Arterial hypertension is a condition in which the blood pressure is persistently elevated to 140/90 mmHg.Art.This pathology is observed in 40% of the adult population and often occurs not only in the elderly, but also in adolescents, young adults and pregnant women.It has become a real "epidemic of the 21st century", and in many countries doctors ask everyone to measure their blood pressure regularly from the age of 25.
According to statistics, only 20-30% of patients with arterial hypertension receive appropriate therapy, and only 7% of men and 18% of women regularly check their blood pressure.At the initial stage, arterial hypertension is asymptomatic, or it is detected accidentally during examinations or when patients consult a doctor for treatment of other diseases.This leads to the progression of 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 permanent treatment to correct blood pressure to a normal level (up to 130/80 mmHg) have serious complications of this pathology: stroke, heart attack, 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 neural processes.When the walls of blood vessels narrow, the work of the heart increases, and the patient develops essential (i.e., primary) high blood pressure.This pathology occurs in 90% of patients.In the remaining 10%, hypertension is symptomatic (i.e. 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 caused by disturbances in the functioning of the 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 as:
- kidney (parenchymal and renovascular):congenital or acquired hydronephrosis, acute or chronic glomerulo- and pyelonephritis, polycystic kidney disease, radiation kidney disease, diabetic glomerulonephritis, etc.is formed as a result of;
- hemodynamic (mechanical and cardiovascular):with aortic valve insufficiency, complete atrioventricular block, aortic atherosclerosis, open aortic conduit, coarctation of the aorta, Paget's disease, arteriovenous fistulas, etc.are formed;
- endocrine:with pheochromocytoma (hormonally active tumor of the adrenal gland), paragangliomas, Cohn's syndrome, acromegaly, Itsenko-Cushing syndrome or disease, etc.develops;
- neurogenic:it develops with diseases and focal changes of the spinal cord and brain, with hypercapnia (an increase in the amount of carbon dioxide in the blood) and acidosis (a shift in the acid-base balance towards acidity);
- others:it develops with late toxicosis during pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning with hormone excess), porphyria (hereditary disorder of pigment metabolism), overdose of glucocorticoids, ephedrine, catecholamines, taking hormonal contraceptives, eating foods containing tyramine while taking MAO inhibitors.
Depending on the nature of the course, arterial hypertension can be:
- transition:an increase in blood pressure can be observed sporadically, lasts from several hours to several days, and normalizes without the use of drugs;
- labile:blood pressure rises due to any provoking factor (physical or psycho-emotional stress), medication is required to stabilize the condition;
- stabile:the patient's blood pressure is constantly rising, to normalize it requires serious and constant therapy;
- crisis:the patient experiences periodic hypertensive crises;
- malicious:blood pressure rises to a high level, the pathology progresses rapidly and can lead to serious complications and the death of the patient.
Arterial hypertension can be classified according to their 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 mmHg.Art.;
- Grade III: blood pressure rises to 180/110 mmHg.Art.and higher.
In the case of isolated systolic hypertension, only an increase in systolic pressure above 140 mm Hg is characteristic.Art.This form of hypertension is more often observed in people over 50-60 years of age, and its treatment has its own characteristics.
Signs of arterial hypertension
Patients with arterial hypertension may experience headaches and dizziness.
Patients may not be aware of the presence of arterial hypertension for many years.Some of them experience weakness, dizziness and discomfort in their psycho-emotional state during the initial period of high blood pressure.With the development of stable or labile hypertension, the patient begins to complain:
- general weakness;
- flashes of flies before the eyes;
- nausea;
- dizziness;
- throbbing headache;
- numbness and paresthesia in the limbs;
- shortness of breath;
- difficulty speaking;
- heartache;
- swelling of the limbs and face;
- visual impairment etc.
When examining the patient, changes are revealed:
- kidneys: uremia, polyuria, proteinuria, renal failure;
- brain: hypertensive encephalopathy, cerebrovascular accident;
- heart: thickening of the walls of the heart, left ventricular hypertrophy;
- vessels: narrowing of the lumen of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
- fundus: hemorrhages, retinopathy, blindness.
Diagnosis and treatment
The following types of tests may be prescribed for patients showing symptoms of arterial hypertension:
- blood pressure measurement;
- general urine and blood test;
- biochemical blood test to determine the level of total cholesterol, lipoprotein cholesterol, creatinine, potassium, glucose and triglycerides;
- EKG;
- Echo-CG;
- fundus examination;
- Ultrasound of the kidneys and abdominal cavity.
If necessary, the patient is recommended to undergo further tests.After analyzing the received data, the doctor selects the medication regimen and gives detailed recommendations for changing the patient's lifestyle.