Arterial hypertension is a condition in which a continuous increase in blood pressure is defined as 140/90 mm Hg.Art.This pathology is detected in 40% of the adult population and often occurs not only in the elderly, but also in teenagers, young adults and pregnant women.It has become the "epidemic of the 21st century" and doctors in many countries urge everyone to regularly measure their blood pressure, 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 early stages, arterial hypertension is asymptomatic or detected accidentally during an examination or when the patient visits a doctor for the treatment of another disease.This leads to the development 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 continuous treatment to correct blood pressure to a normal level (not more than 130/80 mm Hg) Risk of severe complications of this pathology: stroke, myocardial infarction, heart failure, etc.
Mechanism of development and classification
The increase in blood pressure occurs due to the narrowing of the lumen of the main artery and arterioles (smaller branches of the artery), which is caused by complex hormonal and nervous processes.When the walls of the 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 (that is, secondary) and caused by other diseases (usually cardiovascular).
Essential hypertension (or hypertension) does not develop as a result of damage to any organ.Next, it leads to target organ damage.
Secondary hypertension is provoked by disturbances in the functioning of systems and organs involved in the regulation of blood pressure, i.e. changes in high blood pressure are symptoms 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 and pyelonephritis, polycystic kidney disease, radiation kidney disease, diabetic glomerulonephritis, etc.;
- Hemodynamics (mechanical and cardiovascular):Develop with aortic valve deficiency, complete atrioventricular block, aortic atherosclerosis, open aortic channel, coarctation of the aorta, Paget's disease, arteriovenous fistula, etc.;
- Endocrine:Develop with pheochromocytoma (adrenal hormone active tumor), paragangliomas, Cohn's syndrome, acromegaly, syndromes or their diseases;
- Neurogenic:Develop with diseases and focal lesions of the spinal cord and brain, hypercapnia (increased amount of carbon dioxide in the blood) and acidosis (shift in acid balance towards acidity);
- others:Develops with late toxicosis during pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning with excessive hormones), porphyria (hereditary disorder of pigment metabolism), overdose of glucocorticoids, ephedrine, catecholamine, taking hormonal contraception.
According to the nature of the course, arterial hypertension can:
- Transient:An increase in blood pressure is observed sporadically, lasts from several hours to several days, and normalizes without the use of drugs;
- Labile:Blood pressure increases due to the influence of any factor that causes stress (physical or psycho-emotional stress), drugs are needed to stabilize the situation;
- stable:The patient has a constant increase in blood pressure, and serious and continuous therapy is required to normalize it;
- Crisis:Patients experience periodic hypertensive crises;
- Malignant:Blood pressure rises to a high level, the pathology develops rapidly and can cause severe complications and 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 higher.
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 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, during the period of initial hypertension, notice episodes of weakness, dizziness and discomfort in their psycho-emotional state.With the development of stable or labile hypertension, patients begin to complain:
- general weakness;
- Flicker flies before the eyes;
- nausea;
- dizziness;
- throbbing headache;
- numbness and paresthesia in the limbs;
- breathing difficulties;
- difficulty speaking;
- heart disease;
- swelling of limbs and face;
- Visual impairment, etc.
When examining the patient, the wound is revealed:
- Kidneys: uremia, polyuria, proteinuria, renal failure;
- Brain: hypertensive encephalopathy, cerebrovascular accidents;
- Heart: Thickening of the heart wall, left ventricular hypertrophy;
- Vessels: Narrowing the lumen of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
- Fundus: Bleeding, retinopathy, blindness.
Diagnosis and treatment
Patients with signs of arterial hypertension can be prescribed the following types of examinations:
- blood pressure measurement;
- general urine and blood tests;
- biochemical blood tests to determine the level of total cholesterol, lipoprotein cholesterol, creatinine, potassium, glucose and triglycerides;
- ECG;
- 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 obtained data, the doctor selects a drug therapy regimen and gives detailed recommendations on changing the patient's lifestyle.