Arterial hypertension is a condition in which a persistent 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 occurs not only in older people, but also in adolescents, young adults and pregnant women.It has become a real “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 initial stages, arterial hypertension is asymptomatic or is detected accidentally during examinations or when patients visit 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 constant treatment to correct blood pressure to normal levels (no more than 130/80 mm Hg) risk severe complications of this pathology: stroke, myocardial infarction, heart failure, etc.
Development mechanisms and classification
The rise 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 (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 (usually cardiovascular).
Essential hypertension (or hypertension) does not develop as a result of damage to any organs.Subsequently, it leads to target organ damage.
Secondary hypertension is provoked by disturbances in the functioning of systems and organs that are involved in the regulation of blood pressure, i.e., 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 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, 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 syndrome, acromegaly, Itsenko-Cushing syndrome or disease, etc.;
- neurogenic:develop with diseases and focal lesions of the spinal cord and brain, hypercapnia (an increase in the amount of carbon dioxide in the blood) and acidosis (a shift in the acid-base balance towards acidity);
- 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.
According to the nature of the course, arterial hypertension can be:
- transient:a rise 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 constant therapy is required to normalize it;
- crisis:the patient experiences periodic hypertensive crises;
- malignant:blood pressure rises to high levels, the pathology rapidly progresses and can lead to 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 of age, 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 discomfort 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 headaches;
- numbness and paresthesia in the limbs;
- shortness of breath;
- difficulty speaking;
- heart pain;
- swelling of the limbs and face;
- visual impairment, etc.
When examining the patient, lesions are revealed:
- kidneys: uremia, polyuria, proteinuria, renal failure;
- brain: hypertensive encephalopathy, cerebrovascular accident;
- heart: thickening of the cardiac walls, left ventricular hypertrophy;
- vessels: narrowing of the lumen of arteries and arterioles, atherosclerosis, aneurysms, aortic dissection;
- fundus: hemorrhages, 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;
- fundus examination;
- Ultrasound of the kidneys and abdominal cavity.
If necessary, the patient may be recommended to undergo additional examinations.After analyzing the data obtained, the doctor selects a drug therapy regimen and gives detailed recommendations on changing the patient’s lifestyle.