and abdominal cavity.
If necessary, the patient may be recommended to undergo additional examinations.After analyzing the data obtained, the doctor selects a drug treatment regimen and gives detailed recommendations on changing the patient's lifestyle.