Arterial hypertension is a disease in which a persistent increase in blood pressure to 140/90 mm Hg is detected.Art.This pathology is detected 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 doctors in many countries are urging everyone to measure their blood pressure regularly starting at age 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 is discovered accidentally during examinations or when visiting a doctor for the 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 constant treatment to correct blood pressure to a normal level (no more than 130/80 mm Hg) risk serious complications of this pathology: stroke, myocardial infarction, heart failure, etc.
Development mechanisms and classification
The increase in blood pressure occurs due to a narrowing of the lumen of the main arteries and arterioles (smaller branches of 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 (i.e. primary) hypertension.This pathology occurs in 90% of patients.In the remaining 10%, hypertension is symptomatic (i.e. secondary) and is caused by other diseases (mostly cardiovascular disease).
Essential hypertension (or hypertension) does not arise as a result of organ damage.Damage to the target organ then occurs.
Secondary hypertension is caused by dysfunction of systems and organs involved in the regulation of blood pressure, i.e.h.an increase in blood pressure is a symptom of the underlying disease.They are divided into:
- renal (parenchymal and renovascular):arise as a result of congenital or acquired hydronephrosis, acute or chronic glomerulo- and pyelonephritis, polycystic kidney disease, radiation kidney disease, diabetic glomerulonephrosis, etc.;
- Hemodynamic (mechanical and cardiovascular):develop with aortic valve insufficiency, complete atrioventricular block, aortic atherosclerosis, patent aortic duct, aortic coarctation, Paget's disease, arteriovenous fistulas, etc.;
- endocrine:develop with pheochromocytoma (a hormonally active tumor of the adrenal glands), paragangliomas, Cohn syndrome, acromegaly, Itsenko-Cushing syndrome or disease, etc.;
- neurogenic:develop with diseases and focal lesions of the spinal cord and brain, hypercapnia (increase in the amount of carbon dioxide in the blood) and acidosis (shift of acid-base balance towards acid);
- other:develop with late toxicosis during pregnancy, thallium and lead poisoning, carcinoid syndrome (blood poisoning with excess hormones), porphyria (hereditary disorder of pigment metabolism), overdose of glucocorticoids, ephedrine, catecholamines, taking hormonal contraceptives, eating foods with tyramine while taking MAO inhibitors.
Depending on the nature of the course, arterial hypertension can be:
- temporary:an increase in blood pressure is observed sporadically, lasts from several hours to several days and normalizes without the use of medication;
- unstable:Blood pressure increases due to the influence of a provoking factor (physical or psycho-emotional stress).Medication is required to stabilize the condition.
- stable:The patient's blood pressure constantly increases and serious and constant therapy is required to normalize it.
- 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 death of the patient.
Depending on the severity, arterial hypertension is classified 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.Art.and higher.
In isolated systolic hypertension, only an increase in systolic pressure over 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
Headache and dizziness may occur in patients with arterial hypertension.
For many years, patients may not be aware that they have arterial hypertension.Some of them note episodes of weakness, dizziness and malaise in their psycho-emotional state in the initial stages of hypertension.With the development of stable or unstable hypertension, the patient begins to complain of:
- general weakness;
- flickering of flies before the eyes;
- nausea;
- Dizziness;
- throbbing headache;
- numbness and paresthesias in the limbs;
- Shortness of breath;
- difficulty speaking;
- heartache;
- swelling of the limbs and face;
- visual impairment etc.
When examining the patient, lesions are revealed:
- Renal: uremia, polyuria, proteinuria, renal failure;
- Brain: hypertensive encephalopathy, cerebrovascular accident;
- Heart: thickening of the heart walls, left ventricular hypertrophy;
- Vessels: narrowing of the lumen of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
- Fundus: hemorrhage, 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 test to determine total cholesterol, lipoprotein cholesterol, creatinine, potassium, glucose and triglyceride levels;
- ECG;
- Echo CG;
- fundus examination;
- Ultrasound of the kidneys and abdominal cavity.
If necessary, further examinations can be recommended to the patient.After analyzing the data obtained, the doctor selects a drug therapy regimen and gives detailed recommendations for changing the patient's lifestyle.