Arterial hypertension is a condition in which a continuous increase in blood pressure is determined to be 140/90 mm Hg.Art.This pathology is detected in 40% of the adult population and often appears not only in the elderly, but also in teenagers, young people and pregnant women.It has become a "true 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 monitor their blood pressure regularly.In the initial stages, arterial hypertension is asymptomatic or is discovered accidentally during examinations or when patients visit the doctor for the treatment of other diseases.This leads to the progression of the pathology and a 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 continuous 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.
Mechanisms of development and classification
The increase in blood pressure occurs due to a 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 (ie, primary) hypertension.This pathology occurs in 90% of patients.In the remaining 10%, hypertension is symptomatic (ie, secondary) and caused by other diseases (usually cardiovascular).
Essential hypertension (or hypertension) does not develop as a result of damage to any organ.It then leads to target organ damage.
Secondary hypertension is provoked by disorders in the functioning of systems and organs that are involved in the regulation of blood pressure, i.e., an increasing change in blood pressure is a symptom of the underlying disease.They are classified into:
- renal (parenchymal and renovascular):develop as a result of congenital or acquired hydronephrosis, acute or chronic glomerulonephritis, polycystic kidney disease, radiation kidney disease, diabetic glomerulonephritis, etc.;
- hemodynamic (mechanical and cardiovascular):develop with aortic valve insufficiency, complete atrioventricular block, aortic atherosclerosis, open aortic canal, coarctation of the aorta, Paget's disease, arteriovenous fistula, etc.;
- endocrine:develop with pheochromocytoma (hormonally active tumor of the adrenal glands), paraganglioma, Cohn syndrome, acromegaly, Itsenko-Cushing syndrome or disease, etc.;
- neurogenic:develops with diseases and focal lesions of the spinal cord and brain, hypercapnia (increased amount of carbon dioxide in the blood) and acidosis (a shift in the acid-base balance towards acidity);
- others:develop with late toxicosis during pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning with excess hormones), porphyria (hereditary disorder of pigment metabolism), overdose with glucocorticoids, ephedrine, catecholamines, taking hormonal contraceptives, eating foods with MAO inhibit.
According to the nature of the course, arterial hypertension can be:
- transient:an increase in blood pressure is observed sporadically, lasts from several hours to several days and normalizes without the use of medications;
- labile:blood pressure increases due to the influence of any provoking factor (physical or psycho-emotional stress), medication is necessary to stabilize the condition;
- stable:the patient has a constant increase in blood pressure and serious and continuous therapy is required to normalize it;
- crisis:the patient experiences periodic hypertensive crises;
- malignant:Blood pressure rises to high levels, the pathology progresses rapidly and can lead to serious complications and death of the patient.
Arterial hypertension is classified according to severity as follows:
- Grade I: blood pressure rises to 140-159_90-99 mm Hg.Art.;
- Grade II: blood pressure rises to 160-170/100-109 mm Hg.Art.;
- Grade III: blood pressure rises to 180/110 mm Hg.Art.and above.
With 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 over 50-60 years old 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, during the initial period of hypertension, note episodes of weakness, dizziness and disturbance 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 headache;
- numbness and paresthesia in the limbs;
- shortness of breath;
- difficulty speaking;
- heart pain;
- swelling of the limbs and face;
- visual impairment etc.
During the examination of the patient, lesions are detected:
- kidneys: uremia, polyuria, proteinuria, renal failure;
- brain: hypertensive encephalopathy, cerebrovascular accident;
- heart: thickening of cardiac walls, left ventricular hypertrophy;
- vessels: narrowing of the lumen of arteries and arterioles, atherosclerosis, aneurysms, dissection of the aorta;
- fundus: hemorrhage, 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;
- ECG;
- Echo-CG;
- examination of the fundus;
- Ultrasound of the kidneys and the abdominal cavity.
If necessary, the patient may be recommended to undergo additional examinations.After analyzing the obtained data, the doctor chooses a regimen of drug therapy and gives detailed recommendations for changing the patient's lifestyle.