Arterial hypertension is a condition in which a persistent increase in blood pressure is determined at 140/90 mm Hg.Art.This pathology is detected in 40% of the adult population and frequently occurs not only in the elderly, but also in adolescents, young adults and pregnant women.It has become a true “epidemic of the 21st century” and doctors in many countries encourage 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 early stages, high blood pressure is asymptomatic or is detected accidentally during examinations or when patients go to the 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 constant treatment to correct 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.
Development and classification mechanisms
The increase in blood pressure occurs due to the narrowing of the lumen of the main arteries and arterioles (smaller branches of the arteries), 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 (that is, primary) hypertension.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 subsequently leads to target organ damage.
Secondary hypertension is caused by disturbances in the functioning of systems and organs involved in regulating blood pressure, that is, an upward 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 glomerulus and pyelonephritis, polycystic kidney disease, radiation kidney disease, diabetic glomerulonephrosis, etc.;
- hemodynamics (mechanical and cardiovascular):develop with aortic valve insufficiency, complete atrioventricular block, aortic atherosclerosis, open aortic duct, aortic coarctation, Paget's disease, arteriovenous fistulas, etc.;
- endocrine:develop with pheochromocytoma (a hormonally active tumor of the adrenal glands), paragangliomas, Cohn's syndrome, acromegaly, Itsenko-Cushing's syndrome or disease, etc.;
- neurogenic:develop with focal diseases and 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 poisoning during pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning with an excess of hormones), porphyria (hereditary disorder of pigment metabolism), overdose of glucocorticoids, ephedrine, catecholamines, use of hormonal contraceptives, taking foods with tyramine while taking MAO inhibitors.
According to the nature of the course, arterial hypertension can be:
- transitional:the 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 some provoking factor (physical or psycho-emotional stress), requiring medication to stabilize the condition;
- stable:the patient has a constant increase in blood pressure and serious and constant therapy is needed to normalize it;
- crisis:the patient has 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:
- Degree: 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 higher.
In isolated systolic hypertension, only an increase in systolic pressure above 140 mmHg is typical.Art.This form of hypertension is most often observed in people over 50 to 60 years of age and its treatment has its own characteristics.
Signs of high blood pressure
Patients with high blood pressure may experience headaches and dizziness.
For many years, patients may not be aware of the presence of high blood pressure.Some of them, in the initial period of hypertension, note episodes of weakness, dizziness and discomfort in the 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 in the limbs;
- shortness of breathe;
- difficulty speaking;
- heart pain;
- swelling of the limbs and face;
- visual impairment, etc.
When examining the patient, injuries are revealed:
- kidneys: uremia, polyuria, proteinuria, renal failure;
- brain: hypertensive encephalopathy, stroke;
- heart: thickening of the heart walls, left ventricular hypertrophy;
- vessels: narrowing of the lumen of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
- background: hemorrhages, retinopathy, blindness.
Diagnosis and treatment
Patients with signs of high blood pressure may be prescribed the following types of tests:
- 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;
- Eco-CG;
- fundus examination;
- Ultrasound of the kidneys and abdominal cavity.
If necessary, the patient may be recommended to undergo additional tests.After analyzing the data obtained, the doctor selects a drug therapy regimen and gives detailed recommendations on changing the patient's lifestyle.